Doc Talk #22 - Schizophrenia

Schizophrenia is a mental disease which is often associated with many misinformation, myths and harmful beliefs. Modern psychiatry came to many important findings about schizophrenia and it's causes.

What is schizophrenia?

Term schizophrenia comes from greek words "Shizo" which means to split and "fren" which means sould or mind. Schizophrenia would therefore mean splitting of the mind. Schizophrenia is a group of mental disease which manifest as distorted perception of reality, derealization and withdrawal into autistic world or a world of bizarre fantasies. Schizophrenia can present in a way that person affect feel they are another person or even an animal. It can lead to social, professional and family dysfunction. Some symtoms include:

• bizarre thoughts
• dissociated thoughts
• illusion
• hallucinations
• inappropriate emotional spectrum

How likely is one to get schizophrenia?

Generally it can be said that the risk globally is between 0,4-1,0%. It is generally considered that there is no difference between population across the world. There's no difference between men and women in developed countries. They are both equally likely to get schizophrenia. However, incidence of schizophrenia is couple of times higher in men than in women in developing countries.

Why do we get schizophrenia

No one exactly knows the cause of schizophrenia. It is known that there is certain biological hereditary predisposition and that there are some predisposing psychosocial factors. Higher incidence of schizophrenia in some families is a proof that genetics play a role.
People with much higher risk are those who have close relatives affected with schizophrenia Closer the relative, higher the risk. Another risk factors are:

• complicated birth
• viral infections
• eating disorders
• stress
• psychotrauma

There is multitude of scientific studies that correlated incidence of schizophrenia with abnormalities in development of central nervous system, neurodegenerative disease, brain microtrauma, metabolic and autoimmune disorders. There are also numerous psychological theories.

Symptoms

Illogical, unreal and weird idea which cannot be corrected by presenting facts is one of the most dominant symptom of schizophrenia. It can manifest as ideas about grandiosity, paranoid and erotic thoughts, religious and mystic ideas and hypochondriac predisposition.
Primary symptoms are:

• auditory hallucinations such as dialog, commands
• tactile hallucinations
• feeling of being controlled or being forced to think certain thoughts
• visual hallucinations

Secondary symptoms are:

• derealization
• agitation
• gesticulation
• ambivalence
• anhedonia, anxiety, depression
• loss of motivation
• feeling of emptyness
• loss of speech dynamic and loss of vocabulary
• autodestructive or aggressive behavior

Hallucinations and other symptoms must be present at least for a month for diagnosis to be made. Different types of schizophrenia are:

• paranoid schizophrenia
• hebephrenic schizophrenia: aimless behavior, emotional blandness and incoherent speech
• catatonic schizophrenia: in which person often remains fixed and doesn't move for prolonged time
• undifferentiated schizophrenia, post-schizophrenic depression, resiudal schizophrenia.

Most schizophrenias are mixed.

Schizophreniform personality disorder is not schizophrenia and it has better prognosis.

Treatment

Pharmacotherapy is a staple of treatment, but it is not the only tool at our disposal since psychotherapy and sociotherapy might be helpful. The goal of treatment is not only the reduction of symptoms but the stopping of the disease process all together and prevention of relapse.

Various drugs are used. There's a therapy for cessation of acute episode and drugs that are taken daily to prevent the disease from exarcabating.

It remains a serious and debilitating disease with poor prognosis, but the on going research is bringing new hope.

Sources:

• my medical education. Psychiatry textbooks.
• All images are found on Google

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