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Schizophrenia: Causes, Symptoms And Treatment
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 [1] . Disability either occurs from both negative symptoms that are characterised by loss or deficits and cognitive symptoms[2] . That's not all - a relapse could also occur due to positive symptoms such as suspiciousness, delusions and hallucinations [3] [4] .
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.[5]
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. [6]
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. [7]
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.[8]
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.[9]
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. [10]
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) .[11] 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."[12] At least one of the qualifying symptoms must be delusions, hallucinations, or disorganized speech.[13]
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[14] . There must also be continuous signs of schizophrenia for at least six months, including the one-month period of active-phase symptoms noted above.[15]
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.[16] In addition, the clinician must confirm that the presenting symptoms are not a result of substance abuse or another medical condition.[17]
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[18]
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 [19] . 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.[20]
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[21] . 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[22] . Alcohol, caffeine, and nicotine also have the potential to cause drug interactions [23] .
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 [24] .
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[25] .
• 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 [26] .
• 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 [27] .
In combination therapy, two antipsychotic drugs such as an FGA and an SGA, or two different SGAs are administered concurrently [28] .
- [1] Lavretsky H. History of Schizophrenia as a Psychiatric Disorder. In: Mueser KT, Jeste DV, editors. Clinical Handbook of Schizophrenia. New York, New York: Guilford Press; 2008. pp. 3–12.
- [2] Crismon L, Argo TR, Buckley PF. Schizophrenia. In: DiPiro JT, Talbert RL, Yee GC, et al., editors. 1 Pharmacotherapy: A Pathophysiologic Approach. 9th ed. New York, New York: McGraw-Hill; 2014. pp. 1019–1046.
- [3] Lavretsky H. History of Schizophrenia as a Psychiatric Disorder. In: Mueser KT, Jeste DV, editors. Clinical Handbook of Schizophrenia. New York, New York: Guilford Press; 2008. pp. 3–12.
- [4] Crismon L, Argo TR, Buckley PF. Schizophrenia. In: DiPiro JT, Talbert RL, Yee GC, et al., editors. 1 Pharmacotherapy: A Pathophysiologic Approach. 9th ed. New York, New York: McGraw-Hill; 2014. pp. 1019–1046.
- [5] Hanssen M, Bak M, Bijl R, Vollebergh W, van Os J Br J Clin Psychol. 2005 Jun; 44(Pt 2):181-91.
- [6] Lieberman JA, Perkins D, Belger A, Chakos M, Jarskog F, Boteva K, Gilmore J Biol Psychiatry. 2001 Dec 1; 50(11):884-97.
- [7] Lieberman JA, Perkins D, Belger A, Chakos M, Jarskog F, Boteva K, Gilmore J Biol Psychiatry. 2001 Dec 1; 50(11):884-97.
- [8] McDonald C, Murphy KC. The new genetics of schizophrenia. Psychiatr Clin North Am. 2003;26(1):41–63.
- [9] McDonald C, Murphy KC. The new genetics of schizophrenia. Psychiatr Clin North Am. 2003;26(1):41–63.
- [10] Lewis SW., Murray RM. Obstetric complications, neurodevelopmental deviance, and risk of schizophrenia [review]. J Psychiatr Res. 1987;21:413–421.
- [11] American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013. Schizophrenia and other psychotic disorders; pp. 89–122.
- [12] American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013. Schizophrenia and other psychotic disorders; pp. 89–122.
- [13] American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013. Schizophrenia and other psychotic disorders; pp. 89–122.
- [14] American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013. Schizophrenia and other psychotic disorders; pp. 89–122.
- [15] American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013. Schizophrenia and other psychotic disorders; pp. 89–122.
- [16] American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013. Schizophrenia and other psychotic disorders; pp. 89–122
- [17] American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013. Schizophrenia and other psychotic disorders; pp. 89–122.
- [18] Lindenmayer JP, Liu-Seifert H, Kulkarni PM, et al. Medication non-adherence and treatment outcomes in patients with schizophrenia or schizoaffective disorder with suboptimal prior response. J Clin Psychiatry. 2009;70(7):990–996.
- [19] Lindenmayer JP, Liu-Seifert H, Kulkarni PM, et al. Medication non-adherence and treatment outcomes in patients with schizophrenia or schizoaffective disorder with suboptimal prior response. J Clin Psychiatry. 2009;70(7):990–996.
- [20] Lindenmayer JP, Liu-Seifert H, Kulkarni PM, et al. Medication non-adherence and treatment outcomes in patients with schizophrenia or schizoaffective disorder with suboptimal prior response. J Clin Psychiatry. 2009;70(7):990–996.
- [21] Lehman AF, Lieberman JA, Dixon LB, et al. American Psychiatric Association Practice Guidelines; Work Group on Schizophrenia. Practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry. (2nd ed) 2004;161(suppl 2):1–56.
- [22] Lehman AF, Lieberman JA, Dixon LB, et al. American Psychiatric Association Practice Guidelines; Work Group on Schizophrenia. Practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry. (2nd ed) 2004;161(suppl 2):1–56.
- [23] Lehman AF, Lieberman JA, Dixon LB, et al. American Psychiatric Association Practice Guidelines; Work Group on Schizophrenia. Practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry. (2nd ed) 2004;161(suppl 2):1–56.
- [24] Dickerson FB, Lehman AF. Evidence-based psychotherapy for schizophrenia: 2011 update. J Nerv Ment Dis. 2011;199(8):520–526.
- [25] Dickerson FB, Lehman AF. Evidence-based psychotherapy for schizophrenia: 2011 update. J Nerv Ment Dis. 2011;199(8):520–526.
- [26] Spears NM, Leadbetter RA, Shutty MS. Clozapine treatment in polydipsia and intermittent hyponatremia. J Clin Psychiatry. 1996;57(3):123–128
- [27] Spears NM, Leadbetter RA, Shutty MS. Clozapine treatment in polydipsia and intermittent hyponatremia. J Clin Psychiatry. 1996;57(3):123–128.
- [28] .Spears NM, Leadbetter RA, Shutty MS. Clozapine treatment in polydipsia and intermittent hyponatremia. J Clin Psychiatry. 1996;57(3):123–128.
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