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RELATED LITERATURE

1st Journal Article by Michael Bengston, M.D.,(April 8, 2006)

Source: http://psychcentral.com/lib/2006/undifferentiated-

schizophrenia/

The undifferentiated subtype is diagnosed when people have

symptoms of schizophrenia that are not sufficiently formed or specific

enough to permit classification of the illness into one of the other

subtypes.

The symptoms of any one person can fluctuate at different points in

time, resulting in uncertainty as to the correct subtype classification.

Other people will exhibit symptoms that are remarkably stable over time

but still may not fit one of the typical subtype pictures. In either instance,

diagnosis of the undifferentiated subtype may best describe the mixed

clinical syndrome.

How is it diagnosed? Undifferentiated schizophrenia is a difficult

diagnosis to make with any confidence because it depends on establishing

the slowly progressive development of the characteristic “negative”

symptoms of schizophrenia without any history of hallucinations,


delusions, or other manifestations of an earlier psychotic episode, and

with significant changes in personal behaviour, manifest as a marked loss

of interest, idleness, and social withdrawal.

2nd Journal Article by S.E. Smith (September 8, 2010)

Source: http://www.wisegeek.com/what-is-undifferentiated-

schizophrenia.htm

Undifferentiated schizophrenia is a mental disorder which is part of

the family of disorders broadly known as “schizophrenia.” There are a

number of subcategories of schizophrenia including paranoid

schizophrenia, catatonic schizophrenia, disorganized schizophrenia,

residual schizophrenia, and schizoaffective disorder; undifferentiated

schizophrenia is often defined as a form in which enough symptoms for a

diagnosis are present, but the patient does not fall into the catatonic,

disorganized, or paranoid subcategories.

Schizophrenia is characterized by a lack of grounding in reality,

known as psychosis. People in a state of psychosis can experience

hallucinations, delusions, and other events in which they break from

reality. Individuals with schizophrenia experience psychosis and can also


develop symptoms such as disorganized speech, lack of interest in social

interactions, a flat affect, inappropriate emotional responses to situations,

confusion, and disorganized thinking.

Patients with undifferentiated schizophrenia do not experience the

paranoia associated with paranoid schizophrenia, the catatonic state seen

in patients with catatonic schizophrenia, or the disorganized thought and

expression observed in patients with disorganized schizophrenia.

However, they do experience psychosis and a variety of other symptoms

associated with schizophrenia, including behavioral changes which may

be noticeable to family and friends.

This mental disorder is challenging to diagnose, and it can take

weeks or months to confirm a diagnosis of schizophrenia. During this

process, other causes for the symptoms are ruled out, and the patient is

observed to collect information about changes in the patient's personality,

modes of expression, and mood. Family members and friends may also be

interviewed and asked for information with a goal of painting a more

complete picture of what is going on inside the patient's mind.

There are a number of treatment options available for

undifferentiated schizophrenia. Patients can discuss treatment options

with their physicians, although it is important to be aware that it can take


time for treatment to be effective. Once patients start experiencing a

change, they may require periodic adjustments to their medications and

treatment regimen to respond to changes they experience over time.

Undifferentiated schizophrenia cannot be cured, but it can be managed

with a cooperative effort.

It is important to be aware that managing schizophrenia requires a

lifetime commitment which includes regular appointments with psychiatric

professionals for evaluation. Patients may want to meet with several

physicians to find a regular doctor they feel comfortable with, as every

medical professional has a slightly different approach to schizophrenia

treatment and it is important to have a doctor who is trustworthy to work

with.

3rd Journal Article by Charles Pearson

Source: http://www.ehow.com/about_5081978_causes-

undifferentiated-schizophrenia.html

Schizophrenia is a serious mental disorder that causes sufferers to

lose touch with reality. Schizophrenics have a difficulty interpreting actual

senses and they also sense sights, sounds and smells that others cannot

sense. Schizophrenia comes in a variety of forms and the causes of some


of these forms are somewhat understood. However, there are some

patients who have schizophrenia symptoms that do not seem to fall into

any particular category of the condition.

Genetics

1. Undifferentiated schizophrenia seems to have genetic causes, since

those with undifferentiated schizophrenia are 10 times more likely

to have relatives who have had the condition. Researchers are

beginning to suggest that those with a genetic predisposition to

schizophrenia might not necessarily develop schizophrenia if they

are not exposed to certain triggers.

Migration

2. Schizophrenia is common among those who travel to different

countries have a higher chance of experiencing undifferentiated

schizophrenia. Researchers theorize that the separation from family

and the inability to adjust to a new setting with new prejudices

contributes to the development of schizophrenia.

Virus

3. One theory on the cause of schizophrenia is that the disease

actually results from a virus that attacks and damages the

hippocampus, a part of the brain that has to do with the processing

of senses. Two viruses that might cause schizophrenia are herpes

simplex and endogenous retroviruses.


Family

4. In Finland, researchers have discovered that 36 percent of children

in dysfunction families develop some forms of schizophrenia, while

only 6 percent of children in healthy families develop this condition.

When schizophrenia occurs, the sufferer may believe his delusions

and resist treatment. Therefore, the family must play an active role

in ensuring that the sufferer receive the treatment she needs.

Other Triggers

5. Individuals born in cold and urban environments are more likely to

develop undifferentiated schizophrenia. Those infected with

influenza, poliovirus, CNS, respiratory diseases and Rubella have a

10 to 50 percent higher chance of developing schizophrenia. During

the prenatal stage, those children subjected to famine, motherly

depression, bereavement and flood are more likely to develop

schizophrenia.
4th Journal Article by Mark Moran (September 18, 2009)

Source:

http://psychservices.psychiatryonline.org/cgi/content/abstract/60/

8/1059

Hospital discharge records of people with a primary diagnosis of

undifferentiated schizophrenia showed higher proportions of all comorbid

psychiatric conditions and of several general medical conditions than did

those of people who did not have schizophrenia.

The survey data confirm what has been reported before: that

patient with undifferentiated schizophrenia have higher rates of morbidity

associated with some general medical conditions.

However, the study authors pointed out that virtually all existing

studies of comorbid disorders in undifferentiated schizophrenia test

hypotheses and have focused on a single comorbid condition in relatively

small and nonrepresentative samples. The current study appears to be

the first systematic analysis of comorbidity in general with schizophrenia

in the U.S. hospitalized population.

“Our study is hypothesis-generating rather than hypothesis-testing, with

the main purpose of presenting a systematic review of comorbid

conditions,” said coauthor Natalya Weber, M.D., M.P.H.“ Psychiatrists can


see in this very large and representative sample what conditions are more

frequently comorbid with a primary diagnosis of undifferentiated

schizophrenia compared to any other primary diagnosis among the U.S.

hospital discharges.”

Weber is health science administrator in the Division of Preventive

Medicine at Walter Reed Army Institute of Research.

Further, the proportion of discharges with comorbid psychiatric

disorders was much higher among patients discharged with a primary

diagnosis of undifferentiated schizophrenia. These conditions included (in

descending order of morbidity ratios): mild mental retardation, personality

disorders, affective psychoses, nondependent abuse of drugs, adjustment

reaction, alcohol dependence, drug dependence, depressive disorder not

elsewhere classified, and neurotic disorders.

In addition, discharge records of patients with undifferentiated

schizophrenia as the primary diagnosis were significantly more likely to

list the following nonpsychiatric comorbid conditions (in descending order

of morbidity ratios): acquired hypothyroidism, obesity and other

hyperalimentation disorders, asthma, chronic airway obstruction not

elsewhere classified, essential hypertension, and type 2 diabetes.

The frequency of cardiovascular and metabolic conditions comes as

no surprise and has been reported widely. Psychiatrist John Newcomer,

M.D., who has specialized in the research and treatment of metabolic

conditions in schizophrenia and who reviewed the report for Psychiatric


News, said the data likely underestimate the true prevalence of these

comorbid conditions—a point the study researchers acknowledged.

“The very nature of the problem with this diagnosis [of

undifferentiated schizophrenia] is that the patients tend to receive a lower

standard of medical care, so there is going to be massive under

estimation,” Newcomer told Psychiatric News. “If someone has a comorbid

diagnosis that means that someone had to see you and diagnose you and

engage you in treatment. We are worried that this is a significant

underestimation of the true prevalence [of medical comorbidity].”

Weber acknowledged in an interview that she and her colleagues

had expected to see much higher rates of metabolic and cardiovascular

disease. “We can only speculate that the conditions are under diagnosed

in patients with undifferentiated schizophrenia.”

One finding that was somewhat surprising was the frequency of

comorbid epilepsy. “It is of interest that epilepsy was twice as prevalent

among discharges with schizophrenia,” the authors wrote. “This

association has no clear pathogenic mechanism and has been reported in

only a few previous studies.”

Also noteworthy was the frequency of contact dermatitis and other

forms of eczema. Weber told Psychiatric News that these are typically

caused by contact with detergents, oils, solvents, drugs, plants, solar

radiation, and other environmental agents.


“We can speculate that these skin diseases could be

disproportionally present in patients with undifferentiated schizophrenia

due to their higher exposure to these harmful environmental agents as a

result of substandard living and working conditions, lower-paid manual

jobs, and homelessness,” she said.“ Although these conditions were found

a few times higher among discharges with a primary diagnosis of

undifferentiated schizophrenia, they are quite rare—less than 1 percent of

all comorbid conditions.”

5th Journal Article by Joan Arehart-Treichel (August 6,2010)

Source: http://archpsyc.ama-assn.org/cgi/content/short/2010.63

Cognitive therapy interventions appear to improve cognition

moderately in people with undifferentiated schizophrenia. And they may

to do so by changing areas of the brain damaged by the disease.

As psychiatrists well know, psychotropic medications are of only

limited value in improving cognition in people with undifferentiated

schizophrenia. So scientists have been working diligently to develop

effective cognitive remediation programs for such individuals—for

example, drill-and-practice exercises or computer-based neurocognitive

training.
And it looks as if such programs can lead to moderate cognitive

improvement, a meta-analysis published in the December 2007 American

Journal of Psychiatry showed.

As the lead investigator, Susan McGurk, Ph.D., of the Dartmouth

Psychiatric Research Center, and colleagues wrote: “The effects of

cognitive remediation on cognitive performance were remarkably similar

across the 26 studies included in the analysis despite differences in length

and training methods between cognitive remediation programs,

inpatient/outpatient setting, patient age, and provision of adjunctive

psychiatric rehabilitation.”

Matcheri Keshavan, M.D.: “Our observations provide a neurological

basis of understanding how psychosocial treatments such as cognitive

remediation work.”

But what is it that makes such programs effective? They prevent or

reverse undifferentiated schizophrenia-induced damage to the brain, a

study by Matcheri Keshavan, M.D., a professor of psychiatry at Harvard

Medical School, and colleagues suggested. The report of their findings was

published May 3 in the Archives of General Psychiatry.

The researchers selected as their subjects 53 symptomatically

stabilized but cognitively disabled outpatients fairly early in the course of

schizophrenia or schizoaffective disorder. That is, most had experienced

their first psychotic symptoms within the previous five years. Subjects'

average age was 26.


The subjects were randomized to receive, over the next two years,

either a cognitive remediation program called cognitive enhancement

therapy (CET) or a control regimen called enriched supportive therapy

(EST).

CET included 60 hours of weekly computer-based neurocognitive

training in attention, memory, and problem solving as well as 45 weekly

sessions designed to address key social-cognitive deficits that can limit

functional recovery from schizophrenia, such as difficulties in managing

emotions, trouble communicating nonverbally, a lack of foresight, or a

lack of perspective. The researchers had previously found that CET could

produce strong and lasting improvements in cognition in subjects who had

undifferentiated schizophrenia for many years. Subjects in the EST group

met individually with a therapist to learn and practice a variety of stress-

reduction and illness-management techniques designed to forestall

relapse and enhance adjustment to their illness.

The researchers used structural MRI scans to evaluate the brain

topography of all subjects at the start of the study, a year later, and at the

end of the study two years later. They then compared subjects' brain-scan

results.

By the end of the study, the cognitive-therapy group had a

significantly greater preservation of gray matter in several brain regions

known to be impaired by undifferentiated schizophrenia—the


hippocampus, parahippocampal gyrus, and fusiform gyrus—than the

control group did.

And crucially, the researchers noted, “These differential effects of

CET on gray-matter change were significantly related to improved

cognitive outcome, with patients who experienced less gray-matter

decline and greater gray-matter increases also demonstrating significantly

greater cognitive improvement over the two years of the study.”

Summary

The studies and articles explained and shows hospital discharge

records of people with a primary diagnosis of undifferentiated

schizophrenia showed higher proportions of all comorbid psychiatric

conditions and of several general medical conditions than did those of

people who did not have schizophrenia. Patient with undifferentiated

schizophrenia show high rates of comorbid illness, metabolic conditions

were common but so were such medical conditions as epilepsy and viral

hepatitis.

The general medical conditions included acquired hypothyroidism,

obesity, epilepsy, viral hepatitis, type 2 diabetes, essential hypertension,

various chronic obstructive pulmonary diseases, and contact dermatitis

and other forms of eczema, according to data from the National Hospital

Discharge Survey reported in the August Psychiatric Services by

researchers in the Department of Epidemiology at Walter Reed Army

Institute of Research.
I agreed to Newcomer told Psychiatric News that very nature of the

problem with this diagnosis [of undifferentiated schizophrenia] is that the

patients tend to receive a lower standard of medical care, so there is

going to be massive under estimation. Base on the study I have read

there is no such thing that I can disagree because it is explain vividly and

true thing that happened most in patient with undifferentiated

schizophrenia.

The significant of these studies for clinicians and student as nursing

was that individuals with undifferentiated schizophrenia have more than

their share of associated, and often serious, medical conditions and thus

require especially careful medical attention. This may help to timely

diagnose and treat comorbid conditions and perhaps take some

preventive measurements in those who are predisposed to them.”

The article explained that cognitive therapy interventions appear to

improve cognition moderately in people with undifferentiated

schizophrenia. And they may to do so by changing areas of the brain

damaged by the disease.

As psychiatrists well know, psychotropic medications are of only

limited value in improving cognition in people with undifferentiated

schizophrenia. So scientists have been working diligently to develop

effective cognitive remediation programs for such individuals—for

example, drill-and-practice exercises or computer-based neurocognitive

training.
I agreed to the researchers noted that differential effects of CET on

gray-matter change were significantly related to improved cognitive

outcome, with patients who experienced less gray-matter decline and

greater gray-matter increases also demonstrating significantly greater

cognitive improvement over the two years of the study. There was no

reasoned to say I disagreed because it explained properly understood that

it provide a neurological basis of understanding how psychosocial

treatments such as cognitive remediation work.

The significance of this study for a student as nurse we can gave

well care to our patient especially in mentally ill patient (patient with

undifferentiated schizophrenia) who needs cognitive remediation that will

benefit in cognition by preventing or reversing gray-matter loss.

As student nurses it is crucial in our lives how people with these

kinds of disorders go about. They need our understanding, acceptance,

and non-judgmental approach. We should never label patients. We don’t

say a Schizophrenic patient but instead, we say, “a patient with

schizophrenia.” Respect is vital is this field. Having this disorder does not

make them less of a human. And like us, they share equal rights and

privileges and we ought to give what is also due to them.