Detailed about Schizophrenia ?

What is schizophrenia?

Schizophrenia is a major mental illness that causes changes in perception, thoughts and behaviour.
It is a complex condition that defies simple description, but a distinction can be made between two broad types: acute schizophrenia and chronic schizophrenia.

Acute schizophrenia

This is the form that probably most comes to mind when people think of schizophrenia.
Acute schizophrenia is when a previously healthy person, generally a young adult, shows increasingly odd behaviour over a fairly short period of time of perhaps a few weeks.
It can take the form of hallucinations, irrational beliefs or disordered thoughts, ie illogical or incoherent thinking of any degree of severity.

'Positive' symptoms

The most common symptoms of acute schizophrenia are:

• lack of insight
• auditory hallucinations (hearing sounds, voices or music)
• delusions of persecution
• suspiciousness
• flat mood
• thoughts spoken aloud.

These symptoms are called the positive symptoms of schizophrenia.
Not all patients with acute schizophrenia experience all of these symptoms.

Mood disturbance often accompanies acute schizophrenia and can be of any type, such as depression and anxiety, irritability or euphoria.
Emotional responses are often inappropriate for their surroundings – for example, laughing at sad news or appearing unconcerned by important events.
Generally, a schizophrenic knows where they are in time and place, but the presence of disordered thoughts may make them feel confused.
Higher mental reasoning is usually impaired and they often lack insight into their condition. They find it difficult to plan things or organise themselves.

Spotting the signs

Usually a person suffering from schizophrenia will not know they are experiencing symptoms of the illness.
By definition, hallucinations and delusions are experienced as real by the person having them.
As a result, the person with schizophrenia may have different perceptions of the world compared with the rest of us.

Delusions

The following delusions are strongly suggestive of schizophrenia:

• the belief they are under the control of another influence
• that thoughts are being put into or taken out of their mind.

If a person has delusions of persecution, they may be suspicious of any questions about their mental state.

Often the person may feel persecuted or 'got at' in some way, which can cause fear and anxiety.
Other people may notice a change in the person's behaviour, or in the content of their speech.
Sufferers may become preoccupied with certain issues that seem bizarre to those around them.
They may express paranoid ideas or respond to the hallucinations they experience. These hallucinations usually take the form of hearing voices that other people cannot hear.

Chronic schizophrenia

This is the longer-term state and is characterised by:

• a lack of drive
• underactivity
• social withdrawal.

Left to their own devices, schizophrenics may spend long periods of time doing nothing, or engage in repeated and purposeless activity. Sometimes they can neglect themselves quite markedly.
As with the acute state, hallucinations and delusions are common.
Sometimes in chronic schizophrenia the person appears to become used to these disordered thoughts.
For example, they might harbour the idea that someone is trying to get at them, but this does not cause any emotional reaction.

'Negative' symptoms

The most common symptoms of chronic schizophrenia are:

• social withdrawal
• underactivity and slowness
• lack of conversation or interests
• odd ideas or behaviour
• neglect of appearance
• depression.

These symptoms are often called the negative symptoms of schizophrenia.
Not all people with chronic schizophrenia experience all of the symptoms.

How common is schizophrenia?

Worldwide schizophrenia is present in two to four people per 1000 of the population at any one time. One in 100 people will develop schizophrenia in their lifetime.

How does schizophrenia develop?

The cause of schizophrenia is unknown, but it may have a genetic component.
There is no 'gene for schizophrenia' but a family history of the illness increases the risk of being affected:

• if a grandparent had the illness, the risk rises to 3 per cent
• if one parent was affected, the risk is as high as 10 per cent
• this rises to 40 per cent if both parents have schizophrenia.

Other predisposing factors in the development of schizophrenia include complications during pregnancy or childbirth and difficulties in childhood development.
Factors that may trigger an episode of schizophrenia include stressful life events, and the use of illegal drugs, such as cannabis.

What can schizophrenics and their families do to help themselves?

If you think you are experiencing symptoms of schizophrenia, you should seek help from your doctor.
However, one of the features of the disease is sufferers do not understand they are unwell during acute episodes of illness. It is therefore important that family and friends are able to seek help on their behalf.
The first point of call should be the person's family doctor or mental health team worker.
Schizophrenics who are on long-term medication should continue to take this medication, because it has a protective effect against future relapses.

How does the doctor make a diagnosis?

The diagnosis is based on an assessment of the history given by the patient and by any other people who are able to give further information.

What is the course of the disease?

• About a quarter of the people diagnosed with schizophrenia will have one episode of illness, make a good recovery and have no further problems.
• A further 25 per cent will develop a long-term chronic illness with no periods of remission.
• The remaining 50 per cent of those diagnosed will have a long-term illness that comes and goes with periods of remission and relapse.

The long-term outcome may be worse in people:

• with poor social support
• with a strong family history of schizophrenia
• in whom the illness came on slowly
• in whom treatment was delayed.

Male sex and continuing use of illicit drugs are also associated with a poorer outcome.
The risk of relapse is significantly improved by continuing appropriate medication for at least six months after an acute episode.
Positive family intervention may also help to maintain periods without illness, as can help with social skills training and psychological therapy.
People with schizophrenia have higher rates of depression than the general population. There are also high rates of suicide among people with schizophrenia.

What medicines can treat schizophrenia?

Injections

Antipsychotic drugs can be given as an injection that lasts for days or weeks, called a depot injection.
It is often used to prevent a relapse after recovery from acute illness.
It also helps those who prefer it to remembering daily medication.

There are many different  avaantipsychotic medicinesilable, all of which aim to calm someone without making them excessively drowsy.
Modern treatments are called atypical antipsychotics and include:
These are said to have fewer side-effects than some of the older antipsychotics, and so are now the usual treatment for most patients.
Examples of the older treatments include:     amisulpride (eg Solian)olanzapine (eg Zyprexa)quetiapine (eg Seroquel)risperidone (eg Risperdal)clozapine (eg Clozaril)     chlorpromazine (eg Largactil)hyaloperidol (eg Haldol)trifluoperazine (eg Stelazine)
  
Although not a cure, studies show antipsychotic medicines improve the symptoms of schizophrenia and help prevent relapse.
They are effective against the positive symptoms of schizophrenia, eg hallucinations, but have little impact on the negative symptoms, such as lack of motivation and flat mood.
Antipsychotic medicines have important short-term and long-term side-effects.
Side-effects can include:

• sedation
• dry mouth
• constipation
• blurred vision
• light-headedness.

Antipsychotic medicines can also affect movement, for example in slowing gait or causing tremor or abnormal face and body movements.
If these side-effects occur, your doctor may change your dose or prescribe other medicines to help with the side-effects, or another antipsychotic medicine can be tried that may cause less problems.
A long-term movement problem known as tardive dyskinesia occurs in some patients who are on treatment for a prolonged period.
Because there is a high risk that schizophrenia symptoms will recur, treatment should continue for at least one to two years.
If taking medication is a problem then a GP or specialist can prescribe injectable antipsychotic treatment usually given monthly and many patients find this very useful.

Is therapy helpful?

Research shows interventions with the families of schizophrenics can reduce relapse rates.
These family interventions usually last several weeks and consist of education about the illness and help with problem solving.
Research also suggests a type of psychological therapy known as cognitive behavioural therapy may help to reduce relapse rates. Further studies are required in this area.
There is limited evidence that giving people with schizophrenia help and training in social skills may help prevent relapses.

Like us on Facebook

www.facebook.com/navjivanmehnagar