Schizophrenia is a disorder of the mind that affects how one feels, thinks, and behaves. It can be severe and distressing for some and is often chronic in nature. Affected persons are unable to differentiate between their own ideas or thoughts and reality and exhibit a range of psychological symptoms.
There is a widespread stigma against affected individuals, and this can have a debilitating impact on their personal relationships. The existing symptoms aggravate when social exclusions of these kinds persist. Moreover, it results in neglect and an increase in the abuse of people with schizophrenia.
Men and women are equally affected and most people are between the age of 20 and 35 when they are diagnosed with schizophrenia.
Symptoms
Many of the symptoms seen in schizophrenia are called psychotic symptoms and are also observed in other disorders. Often, people with this condition find it difficult to take part in daily activities. The condition develops slowly, and the first signs are observed during adolescence and commonly misunderstood as a “phase”.
Acute schizophrenia – Many people show periods of remission followed by exacerbation during which they are severely affected and exhibit symptoms. Usually these symptoms are categorised as –
Positive symptoms – Everyone has unusual experiences occasionally, but in persons with schizophrenia, these symptoms become intense and distressing.
They can be in the form of –
- Hallucinations – The affected people hear, see, or feel things that are not actually present. They claim to hear voices that come from outside them, although others cannot hear them.
- Delusions – These are beliefs that the affected people have in a completely different way from others. They become paranoid and may claim that they are being watched or harassed by others.
- Confusion – People have difficulty in controlling their thoughts and conversations, and often end up getting jumbled. It becomes difficult to finish something as simple as reading a newspaper, completing a task in the office, or even studying regularly.
- Behavioural changes- These include shouting, getting agitated, and blaming someone else for controlling their thoughts and actions.
Prodromal period of schizophrenia – Before the acute episodes, some of the signs appear slowly and worsen eventually. This is the prodromal stage, and includes the following negative symptoms –
- Lack of care about clothes and physical appearance
- Neglecting personal hygiene
- Poor concentration
- Loss of interest in social life and going outdoors
- Lack of interest in maintaining physical relationships
- Discomfort around people
Causes
There is not enough proof of a single definite cause for schizophrenia. Research indicates a combination of factors, including physical, genetic, and environmental, that can lead to schizophrenia.
- Heredity and genes – The risk of developing schizophrenia is greatest when one of the parents is affected, or when an identical twin (same genetic makeup) has schizophrenia.
- Small differences in the structure of the brain may occur during pregnancy or birth, due to malnutrition, lack of oxygen during birth, or any Such complications are more likely to cause schizophrenia.
- A chemical imbalance in the brain such as changes in the levels of neurotransmitters like dopamine and serotonin.
These factors can make some individuals vulnerable to schizophrenia, and their risk of developing it can be triggered by –
- Stress like job loss or losing a loved one
- Drug abuse
- Physical, emotional, or sexual abuse
Diagnosis
Schizophrenia is usually diagnosed by mental health professionals who use a diagnostic checklist along with a detailed personal history, and discussions with close family members.
A doctor can establish the diagnosis by following certain criteria:
- If the affected individual has exhibited one or more of the positive or negative symptoms for a significant number of days in a month.
- The symptoms have hampered the individual’s daily activities.
- A medical examination has been carried out to rule out substance abuse and other neurological conditions that mimic schizophrenia.
Treatment
Early diagnosis and treatment are essential for a speedy recovery.
The focus of the treatment is to manage symptoms. Further, therapy can help the individual improve routine functioning, manage relationships, and achieve personal goals.
Medications
Antipsychotics are the mainstay of treating acute episodes of schizophrenia. They block the effects of dopamine and help to reduce anxiety or aggression.
Antipsychotics are available as pills and slow-release injectables. There are two types:
- Typical antipsychotics (first generation)
- Atypical antipsychotics (newer generation)
The prescribed medicines need to be taken at least until the acute phase has passed. They can also be used to prevent further episodes. Most of these medicines are tried in a variety of combinations and tailored to suit the affected individuals. It is important to find alternatives if a particular medicine does not reduce the symptoms. However, there are a few side effects such as drowsiness, blurred vision, and constipation.
A serious acute episode of schizophrenia may require the person to be admitted to a hospital ward until it is determined that there is no longer any danger to oneself and to others.
Supportive treatments
Antipsychotics are usually combined with psychological treatments to help people cope with positive and negative symptoms. These treatments include –
- Cognitive behavioural therapy helps affected individuals with their thinking patterns and behaviour, replacing their unwanted thoughts with more realistic ones.
- Skills training and employment support by teaching them structured activities.
- Family education and support are important as many affected individuals are unable to understand their condition and require help in adhering to treatment protocols.
- Treatment for substance abuse.
Doctors may recommend electroconvulsive therapy (ECT) as a last resort when there is a risk of self-harm or danger to others, and when medications do not work. It has been found to help people with severe depression and agitation.
Family and peer support
The role of family and peer support is necessary for schizophrenic people because the condition is often inaccurately associated with violence and disturbance. Thus, people with schizophrenia are often discriminated against and experience violations of their rights within the community and in mental health institutions.
Although schizophrenia cannot be cured completely, it is often treatable and can be managed with a combination of the above treatments.
Sources
1.https://www.nhs.uk/mental-health/conditions/schizophrenia/overview/
2.https://www.nimh.nih.gov/health/topics/schizophrenia
3.https://www.rcpsych.ac.uk/mental-health/problems-disorders/schizophrenia
