Clinical Relevance of Loneliness in Schizophrenia Patients

Introductions: Loneliness is a subjective feeling that is described as a sense of isolation, a bad feeling about the quality and quantity of social relationships that has a major impact on mental health, well-being and quality of life. Social isolation is an important predictor of loneliness. Social isolation is often experienced by schizophrenia patients who experience alienation, social disconnection, limited access, and social support for their mental health. This study aimed to describe the relationship and its effect and factors related of loneliness and mental health, expecially in Scizophrenia patients. Methods: This study is a literature review that collects from various sources of scientific journals related to loneliness and its effect to Schizophrenia patients. Results: Lack of social interaction causes low or poor and vulnerable self-concepts experienced by schizophrenia patients, this is suspected of causing maladaptive cognition of oneself and others. Self-esteem that is seen as bad, hallucinations and delusions that are negative and self-critical reinforces negative self-concept. Schizophrenic sufferers tend to experience distortions related to self-confidence and their environment, they often think that they cannot be accepted by their environment and their environment rejects them. These increases feelings of loneliness and is thought to increase the incidence of psychotic symptoms. Conclusions: Social isolation and loneliness are important issues for schizophrenia patients because they can increase morbidity and mortality rates. Loneliness increases the incidence of auditory hallucinations with paranoid thinking, as well as negative beliefs about oneself and others in schizophrenia patients.

Keywords: Schizophrenia, Mental Health, Loneliness

Introduction

Schizophrenia causes disturbances in several dimensions, including thought processes, perceptions, behavior, emotions, and cognition. Therapeutic goals have expanded from positive and negative symptom reduction to cognitive rehabilitation, to address quality of life, subjective well-being, and recovery. The belief that schizophrenic patients are unable or unwilling to express their emotions and feelings is considered part of the negative symptoms. Recent studies have shown that loneliness in schizophrenia patients is a common phenomenon. Loneliness is also associated with several mental and physical health problems, as well as being a major obstacle to the recovery process[1].

Social exclusion or isolation is a key factor associated with several mental disorders including mood disorders, psychosis, and drug addiction. Social isolation is a growing public health problem and has an impact on morbidity and mortality that can reduce a person's quality of life[2].

Feelings of loneliness are vulnerable to being experienced and become a common problem that is often encountered for those with or without mental disorders who are often stigmatized, ignored, or underestimated. The quality of social interaction mediates between objective and subjective dimensions which can change the direction and strength of the association between social isolation and loneliness which has become a widespread and growing phenomenon in developing countries which has implications for several psychiatric problems including schizophrenia[2],[3].

The purpose of this literature review is to explore the relationship, influencing factors, and interventions that can be carried out between loneliness and schizophrenic patients.

Loneliness and Social Isolation Concept

Social isolation is defined as an objective lack of social interaction, while the impact of social isolation is a subjective feeling of loneliness. Social isolation and loneliness have different concepts, even when a person has abundant social networks and social contacts, feelings of loneliness can still arise. Humans are social beings with one of the fundamental needs in life is the "need to belong" in a group, when this need is not met then humans will feel lonely, defined as a negative emotional response to the desired differences and which is achieved from reciprocal interactions in relationships, which is an important key to human social life[4].

Loneliness is also defined as the distressing experience that a person has when their social relationships are judged to be lacking in quantity and especially quality. Loneliness has two general elements: an emotional component (sadness and distress) and a social component (a feeling that social relationships are not sufficient to meet the individual's needs). Loneliness will arise when a person is ostracized, misunderstood, or rejected by others, or when a person is dissatisfied with his social relationships. Loneliness is also an emotional consequence of unfulfilled cognitive evaluations of social and environmental interactions, giving rise to negative emotional reactions. The duration of loneliness plays an important role in an individual's ability to adapt to loneliness.[2],[5]–[8].

Feelings of loneliness are very impactful for individuals with psychosis because most cases report that loneliness and social isolation are burdensome in the recovery process and are related to well-being, social perception, and psychopathology. What about individuals with psychosis views, processes, and overcomes the experience of loneliness is still being researched and studied[9].

The relationship between loneliness and schizophrenic patients

The relationship between loneliness and psychotic conditions is stronger when compared to the nonclinical group, loneliness acts as a risk factor for the development of psychotic symptoms and has an effect on treatment plans[10].

Common manifestations of impaired social functioning in schizophrenia include deficits in social skills and motivation, poor social cognition, and difficulty experiencing positive emotions from social interactions. Patients with schizophrenia have levels of loneliness three times greater than those in the nonclinical group. Loneliness is associated with the three core symptom groups of schizophrenia, namely: suspicious thoughts, social anhedonia/a-sociality, and social distancing speech or behavior that leads to social disconnection from the public. Loneliness increases negative beliefs about oneself and others, which in turn exacerbates paranoid thoughts, increases sensitivity to threats, and reduces interpersonal relationships. Social isolation and feelings of loneliness increase stimuli that allow individuals to perceive hearing voices or detecting human presence around them that is not real or so-called 'anthropomorphism'. Psychotic symptoms cause individuals to feel ostracised and stigmatised which contributes to increased feelings of loneliness and the creation of imaginary friends to manage feelings of loneliness. The difficulty of individuals with schizophrenia in anticipating pleasure and social interaction will increase feelings of loneliness[1],[10],[11].

Lack of social interaction causes low or poor and vulnerable self-concepts experienced by schizophrenia patients, this is suspected of causing maladaptive cognition of oneself and others. Self-esteem that is seen as bad, hallucinations, and delusions that are negative and self-critical reinforces negative self-concept. People with schizophrenia tend to experience distortions related to their beliefs and environment, they often think that they are unacceptable to their environment and their environment rejects them. This condition increases feelings of loneliness and is thought to increase the incidence of psychotic symptoms. These maladaptive social cognitive processes are associated with less skilled interactions and hinder the accurate assessment of social situations. As a result, this cognitive and behavioral confirmation bias appears to reinforce loneliness by communicating to the individual that he or she lacks competence, meaning, and value. Loneliness is a sign of weakening social relationships[11].

The experience of loneliness is socially

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