Schizophrenia: Symptoms, Causes, Treatment

Schizophrenia causes the schizophrenia is a syndrome that can affect thinking, perception, speech and movement of the affected person.

It affects almost all areas of the person’s life; family, employment, training, health, personal relationships…

Schizophrenia Causes

1-History of schizophrenia

In 1809, John Hassam described in Madness and Melancholy a form of dementia as follows:

Schizophrenia Causes

They precede a degree of apparent seriousness and inactivity, along with a diminution of ordinary curiosity concerning what is happening before them … Sensitivity seems to be particularly dull; do not give the same affection to their parents and their relationships …

At about the same time, Philippe Panel, a French physician, wrote about the people who would later become known as schizophrenics. Fifty years later Benedict Morel used the term demine precooked (early loss of mind).

At the end of the 19th century, Emil Kraepelin, a German psychiatrist, established the description and classification of schizophrenia.

In 1908 Eugene Bleaker, a Swiss psychiatrist, introduced the term schizophrenia, considering thought as the main problem.

The term “schizophrenia” comes from the Greek words “schizoid” (excision) and “fern” (mind). It reflects Bleeper’s view that there is an associative split between the personality areas.

2-Symptoms of schizophrenia

Symptoms of schizophrenia are divided into three categories: positive symptoms, negative symptoms and disorganized symptoms.

Positive symptoms

People with positive symptoms lose contact with reality and their symptoms appear and disappear. Sometimes they are severe and other times they are hardly noticeable, depending on whether the person receives treatment.

They include:

  • Delusions are beliefs that are not part of the culture or society of the person.

For example, a common delirium of those with schizophrenia is that of persecution, that is, the belief that others are trying to catch you.

Other delusions are that of Coward (a part of the body has changed or believe to be dead) and the one of Capers (to have been replaced by a double).

  • Hallucinations: they are sensory experiences without stimuli. The person can see, smell, hear or feel things that no one else can.

The most common type of hallucination in schizophrenia is hearing. The affected person can hear voices that they believe are from other people and that order, warn or comment on their behavior. Sometimes the voices speak to each other.

Positron emission computed tomography studies have confirmed that schizophrenics do not hear the voice of others, but their own thinking or voice and cannot recognize the difference (the most active part of the brain during hallucinations is the Boca area associated with verbal production).

Other types of hallucinations include seeing people or objects, smelling smells and feeling invisible fingers touching the body.

Negative symptoms

Negative symptoms indicate absence or lack of normal behavior. They are associated with interruptions of normal emotions and behaviors.

People with negative symptoms often need help doing daily tasks. They often neglect basic hygiene and may appear lazy or unable to help themselves.

They include:

  • Apathy: inability to initiate and persist in activities. Little interest in basic daily activities, such as personal hygiene.
  • Logia: relative absence of speech and answer questions with very brief answers. Little interest in having conversations.
  • Anhedonia: lack of pleasure and indifference for activities that are considered pleasurable like eating, having sex or interacting socially.
  • Flat affectivity: expression absent, speech dull and monotonous, without external reaction to emotional situations.

Disorganized symptoms

  • It speaks disorganized: jump from one topic to another, talk illogically, tangential responses (walking through the branches).
  • Inappropriate Affection: Laughing or crying at inappropriate times,
  • Disorganized behavior: behaving strangely in public, accumulating objects, catatonia (from unrestrained agitation to immobility), waxy flexibility (keeping the body and limbs in the position in which someone places them).

In this article you can know the main consequences of schizophrenia in health, family and society.

3-Subtypes of schizophrenia

  • Paranoid: it is characterized by delusions and hallucinations, being maintained the affection and thought intact. Delusions and hallucinations are often based on a subject, such as persecution or greatness.
  • Disorganized: problems in speech and behavior, with flat or inappropriate affection. If there are hallucinations or delusions they are not usually organized in a central theme. People affected with this type often give early signs of the disorder.
  • Catatonic : rigid postures, waxy flexibility, overdoing activities, strange mannerisms with body and face, grimaces, repetition of words (echolalia), repetition of others ( ecopraxia ).
  • Undifferentiated: people with major symptoms of schizophrenia without meeting paranoid, disorganized or catatonic criteria.
  • Residual: people who have had at least one episode without maintaining the main symptoms. Residual symptoms such as negative beliefs, rare (non-delusional) ideas, social withdrawal, inactivity, strange thoughts and flat affect can be maintained.

4-Causes of schizophrenia

Schizophrenia is caused primarily by genetic and environmental factors.

Genetic factors

It occurs in families, occurring in 10% of people who have relatives with the disorder (parents or siblings). People with second-degree relatives also develop schizophrenia more frequently than the general population.

If a parent is affected, the risk is approximately 13% and if both are affected the risk is 50%.

It is likely that many genes are involved, each contributing a small effect.

Environmental factors

Environmental factors that are associated with the development of schizophrenia include living environment, drug abuse, and prenatal stressors.

The paternal style of education seems to have no effect, although democratic parents seem to be better than the critics or hostiles.

Childhood trauma, parent death, or bullying increase the risk of developing psychosis.

On the other hand, it has been found that living in an urban environment during childhood or as an adult increases the risk by two.

Other factors that play a role include social isolation, racial discrimination, family problems, unemployment, and poor household conditions.

Substance abuse

It is estimated that half of people with people with schizophrenia use alcohol or drugs excessively.

The use of cocaine, amphetamines, and to a lesser extent alcohol, may result in psychosis resembling schizophrenia.

In addition, although not considered as a cause of the disease, people with schizophrenia use nicotine more than the general population.

Alcohol abuse may occasionally lead to the development of a psychosis indicated by chronic substance abuse.

A significant proportion of people with schizophrenia use cannabis to cope with their symptoms. Although cannabis may be a contributory factor to schizophrenia, it cannot provoke it on its own.

Early exposure of the developing brain increases the risk of developing schizophrenia, although development may require the presence of certain genes in the person.

Developmental Factors

Hypoxia, infections, stress or malnutrition during fetal development may increase the chances of developing schizophrenia.

People with schizophrenia are more likely to be born in spring or winter (at least in the northern hemisphere), which may be a result of increased exposure to viruses in the uterus.

Brain Mechanisms

Psychological mechanisms

Cognitive errors have been identified in people diagnosed with schizophrenia, especially when they are under stress or in confusing situations.

Recent research indicates that schizophrenic patients may be highly sensitive to stressful situations. Some evidence suggests that the content of delusional beliefs and psychotic experiences may reflect emotional causes of the disorder and that the way in which the person interprets those experiences may influence the symptomatology.

Neural mechanisms

Schizophrenia is associated with small brain differences, found in 40 to 50% of cases, and in brain chemistry during psychotic states.

Studies using brain imaging technologies such as magnetic resonance imaging (MRI) or positron emission tomography (PET) have shown that differences are often found in the frontal lobes, hippocampus, and temporal lobes.

Reduction of brain volume has also been found in areas of the frontal cortex and temporal lobes. It is not known exactly whether these volume changes are progressive or are prior to the onset of the disorder.

Special attention has been given to the role of dopamine in the mesolimbic pathway of the brain.

This hypothesis proposes that schizophrenia is caused by excessive activation of D2 receptors.

Interest has also been focused on glutamate and its reduced function at the NMDA receptor in schizophrenia.

Reduced glutamate function is associated with poor test results requiring use of the frontal lobe and hippocampus. In addition, glutamate can affect the function of dopamine.

5-Diagnosis

The diagnosis of schizophrenia is based on a psychiatric evaluation, medical history, physical examination and laboratory tests.

  • Psychiatric evaluation: study of symptoms, psychiatric history and family history of mental disorders.
  • Medical history and examination: Know the family health history and complete a physical examination to rule out physical problems that cause the problem.
  • Laboratory tests: There are no laboratory tests that diagnose schizophrenia, although blood or urine tests may rule out other medical conditions. In addition, imaging studies such as MRI can be performed.

Diagnostic criteria according to DSM-IV

  1. Characteristic Symptoms: Two (or more) of the following, each present for a significant part of a 1-month period (or less if successfully treated):
  2. Delirious ideas
  3. Hallucinations
  4. Disorganized language (egg, frequent derailment or incoherence)
  5. Catatonic or severely disorganized behavior
  6. Negative symptoms, for example, affective flattening, logia or Apulia

Note: Only a symptom of Criterion A is required if delusional ideas are strange, or if delusional ideas consist of a voice that continually comments on the thoughts or behavior of the subject, or if two or more voices talk to each other.

  1. Social / occupational dysfunction: During a significant part of the time since the beginning of the disturbance, one or more important areas of activity, such as work, interpersonal relationships or self-care, are clearly below the pre-onset level of the disorder (or, when the onset is in childhood or adolescence, failure to reach the expected level of interpersonal, academic or work performance).
  2. Duration: Continuous signs of alteration persist for at least 6 months. This 6-month period should include at least 1 month of symptoms meeting Criterion A (or less if successfully treated) and may include periods of prodromal and residual symptoms. During these prodromal or residual periods, signs of alteration may be manifested only by negative symptoms or by two or more symptoms of the Criterion A list, attenuated (egg, rare beliefs, unusual perceptual experiences).
  3. Exclusion of Schizoaffective and Mood Disorders: Schizoaffective disorder and mood disorder with psychotic symptoms have been ruled out because: 1) there have been no major, manic or mixed depressive episodes concurrent with phase symptoms active; or 2) if episodes of mood alteration have appeared during the symptoms of the active phase, their total duration has been brief in relation to the duration of the active and residual periods.
  4. Exclusion of substance use and medical illness: The disorder is not due to the direct physiological effects of a substance (eg, a drug of abuse, a drug) or a medical illness.
  5. Relationship to generalized developmental disorder: If there is a history of autistic disorder or another generalized developmental disorder, the additional diagnosis of schizophrenia will only be made if delusional ideas or hallucinations are also maintained for at least 1 month (or less if have successfully addressed).

Classification of longitudinal course:

Episodic with interepisodic residual symptoms (episodes are determined by the reappearance of prominent psychotic symptoms): specify also if: with marked negative symptoms Episodic without interepisodic residual symptoms: Continuous (existence of clear psychotic symptoms throughout the observation period): specify also if: with negative symptoms accused Single episode in partial remission: specify also whether: with negative symptoms accused Single episode in full remission Other or unspecified pattern Less than 1 year from the start of the first active phase symptoms

Differential diagnosis

Psychotic symptoms may occur in other mental disorders such as:

  • Bipolar disorder.
  • Borderline personality disorder.
  • Drug intoxication.
  • Substance-induced psychosis.

Delusions are also in delusional disorder and social isolation is in social phobia, avoidance personality disorder, and schizotypal personality disorder.

Schizotypal personality disorder has symptoms that are similar but less severe than those of schizophrenia.

Schizophrenia occurs along with obsessive-compulsive disorder more frequently than could be accounted for by chance, although it may be difficult to distinguish the obsessions that occur in OCD from the delusions of schizophrenia.

Some people who leave benzodiazepines experience a severe withdrawal syndrome that can last quite a while and can be confused with schizophrenia.

A medical and neurological examination may be needed to rule out other medical conditions that may produce psychotic symptoms similar to those of schizophrenia:

  • Metabolic alteration.
  • Systemic infection.
  • Syphilis.
  • HIV infection.
  • Epilepsy.
  • Brain injuries.
  • Stroke.
  • Multiple sclerosis.
  • Hyperthyroidism.
  • Hypothyroidism.
  • Alzheimer’s disease.
  • Huntington’s disease.
  • Front temporal dementia.
  • Dementia of Lowy bodies.
  • Post-traumatic stress disorder.

6-Treatment

Schizophrenia requires long-term treatment, even when symptoms have disappeared.

Treatment with medication and psychosocial therapy can control the disorder and during periods of crisis or severe symptoms, hospitalization may be necessary to ensure adequate nutrition, safety, hygiene and adequate sleep.

Usually the treatment is guided by a psychiatrist, and may include the team to psychologists, social workers or nurses.

Medication

Antipsychotic drugs are the drugs most commonly prescribed to treat schizophrenia. It is thought to control the symptoms affecting the neurotransmitters dopamine and serotonin.

The willingness to cooperate with treatment may affect the medication used. Someone who is resistant to taking medication may need injections instead of pills. Someone who is agitated may need to be reassured initially with a benzodiazepine such as lorazepam, which can be combined with an antipsychotic.

Atypical antipsychotics

These second generation drugs are generally preferred because they have a lower risk of developing side effects than conventional antipsychotics.

In general, the goal of antipsychotic treatment is to effectively control the symptoms with the lowest dose possible.

They include:


  • Aripiprazole.
  • Asenapine.
  • Clozapine.
  • Iloperidone.
  • Lurasidone.
  • Olanzapine.
  • Paliperidone.
  • Quetiapine.
  • Risperidone.
  • Ziprasidone.

Atypical antipsychotics may have side effects such as:

  • Loss of motivation.
  • Drowsiness.
  • Nervousness.
  • Weight gain.
  • Sexual dysfunctions.

Conventional antipsychotics

This first generation of antipsychotic drugs has frequent side effects, including the possibility of developing dyskinesia (abnormal and voluntary movements).

They include:

  • Chlorpromazine.
  • Fluphenazine
  • Haloperidol.
  • Perphenazine.

Psychosocial treatment

When psychosis is controlled, it is important to proceed with psychosocial and social interventions, in addition to continuing medication.

They may be:

  • Cognitive-behavioral therapy: focuses on changing patterns of thinking and behavior and learning to cope with stress and identify early symptoms of relapse.
  • Social skills training: improving communication and social interactions.
  • Family therapy: support and education for families to deal with schizophrenia.
  • Vocational rehabilitation and employment support: helping people with schizophrenia prepare for employment.
  • Support Groups: People in these groups know that other people face the same problems, which makes them feel less isolated socially.

7-Forecast

Schizophrenia is a great human and economic cost.

It results in a decrease in life expectancy of 10-15 years. This is especially due to its association with obesity, poor diet, sedentary lifestyle, smoking and a higher rate of suicides.

This is a very important cause of disability. Psychosis is considered the third most disabling condition, after quadriplegia and dementia and ahead of paraplegia and blindness.

Approximately three out of four people of schizophrenic people have permanent disability with relapses and 16.7 million people globally have moderate or severe disability.

Some people recover completely and others manage to function properly in society. Most, however, live independently alongside community support.

A recent analysis estimates that there is a suicide rate in schizophrenia of 4.9%, occurring more often in the period following the first hospital stay. Risk factors include gender, depression and high IQ.

Smoking is especially high in people diagnosed with schizophrenia, with estimates ranging from 80 to 90%, compared to 20% of the general population.

8-Epidemiology

Schizophrenia affects approximately 0.3-0.7% of people at some point in their lives; 24 million people (approx.) Worldwide.

It occurs more frequently in men than in women and usually appears earlier in men; the mean age of onset in men is 25 years and in women of 27 years. The appearance in childhood is rarer.

People with schizophrenia are 2 to 2.5 times more likely to die at an early age than the population as a whole. This is usually due to physical diseases such as cardiovascular, metabolic and infectious diseases.

9-Complications

Failure to treat schizophrenia can lead to emotional, behavioral, health or even financial problems.

Can be:

  • Suicide.
  • Any type of self harm.
  • Depression.
  • Abuse of alcohol, drugs or drugs.
  • Poverty.
  • Stay homeless.
  • Family problems.
  • Inability to go to work.
  • Social isolation.
  • Health problems.

10-Risk Factors

Some factors appear to increase the risk of developing schizophrenia:

  • Having relatives with the disease.
  • Exposure to viruses, toxins or prenatal malnutrition (especially in the third and second semesters).
  • Autoimmune diseases.
  • Older age of the father.
  • Taking drugs at an early age.

11-Tips for patients

Receiving a diagnosis of schizophrenia can be very painful, although with the right treatment you can lead a good life.

Early diagnosis can prevent complications and improve the chances of recovery.

With the right treatment and support, many people are able to reduce their symptoms, live and work independently, build satisfying relationships and enjoy life.

Recovery is a long-term process; there will always be new challenges to face. Therefore, you have to learn to manage your symptoms, develop the support you need and create a life with a purpose.

A complete treatment includes medication with community supports and therapy, and aims to reduce symptoms, prevent future psychotic episodes and re-establish your ability to lead a good life.

Facts to encourage you:

  • Schizophrenia is treatable: although there is currently no cure, it can be treated and controlled.
  • You can lead a good life: most people who are well treated are able to have good personal relationships, work or play leisure activities.

Here are some tips that can help you better control the disease:

1-Show interest in treatment

If you think you have symptoms of schizophrenia, seek help from a professional as soon as possible.

Getting a proper diagnosis is not always easy, as the symptoms can be confused with another mental disorder or medical condition.

It is best to go to a psychiatrist with experience in the treatment of schizophrenia. The earlier you start treating it, the more likely you are to control it and improve it.

To make the most of a treatment, it is important to educate yourself about the illness, to communicate with doctors and therapists, to adopt a healthy lifestyle, to have a strong support system and to be consistent with the treatment.

If you are an active participant in your own treatment, recovery will be better. In addition, your attitude will be important:

  • Communicate with your doctor: Tell him about your improvements, concerns, problems and make sure you take the right doses of medication.
  • Do not fall into the stigma of schizophrenia: many fears about this disease are not based on reality. It is important that you take it seriously, but do not believe that you cannot improve. Approach people who treat you well and be positive.
  • Establish a comprehensive treatment: medication is not enough. Cognitive-behavioral therapy can help you with irrational beliefs.
  • Establish vital goals: you can continue working, have personal relationships or engage in leisure activities. It is important that you set important goals for yourself.

2-Build social support

Social support is very important to have a good prognosis, especially the support of friends and family.

Use social services: ask your doctor about the community services that exist in your city or locality.

Trust friends and family: your close friends and family can help you with treatment, keep your symptoms under control, and function well in your community.

It is important that you have a stable place to live. Studies show that it is better for people with schizophrenia to be surrounded by people who show support.

Living with your family is a good choice if you know the disease well, show support and are willing to help.

However, your interest is the most important; follow your treatment, avoid drugs or alcohol and use support services.

3-Build a healthy lifestyle

The course that follows schizophrenia is different for each person; however you can always improve your situation with habits that build a healthy lifestyle.

  • Controlling Stress: Stress can trigger psychosis and worsen symptoms. Do not do more than you can, set your limits at home or in your training.
  • Get enough sleep: Although people with schizophrenia may have problems with sleep, changes in lifestyle can help (exercise, avoid caffeine, and establish sleep routines …).
  • Avoid drugs and alcohol: substance abuse complicates schizophrenia.
  • Exercise Regularly: Some studies indicate that regular exercise can help reduce the symptoms of schizophrenia, in addition to its mental and physical benefits. Try to do at least 30 minutes of physical exercise a day.
  • Find important activities: If you cannot work, find activities that are purposeful and pleasing to you.

12-Tips for family members

The love and support of the family are important for the recovery and treatment of a person with schizophrenia.

If a family member or friend has this disease, you can help a lot when trying to seek treatment, face the symptoms and as social support.

Although dealing with a schizophrenic person can be tough, you do not have to do it alone. You can support yourself in other people or use community services.

To treat adequately with the esqzuizophrenia of a relative is important:

  • Be realistic about what is expected of the patient and self.
  • Accept the disease and its difficulties.
  • Maintain a sense of humor.
  • Educate yourself: learn about the disease and its treatment will allow you to make decisions.
  • Reduce Stress: Stress can make symptoms worse, so it is important for the affected family member to be in an environment with supports and resources.

Here are some tips to help you get the situation better:

1-Take care of yourself

It is important that you take care of your own needs and find new ways to face the challenges you face.

Like your relative, you also need understanding, encouragement, and help. This way you will be in a better position to help your family member or friend.

  • Go to a support group: meeting other people in your situation will provide you with experiences, advice, information and you will have less feeling of isolation.
  • Have free time: set time each day to enjoy the activities you like.
  • Take care of your health: get enough sleep, exercise, eat a balanced diet…
  • Cultivate other relationships: maintaining family and friends relationships will be an important support to address the situation.

2-Support the treatment

The best way to help a family member with schizophrenia is to get the treatment started and help you maintain it.

For people with this disease, delusions or hallucinations are real, so they do not think they need treatment.

Early intervention makes a difference in the course of the disease. Therefore, try to look for a good doctor as soon as possible.

On the other hand, instead of doing everything for your family member, encourage her to take care of herself and encourage her self-esteem.

It is important for your family member to have a voice in their own treatment, so that they feel respected and motivated to follow with constancy.

3-Control the medication

  • Watch for side effects: Many people stop their medication because of the side effects. Tell your doctor if any side effects occur in your family, so you can reduce the dose, change the drug or add another.
  • Encourage your family member to take medication regularly: even when side effects are controlled, some people refuse to take drugs. This may be due to a lack of disease awareness. In addition, forgetfulness can occur, which can be solved with calendars or boxes of pills weekly.
  • Beware of drug interactions: Antipsychotics can cause unpleasant effects or side effects when combined with other substances, drugs, vitamins or herbs. Give the doctor a complete list of drugs, drugs, or supplements your family member is taking. Mixing alcohol or drugs with medication is very dangerous.
  • Monitor Progress: Tell the doctor about changes in mood, behavior, and other symptoms of your family member. A diary is a good way to control medication, side effects and details that you can forget.
  • Note signs of relapse: It is important to monitor that medication is continued, because stopping is the most common cause of relapse. Many people whose schizophrenia is stabilized need to take medication to maintain the results.

Even if medication is taken, there is a risk of relapse and onset of a new psychotic episode. If you learn to recognize the early signs of relapse, you can act quickly to treat them and even prevent the crisis.

Common signs of relapse are:

  • Social isolation.
  • Impairment of personal hygiene.
  • Paranoia.
  • Insomnia.
  • Hostility.
  • She speaks confused.
  • Hallucinations.

4-Prepare for crises

Although you strive to prevent relapse, there may be times when a new crisis appears. Hospitalization may be necessary to maintain safety.

Having an emergency plan for these crises will help you deal with it safely and quickly:

  • A list of emergency telephones (doctors, therapists, services, police …).
  • The address and phone number of the hospital you will be going to in case of emergency.
  • Friends or family members who can help you care for children or other family members.

Some Tips for Managing Crises:

  • The person may be terrified by their own feelings.
  • Do not express anger or hatred.
  • Do not scream.
  • Do not use sarcasm or hurtful humor.
  • It decreases distractions (turns off TV, radio, fluorescents …).
  • Avoid direct eye contact.
  • Avoid touching the person.
  • You cannot reason with acute psychosis.
  • Sit down and ask the person to sit.

Source:  World Fellowship for Schizophrenia and Allied Disorders.

5-House or residence?

The treatment of schizophrenia cannot be successful if the affected person does not have a stable place to live.

When thinking about possibilities ask you:

  • Can your family care for the affected person?
  • How much support do you need with daily activities?
  • Does your family have problems with alcohol or drugs?
  • How much treatment supervision do you need?

Living with the family can be an option for affected people if the family understands the disease well, has social supports and is willing to give assistance.

Living with the family works best if:

  • The affected person works properly on a certain level, has friendships and does leisure activities.
  • Family interaction is relaxed.
  • The affected person avails himself of the community supports and available services.
  • The situation has no impact on a child living in the home.

Living with the family is not advised if:

  • The main support is single, sick or elderly.
  • The affected person is very affected and cannot lead a normal life.
  • The situation causes stress in marriage or causes problems for children.
  • No support services are used or there are none.

Also Read: What is Acrophobia and How to Overcome It?

If you cannot keep the affected person in your home, do not feel guilty. If you cannot take care of your own needs first or other people in the home, your affected family member will be better off somewhere else.

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