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Schizophrenia

Schizophrenia

Schizophrenia is a chronic brain disorder that affects about one percent of the population. It is prevalent across racial, sociocultural and national boundaries. It is usually a progressive disease and is treatable but may not be curable especially when treatment is started after a long period of illness. Disorder usually begins before 25 years of age and persists throughout the life. Diagnosis is entirely based on clinical history and mental status examination.

When schizophrenia is active, symptoms can include delusions, hallucinations, trouble with thinking and concentration, and lack of motivation, disorganized speech and behavior. However, when these symptoms are treated, most people with schizophrenia will greatly improve over time.

While there is no cure for schizophrenia, research is leading to new, safer treatments. Experts also are unraveling the causes of the disease by studying genetics, conducting behavioral research, and by using advanced imaging to look at the brain’s structure and function. These approaches hold the promise of new, more effective therapies.

Schizophrenia affects men and women about equally but the onset is earlier in males compared to females. Rates are similar in all ethnic groups around the world. Schizophrenia is considered a group of disorders where causes and symptoms vary considerable between individuals.

 Causes

The etiology of schizophrenia is multi-factorial but common etiologic factors include 1) genetic causes- if first degree relative or identical twin had schizophrenia, the chances of its development in progeny or other twin are higher. 2) Neuro-chemical imbalance is second important causative factor causing increase in brain Dopamine level or functions in certain areas of brain. 3) Factors like infections during pregnancy and injury to the brain of a baby in womb or during child birth can also increase the chances of developing schizophrenia in future.

Symptoms

When the disease is active, there can be variety of symptoms. Disorder may present with episodic illness or continuous one. There is impaired sense of reality. As with any illness, the severity, duration and frequency of symptoms can vary; however, in persons with schizophrenia, the incidence of severe psychotic symptoms often decreases during a patient’s lifetime. Non-compliance, use of alcohol or illicit drugs, and any stressful life situations tend to increase symptoms. Symptoms fall into several categories:

  • Positive psychotic symptoms: Hallucinations, such as hearing voices, paranoid delusions and exaggerated or distorted perceptions, beliefs and behaviors.
  • Negative symptoms: A loss or a decrease in the ability to initiate plans, speak, express emotion or find pleasure. Lack of interest in surrounding.
  • Disorganization symptoms: Disordered thinking and speech, trouble with logical thinking and sometimes bizarre behavior or abnormal movements.
  • Impaired cognition: Problems with attention, concentration, memory, judgment, concepts and declining educational performance.

Symptoms usually first appear in early adulthood. Men often experience symptoms in their early 20s and women often first show signs in their late 20s and early 30s. Patients have socio-occupational dysfunctioning, troubled relationships, poor school performance and reduced motivation. It is rarely diagnosed in children or adolescents.

  • Course and prognosis

The classic course is one of exacerbations and remissions. After the first episode patient gradually recovers but further deterioration in patients’ functioning occurs following each relapse of psychosis. Subsequently patient fails to return to baseline functioning. More than 50% of the patients can be described as having a poor outcome, with repeated hospitalizations, exacerbation of symptoms, episodes of major mood disorders and suicidal attempts. Good prognostic factors include late onset of illness, obvious precipitating factors, acute onset, good premorbid functioning and good support system (family and social). About 20-30 % of the patients continue to experience moderate symptoms and 40-60% remain significantly impaired by the disorder for their entire lives.

  • Treatment

Pharmacotherapy

Antipsychotic drugs are the mainstay of treatment though psychosocial treatment modalities should also be integrated in to the drug treatment regimen. Olanzapine, Risperidone, Aripiprazole, Trifluperazine are some of the examples of anti-psychotic medication.

Treatment is generally required for long duration. First episode schizophrenia needs to be treated at least for 2 year. If the patient has 2 episodes, treatment should be continued for at least 5 years and lifelong for further episodes.

Non-pharmacological management

Along with medication psycho-social rehabilitation of patient is necessary once the patient is improved. Social skills training, vocational training and life skills enhancement need to be done. Patient and family members have to be psycho-educated about the course of illness, signs of relapse, need for medication, importance of compliance and regular follow up.

Related Conditions

  • Schizoaffective disorder
  • Delusional disorder
  • Brief psychotic disorder
  • Schizophreniform disorder
  • Catatonia