Schizophrenia

Definition

Schizophrenia is a psychiatric disorder in which there is irrational interpretation of reality by the patient marked by psychosis. Symptoms of hallucination and delusions are usually present but the symptoms can vary in intensity from one patient to another. The condition highly impairs the person’s life and his relation with the family members. Treatment of the disease may need lifetime treatment.

Symptoms

Some of the symptoms of schizophrenia are similar to those of other mental illnesses. The collective form of symptoms helps in differentiating it from other diseases. The symptoms tends to appear in the teenage years or till about 30 years of age in men whereas in women between the age of 20 to 30 years. Children and people older than 45 years are rarely diagnosed with schizophrenia. The symptoms can be classified in three groups as follows:

Positive symptoms

There is a distortion or excess of normal function. Symptoms include:

  • Delusions. Misinterpretations of otherwise normal events.
  • Hallucinations. Hallucinations can be present of any of the senses involving abnormal perceptions of senses which do not exist. Auditory hallucinations are common.
  • Thought disorder. Not able to speak rationally and symptoms of disorganized thoughts.
  • Disorganized behavior. Symptoms such as agitation or childish behavior may be seen.

Negative symptoms

There is absence of or diminished normal functions. Symptoms include:

  • Lack of emotions.
  • Apathy and emotional blunting.
  • Inability to carry out activities.
  • Apathy about personal hygiene.
  • Isolation.
  • Lack of motivation.

Cognitive symptoms

These symptoms greatly impair the person’s ability to function normally. These include problems with thought processes which include:

  • Difficulty concentrating.
  • Illogical thoughts.
  • Memory problems.

Schizophrenia if not treated adequately can lead to complications such as suicidal tendencies, severe depression, substance abuse, unemployment, unable to attend schools and involvement in violent crimes.

Causes

The exact cause of the disease is not known but it appears to be due to a genetic predisposition and the presence of certain environmental conditions.  Brain chemicals such as dopamine and glutamate are involved in proper functioning of the brain and passing of signals from the brain to the body. Problems in these chemicals may contribute in causing schizophrenia. Structural deformities in the brain are seen in patients with schizophrenia and can be seen in neuro-imaging studies.

Risk factors of schizophrenia include having a family history of schizophrenia, exposure to toxins or malnutrition during pregnancy, excessive stress, old paternal age and substance abuse.

Treatment

Careful personal and family history helps in the diagnosis and the presence of criteria as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The treatment of schizophrenia is usually necessary for the lifetime. Hospitalization may be necessary if symptoms are severe or if patient undergoes psychotic episodes that are not responsive to the usual drugs.

Antipsychotic medications used in the treatment. The most commonly used medications are clozapine, aripiprazole, olanzapine, quetiapine and risperidone. Other medications that can be used are fluphenazine, haloperidol, chlorpromazine and perphenazine. These drugs are used with caution due to higher chances of side effects.

Improvement in symptoms may be gradual. Antidepressant and anti-anxiety medications may be necessary. Psychosocial treatment includes social skill training and training to control stress and recurrence of symptoms. Education of the patient’s family helps them understand the condition and ways to cope with it.

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