Schizophrenia is a complex and chronic mental health condition characterised by several symptoms such as delusions, hallucinations, disorganised speech or behaviour and impaired cognitive ability. The early onset of the disease, along with its chronic course, make it a disabling disorder for many patients and their families . Disability either occurs from both negative symptoms that are characterised by loss or deficits and cognitive symptoms. That's not all - a relapse could also occur due to positive symptoms such as suspiciousness, delusions and hallucinations .
Types Of Schizophrenia
• Paranoid schizophrenia: In this case, a person may have certain false beliefs or delusions that an individual or group of people are conspiring to harm them.
• Hebephrenic schizophrenia: This is characterised by disorganised thinking and behaviour. The patient generally has incoherent and illogical thoughts as well as speech. This can also hamper daily activity such as cooking, taking care of personal hygiene or even washing.
• Catatonic schizophrenia: This type can include excessive and peculiar motor behaviours, sometimes referred to as catatonic excitement. In some cases, there can be decreased motor activity and engagement. For instance, in some people, there's a dramatic reduction in activity where the patient can't speak, move or respond.
• Simple schizophrenia: This is a case in which symptoms are mild and don't exhibit extremities. These include the inability to perform in society, poor hygiene and other minor physical and psychological problems.
Symptoms Of Schizophrenia
The symptoms of schizophrenia vary from patient to patient. For some, symptoms may develop gradually over months or years or appear very abruptly. It could also come and go in cycles of relapse and remission.
Here are a few early warning signs of schizophrenia:
• Hearing or seeing something that isn't there
• A constant feeling of being watched
• Peculiar or nonsensical way of speaking or writing
• Strange body positioning
• Feeling indifferent to very important situations
• Deterioration of academic or work performance
• A change in personal hygiene and appearance
• A change in personality
• Increasing withdrawal from social situations
• Irrational, angry or fearful response to loved ones
• Inability to sleep or concentrate
• Inappropriate or bizarre behaviour
• Extreme preoccupation with religion or the occult
Anyone who experiences several of these symptoms for more than two weeks should seek help immediately.
In most cases, schizophrenia is defined by hallucinations, delusions, paranoia and thought disorder and include abnormalities in all aspects of thought, cognition and emotion. The psychotic symptoms are generally characterised by a failure of logic, customary associations, intent and organisation that accompanies human thought.
Positive symptoms are disturbances that are added to the person's personality. These include the following:
Delusions: These are generally false ideas that individuals may have, especially that someone is spying on them or even that they are famous.
Hallucinations: Seeing, feeling, tasting, hearing or smelling something that does not exist. Several patients hear imaginary sounds that give commands.
Disordered thinking and speech: This is when a patient switches from one subject to another in a very abrupt and nonsensical fashion. Patients may repeat words, sounds or rhymes over and over again.
Disorganized behaviour: This can range from having problems with routine behaviour like hygiene or choosing appropriate clothing for the weather to impulsive and uninhibited actions.
Negative symptoms are capabilities that are generally lost from a person's personality. This can include lack of emotional response, loss of interest and an inability to feel for others.Causes Of Schizophrenia
Genetics: The risk for schizophrenia is inherited. Studies suggest that the more a patient is closely associated with an individual with schizophrenia, the more he/she is at risk of contracting it. The disease is common in all cultures and people around the world. Association studies show that schizophrenia is a complex multi-genetic disorder. Each risk factor confers a small risk, with the genetic factors being the most potent.
Prenatal or perinatal events: Catastrophic prenatal or perinatal events, like exposure to famine, radiation, or a maternal viral illness, especially during the second trimester, are significant risk factors for schizophrenia. These early events do not have much power as the genetic factors. Perinatal events like toxaemia and hypoxia at birth are risk factors for schizophrenia, as is winter birth.
Factors during childhood and adolescence: Environmental factors are also considered as huge risks for schizophrenia. These most prominently include the use of marijuana and other forms of drug dependence, although this is less rigorously documented. Trauma is often mentioned as a proximal risk factor for the illness. The rearing environment characterized by emotion and stress is also often identified as a trigger for schizophrenia.
In some cases, drug abuse is also a huge risk factor for schizophrenia. Certain drugs, including cannabis, cocaine, LSD could trigger schizophrenia in those who are susceptible. Using amphetamines or cocaine can lead to psychosis and can cause a relapse in patients.Diagnosis Of Schizophrenia
A diagnosis of schizophrenia is reached through an assessment of patient-specific signs and symptoms, as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) . The DSM-5 states that "the diagnostic criteria [for schizophrenia] include the persistence of two or more of the following active-phase symptoms, each lasting for a significant portion of at least a one-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behaviour, and negative symptoms." At least one of the qualifying symptoms must be delusions, hallucinations, or disorganized speech.
Moreover, the DSM-5 states that, to warrant a diagnosis of schizophrenia, the patient must also exhibit a decreased level of functioning regarding work, interpersonal relationships, or self-care . There must also be continuous signs of schizophrenia for at least six months, including the one-month period of active-phase symptoms noted above.
Schizophrenia can be differentiated from other similar conditions through a careful examination of the duration of the illness, the timing of delusions or hallucinations, and the severity of depressive or manic symptoms. In addition, the clinician must confirm that the presenting symptoms are not a result of substance abuse or another medical condition.Tests used to diagnose schizophrenia
To be certain, the doctor may conduct a urine or blood test to be sure if alcohol or drug abuse is not the cause. Next, tests that scan the body and brain, like Magnetic Resonance Imaging (MRI) or Computed Tomography (CT scan) might also help in ruling out other diseases like brain tumour
Tests are also carried out to measure how much a person understands, personality tests and open-ended tests like the inkblot test.
Early diagnosis is essential to improve your loved one's chances of managing the illness.Treatment For Schizophrenia
• Non-pharmacological therapy
The goals in treating schizophrenia include targeting symptoms, preventing relapse, and increasing adaptive functioning so that the patient can be integrated back into the community . Since patients rarely return to their baseline level of adaptive functioning, both nonpharmacological and pharmacological treatments must be used to optimize long-term outcomes. Pharmacotherapy is the mainstay of schizophrenia management, but residual symptoms may persist. For that reason, nonpharmacological treatments, such as psychotherapy, are also important.
Individuals with mental disorders tend to be less adherent for several reasons.
They may deny their illness; they may experience adverse effects that dissuade them from taking more medication; they may not perceive their need for medication, or they may have grandiose symptoms or paranoia.
Patients with schizophrenia who stop taking their medication are at increased risk of relapse, which can lead to hospitalization. Therefore, it is important to keep patients informed about their illness and about the risks and effectiveness of treatment. Some psychotherapies can help educate patients about the importance of taking their medications. These initiatives include cognitive behavioural therapy (CBT), personal therapy, and compliance therapy.
• Pharmacological therapy
In most schizophrenia patients, it is difficult to implement effective rehabilitation programs without antipsychotic agents. Prompt initiation of drug treatment is vital, especially within five years after the first acute episode, as this is when most illness-related changes in the brain occur. Predictors of a poor prognosis include the illicit use of amphetamines and other central nervous system stimulants, as well as alcohol and drug abuse. Alcohol, caffeine, and nicotine also have the potential to cause drug interactions .
In the event of an acute psychotic episode, drug therapy should be administered immediately. During the first seven days of treatment, the goal is to decrease hostility and to attempt to return the patient to normal functioning (e.g., sleeping and eating). At the start of treatment, appropriate dosing should be titrated based on the patient's response .
Treatment during the acute phase of schizophrenia is followed by maintenance therapy, which should be aimed at increasing socialization and at improving self-care and mood. Maintenance treatment is necessary to help prevent relapse.
• Long-acting injectable antipsychotic agents
Long-acting injectable (LAI) antipsychotic medications offer a viable option for patients who are non-adherent to oral medication.
• Treatment-resistant schizophrenia
Clozapine is the most effective antipsychotic in terms of managing treatment-resistant schizophrenia. This drug is approximately 30% effective in controlling schizophrenic episodes in treatment-resistant patients, compared with a 4% efficacy rate with the combination of chlorpromazine and benztropine .
• Augmentation and combination therapy
Both augmentation therapy (with ECT or a mood stabilizer) and combination therapy (with antipsychotics) may be considered for patients who fail to show an adequate response to clozapine. Mood stabilizers are common augmentation agents. Lithium, for example, improves mood and behaviour in some patients but does not have an antipsychotic effect .
In combination therapy, two antipsychotic drugs such as an FGA and an SGA, or two different SGAs are administered concurrently .