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Schizophrenia

Introduction

Schizophrenia is a chronic, severe and disabling brain disease that typically shows its first clear symptoms in late adolescence or early adulthood. It is one of several types of Psychotic Disorders. It is characterized by fundamental distortions in thinking and perception, and by inappropriate emotions. The disturbance involves many of the most basic functions that give the normal person a feeling of individuality, self-direction, and independence in functioning.

Overview and Facts

Schizophrenia occurs in as much as 1% of all adults, with onset typically in late adolescence or early adulthood. It is uncommon in pre-pubertal children and it is hard to recognize in its early phases in this age group. People with Schizophrenia may attempt suicide at some time during the course of their illness. Studies show that 30% of patients diagnosed with this disorder had attempted suicide at least once during their lifetime. About 10% of persons with Schizophrenia die through suicide.

Symptoms

The types of symptoms present in Schizophrenia are generally divided into 3 categories: “positive”, “negative”, and “disorganized symptoms”.

Positive symptoms (symptoms added to the personality) include:
  • Delusions which are false personal beliefs that are not subject to reason or contradictory evidence and are not explained by one’s usual cultural concepts.
  • Hallucinations which are disturbances of perception that are common in people suffering from Schizophrenia. They can occur in any sensory form: auditory (hearing things), visual (seeing things), tactile (touch), gustatory (taste), or olfactory (smell).

Negative symptoms (symptoms lost from the personality ) include:
  • Emotional flatness or lack of expression,
  • Speech that is brief and lacking content,
  • Lack of interest in life and an inability to follow through with activities.
  • Low motivation for work, as well as for interest or enjoyment of life.

Disorganized symptoms refer to:
  • Cognitive deficits that might lead to a certain disorganized behavior. For example, the person may not be able to concentrate on one thought or on one simple task for very long and may be easily distracted.
  • Difficulties connecting thoughts into logical sequences occur, thus thoughts become disorganized and fragmented. This lack of logical continuity of thoughts, called “thought disorder”, can make conversation very difficult and may contribute to further social isolation.

Also, people with schizophrenia might have disorders of movement. People with schizophrenia can be clumsy and uncoordinated. They may also exhibit involuntary movements and may grimace or exhibit unusual mannerisms. They may repeat certain motions over and over or, in extreme cases, may become catatonic. Catatonia is a state of immobility and unresponsiveness. It was more common when treatment for schizophrenia was not available; fortunately, it is now rare.

Causes and Risk Factors

Experts do not know what causes schizophrenia. It may have different causes for different people. In some people, brain chemistry (involving the neurotransmitters dopamine and glutamate) and brain structure are not normal.

Family history plays a role; in fact schizophrenia occurs in 10% of people who have a first-degree relative with the disorder, (parent, brother, or sister). People who have second-degree relatives (aunts, uncles, grandparents, or cousins) with schizophrenia also develop the disorder more often than the general population. The risk is highest for an identical twin of a person with schizophrenia. He or she has a 40 to 65 % chance of developing the disorder. Scientists also found that some genes and genetic mutations are associated with an increased risk of schizophrenia. Genes are not sufficient to develop schizophrenia as environmental factors play a role such as exposure to viruses and malnutrition that harm a baby's brain during pregnancy.

Tests and Diagnosis

To diagnose schizophrenia, a person should consult a mental health professional who rely on scientific criteria to check whether he/she has the disorder.

The doctor will examine you and ask about your symptoms. At least one of the symptoms must be delusions, hallucinations or disorganized speech.

He or she may ask other questions to see how you are doing emotionally. This is called a mental health assessment.

The doctor may also do blood or urine tests to rule out other conditions, that can cause similar symptoms such as substance abuse, medications or a medical condition. The doctor may also request imaging studies, such as an MRI or CT scan.

Treatment

Schizophrenia requires lifelong treatment, even when symptoms have stopped. Treatment is composed of medications and psychotherapy:

Medications
  • Antipsychotic medications are mostly used to control symptoms by affecting the neurotransmitters dopamine and serotonin. In general, antipsychotic medications are used to control signs and symptoms at the lowest possible dosage. The psychiatrist may try different medications, dosages or combinations over time to achieve the best result.
    • Atypical antipsychotics: these are second-generation medications and have a lower risk of side effects than conventional medications.
    • Conventional, or typical antipsychotics: these first-generation medications have frequent side effects, including the possibility of developing a movement disorder (tardive dyskinesia) that may or may not be reversible. These medications are cheaper than the second generation; this is why they are considered for long term treatment. It is important to know that it can take several weeks after starting a medication to notice an improvement in symptoms.
  • Antidepressants or anti-anxiety medications can be used as well in some cases.

Psychotherapy

Psychotherapy helps the person to cope with stress and identify signs of relapse. Family therapy is also a way to help families support their relatives who are dealing with schizophrenia. A lot of people also benefit from social skills training which focuses on improving communication and social interactions.

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