Schizophrenia: Symptoms, Causes, Treatment

The schizophrenia Is a syndrome that can affect the thinking, perception, speech and movement of the affected person.

It affects almost all areas of the person's life; Family, employment, training, health, personal relationships...

1-History of schizophrenia

In 1809, John Haslam described in Madness and Melancholy A form of dementia as follows:

They precede a degree of apparent seriousness and inactivity, along with a decrease in ordinary curiosity concerning what is happening in front of them... Sensitivity seems to be particularly dull; Do not give the same affection to their parents and their relationships...

Almost at the same time Philippe Pinel - a French physician - wrote about people who would later become known as schizophrenics. Fifty years later Benedict Morel He used the term démence precoce (early loss of mind).

At the end of the 19th century, Emil Kraepelin - German psychiatrist - established the description and classification of schizophrenia.

In 1908 Eugen Bleuler - Swiss psychiatrist - introduced the term schizophrenia, considering the thought as the main problem.

The term"schizophrenia"comes from the Greek words"schizo"(excision) and"fren"(mind). It reflects Bleuler's view that there is an associative split between personality areas.

2-Symptoms of schizophrenia

Symptoms of schizophrenia are divided into three categories: positive symptoms, negative symptoms, and disorganized symptoms.

Positive symptoms

People with positive symptoms lose touch with reality and their symptoms appear and disappear. Sometimes they are severe and sometimes they are barely noticeable, depending on whether the person receives treatment.

They include:

• Delusions : They are beliefs that are not part of the culture or society of the person.

For example, a common delusion of those with schizophrenia is that of persecution, that is, the belief that others are trying to catch you.

Other delusions are those of Cotard (a part of the body has changed or believes to be dead) and the From Capgras (Having been replaced by a double).

• Hallucinations : They are sensory experiences without stimuli. The person can see, smell, hear or feel things that no one else can.

The most common type of hallucination in schizophrenia is hearing. The affected person can hear voices that they believe are from other people and that order, warn or comment on their behavior. Sometimes the voices speak to each other.

Positron emission computed tomography studies have confirmed that schizophrenics do not hear the voice of others, but their own thinking or voice and can not recognize the difference (the most active part of the brain during hallucinations is the Broca area , Associated with verbal production).

Other types of hallucinations include seeing people or objects, smelling smells and feeling invisible fingers touching the body.

Negative symptoms

Negative symptoms indicate absence or lack of normal behavior. They are associated with interruptions of normal emotions and behaviors.

People with negative symptoms often need help doing daily tasks. They often neglect basic hygiene and may appear lazy or unable to help themselves.

They include:

• Apathy : Inability to initiate and persist in activities. Little interest in basic daily activities, such as personal hygiene.
• Alogia : Relative absence of speech and answering questions with very brief answers. Little interest in having conversations.
• Anhedonia : Lack of pleasure and indifference to activities that are considered pleasurable like eating, having sex or interacting socially.
• Flat affectivity : Expression absent, speech dull and monotonous, without external reaction to emotional situations.

Disorganized symptoms

• Disorganized speech : Jump from one topic to another, talk illogically, tangential responses (walking through the branches).
• Inappropriate Affection : Laugh or cry at inappropriate times,
• Disorganized behavior : Behaving strangely in public, accumulating objects, Catatonia (From unbridled agitation to immobility), Wax flexibility (Keeping the body and limbs in the position in which someone places them).

In this article You can know the main consequences of schizophrenia in health, family and society.

3-Subtypes of schizophrenia

• Paranoid : It is characterized by delusions and hallucinations, being maintained the affection and thought intact. Delusions and hallucinations are usually based on a subject, such as persecution or greatness.
• Disorganized : Problems in speech and behavior, with flat or inappropriate affection. If there are hallucinations or delusions they are not usually organized in a central theme. People with this type often give early signs of the disorder.
• Catatonic : Rigid postures, waxy flexibility, overdoing activities, strange mannerisms with body and face, grimaces, repetition of words (echolalia), repetition of others ( Ecopraxia ).
• Undifferentiated : People with major symptoms of schizophrenia without meeting paranoid, disorganized or catatonic criteria.
• Residual : People who have had at least one episode without maintaining the main symptoms. Residual symptoms such as negative beliefs, rare (non-delusional) ideas, social withdrawal, inactivity, strange thoughts, and flat affect can be maintained.

4-Causes of schizophrenia

Schizophrenia is caused primarily by genetic and environmental factors.

Genetic factors

It occurs in families, occurring in 10% of people who have relatives with the disorder (parents or siblings). People with second-degree relatives also develop schizophrenia more frequently than the general population.

If a parent is affected, the risk is approximately 13% and if both are affected the risk is 50%.

It is likely that many genes are involved, each contributing a small effect.

Environmental factors

Environmental factors that are associated with the development of schizophrenia include living environment, drug abuse, and prenatal stressors.

The paternal style of education seems to have no effect, although democratic parents seem to be better than the critics or hostiles.

Trauma in childhood, death of parents or Bullying Increase the risk of developing psychosis.

On the other hand, it has been found that living in an urban environment during childhood or as an adult increases the risk by two.

Other factors that play a role include social isolation, racial discrimination, family problems, unemployment and poor home conditions.

Substance abuse

It is estimated that half of people with people with schizophrenia use alcohol or drugs excessively.

The use of cocaine , Amphetamines, and to a lesser extent alcohol, can result in psychosis resembling schizophrenia.

In addition, although not considered as a cause of the disease, people with schizophrenia use nicotine more than the general population.

Alcohol abuse can occasionally lead to the development of a psychosis indicated by chronic substance abuse.

A significant proportion of people with schizophrenia use cannabis to cope with their symptoms. Although cannabis may be a contributory factor to schizophrenia, it can not provoke it on its own.

Early exposure of the developing brain increases the risk of developing schizophrenia, although development may require the presence of certain genes in the person.

Developmental Factors

Hypoxia, infections, stress or malnutrition during fetal development may increase the chances of developing schizophrenia.

People with schizophrenia are more likely to be born in spring or winter (at least in the northern hemisphere), which may be a result of increased exposure to viruses in the uterus.

Brain Mechanisms

Psychological mechanisms

Cognitive errors have been identified in people diagnosed with schizophrenia, especially when They are under stress Or in confusing situations.

Recent research indicates that schizophrenic patients may be highly sensitive to stressful situations. Some evidence suggests that the content of delusional beliefs and psychotic experiences may reflect emotional causes of the disorder and that the way in which the person interprets those experiences may influence symptomatology.

Neural mechanisms

Schizophrenia is associated with small brain differences, found in 40 to 50% of cases, and in brain chemistry during psychotic states.

Studies using brain imaging technologies as an image by magnetic resonance (MRI) or Positron emission tomography (PET) have shown that the differences are usually found in the frontal lobes, hippocampus Y Temporal lobes .

Reduction of brain volume has also been found in areas of the frontal cortex and temporal lobes. It is not known exactly whether these volume changes are progressive or are prior to the onset of the disorder.

Particular attention has been paid to the role of Dopamine In the mesolimbic way of the brain.

This hypothesis proposes that schizophrenia is caused by excessive activation of D2 receptors.

There has also been an interest in glutamate And its reduced function at the NMDA receptor in schizophrenia.

The reduced function of glutamate is associated with poor results in tests requiring the use of the frontal lobe and hippocampus. In addition, glutamate can affect the function of dopamine.

5-Diagnosis

The diagnosis of schizophrenia is based on a psychiatric evaluation, medical history, physical examination and laboratory tests.

• Psychiatric evaluation : Study of symptoms, psychiatric history and family history of mental disorders.
• Medical history and examination : Know the family health history and complete a physical examination to rule out physical problems that cause the problem.
• Lab tests : There are no laboratory tests diagnosing schizophrenia, although blood or urine tests may rule out other medical conditions. In addition, imaging studies such as MRI can be performed.

Diagnostic criteria according to DSM-IV

TO . Characteristic symptoms: Two (or more) of the following, each present for a significant portion of a period of 1 month (or less if successfully treated):

1. Delirious ideas
2. Hallucinations
3. Disorganized language (eg, frequent derailment or incoherence)
4. Catatonic or severely disorganized behavior
5. Negative symptoms, for example, Affective flattening , Alogia o abulia

Note : Only a symptom of Criterion A is required if delusional ideas are strange, or if delusional ideas consist of a voice that continually comments on the thoughts or behavior of the subject, or if two or more voices talk to each other.

B . Social / occupational dysfunction: During a significant part of the time since the onset of the disorder, one or more important areas of activity, such as work, interpersonal relationships, or self-care, are clearly below the level prior to the onset of the disorder (or, When the onset is in infancy or adolescence, failure to reach the expected level of interpersonal, academic or work performance).

C . Duration: Continuous signs of alteration persist for at least 6 months. This 6-month period should include at least 1 month of symptoms meeting Criterion A (or less if successfully treated) and may include periods of prodromal and residual symptoms. During these prodromal or residual periods, signs of alteration may be manifested only by negative symptoms or by two or more symptoms of the Criterion A list, attenuated (eg, rare beliefs, unusual perceptual experiences).

D . Exclusion of schizoaffective and mood disorders: Schizoaffective disorder and mood disorder with psychotic symptoms have been ruled out because: 1) there have been no major, manic or mixed depressive episodes concurrent with the symptoms of the active phase; Or 2) if episodes of mood disturbance have appeared during the symptoms of the active phase, their total duration has been brief in relation to the duration of the active and residual periods.

AND . Exclusion of substance use and medical illness: The disorder is not due to the direct physiological effects of a substance (eg, a drug of abuse, a drug) or a medical illness.

F . Relationship to a generalized developmental disorder: If there is a history of autistic disorder or another generalized developmental disorder, the additional diagnosis of schizophrenia will only be made if delusional ideas or hallucinations are also maintained for at least 1 month (or less if successfully treated).

Classification of longitudinal course:

6-Treatment

Schizophrenia requires long-term treatment, even when symptoms have disappeared.

Treatment with medication And psychosocial therapy can control the disorder and during periods of crisis or severe symptoms, hospitalization may be necessary to ensure adequate nutrition, safety, hygiene and adequate sleep.

Usually the treatment is guided by a psychiatrist, and may include the team to psychologists, social workers or nurses.

Medication

Antipsychotic drugs are the drugs most commonly prescribed to treat schizophrenia. It is thought to control the symptoms affecting the neutrotransmitters dopamine and serotonin.

The willingness to cooperate with treatment may affect the medication used. Someone who is resistant to taking medication may need injections instead of pills. Someone who is agitated may need to be reassured initially with a benzodiazepine such as lorazepam, which can be combined with an antipsychotic.

Atypical antipsychotics

These second generation drugs are generally preferred because they have a lower risk of developing side effects than Antipsychotics Conventional.

In general, the goal of antipsychotic treatment is to effectively control the symptoms with the lowest dose possible.

They include:

• Aripiprazole.
• Asenapine.
• Clozapine.
• Iloperidone.
• Lurasidone.
• Olanzapine.
• Paliperidone.
• Quetiapine.
• Risperidone.
• Ziprasidone.

Atypical antipsychotics may have side effects such as:

• Loss of motivation.
• Drowsiness.
• Nervousness.
• Weight gain.
• Sexual dysfunctions.

Conventional antipsychotics

This first generation of antipsychotic drugs have frequent side effects, including the possibility of developing dyskinesia (abnormal and voluntary movements).

They include:

• Chlorpromazine.
• Fluphenazine
• Haloperidol.
• Perphenazine.

Psychosocial treatment

When psychosis is controlled, it is important to proceed with psychosocial and social interventions, in addition to continuing medication.

They may be:

• Cognitive-behavioral therapy : Focuses on changing patterns of thinking and behavior and learning to cope with stress and identifying early symptoms of relapse.
• Social skills training : Improve communication and social interactions.
• Family therapy : Support and education for families to deal with schizophrenia.
• Vocational rehabilitation and employment support : Helping people with schizophrenia prepare for employment.
• Support groups : People in these groups know that other people face the same problems, which makes them feel less isolated socially.

People with schizophrenia are 2 to 2.5 times more likely to die at an early age than the population as a whole. This is usually due to physical diseases such as cardiovascular, metabolic and infectious diseases.

9-Complications

Failure to treat schizophrenia can lead to emotional, behavioral, health or even financial problems.

Can be:

• Suicide .
• Any type of self harm.
• Depression .
• Abuse of alcohol, drugs or drugs.
• Poverty.
• Stay homeless.
• Family problems.
• Inability to go to work.
• Social isolation.
• Health problems.

10-Risk Factors

Some factors appear to increase the risk of developing schizophrenia:

• Having relatives with the disease.
• Exposure to viruses, toxins or prenatal malnutrition (especially in the third and second semesters).
• Autoimmune diseases.
• Older age of the father.
• Taking drugs at an early age.

11-Advice for patients

Receiving a diagnosis of schizophrenia can be very painful, although with the right treatment you can lead a good life.

Early diagnosis can prevent complications and improve the chances of recovery.

With the right treatment and support, many people are able to reduce their symptoms, live and work independently, build satisfying relationships and enjoy life.

Recovery is a long-term process, there will always be new challenges to face. Therefore, you have to learn to manage your symptoms, develop the support you need and create a life with a purpose.

A complete treatment includes medication with community supports and therapy, and aims to reduce symptoms, prevent future psychotic episodes and re-establish your ability to lead a good life.

Facts to encourage you:

• Schizophrenia is treatable: although there is currently no cure, it can be treated and controlled.
• You can lead a good life: most people who are properly treated are able to have good personal relationships, work or play leisure activities.

Here are some tips that can help you better control the disease:

1-Show interest in treatment

If you think you have symptoms of schizophrenia, seek professional help as soon as possible.

Getting a proper diagnosis is not always easy, as the symptoms can be confused with another mental disorder or medical condition.

It is best to go to a psychiatrist with experience in the treatment of schizophrenia. The sooner you start to treat it, the more likely you are to control it and improve it.

To make the most of a treatment, it is important to educate yourself about the disease, to communicate with doctors and therapists, to adopt a healthy lifestyle, to have a strong support system and to be consistent with the treatment.

If you are an active participant in your own treatment, recovery will be better. In addition, your attitude will be important:

• Contact your doctor : Tell them about your improvements, concerns, problems and make sure you take the right doses of medication.
• Do not fall into the stigma of schizophrenia : Many fears about this disease are not based on reality. It is important that you take it seriously, but do not believe that you can not improve. Approach people who treat you well and be positive.
• Establish an integral treatment : Medication is not enough. Cognitive-behavioral therapy can help you with irrational beliefs.
• Establish vital goals : You can continue working, have personal relationships or engage in leisure activities. It is important that you establish important goals for yourself.

2-Build social support

Social support is very important to have a good prognosis, especially the support of friends and family.

• Use social services : Ask your doctor for the community services that exist in your city or locality.
• Trust friends and family : Your close friends and family can help you with the treatment, keep your symptoms under control, and work well in your community.

It is important that you have a stable place to live. Studies show that it is better for people with schizophrenia to be surrounded by people who show support.

Living with your family is a good choice if you know the disease well, show support and are willing to help.

However, your interest is the most important; Follow your treatment, avoid drugs or alcohol, and use supportive services.

3-Build a healthy lifestyle

The course that follows schizophrenia is different for each person, however you can always improve your situation with habits that build a healthy lifestyle.

• Manage Stress : Stress can trigger psychosis and worsen symptoms. Do not do more than you can, set your limits at home or in your training.
• Sleep enough : Although people with schizophrenia may have problems with sleep, changes in lifestyle may help (exercise, avoid caffeine, establish sleep routines...).
• Avoid drugs and alcohol : Substance abuse complicates schizophrenia.
• Exercise Regularly : Some studies indicate that regular exercise can help reduce the symptoms of schizophrenia, in addition to its mental and physical benefits. Try to do at least 30 minutes of physical exercise a day.
• Find important activities : If you can not work, find activities that you suppose a purpose and that you like.

12-Tips for family members

The love and support of the family are important for the recovery and treatment of a person with schizophrenia.

If a family member or friend has this disease, you can help a lot in trying to seek treatment, address the symptoms and social support.

Although dealing with a schizophrenic person can be hard, you do not have to do it alone. You can support yourself in other people or use community services.

To treat adequately with the schizophrenia of a relative is important:

• Be realistic about what is expected of the patient and self.
• Accept the disease and its difficulties.
• Maintain a sense of humor.
• Educate yourself: learn about the disease and its treatment will allow you to make decisions.
• Reduce Stress: Stress can make symptoms worse, so it is important for the affected family member to be in an environment with supports and resources.

Here are some tips that will help you better take the situation:

1-Take care of yourself

It is important that you take care of your own needs and find new ways to face the challenges you face.

Like your relative, you also need understanding, encouragement, and help. This way you will be in a better position to help your family member or friend.

• Go to a support group : Knowing other people in your situation will provide you with experiences, advice, information and you will have less feeling of isolation.
• To have free time : Set time each day to enjoy the activities you like.
• Take care of your health : Get enough sleep, exercise, eat a balanced diet...
• Cultivate other relationships : Maintaining family and friends will be an important support to face the situation.

2-Support the treatment

The best way to help a family member with schizophrenia is to get you started on treatment and help you maintain it.

For people with this disease, delusions or hallucinations are real, so do not think they need treatment.

Early intervention makes the difference in the course of the disease. Therefore, try to look for a good doctor as soon as possible.

On the other hand, instead of doing everything for your relative, encourage him to take care of himself and Encourages self-esteem .

It is important for your family member to have a voice in their own treatment, so that they feel respected and motivated to follow with constancy.

3-Control the medication

• Monitor side effects : Many people leave medication because of side effects. Tell your doctor if any side effects occur in your family, so you can reduce the dose, change the drug or add another.
• Encourage your family member to take medication regularly : Even when side effects are controlled, some people refuse to take drugs. This may be due to a lack of disease awareness. In addition, forgetfulness can occur, which can be solved with calendars or boxes of pills weekly.
• Beware of pharmacological interactions : Antipsychotics can cause unpleasant side effects or side effects when combined with other substances, drugs, vitamins or herbs. Give the doctor a complete list of drugs, drugs or supplements your family member is taking. Mixing alcohol or drugs with medication is very dangerous.
• Monitor progress : Tell the doctor about changes in mood, behavior, and other symptoms of your family member. A diary is a good way to control medication, side effects and details that you can forget.
• Watch for signs of relapse : It is important to monitor that medication is continued, because stopping is the most frequent cause of relapse. Many people whose schizophrenia is stabilized need to take medication to maintain the results.

Even if the medication is taken, there is a risk of relapse and the onset of a new psychotic episode. If you learn to recognize the early signs of relapse, you can act quickly to treat them and even prevent the crisis.

Common signs of relapse are:

• Social isolation.
• Impairment of personal hygiene.
• Paranoia.
• Insomnia.
• Hostility.
• She speaks confused.
• Hallucinations.

4-Prepare for crises

Although you strive to prevent relapse, there may be times when a new crisis appears. Hospitalization may be necessary to maintain safety.

Having an emergency plan for these crises will help you deal with it safely and quickly:

• A list of emergency telephones (doctors, therapists, services, police...).
• The address and phone number of the hospital you will be going to in case of emergency.
• Friends or family members who can help you care for children or other family members.

Some Tips for Managing Crises:

• The person may be terrified of their own feelings.
• Do not express anger or hatred.
• Do not scream.
• Do not use sarcasm or hurtful humor.
• It reduces distractions (turns off the TV, radio, fluorescents...).
• Avoid direct eye contact.
• Avoid touching the person.
• You can not reason with acute psychosis.
• Sit down and ask the person to sit.

Source: World Fellowship for Schizophrenia and Allied Disorders.

5-House or residence?

The treatment of schizophrenia can not be successful if the affected person does not have a stable place to live.

When thinking about possibilities ask yourself:

• Can your family care for the affected person?
• How much support do you need with daily activities?
• Does your family have problems with alcohol or drugs?
• How much treatment supervision do you need?

Living with the family can be an option for affected people if the family understands the disease well, has social supports and is willing to give assistance.

Living with the family works best if:

• The affected person works properly at a certain level, has friendships and does leisure activities.
• Family interaction is relaxed.
• The affected person avails himself of the community supports and available services.
• The situation has no impact on a child living in the home.

Living with the family is not advised if:

• The main support is single, sick or elderly.
• The affected person is very affected and can not lead a normal life.
• The situation causes stress in marriage or causes problems for children.
• No support services are used or none are available.

If you can not keep the affected person in your home, do not feel guilty. If you can not first take care of your own needs or other people in the home, your affected family member will be better off somewhere else.

And what experiences do you have with schizophrenia?

References

1. American Psychiatric Association. Task Force on DSM-IV. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Pub. ISBN 978-0-89042-025-6. P. 299.
2. Brunet-Gouet E, Decety J (December 2006). "Social brain dysfunctions in schizophrenia: a review of neuroimaging studies". Psychiatry Res 148 (2-3): 75-92.
3. Hor K, Taylor M (November 2010). "Suicide and schizophrenia: a systematic review of rates and risk factors". Journal of psychopharmacology (Oxford, England) 24 (4 Suppl): 81-90.
4. Baier M (August 2010). "Insight in schizophrenia: a review". Current psychiatry reports 12 (4): 356-61.
5. O'Donovan MC, Craddock NJ, Owen MJ (July 2009). "Genetics of psychosis; Insights from views across the genome." Hum. Genet. 126 (1): 3-12.
6. Mueser KT, Jeste DV (2008). Clinical Handbook of Schizophrenia. New York: Guilford Press. Pp. 22-23.
7. Gregg L., Barrowclough C, Haddock G (2007). "Reasons for increased substance use in psychosis". Clin Psychol Rev 27 (4): 494-510.
8. Beck, AT (2004). "A Cognitive Model of Schizophrenia". Journal of Cognitive Psychotherapy 18 (3): 281-88.
9. Coyle JT, Tsai G, Goff D (2003). "Converging evidence of NMDA receptor hypofunction in the pathophysiology of schizophrenia". Annals of the New York Academy of Sciences 1003: 318-27.
10. "The ICD-10 Classification of Mental and Behavioral Disorders"(PDF). World Health Organization. P. 26.
11. Marshall M, Rathbone J (Jun 15, 2011). "Early intervention for psychosis". The Cochrane Database of Systematic Reviews (6): CD004718.
12. "Psychosis and schizophrenia in adults: treatment and management"(PDF). NICE. Mar 2014. p. 7. Retrieved 19 April 2014.
13. Kane JM, Correll CU (2010). Pharmacologic treatment of schizophrenia. Dialogues Clin Neurosci 12 (3): 345-57.
14. Ayuso-Mateos JL. "Global burden of schizophrenia in the year 2000"(PDF). World Health Organization. Retrieved 27 February 2013.
15. McNally K (2009). "Eugen Bleuler's"Four A's"". History of Psychology 12 (2): 43-59.