Schizophrenia

Definition

Schizophrenia is a group of brain disorders characterized by hallucinations, delusions, apathy, impaired reasoning, and disordered thinking and behavior. People suffering from schizophrenia often lose contact with reality. These patients have poor emotional responses and may act abnormally in social situations.

Schizophrenia patients can be described as one of the following five subtypes:

  • paranoid – with delusions or auditory hallucinations
  • disorganized – disordered speech and behavior
  • catatonic – with physical symptoms like hyperactivity or stillness
  • residual – with a clear history of symptoms
  • undifferentiated- with symptoms of the other subtypes

Schizophrenia affects about 1% population around the world. It often starts in young adults, and affects both men and women equally.

Symptoms

Schizophrenia patients show non-specific symptoms similar to other mental illnesses. Symptoms depend on the phase of schizophrenia and can be categorized as:

  1. Pre-morbid phase: In this phase, some patients may not show any symptoms, while some may exhibit difficulty in social skills, disorganized thoughts, distorted perceptions, or lack of happiness (anhedonia).
  2. Prodromal phase: In this phase, schizophrenia patients withdraw themselves, become irritable, more disorganized and suspicious. Delusions and hallucinations start during this phase either suddenly or slowly.
  3. Middle phase: Ability to function deteriorates in this phase and symptoms appear either periodically or continuously.
  4. Late illness phase: In this phase, the illness pattern is established. Symptoms may stabilize or may disappear.

The positive or active and excess symptoms in schizophrenia patients include delusions, hallucination (mostly auditory), disorganized behavior, and difficulty speaking and organizing thoughts.

The negative, diminished or absent symptoms include loss of interest in day-to-day activities, social withdrawal, neglecting personal care, difficulty planning, lack of emotions and motivation.

The cognitive (mental) symptoms and problems with thought processes include difficulty comprehending information, difficulty paying attention, and problems with memory. Suicidal thoughts are also common among people with schizophrenia.

Causes

The specific cause of schizophrenia is unknown; however, changes in brain structure and in levels of brain chemicals or neurotransmitters (dopamine and glutamate) are seen. Possible causes, risk factors or triggers of schizophrenia may include:

  • Genetics
  • Complications during pregnancy, birth, or after birth
  • Viral infections of brain or spinal cord
  • Malnourishment during pregnancy
  • Influenza during pregnancy
  • Birth weight less than 5.5 pounds
  • Substance abuse especially with hallucinogenics
  • Severe emotional stress

Treatment

Patients of schizophrenia require lifelong treatment, even after symptoms disappear.

Medication

Antipsychotic drugs control the symptoms by affecting the levels of dopamine and serotonin.

  • Conventional antipsychotics include chlorpromazine, haloperidol, fluphenazine, and perphenazine. These drugs may have frequent and severe neurological side effects. The side-effects include drowsiness, movement disorders, tremors, muscle stiffness, and obesity.
  • Commonly prescribed atypical antipsychotics are clozapine, aripiprazole, paliperidone, olanzapine, quetiapine, ziprasidone, and risperidone. Side-effects may include weight gain, high blood cholesterol, and diabetes. These drugs manage negative symptoms effectively but may promote positive symptoms in some patients.

Antidepressants or anti-anxiety drugs may also be given to some patients.

 

Psychotherapy

 

Psychotherapy teaches patients to understand and manage the illness, to take medications, and to deal with stress more effectively.  Psychotherapy also trains schizophrenic patients different social skills like improving social interactions and communication. These methods have been effective in decreasing the rate of relapse in patients. However, medication is always necessary to treat schizophrenia.

 

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