Schizophrenia is a mental disorder which alters the way a person acts, thinks, sees the world in general or behaves. Their perception of reality gets changed and often includes loss of contact with reality. Mostly the onset appears in the late teens or early adulthood. Onset in childhood is very rare and the earlier it appears the severe it is. Schizophrenia is more common and severe in men than in women. The word Schizophrenia has been taken from the Greek word Skhizein meaning “to split” and Phrenos meaning “mind”. Despite the meaning it doesn’t mean that people with schizophrenia has a split of personality rather it means splitting of the mental functions.
Signs and Symptoms of Schizophrenia
The signs and symptoms vary from individual to individual. The symptoms are divided into four categories:
- Positive symptoms: It comprises of those which people without schizophrenia do not experience. For example, hallucination and delusion.
- Negative Symptoms: These refers to loss or absence of the traits or abilities which people with schizophrenia previously had. For example, social isolation.
- Cognitive Symptoms: It refers to changes in the thought processes which might be positive or negative symptoms viz., poor attention is a negative symptom.
- Emotional Symptoms: refers to the person’s emotions and feelings viz., blunted emotions.
The widely experienced symptoms as reported are:
- Thought disorder
- Disorganized thinking and speech
- Not understandable speech known as “Word Salad”
- Social withdrawal and isolation
- Sloppiness of dress and hygiene
- Loss of motivation
- Difficulty in working
- Difficulty in long-term memory, attention and executive function
- Inability to experience pleasure
- Low or no desire to form relationships
- Loss of appetite
- Unaware of illness
Types of Schizophrenia
The types include the following:
- Paranoid-type Schizophrenia: This type is usually characterized by hallucinations and delusions however the individual will have relatively normal intellectual functioning and the expression of emotions would be normal.
- Disorganized-type Schizophrenia: This is characterized by thought, speech and behavior which are disorganized or difficult to understand and inappropriate or flat emotions.
- Catatonic-type Schizophrenia: This is characterized by disturbances in movement. People with this type of schizophrenia might keep them immobile for hours, days or even years. It is also accompanied by a state of euphoria.
- Undifferentiated-type Schizophrenia: This is usually characterized by some of the symptoms from all the categories and defining it with any particular type is difficult.
- Residual-type Schizophrenia: This is usually characterized by a past history of a minimum of one episode, but the person doesn’t experience any of the positive symptoms at present. However, they may continue to exhibit the negative symptoms like loss of speech, flat emotional expression, etc.
Causes of Schizophrenia
Although the exact cause for the onset of the disease is not known, experts believe that a combination of genetic and the environmental factors contribute to the development of the disorder.
- Genetic Factors for Schizophrenia: A strong link has been established between biological predisposition and schizophrenia. It has been repeatedly found that having one biological parent with the disorder increases the risk by 13%, both parents affected- the risk is nearly 50%. In twin studies it was found that the chances increase to 40% in case of mono-zygotic twins. The risk is about 6.5% in case a first-degree relative has the disorder.
- Environmental Factors that influence Schizophrenia: The environmental factors include living conditions, childhood trauma, separation from parent at an early age, being bullied or physical and sexual abuse, social isolation, immigration due to social adversity, exposure to extremes of natural calamity, racial discrimination, family dysfunction, parental separation etc. Though parental styles have not been found to directly contribute to the disorder, yet it was found that individuals with a supportive parent do better than individuals with critical and hostile parents.
- Developmental Factors contributing to Schizophrenia: Factors such as hypoxia, infection, malnutrition and stress during pregnancy can increase the chances of schizophrenia later in life. Moreover it was also found that people who are born in winter might have an increased chance of developing the disorder due to early exposure to virus-borne infections.
- Substance Abuse as a factor for increased chances of Schizophrenia: Substance use can increase the chances of schizophrenia in people who are biologically predisposed to the disorder. Amphetamine, cocaine, nicotine can result in psychosis and present symptoms similar to those of schizophrenia. However, cannabis can be a contributory factor for the onset of the disorder yet cannot cause it alone.
- Brain structures and Neurotransmitters responsible for Schizophrenia: Almost 40-50% of the patients with schizophrenia have been found to have subtle differences in brain structures. fMRI and PET have shown functional differences in brain activity in the frontal lobes, hippocampus and temporal lobes and reduced brain volume. Although it has not yet been established whether the reduced volume preexists prior to the onset of the disorder or it is due to the treatment with anti-psychotic drugs. Moreover, neurotransmitters named dopamine and glutamate is found to have significant impact on the onset of the disorder. Excessive activation of the dopamine receptor and reduced levels of glutamate receptors are found to trigger the positive symptoms of schizophrenia and decrease in cognitive functions respectively.
Treatment for Schizophrenia
- Medication for Schizophrenia: Typically the first line of treatment for schizophrenia is antipsychotic drugs for reducing the positive symptoms. However, it cannot improve the negative symptoms and cognitive dysfunction. The treatment has two phases – an acute phase when high doses of medications are given to treat the psychotic symptoms; and a maintenance phase which usually prolongs for life time. In the maintenance phase, the dosage of the medicine is slowly reduced to minimum for preventing further outbreak of symptoms. If the symptoms increase due to reduced dosage, the doctor will usually increase it to the required level to prevent the occurrence of symptoms. The choice of medication depends on the willingness of the patient to co-operate with the treatment.
- Psychosocial Interventions in Schizophrenia: It is very important to start the psychosocial (psychological and social) interventions once the psychotic symptoms recede. It includes:
- Individual Therapy: It includes regular sessions with a trained therapist to deal with the stresses, past or current problems, thoughts, feelings, early warning signs of relapse and thus are better able to cope with the disorder and lead a better life.
- Cognitive Remediation: It’s a therapy using pen-and paper exercises or computer based series of exercises which help patients with schizophrenia strengthen their cognitive skills and also to learn new strategies to deal with problems in attention, memory, planning and organizing skills.
- Family Therapy: The focus for this therapy is mainly to educate the family and support them to deal with patients with schizophrenia and provide the patients with better care.
- Social Skills Training: This focuses on helping the patients improve their social and communication skills.
- Vocational rehabilitation and Supported Employment: The aim is to provide vocational counseling for patients with schizophrenia to help them find and keep up their jobs and education on money management.
- Counseling for Substance use and Weight Management: Often people with schizophrenia are involved with substance use. The aim of this session is to help them withdraw from substance abuse. As the side effect of the psychotic drugs, many patients gain a lot of weight. Thus counseling for weight management is also provided.
- Self-help Groups: These are groups managed by experts and trained therapists to provide information on treatments and support to patients with schizophrenia and their families. Being actively involved in a self-help group promotes faster recovery as the patients don’t feel that they are the only person affected with the disorder, gives them a platform to share their own experiences while increasing the knowledge on the disorder and ways to tackle it, avoids relapse, non-compliance to the treatment, legal problems and repetition of hospitalization.
Though it is rarely possible to prevent the onset of the disorder, early treatment can help in preventing worsening of the condition. Complying with treatment plan also helps in preventing further relapses. Experts believe that being aware of the risk factors for the disorder might lead to early diagnosis and treatment.