Schizophrenia

What Is Schizophrenia?

The word schizophrenia comes from the Greek word skhizein meaning "to split" and the Greek word Phrenos (phren) meaning "diaphragm, heart, mind". According to Medilexicon's medical dictionary, schizophrenia is "A term coined by Bleuler, synonymous with and replacing dementia praecox, denoting a common type of psychosis, characterized by abnormalities in perception, content of thought, and thought processes (hallucinations and delusions) and by extensive withdrawal of interest from other people and the outside world, with excessive focusing on one's own mental life. Now considered a group or spectrum of disorders rather than a single entity, with distinction sometimes made between process schizophrenia and reactive schizophrenia. The "split" personality of schizophrenia, in which individual psychic components or functions split off and become autonomous, is popularly but erroneously identified with multiple personality, in which two or more relatively complete personalities dominate by turns the psychic life of a patient.".

In 1910, the Swiss psychiatrist, Eugen Bleuler (1857-1939) created the term Schizophrenie.

Schizophrenia is a mental disorder that generally appears in late adolescence or early adulthood - however, it can emerge at any time in life. It most commonly strikes between the ages of 15 to 25 among men, and about 25 to 35 in women. In many cases the disorder develops so slowly that the sufferer does not know he/she has it for a long time. While, with other people it can strike suddenly and develop fast.
It is a complex, chronic, severe, and disabling brain disorder and affects approximately 1% of all adults globally. Experts say schizophrenia is probably many illnesses masquerading as one. Research indicates that schizophrenia is likely to be the result of faulty neuronal development in the brain of the fetus, which later in life emerges as a full-blown illness.

The brain

Our brain consists of billions of nerve cells. Each nerve cell has branches that give out and receive messages from other nerve cells. The ending of these nerve cells release neurotransmitters - types of chemicals. These neurotransmitters carry messages from the endings of one nerve cell to the nerve cell body of another. In the brain of a person who has schizophrenia, this messaging system does not work properly.

What are the signs and symptoms of schizophrenia?

There is, to date, no physical or laboratory test that can absolutely diagnose schizophrenia. The doctor, a psychiatrist, will make a diagnosis based on the patient's clinical symptoms. However, physical testing can rule out some other disorders and conditions which sometimes have similar symptoms, such as seizure disorders, thyroid dysfunction, brain tumor, drug use, and metabolic disorders.
Symptoms and signs of schizophrenia will vary, depending on the individual. The symptoms are classified into four categories:

• Positive symptoms - also known as psychotic symptoms. These are symptoms that appear, which people without schizophrenia do not have. For example, delusion.
• Negative symptoms - these refer to elements that are taken away from the individual; loss or absence of normal traits or abilities that people without schizophrenia normally have. For example, blunted emotion.
• Cognitive symptoms - these are symptoms within the person's thought processes. They may be positive or negative symptoms, for example, poor concentration is a negative symptom.
• Emotional symptoms - these are symptoms within the person's feelings. They are usually negative symptoms, such as blunted emotions.

Below is a list of the major symptoms:

• Delusions - The patient has false beliefs of persecution, guilt of grandeur. He/she may feel things are being controlled from outside. It is not uncommon for people with schizophrenia to describe plots against them. They may think they have extraordinary powers and gifts. Some patients with schizophrenia may hide in order to protect themselves from an imagined persecution.
• Hallucinations - hearing voices is much more common than seeing, feeling, tasting, or smelling things which are not there, but seem very real to the patient.
• Thought disorder - the person may jump from one subject to another for no logical reason. The speaker may be hard to follow. The patient's speech might be muddled and incoherent. In some cases the patient may believe that somebody is messing with his/her mind.

Other symptoms schizophrenia patients may experience include:

• Lack of motivation (avolition) - the patient loses his/her drive. Everyday automatic actions, such as washing and cooking are abandoned. It is important that those close to the patient understand that this loss of drive is due to the illness, and has nothing to do with slothfulness.
• Poor expression of emotions - responses to happy or sad occasions may be lacking, or inappropriate.
• Social withdrawal - when a patient with schizophrenia withdraws socially it is often because he/she believes somebody is going to harm them. Other reasons could be a fear of interacting with other humans because of poor social skills.
• Unaware of illness - as the hallucinations and delusions seem so real for the patients, many of them may not believe they are ill. They may refuse to take medications which could help them enormously for fear of side-effects, for example.
• Cognitive difficulties - the patient's ability to concentrate, remember things, plan ahead, and to organize himself/herself are affected. Communication becomes more difficult.

What causes schizophrenia?

Nobody has been able to pinpoint one single cause. Experts believe several factors are generally involved in contributing to the onset of schizophrenia.

The likely factors do not work in isolation, either. Evidence does suggest that genetic and environmental factors generally act together to bring about schizophrenia. Evidence indicated that the diagnosis of schizophrenia has an inherited element, but it is also significantly influenced by environmental triggers. In other words, imagine your body is full of buttons, and some of those buttons result in schizophrenia if somebody comes and presses them enough times and in the right sequences. The buttons would be your genetic susceptibility, while the person pressing them would be the environmental factors.

Below is a list of the factors that are thought to contribute towards the onset of schizophrenia:

• Your genes
  
  If there is no history of schizophrenia in your family your chances of developing it are less than 1%. However, that risk rises to 10% if one of your parents was/is a sufferer.
  
  A gene that is probably the most studied "schizophrenia gene" plays a surprising role in the brain: It controls the birth of new neurons in addition to their integration into existing brain circuitry, according to an article published by Cell.
  
  A Swedish study found that schizophrenia and bipolar disorder have the same genetic causes.
• Chemical imbalance in the brain
  
  Experts believe that an imbalance of dopamine, a neurotransmitter, is involved in the onset of schizophrenia. They also believe that this imbalance is most likely caused by your genes making you susceptible to the illness. Some researchers say other the levels of other neurotransmitters, such as serotonin, may also be involved.
  
  Changes in key brain functions, such as perception, emotion and behavior lead experts to conclude that the brain is the biological site of schizophrenia.
  
  Schizophrenia could be caused by faulty signaling in the brain, according to research published in the journal Molecular Psychiatry.
• Family relationships
  
  Although there is no evidence to prove or even indicate that family relationships might cause schizophrenia, some patients with the illness believe family tension may trigger relapses.
• Environment
  
  Although there is yet no definite proof, many suspect that prenatal or perinatal trauma, and viral infections may contribute to the development of the disease. Perinatal means "occurring about 5 months before and up to one month after birth".
  
  Stressful experiences often precede the emergence of schizophrenia. Before any acute symptoms are apparent, people with schizophrenia habitually become bad-tempered, anxious, and unfocussed. This can trigger relationship problems, divorce and unemployment. These factors are often blamed for the onset of the disease, when really it was the other way round - the disease caused the crisis. Therefore, it is extremely difficult to know whether schizophrenia caused certain stresses or occurred as a result of them.
• Some drugs
  
  Cannabis and LSD are known to cause schizophrenia relapses.

What are the treatment options for schizophrenia?

Psychiatrists say the most effective treatment for schizophrenia patients is usually a combination of medication, psychological counseling, and self-help resources.

Anti-psychosis drugs have transformed schizophrenia treatment. Thanks to them, the majority of patients are able to live in the community, rather than stay in hospital. In many parts of the world care is delivered in the community, rather than in hospital.

The primary schizophrenia treatment is medication. Sadly, compliance is a major problem. Compliance, in medicine, means following the medication regimen. People with schizophrenia often go off their medication for long periods during their lives, at huge personal costs to themselves and often to those around them as well.

The majority of patients go off their medication within the first year of treatment. In order to address this, successful schizophrenia treatment needs to consist of a life-long regimen of both drug and psychosocial, support therapies. The medication can help control the patient's hallucinations and delusions, but it cannot help them learn to communicate with others, get a job, and thrive in society.

Although a significant number of people with schizophrenia live in poverty, this does not have to be the case. A person with schizophrenia who complies with the treatment regimen long-term will be able to lead a happy and productive life.

The first time a person experiences schizophrenia symptoms can be very unpleasant. He/she may take a long time to recover, and that recovery can be a lonely experience. It is crucial that a schizophrenia sufferer receives the full support of his/her family, friends, and community services when onset appears for the first time.

Medications

The medical management of schizophrenia generally involves drugs for psychosis, depression and anxiety. This is because schizophrenia is a combination of thought disorder, mood disorder and anxiety disorder.

The most common antipsychotic drugs are Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon), and Clozapine (Clozaril):

• Risperidone (Risperdal) - introduced in America in 1994. This drug is less sedating than other atypical antipsychotics. There is a higher probability, compared to other atypical antipsychotics, of extrapyramidal symptoms (affecting the extrapyramidal motor system, a neural network located in the brain that is involved in the coordination of movement). Although weight gain and diabetes are possible risks, they are less likely to happen, compared with Clozapine or Olanzapine.
• Olanzapine (Zyprexa) - approved in the USA in 1996. A typical dose is 10 to 20 mg per day. Risk of extrapyramidal symptoms is low, compared to Risperidone. This drug may also improve negative symptoms. However, the risks of serious weight gain and the development of diabetes are significant.
• Quetiapine (Seroquel) - came onto the market in America in 1997. Typical dose is between 400 to 800 mg per day. If the patient is resistant to treatment the dose may be higher. The risk of extrapyramidal symptoms is low, compared to Risperidone. There is a risk of weight gain and diabetes, however the risk is lower than Clozapine or Olanzapine.
• Ziprasidone (Geodon) - became available in the USA in 2001. Typical doses range from 80 to 160 mg per day. This drug can be given orally or by intramuscular administration. The risk of extrapyramidal symptoms is low. The risk of weight gain and diabetes is lower than other atypical antipsychotics. However, it might contribute to cardiac arrhythmia, and must not be taken together with other drugs that also have this side effect.
• Clozapine (Clozaril) - has been available in the USA since 1990. A typical dose ranges from 300 to 700 mg per day. It is very effective for patients who have been resistant to treatment. It is known to lower suicidal behaviors. Patients must have their blood regularly monitored as it can affect the white blood cell count. The risk of weight gain and diabetes is significant.

How common is schizophrenia?

The prevalence of schizophrenia globally varies a slightly, depending on which report you look at, from about 0.7% to 1.2% of the adult population in general. Most of these percentages refer to people suffering from schizophrenia "at some time during their lives".

An Australian study found that schizophrenia is more common in developed nations than developing ones. It also found that the illness is less widespread than previously thought. Estimates of 10 per 1,000 people should be changed to 7 or 8 per 1,000 people, the study concluded.

In the USA about 2.2 million adults, or about 1.1% of the population age 18 and older in a given year have schizophrenia.

Schizophrenia is not a 'very' common disease. Approximately 1% of people throughout the globe suffer from schizophrenia (or perhaps a little less than 1% in developing countries) at some point in their lives. It is estimated that about 1.2% of Americans, a total of 3.2 million people, have the disorder at some point in their lives. Globally, about 1.5 million people each year are diagnosed with schizophrenia. In the UK it is estimated that about 600,000 people have schizophrenia.

Video: A Case Study In Schizophrenia