Schizophrenia: what is it, symptoms and signs, causes, treatment, prognosis

What is schizophrenia?

Schizophrenia is a mental disorder characterized by loss of contact with reality (psychosis), hallucinations (usually auditory), solid confidence in false beliefs (delusions), abnormal thinking and behavior, decreased expression of emotions, decreased motivation, decreased mental function (cognitive performance) and problems in daily functioning, including work, social relationships and caring yourself.

• Schizophrenia is probably caused by heredity and environmental factors.
• Patients can have a variety of symptoms, ranging from strange behavior and incoherent, disorganized speech to loss of emotion, taciturnity or complete lack of speech, inability to concentrate, and disturbances memory.
• Doctors diagnose schizophrenia based on symptoms after testing for other possible causes.
• Treatment consists of antipsychotic medication, education and community support, psychotherapy and family education. Early detection and early treatment contribute to improved functioning in the long term.
• How well patients respond to treatment depends largely on whether they are taking the drugs as directed.
• Treatment consists of antipsychotic medication, education and community support, psychotherapy and family education.
• Early detection and early treatment improve long-term functioning.

Schizophrenia is a serious illness throughout the world. The disorder usually affects young people at the same time they are asserting their independence, and can lead to lifelong disability and shame. In terms of personal and economic costs, schizophrenia has been described as one of the worst disorders affecting humanity.

Schizophrenia affects approximately 1% of the population, equally men and women. Schizophrenia is more common than Alzheimer's disease or multiple sclerosis.

Determining when schizophrenia begins is often difficult, because not knowing the symptoms can delay seeking medical attention by several years. The average age at which the disease occurs is 20 to 25 years for men and a little later for women. Childhood onset is rare, but schizophrenia can develop during adolescence or later.

Deterioration in social functioning can lead to substance use disorder, poverty and homelessness. People with untreated schizophrenia may lose contact with their families and friends and often find themselves living on the streets of large cities. This condition can be lifelong, with impaired psychosocial functioning throughout life in most cases.

Causes and risk factors

It is not known what exactly causes schizophrenia, but current research suggests it is a combination of hereditary and environmental factors. However, it is mostly a biological problem (with changes in the brain), although some external factors such as severe stress or alcohol and drug abuse can serve trigger.

Factors that make people vulnerable to schizophrenia include the following:

• genetic predisposition;
• problems that occur before, during, or after childbirth, such as the mother's flu during the 2nd trimester pregnancy, lack of oxygen during childbirth, low birth weight and incompatibility of the mother's blood type and baby;
• brain infections;
• cannabis use in early adolescence.

For people with a parent or sibling with schizophrenia, the risk of developing the disorder is 10%, while for the general population it is 1%. If one of the twins has schizophrenia, then the risk of developing schizophrenia for the other twin is approximately 50%. This statistic assumes the influence of heredity.

Signs and symptoms

Schizophrenia can start suddenly over a few days or weeks, or slowly and gradually over several years. Although the severity and types of symptoms differ in people with schizophrenia, symptoms are usually severe enough to affect their ability to work, interact with people, and take care of themselves.

However, sometimes symptoms are mild at first (called a prodrome). People may just look withdrawn, disorganized, or suspicious. Doctors may recognize these symptoms as the onset of schizophrenia, but sometimes doctors only recognize them in hindsight.

Schizophrenia is characterized by psychotic symptoms, which include: delirium (see. below), hallucinations, disorganized thinking and speech, and strange and inappropriate behavior. Psychotic symptoms include loss of touch with reality.

In some people with schizophrenia, mental (cognitive) function declines, sometimes from the very beginning of the illness. This cognitive impairment leads to difficulty concentrating, thinking abstractly, and problem solving. The severity of cognitive impairment largely determines the overall disability in people with schizophrenia. Many people with schizophrenia are unemployed and have little or no contact with family members or others.

Symptoms can be triggered or worsened by stressful life events, such as losing a job or ending a romantic relationship. Drug use, including marijuana use, can also cause or worsen symptoms.

In general, the symptoms of schizophrenia fall into four main categories:

• positive symptoms;
• negative symptoms;
• disorganization;
• impaired cognitive function.

Patients can have symptoms from any or all categories.

- Positive symptoms.

Positive symptoms include impairment of normal function. These include:

• Rave Are false beliefs that often represent a misinterpretation of perception or experience. Also, people continue to adhere to these beliefs, despite clear evidence that contradicts them. There are many possible types of delusions. For example, a person with schizophrenia may have delusions of persecution when they think they are being tortured, harassed, cheated, or spied on. In other cases, delusions of attitude can be observed when patients are sure that the text of a book, newspaper or song is addressed directly to them. Also, patients may have delusional ideas about "inserting" and "withdrawing" thoughts; sufferers may feel that other people can read their thoughts, that their thoughts are transmitted to others from a distance, or that thoughts and impulses are suggested to them by external forces. Delusions in schizophrenia may or may not be strange. The strange delusions are clearly implausible and not based on ordinary life experience. For example, people may believe that someone removed their internal organs without leaving a scar. Delusions that are not bizarre include situations that can occur in real life, such as stalking or cheating on a spouse or lover
• Hallucinations include auditory, visual, gustatory, or tactile sensations not seen in others. The most common hallucinations are those that people hear (auditory hallucinations). Patients may hear voices localized in their head commenting on their behavior, talking to each other, or making critical or offensive remarks.

- Negative symptoms.

Negative symptoms include deterioration or loss of normal function. These include:

• Reduced expression of emotion (blunted affect) implies limited or no expression of emotion. The patient's face may appear motionless. Patients avoid eye contact almost or completely. Patients do not use their hands or head to emotionally emphasize their speech. They stop responding to events that usually make them laugh or cry.
• Poor speech - This is a weakening of speech activity. Answers to questions can be short, perhaps one or two words, which gives the impression of an inner emptiness.
• Anhedonia Is a decrease in the ability to experience pleasure. The patient does not show interest in previous hobbies and spends most of the time in aimless activities.
• Uncommunicativeness - This is a lack of interest in relationships with other people.

These negative symptoms are often associated with a general loss of motivation, goals, and purpose.

- Disorganization.

Disorganization includes impaired thinking and strange behavior.

• Impaired thinking - This is disorganization of thinking, when speech becomes incoherent, or the speaker switches from one topic to another. Speech can be mildly disorganized or completely incoherent and incomprehensible.
• Strange behavior can take the form of innocent stupidity, anxiety, or inappropriate appearance, hygiene, or behavior. Catatonia is an extreme form of strange behavior in which patients freeze in one position and resist attempts to make them move or, conversely, move erratically.

- Impaired cognitive function.

Cognitive impairment refers to difficulty with concentration, memory, organization, planning, and problem solving. Some people are unable to concentrate enough to read, follow a movie or television program, or follow instructions. Others are unable to ignore distractions or stay focused on the task at hand. Consequently, work that requires attention to detail, participation in complex procedures, decision-making and understanding of social interaction may not be possible.

- Suicide.

About 5 to 6% of people with schizophrenia commit suicide, about 20% attempt, and many more have significant suicidal thoughts. Suicide is the leading cause of premature death among people with schizophrenia and one of the main reasons why schizophrenia shortens life expectancy by 10 years.

The risk of suicide is increased in young people men with schizophreniaespecially if they have a substance use disorder. The risk is also increased in people with depressive symptoms or feelings of hopelessness, the unemployed, or those who have recently had a psychotic episode or have recently been discharged from the hospital.

The risk of suicide is highest in people who developed schizophrenia later in life and who functioned well before developing it. Such people do not lose the ability to experience sorrow and anguish. In this regard, it is more likely that they may act desperately, as they understand the effects of this disorder. These people also have a better prognosis for recovery.

- Violence.

Contrary to popular belief, people with schizophrenia have only a slightly increased risk of violent behavior. Threats of violence and minor violent outbursts are far more common than truly dangerous behavior. Only a small number of people with severe depression, isolated, paranoid patients attack or kill someone they believe is the only source of their problems (eg government officials, celebrities, their spouses).

People who are more likely to engage in violent activities include:

• Those who abuse drugs or alcohol;
• Those who have delusional ideas that they are being pursued;
• Those who have hallucinations lead them to commit violent acts;
• Those who are not taking prescribed drugs.

However, even with risk factors, it is difficult for doctors to accurately predict whether a particular person with schizophrenia will commit violent acts.

Diagnostics

There is no definitive test for diagnosing schizophrenia. The doctor makes the diagnosis based on a comprehensive assessment of the patient's medical history and symptoms.

A diagnosis of schizophrenia is made when both of the following are present:

• Two or more characteristic symptoms (delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms) persist for at least 6 months.
• These symptoms cause significant impairment at work, school, or social functioning.

Information from family members, friends, or teachers is often important in determining when the disorder began.

Laboratory tests are often done to rule out substance use disorder or an underlying medical, neurological, or hormonal disorder that may have traits psychosis. Examples of such disorders include brain tumors, epilepsy temporal lobe, dysfunction thyroid gland, autoimmune disorders, Huntington's disease, liver disease, side effects of medications and lack of vitamins. Sometimes testing is done for substance use disorder.

Imaging tests of the brain, such as computed tomography (CT) or magnetic resonance imaging (MRI), may be done to rule out a brain tumor. Although people with schizophrenia have brain abnormalities that can be detected by CT or MRI, the abnormalities are not specific enough to help diagnose schizophrenia.

In addition, doctors try to rule out a number of other mental disorders that share similar features to schizophrenia, such as short-term psychotic disorder, schizophreniform disorder, schizoaffective disorder, and schizotypal disorder personality.

Schizophrenia treatment

Therapy includes the following:

• antipsychotics;
• support services (including rehabilitation and community support);
• psychotherapy.

In general, treatment for schizophrenia is aimed at

• reducing the severity of psychotic symptoms;
• prevention of recurrence of symptomatic episodes and related dysfunctions;
• providing support to enable patients to function at their highest level.

The earlier treatment begins, the better the outcome.

Antipsychotic drugs, rehabilitation and community support, and psychotherapy are the main components of treatment. Educating family members about symptoms and treatments for schizophrenia (family psychoeducation) helps provide them with support and helps practitioners maintain contact with the person suffering from schizophrenia.

- Antipsychotics.

Antipsychotic medications can be effective in reducing or relieving symptoms such as delusions, hallucinations, and disorganized thinking. Once the immediate symptoms have subsided, continued use of antipsychotic drugs significantly reduces the likelihood of future episodes.

However, antipsychotic medications have serious side effects, which may include drowsiness, muscle stiffness, tremors, involuntary movements (tardive dyskinesia), weight gain and restless condition. Newer (second generation) antipsychotic drugs that are prescribed more often are less likely to cause muscle stiffness, tremors, and tardive dyskinesia than traditional antipsychotic drugs (first generation).

- Rehabilitation programs and community support.

Rehabilitation and support programs, such as on-the-job training, aim to educate patients in the skills needed to live in the community rather than in the institution. These skills enable people with schizophrenia to go to work, shop, take care of themselves, manage a household, and get along with others.

Community support services provide services to help people with schizophrenia live as independently as possible. These services include accommodation in an apartment or in a group home with a member of staff present who makes sure that the person with schizophrenia is taking prescribed medications or helping the person with finance. Alternatively, a member of staff may periodically visit the patient's home.

During serious relapses, hospitalization may be required, including involuntary hospitalization, if patients are a danger to themselves or others. However, the overall goal is for sick people to be able to live in society.

Some people with schizophrenia are unable to live on their own, either because of persistent severe symptoms or because of the ineffectiveness of drug therapy. They generally require complete care in a safe and supportive environment.

Support and advocacy organizations such as the National Alliance for Mental Illness are often helpful to families.

- Psychotherapy.

In general, psychotherapy does not relieve the symptoms of schizophrenia. However, psychotherapy can be helpful by creating collaborative relationships between people with schizophrenia, their families, and the doctor. In this way, people can learn to understand and manage their disorder, take antipsychotic medications as directed, and manage stresses that can worsen the disorder. A good doctor-patient relationship is often a significant factor in the success of treatment.

If people with schizophrenia live with their families, psychoeducation may be offered to them and their family members. This training provides people and their families with information about the disorder and how to control the disease, for example by teaching them coping skills. This training can help prevent relapse.

Forecast

The earlier treatment is started, the higher the likelihood of a favorable outcome.

For people with schizophrenia, the prognosis is largely dependent on adherence to drug treatment instructions. Without drug treatment, 70-80% of patients have another episode within the first year after diagnosis. Drugs taken continuously can reduce this percentage to about 30% and significantly alleviate the severity of symptoms in most patients. Once they are discharged from the hospital, patients who are not taking their prescribed drugs are very likely to be re-hospitalized within a year. Taking medications as directed significantly reduces the chance of readmission.

Despite the proven benefits of drug therapy, half of people with schizophrenia do not take their prescribed drugs. Some are unaware of their illness and refuse to take medications. Others stop taking their drugs because of unpleasant side effects. Others are prevented from taking prescribed medications, memory problems, disorganization, or simply a lack of money.

Treatment adherence is most likely to improve when specific barriers are removed. If side effects of drugs are the main problem, switching to another drug may help. A consistent, trusting relationship with a doctor or therapist helps some patients schizophrenia more readily accept their illness and admit the need to comply with the prescribed treatment.

In the long term, the forecast varies approximately as follows:

• A third of people experience significant and lasting improvement.
• Another third show some improvement with recurrent relapses and residual disability.
• Another third develop severe and permanent disability.

Only about 15% of all people with schizophrenia are able to function as well as they did before the onset of schizophrenia.

Factors associated with a more optimistic outlookinclude the following:

• Sudden onset of symptoms;
• Symptoms began at an older age;
• A good level of skill and achievement before the onset of the disease;
• Only mild cognitive impairment;
• Having only a few negative symptoms (such as decreased expression of emotions);
• Shorter period of time between the first psychotic episode and treatment.

Factors associated with a poor prognosisinclude the following:

• Symptoms began at a younger age;
• Problems with functioning in social situations and at work before the onset of the disease;
• Family history of schizophrenia;
• The presence of many negative symptoms;
• A longer period of time between the first psychotic episode and treatment.

Men have a worse prognosis than women. Women respond better to antipsychotic treatment.