Clinical Conditions

Schizophrenia

Introduction

Schizophrenia is a chronic and often a severe psychiatric disorder. Its severity and chronicity often result in disability and many individuals require ongoing support and assistance even to manage basic activities of daily living.

How people with schizophrenia differ from others:

Individuals with schizophrenia seem, act and behave oddly. Their perceptions are sometimes completely different from the reality seen by others around them. Often, they would talk to themselves, hear voices or even respond to imaginary fears.

This does not imply that they are like this all the while. Some individuals can appear absolutely normal and perfectly responsible too, even while they may be experiencing hallucinations or delusions. Over the period of time their behaviours may change, especially if they are on medications and have stopped it.

Schizophrenia

Myths:

Schizophrenia is Split Personality

Split Personality is not the same as schizophrenia, it’s a misconception.

Schizophrenia means multiple Personalities and commonly are different persons at different times

Schizophrenia never presents as multiple personalities. These perceptions are incorrect. These could be manifestations of other mental disorders like Dissociative Disorder, Borderline Personality Disorder or Bi-polar Disorder.

WHAT IS SCHIZOPHRENIA?

By Virtue, Schizophrenia is chronic in nature and at times a severe and disabling psychiatric disorder. It’s life time prevalence is about 1% with equal gender distribution i.e. incidence rate same in men and women. In men, seen usually in the late teens or early twenties, whereas in women, manifests commonly in the twenties to early thirties.

Classical Manifestations:

  • Hearing internal voices not heard by others
  • Believing that other people are controlling their thoughts, reading their minds, and often believe that people are plotting to harm them.
  • Disorganised speech and behaviour, often they may be incomprehensible or frightening to others.

Outcome:

Only 20% of schizophrenics show complete recovery. Medications do relieve most of the symptoms, but most of the affected continue to suffer some symptoms throughout their lives.

How is schizophrenia as an Illness?

The chronicity and severity of Schizophrenia brings with it a high amount of disability and often making a productive individual non-productive. Medication and other treatment when used regularly and as prescribed, often just palliate the most distressing symptoms of the illness.

Often the first signs to appear is weird and bizarre behaviour. Family also does have to go through the suffering with the individual, since it’s difficult to forget how productive and involved this person was before he/she became ill.

The acute phase of schizophrenia is characterised by severe psychotic symptoms. Psychotic symptoms and Psychosis are common manifestations in schizophrenia, these are marked by hallucinations, and/or delusions, which are false yet firm beliefs resulting from an inability to differentiate real from unreal experiences. Other symptoms are social withdrawal and isolation. Unusual thoughts, behaviours and speech, may often precede, be seen along with, or follow subsequent to the psychotic symptoms.

There may be cases with single psychotic episodes while there are others that may have many episodes in a lifetime, despite that they lead relatively normal lives during the remission periods. However, cases with "chronic" schizophrenia, or a continuous or recurring pattern of illness, rarely fully recover normal functioning and typically require long-term medical treatment.

Diagnosis of Schizophrenia

Medical History, Physical Examination & Investigations to rule out all other possible causes are important before concluding that a person has schizophrenia.

Drug abuse can mimic symptoms of schizophrenia. Tests to rule out drug abuse are important. The presence of the same can be tested from blood and urine samples.

Bipolar disorders, major depressive disorders to be ruled out often before concluding a diagnosis of Schizophrenia. When symptoms are not readily classifiable then a diagnosis of "schizoaffective disorder" is to be made.

Do Children have Schizophrenia?

Children above five age can develop schizophrenia, but it is very rare before adolescence. Sometimes people who develop schizophrenia at later age may have seemed different from other children from an early age, hallucinations and delusions and other psychotic symptoms are rare before adolescence.

What are the symptoms of Schizophrenia?

The symptoms of Schizophrenia are as under;

  • Distorted Perceptions of Reality

People with schizophrenia think and feel differently for things compared to others around them, they have distorted perceptions of reality. They often behave strangely. While symptoms may seem strange and vague these individuals may seem distant or detached, often preoccupied, restless, sometimes alert and vigilant.

  • Hallucinations

Perceptual disturbances are common in those suffering from schizophrenia. These sensory hallucinations could affect any of the five senses which may be - auditory (sound), visual (sight), tactile (touch), gustatory (taste), and olfactory (smell).Auditory hallucinations are the most common; they may describe hearing voices that other people do not hear. These voices may command the patient's activities, carry on a conversation, often warn of impending dangers, or even issue orders.

  • Delusions

These are false but firm personal beliefs that cannot be reasoned and cannot be explained by the person's usual cultural context. There may be different themes to their Delusions. For example, patients suffering from paranoid symptoms may believe that they are being cheated, harassed, poisoned or at times conspired against, some may have persecutory symptoms. Those with grandiosity believe they are important and famous. There may be those who believe that they are being controlled may be by voices or neighbours, also their thoughts are being broadcast and they may believe that people on television are sending them special signals.

  • Disordered Thinking

People with schizophrenia cannot think straight. They have rapid and wandering thoughts which may come and go rapidly; there is inability to concentrate on one thought for very long and are easily distracted, unable to focus attention. With this there is inability to differentiate things that are relevant from those that are not. There is difficult to logically sequence thoughts. As thoughts become disorganized and fragmented it may make conversation very difficult and lead to social withdrawal and isolation.

  • Emotional Expression

Schizophrenic have difficulty expressing and reciprocating emotions, they are often referred to as having “blunted" or "flat" affect. They may speak in monotonous tone, have few or no facial expressions, appear extremely disconnected and listless. They gradually withdraw socially, and may have very little to contribute to or say when forced to interact. Poor motivation and lack of interest in or enjoyment of life. In very severe cases, a person can spend entire days without doing daily chores often neglecting basic hygiene.

Is there a relation of Substance Abuse and Schizophrenia

Schizophrenic patients often abuse alcohol and/or drugs, and suffer particularly bad reactions to certain drugs. Efficacy of Schizophrenia Treatment is often significantly reduced by Substance abuse. Substances and Stimulants (such as Cocaine, Marijuana, Amphetamines or PCP) often aggravate schizophrenic symptoms and also reduces the possibility of patients following the recommended treatment plans.

Does smoking and Schizophrenia have any Relation?

Smoking is the most common form of substance use among people with schizophrenia. It is three times more common in schizophrenics compared to normal population. Research reveals a complex relationship between smoking and schizophrenia. People with schizophrenia may smoke to self medicate their symptoms but smoking interferes with the response to prescribed medicines. Quitting smoking may be especially difficult since withdrawal will cause temporary worsening of symptoms. Nicotine replacement methods may be effective for smoking cessation

Are Schizophrenic’s Violent?

Most individuals with schizophrenia are not violent; most of them are withdrawn and prefer to be left alone. Crimes are usually not committed by persons with schizophrenia.

Rate of violence is significantly high in those with substance abuse. & also in people who do not have any mental illness. Schizophrenics with paranoid and psychotic symptoms, and who have discontinued medications, are at higher risk for violent behaviour. Violence behaviour if occurs, is most frequently targeted at family members and friends, and more often takes place at home.

Is there a relation between Suicide and Schizophrenia?

Suicide is a serious danger in people who have schizophrenia. If there is an attempt to commit suicide or even if they threaten to do so, immediate professional help should be sought. The rate of suicide is higher among those with schizophrenia as compared to the general population. Approximately 10% of individuals with schizophrenia commit suicide.

What are the causes of Schizophrenia?

Many factors may be responsible, no single cause for schizophrenia has been identified.

Can Schizophrenia be inherited?

Schizophrenia is known to run in families. Children whose parent has schizophrenia has about 10 percent chance of getting schizophrenia as compared to general population whose risk is about 1 percent.

Genetic study reveals that multiple genes are involved in developing a predisposition for this disorder. Other prenatal factors such as intrauterine starvation or viral infections, also perinatal complications, and other nonspecific stressors, also contribute to the development of schizophrenia.

Do Schizophrenia patients have a Chemical Defect In The Brain?

Knowledge about brain chemistry and its association to schizophrenia is expanding rapidly. Yet it is not certain that schizophrenia disorder is associated with chemical imbalance of the systems of the brain, involving neurotransmitters like dopamine and glutamate.

Brain-imaging techniques have revealed evidence of early biochemical changes that precede the disease onset.

What are the different treatments for Schizophrenia?

Medications have proven to be the best in relieving the psychotic symptoms especially the delusions hallucinations and incoherence.

Despite being in remissions schizophrenic patients in remission have difficulty with motivation, communication, self-care, and often establishing and maintaining meaningful relationships with others. As a result they are less likely to complete the training required for skilled work.

Psychosocial approaches may have very little role in acute psychotic cases especially those with delusions, hallucinations and out of touch with reality. However most of the chronic cases with psychological, social and occupational difficulties are benefitted with psychosocial therapies. These are aimed predominantly to increasing their social inclusion and improving their social skills.

Rehabilitation for Schizophrenics

Rehabilitation or Non-medical interventions impart social and vocational training to support those suffering and or formerly having suffered overcome difficulties in these areas. Programs may be based on improving the following skills;

Activities of Daily Living - Participants are taught how to live independently. This includes how to cook, use of public transport and budget money.

Vocational Training - Vocational activities may include placements for sheltered work experiences, volunteer jobs or at times transitional employment placement to get job ready. Participants may be taught how to write a resume, complete a job application form, job interviewing skills

Social Skill Training - Basic training in interpersonal social skills, communication skills help patients socially.

Individual Psychotherapy for Schizophrenics

cognitive-behavioural approaches that support, reality-oriented, individual psychotherapy, and that teach coping and problem-solving skills are beneficial for patients with schizophrenia.

Cognitive-Behavioural Therapy

Cognitive psychotherapy aims to help the client use information from the people, events and world around to make adaptive coping decisions. This eventually helps to improve the client's ability to steer smoothly through life problems & to function independently.

Behaviour therapy teaches clients with schizophrenia the social skills like stress management, assertiveness, communication and problem solving skills to aid them relate effectively with the world around them.

Family Education

Right and Updated information about schizophrenia helps families explore multiple ways at managing patients, also seek new therapies and medications available. The information also helps them learn to prevent/ minimize chances of relapse.

Family "psychoeducation," a part of Cognitive Behavioural Therapy includes teaching various coping strategies and problem-solving skills to families and helps them deal effectively with their ill family member, this contributes to an improved outcome for the patient.

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