Schizophrenia – Symptoms, Causes and Treatment

Overview

Schizophrenia is a serious mental disorder marked by a disconnect from reality. Or rather, the way the person perceives reality, behaves, or shows emotions are quite different from that of people who do not have such a disorder. It is not very common, compared to other mental disorders. However, the psychological damage and hassles faced by the patient and family, are significant. While complete cure is quite rare, better quality of medication over the years has helped patients cope with the condition better. This has helped them lead healthy, happy and normal lives. In this article, we will explore different facets of this condition.

Introduction

There are various mental disorders that have been recognized throughout the history of mankind. Schizophrenia is one such disorder that has been documented as early as 2000 BC in ancient Egypt. However, in recent times, much work has been done on the condition since the mid-16^th century, and more so in the 20^th century.

Schizophrenia is often mistaken for split or multiple personality disorder (collectively called dissociative personality disorder). However, these two are uniquely distinct from each other. Men show symptoms of this disorder sooner, like the early 20s, than women, who show symptoms in the late 20s. Teenage schizophrenia is rare while childhood schizophrenia is rarer.

Early Symptoms

Whether the person develops schizophrenia in childhood, teenage or early adulthood, early symptoms are the same in them. This includes:

• Social withdrawal or isolating oneself from all social groups
• Changing social groups frequently, inability to jell with anybody for long
• Trouble focusing and concentrating
• Trouble sleeping, irritability and agitation during the day
• Drop in academic or sports performance
• Anxiety and being overly suspicious of everybody
• Unusual ideas, and a feeling that the person is different from others
• Being highly sensitive, or overly short-tempered

Advanced Symptoms

Positive symptoms

Here, positive refers to the presence of atypical behaviour. Includes:

• Hallucinations: Refers to imagined experiences that appear very real. Includes – hearing voices, seeing things, smelling things – that don’t exist.
• Delusions: Having beliefs that do not match reality, in-spite of strong evidence or facts to the contrary
• Phobias and Paranoia: The person fears, or is distrustful of people, or day-to-day activities that were routine, previously
• Catatonia: Here, the person is in the same position, or facial expression, or does not speak – for long stretches of time

Negative symptoms

Here, negative refers to the absence of normal behaviour. Includes:

• Social withdrawal: Isolation and reduced speech or interaction with family and friends
• Indifference: reduced interest in studies, sports, work. No excitement about life, inability to experience pleasure, no change in expressions, a lack of emotion
• Sloth and procrastination: difficulty in sticking to a plan or completing daily routines on time, walking or moving very slowly
• Eccentricities: odd, unusual or hyper-emotional responses to situations
• Odd movements: Repeatedly pacing back and forth, or walking in circles, exaggerated gestures
• Grooming: Poor personal hygiene, unhealthy eating habits

Cognitive symptoms

• Incoherent speech: The person shows disorganized thinking and speech, such as changing topic mid-way, using made-up words or phrases, speaking too fast or excitedly, inability to hold a meaningful conversation, writing or saying meaningless things
• Poor memory: forgetfulness with respect to people, daily routines and common information, losing belongings
• Distracted: The person has trouble focusing or paying attention
• Poor decision-making: Inability to understand information and using that to make the best decisions. This includes everyday smells, sounds and sights.
• Cognitive impairment: Difficulty in learning new information and using it

Causes and Risk-factors

• Genetic or genes-related: People whose close family members such as parent, sibling or grandparent have a history of schizophrenia are at high risk of developing the same.
• Environment-related: Being born in the winter increases the risk slightly. Being constantly stressed due to work, academics or an ailment puts one at risk. Being abused in the childhood or teenage (sexual/verbal/physical abuse) increases the risk.
• Ailments: Certain ailments that affect the brain such as some infections and autoimmune diseases increases the risk. Any condition that causes an imbalance in the neurotransmitters serotonin and dopamine can trigger schizophrenia.
• Birth-related: If a pregnant woman has vitamin-D deficiency, gestational diabetes, malnutrition or preeclampsia, that puts the child to be born at high risk of developing schizophrenia. Being underweight at birth, caesarean delivery, or normal childbirth that was painful thereby inducing trauma, can increase the risk. Exposure to viruses, toxins and malnutrition during infancy also increases the risk.
• Lifestyle related: Starting early on alcohol or recreational drugs such as marijuana (cannabis) in teenage can put the person at risk once he/she turns adult. However, this a risk factor and not a direct cause.
• Others: Accidents or falls that cause serious physical injury can trigger schizophrenia in some people.

Complications

Since people suffering from schizophrenia have lost their ability to perceive that something is wrong with them, it becomes the duty of family and friends to seek early medical intervention. If the condition is diagnosed very late, or left untreated, it can cause complications such as:

• Suicidal tendency: thoughts of, and attempts at suicide
• Other mental disorders: obsessive-compulsive disorder (OCD) and anxiety
• Depression, and being emotionally sensitive
• Substance abuse: The person turns to alcohol or drugs frequently
• Reduced performance: Inability to attend school, or work, or enjoy hobbies like before
• Ruin: financial problems that can lead to homelessness
• Social Withdrawal: Isolation from people for long stretches of time
• Health issues: Due to neglecting health and hygiene
• Persecution complex: The person feels victimized all the time
• Aggressive behaviour: which is rare though

Treatment

Medication

• First-generation antipsychotics: These are older and cheaper. However, they come with side-effects such as a movement disorder called tardive dyskinesia. Some drugs include: Perphenazine, Chlorpromazine, Haloperidol and Fluphenazine
• Second-generation antipsychotics: These are newer and costlier. However, there are no significant side-drugs: Some drugs include: Aripiprazole, Ziprasidone, Iloperidone, Quetiapine, Asenapine, Risperidone, Lurasidone, Brexpiprazole, Paliperidone, Cariprazine, Olanzapine and Clozapine
• Long-acting injectable antipsychotics: These are given as intramuscular or subcutaneous injections. Examples include – Aripiprazole, Risperidone, Haloperidol decanoate, Fluphenazine decanoate and Paliperidone
• Anti-anxiety drugs
• Anti-depressants

Psychosocial Interventions

• Individual therapy: One of the types of Psychotherapy which helps the person normalize his/her thought patterns. The person is taught how to cope with stress, how to identify signs and symptoms quickly, so that the illness can be managed better
• Social skills training: Here, the person is helped with improving communication skills, social skills and increased interactions in social groups
• Family therapy: Here, the patient and family members are educated on how to deal with the situation
• Vocational rehabilitation: Here, patients are helped find jobs, keep jobs and undergo any training if required

Electro-Convulsive-Therapy (ECT)

In this, small electrical pulses are passed through the brain inducing a brief and mild seizure. This seizure helps correct abnormal brain circuits or an imbalance in neurotransmitter generation. The person is under general anaesthesia, so is not affected by the seizure.

Hospitalization

When the symptoms are severe, it is best to hospitalize the person for a few days and provide necessary medication. It will also ensure the person’s safety, hygiene, nutrition and good sleep.

Outlook

In the past, patients and their family members had to cope with the situation alone. This made the patient more vulnerable and prevented proper or timely treatment. Social outlook to mental illnesses was also a challenge.

However, in recent times, with more and more people being open about mental illness, and with the proliferation of special interest groups, it’s easier to receive timely treatment for schizophrenia today. Medication for the condition has also become more effective than in the past, which is encouraging.

If you or any of your dear ones are showing early signs or symptoms of schizophrenia, contact a reputed hospital at the earliest. With timely treatment, one can cope with the illness easily and live a normal life like others.

 

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NOTE: Take medications only when prescribed by your doctors, self-medication must be avoided under any circumstances.

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