Creativity & Schizophrenia
Antonio Preti
RETREAT
SYNDROME
Many
patients with schizophrenia, however, are disabled not because cognitive or
thought disorders, but by the burden of negative symptomatology. Affective
inhibition, lack of will, and difficulties in feeling emotions, lead these
patients to aboulia and apathy. This condition, which has also been called
“amotivational syndrome”, is often present at the onset of the disorder, and
becomes manifest when the disorder recurrs (Fenton and McGlashan, 1991; Arndt et
al, 1995). Negative symptomatology also affects the relational sphere of the
patients, causing poverty of speech and a lack of spontaneity,
typical of many patients, and often leading to autism. It is not easy to
distinguish the “pure” negative symptoms, due to the psychobiological
process which sustains the disorder, from the “secondary” negative symptoms
due to defense against the stress that poor relationships with others produce.
Sometimes symptoms of withdrawal arise from depressive reactions, which are not
rare in schizophrenia, and involve a higher risk of suicide (
Treatment
with antipsychotic drugs can also cause a “negative” syndrome as a side
effect: dosage adjustment may be sufficient to solve the problem. In most cases,
however, the “negative” symptomatology is primary, and can lead precociously
to withdrawal, impairment and isolation. Patients often try to limit the
distress due to negative symptoms by abusing psychoactive drugs (Dixon et al,
1991; Mueser et al, 1992; LeDuc and Mittleman, 1995). Many schizophrenic
patients are heavy smokers, others abuse cannabis, using the euphorizing and
ansiolitic actions of this drug (Knudsen and Vilmar, 1984; Schneier and Siris,
1987). Few patients abuse cocaine, due to the high cost of the substance, but
many abuse alcohol (Schneier and Siris, 1987; Dixon et al, 1991). Substance
abuse is a neglected but serious
problem among schizophrenic patients: drug abusing patients generally have a
greater risk of relapse (Smith and Hucker, 1994; Soyka, 1994). Some authors also
report that the use of psychoactive drugs, particularly cannabinoids and
psychedelic drugs, could favour the onset of schizophrenia in predisposed
individuals (Andreasson et al, 1987; Linszen et al, 1994). Due to their
disorganized behaviour these patients (in particular ethilists or heavy smokers)
often have a greater chance of complications due to the abuse, with a greater
risk of precocious mortality (due to cirrhosis, encephalopaties, respiratory and
cardiovascular disorders).