Schizophrenia
Overview
Schizophrenia is severe mental disorder that persists for a long
time, can even continues throughout life and affects a person thinking ability,
his actions, expression of emotions, how he perceives reality and relates to
others. Schizophrenia is as generally not so common and affects approximately
0.3% to 0.7% of people. It’s also not area specific and effects people from all
racial backgrounds but generally more common in males than in females.
What exactly causes schizophrenia is still unknown, but genetic and
environmental factors may play role in developing this disorder. Affected
person seems frightened and withdrawn and have no contact with reality. This
makes him unable to do well in society, in educational institutes, at work
place or in relationships. In order to manage their symptoms and live a
healthy life such persons usually require lifelong care and treatment
Treatment options for schizophrenia may involve medications,
psychotherapy, and social support. Different coping strategies may also be
helpful such as participating in social skills training or joining a peer
support group.
Mostly people think that schizophrenia is like split or multiple
personality disorder but that is not true. Schizophrenia is primarily characterized by
psychosis that is a type of mental disorder in which a person is
unable to differentiate between what’s real from what’s imagined and
resultantly have no touch with reality. Person perceives confusing thoughts,
images, and sounds that are not real. Their behavior may be very strange and
even shocking. This sudden change in personality and behavior, in which a
person lose touch with reality, is called a psychotic episode.
Some people may experience only one psychotic episode, while others have many multiple episodes during a lifetime but live relatively healthy normal lives in between. Schizophrenia may have relapses and remissions cycles in which condition worsen and improve respectively
Types of symptoms in Schizophrenia
 |
| Symptoms of Schizophrenia |
- Early symptoms
- Positive or Psychotics symptoms
- Disorganized symptoms
- Cognitive symptoms
- Negative Symptoms
Early symptoms of Schizophrenia
The disease usually manifest itself in men in their late teens or early
20 period while in case of women it appears at early 20s or 30s.The time period
between when symptoms first start and before full psychosis is termed
as prodromal period. Prodromal period may last few days, weeks, or even years.
It is difficult to identify prodromal period as there is no specific trigger. In
this period teen usually have following behavioral changes:
- Social withdrawal
- A change in grades
- Difficult to concentrate
- Aggressive or changed mood.
- Difficulty in sleeping
Positive symptoms of Schizophrenia
Positive symptoms don’t mean that they are good symptoms. It means that
such symptoms aren’t based in reality like persons shows thought and action
that are imaginary and have no connection with reality. These are also called as
psychotic symptoms. These symptoms includes
- Hallucination
- Delusions
- Catatonia
What is Hallucination:
 |
| Auditory Hallucinations |
In hallucination person feels sensations that aren't real and
not present physically. Auditory type of hallucinations is more common in
people with schizophrenia like hearing different types of voices that are not
really present. These voices may command a person to do different things, comment
on the person's behavior or insult him. Others less common hallucination
include seeing things that aren't present in reality, feeling sensations on
your skin when nothing is touching, smelling strange odors or having a
bizarre taste in mouth.
What are Delusions:
 |
| Delusions |
Delusions are such deceitful and strange beliefs that are not based in
reality and the person sticks to them and refuses to give up, even when shown
the facts. Like people think that they are being spied on, drugged, followed,
slandered, cheated on, or somehow mistreated. For example, a delusional believe
by a boss that his secretary drugging him by adding a substance in the water. Person
with delusions may believe may hear his own thought. The voices tells them that
they are God or the devil or might think that different people are plotting
against them.
What is Catatonia in Schizophrenia:
In catatonia person fell like he is having paralysis, he stop speaking
fixed in a single position for a very long time. Catatonia has following
symptoms.
- Not talking
- Not moving
- Tapping feet or other repeated movements
- Copying someone’s movements or speech over and over
- Sluggish response
- Staring
Disorganized symptoms of Schizophrenia
Such symptoms demonstrate
the person inability to think clearly or respond as expected. Like
- Talking in sentences that don’t have any meaning or using nonsense
words, making it difficult for the person to communicate or hold a dialogue
- Showing Repeating movements or gestures, like pacing or walking in
circles
- Have no logical connections in thoughts and also shifting thoughts
quickly from one to other.
- Fail to recall events or losing things
- Moving or walking slowly
- Difficulty in making decisions
- Have no sense of everyday sights, sounds, and emotions.
- Useless writing without having any meaning.
Cognitive symptoms of Schizophrenia
Cognitive Symptoms
includes following:
- Difficulty in focusing or paying attention
- Showing poor executive functioning like ability to Understand
information and using it to make decisions
- Tendency to Use information instantly after learning it
- Recognizing that they have any of these problems.
Negative symptoms of Schizophrenia
The word
"negative" doesn’t mean "bad or faulty” here but it denotes the
absence of normal behaviors in people with schizophrenia. Negative symptoms of
schizophrenia include:
- Suffer from lack of emotion or a limited range of emotions
- Tends to separate from family, friends, and social activities
- Loss of pleasure or interest in life
- Talk less
- Lack of motivation
- Having Less vigor
- Poor sanitization and grooming habits.
What causes Schizophrenia
The exact cause of
schizophrenia isn’t known. But like cancer and diabetes, schizophrenia is
a real illness with a biological basis. Researchers have uncovered a number of
things that appear to make someone more likely to get schizophrenia, including:
- Genetics (heredity): Schizophrenia
can run in families, which means a greater likelihood to
have schizophrenia may be passed on from parents to their children.
- Brain chemistry
and circuits: People with schizophrenia may not be able to
regulate brain chemicals called neurotransmitters that control certain
pathways, or "circuits," of nerve cells that affect thinking and
behavior.
- Brain abnormality: Research
has found abnormal brain structure in people with schizophrenia. But this
doesn’t apply to all people with schizophrenia. It can affect people
without the disease.
- Environment: Things
like viral
infections, exposure to toxins like marijuana,
or highly stressful situations may trigger schizophrenia in people whose
genes make them more likely to get the disorder. Schizophrenia more often
surfaces when the body is having hormonal and physical changes, like those
that happen during the teen and young adult years.
Who gets Schizophrenia?
Anyone can get
schizophrenia. It affects people all over the world, from all races and
cultures. While it can happen at any age, schizophrenia typically first appears
in the teenage years or early 20s. The disorder affects men and women equally,
although symptoms generally appear earlier in men. The earlier the symptoms
start, the more severe the illness tends to be. Children over the age of 5 can
have schizophrenia, but it’s rare before adolescence.
How to diagnose Schizophrenia?
Normally there are no specific laboratory tests available to diagnose schizophrenia. Physical exams, complete medical history, blood test and brain imaging is carried out to rule out another physical illness or intoxication as the cause of symptom. If no other physical reason for the schizophrenia symptoms is found the case may be referred to psychiatrist or psychologist, mental health professionals trained to diagnose and treat mental illnesses. Such professional used special interviews and assessment tools to evaluate a person for a psychotic disorder
A person is
diagnosed with schizophrenia if they have at least two of these symptoms that
persist for at least 6 months:
- Delusions
- Hallucinations
- Disorganized or catatonic behavior
- Negative symptoms
- Disorganized speech
There must be presence
of any of three of following symptoms in order to diagnose Schizophrenia.
- Delusions
- Hallucinations
- Disorganized speech
There must be a
month of active symptoms during these 6 months. Symptoms should negatively
affect them socially or at work, and can’t be caused by any other medical or
substance related condition.
How is Schizophrenia treated?
Goals of Treatment:
There are mainly
two goal of schizophrenia treatment that are
1.
To ease the symptoms
2. To cut the chances of a relapse, or return of symptoms.
Treatment options of Schizophrenia
- Medication
- Coordinated specialty care (CSC) that includes
- Psychosocial therapy
- Rehabilitation
- Cognitive remediation
- Individual psychotherapy
- Family therapy
- Group therapy/support groups
- Hospitalization:
- Electroconvulsive therapy (ECT)
- Research
Medication:
Antipsychotics medicine are the
primary medications used in treatment of schizophrenia. These drugs have a less
role in cure of schizophrenia but assist to relieve the most troubling
symptoms, including hallucinations, delusions, and thinking problems. These
medicine includes Older (commonly referred to as "first-generation")
antipsychotic medications and Newer ("atypical" or second-generation)
drugs used to treat schizophrenia.
1st Generation antipsychotic medicine includes:
- Fluphenazine (Prolixin)
- Perphenazine (Trilafon)
- Oxilapine (Loxapine)
- Chlorpromazine (Thorazine)
- Haloperidol (Haldol)
- Thiothixene (Navane)
- Trifluoperazine (Stelazine)
2nd Generation antipsychotic medicine includes:
- Clozapine (Clozaril)
- Aripiprazole (Abilify)
- Aripiprazole Lauroxil (Aristada)
- Brexpiprazole (Rexulti)
- Asenapine (Saphris)
- Iloperidone (Fanapt)
- Lurasidone (Latuda)
- Paliperidone Palmitate (Invega Trinza)
- Ziprasidone (Geodon)
- Quetiapine (Seroquel)
- Cariprazine (Vraylar)
- Lumateperone tosylate (Caplyta)
- Olanzapine (Zyprexa)
- Paliperidone (Invega Sustenna)
- Risperidone (Risperdal)
FDA Approval:
Clozapine is currently the only FDA-approved medication for treating
schizophrenia that is resistant to other treatments. Clozapine is used to reduce
suicidal behaviors in those with schizophrenia.
Coordinated Special Care (CPC):
Coordinated specialty care means coordination of different teams or a team
approach toward treating schizophrenia when the first symptoms appear. In this
approach medicine and therapy is combined with social services, employment, and
educational interventions. Involvement of family is very much crucial and involved
as much as possible. Early treatment is key to helping patients lead a normal
life.
Psychotherapy:
In Psychosocial therapy different
various psychosocial treatments can help with the behavioral, psychological,
social, and occupational problems that are associated with the disease. In this
way patients are also able to manage their symptoms, identify early warning
signs of relapse, and come up with a relapse prevention plan. Psychosocial
therapies include:
Rehabilitation: it lays emphasis
on social skills and job training to assist people with schizophrenia to
normally function in the community and live as independently as possible
Cognitive remediation: which
involves learning techniques to cope with problems of information processing.
It often utilizes coaching, drills, and computer-based exercises skills that
improve attention, memory, planning, and organization.
Individual psychotherapy: with
this technique individual is better able to understand their illness, and learn
coping and problem-solving skills
Family therapy: It helps families
to deal with their loved ones that are effected with schizophrenia disorder
Group therapy and support groups:
these provides continuous mutual support
Hospitalization:
Mostly people with schizophrenia
are treated as outpatients. But hospitalization may be the better option for
people:
- Who can’t take care of themselves at home
- Have severe symptoms
- Who might harm themselves or others.
Electroconvulsive Therapy:
Electroconvulsive therapy (ECT): In this technique person is administered general anesthesia and then electrodes are attached to the person's scalp. Administrator sends a small electric shock to the brain. ECT therapy usually involves 2-3 treatments per week and usually continued for several weeks. Each shock treatment causes a controlled seizure. A When a series of treatments are given there is an improvement in mood and thinking.
Still its unknown that how ECT
and the controlled seizures it causes help, but it is thought that
ECT-induced seizures may affect the release of neurotransmitters in the brain. Normally
ECT treatment is less well-proven to help with schizophrenia than with bipolar
disorder or depression so it isn’t used very often when mood symptoms
are not present. It can help in a condition when drugs no longer work, or if
there is severe depression or catatonia that makes treating the illness
difficult.
Research: Researchers are
investigating a new procedure called deep brain stimulation (DBS) to treat
schizophrenia. In this method physician surgically implant electrodes that
stimulate certain brain areas believed to control thinking and perception. It
is already an established treatment for severe Parkinson's disease and essential
tremor, but it’s still in experimental phase for the treatment of psychiatric
disorders.
Are schizophrenic people are dangerous?
The reality is
usually opposite as shown in popular books and movies that often depict people
with schizophrenia as dangerous and violent. Most people with schizophrenia are
not violent or aggressive. Rather they prefer to withdraw from society and want
to be left alone. People with Schizophrenia do take part in dangerous or
violent behaviors, because of their psychosis, when they fear that they’re
being threatened in some way by their environment. Drug or alcohol use
can make violent condition even worse.
People with
schizophrenia can be a danger to themselves also. Suicide is the top cause of
premature death among people with schizophrenia.
Future outlook of schizophrenic people
People with
schizophrenia can lead productive and fulfilling lives depending upon that how much
they stick to proper treatment plan and nature of disease severity. They should
be able and encouraged to live with their families or in community settings
rather than in long-term psychiatric hospitals.
Can Schizophrenia be prevented?
There is still no established way to prevent schizophrenia but early diagnosis and treatment can
helpful to avoid or ease frequent relapses and hospitalizations. Early diagnosis
and treatment may also help to cut the disruption in many areas including person's
life, family, and relationships.
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