Schizophrenia

Topic Highlights

●    Schizophrenia is a chronic, severe and disabling brain disorder classified into five types'paranoid, disorganized, catatonic, undifferentiated, and residual schizophrenia.

●    This visual presentation describes in detail the causes, symptoms, diagnosis, and treatment.

●    It also carries helpful information for caregivers.

Transcript

Schizophrenia is a chronic, severe, and disabling brain disorder. Approximately 1% of the world population suffers from schizophrenia. Many brain regions operate abnormally during schizophrenia. The disorder is common in men and often appears in the late teens or early twenties. In women it generally occurs in the twenties to early thirties.

Schizophrenia is a mental disorder characterized by delusions, hallucinations, disorganized speech and behavior. The patient experiences a loss of emotions about things which were of interest earlier.

Schizophrenia may be classified into five types. In paranoid schizophrenia, patients experience delusions and auditory hallucinations. Delusions are strange and steadfast beliefs that are held only by the observer and that remain unshakeable despite obvious evidence to the contrary. For example, someone with schizophrenia may interpret red and green traffic signals as instructions from space aliens. They believe that they are being watched, spied upon, or plotted against. A common delusion is that one's thoughts are being broadcast over television or radio, or that other people are controlling the person's thoughts. They appear normal, but tend to become argumentative and are suspicious of others.

Disorganized schizophrenia is characterized by auditory or visual hallucinations, which get worse and lead to depersonalization. Hallucinations are perceptions that occur without connection to an appropriate source. Although hallucinations can occur in any sensory form, hearing voices is most common. Sometimes the voices are complimentary, reassuring, and neutral. At other times they are threatening or frightening, and may also command the patient to do things that may be harmful. They exhibit inappropriate emotional responses and their personal appearance becomes unpredictable.

Catatonic schizophrenia is characterized by strange motor activity. People who suffer from this condition exhibit immobility, peculiar postures, and excessive purposeless movements. They may maintain a fixed posture, repeat a word or phrase or repeat the movements of another person.

Undifferentiated schizophrenia patients experience schizophrenic symptoms such as delusions and hallucinations, but do not meet criteria for other types of schizophrenia.

Residual or negative schizophrenia patients are already diagnosed and may not suffer from the characteristic symptoms of schizophrenia. However, they still exhibit eccentric behavior, disorganized speech, lack of emotions, lack of motivation and are withdrawn from society. Facial expressions or hand gestures may be limited or non-existent and the ill individual is unable to express any emotion outwardly.

The actual causes of schizophrenia are not understood, but it is believed to have a genetic component. It is also believed that brain damage during pregnancy, intrauterine starvation and viral infections or damage during delivery may cause schizophrenia. Brain scans show significant changes in schizophrenic patients. Street drugs, alcohol and stress may precipitate or worsen schizophrenia.

There are billions of nerve cells in the brain arranged end-to-end to form circuits. Neurons or brain cells conduct and transmit electrical signals. The area where two neurons join together is called a synapse. Electrical impulses generated within the neuronal cells jump across the synapse with the help of chemicals known as neurotransmitters.

In the brain afflicted with schizophrenia, there is abnormal functioning of these neurotransmitters. Problems associated with the normal functioning of dopamine, one of the neurotransmitters, are believed to cause schizophrenia. Patients with schizophrenia may either have too many dopamine receptors, or have receptors that are overly sensitive to dopamine. When this condition occurs the brain receives too many messages along these pathways resulting in psychotic symptoms.

The characteristic clinical picture diagnoses schizophrenia. There is no diagnostic test available for schizophrenia. It is important to test blood and urine samples to rule out the use of street drugs as these may also cause similar symptoms. Doctors study the genetic and developmental background of the patient and changes in mental state before the onset of illness. The course of the illness and response to treatment is also important. A doctor may suggest CT scans of the head, and other imaging techniques, which may help to identify changes due to schizophrenia. These tests may help rule out other neurological disorders.

Treatment involves administration of antipsychotics, also known as neuroleptic medications. These help balance the brain chemicals thereby controlling the symptoms. These medications may have side effects such as sedation and weight gain. These side effects need to be addressed, but they should not prevent the patient from taking the medication.

Psychotherapy is found to be useful as an adjunct for many patients. Training in social skills may help the patient with social and occupational functioning. Support for the family and knowledge about the disease helps the families cope with the situation.

The patient needs to inform the doctor about any side effects of medication since discontinuing treatment will almost invariably result in a relapse. This helps the doctor make adjustments in the medications to relieve the side effects.

It is important to get help when the patient feels helpless and is unable to care for himself, or when the delusions and hallucinations cause the patient to hurt himself or others.

Do not resort to street drugs or alcohol abuse to cope with the disorder. This may further aggravate the symptoms and may provoke a relapse.

Caregivers should try to remain as calm as possible when trying to handle a schizophrenic patient. Avoid patronizing and authoritative statements. Repeat questions using the same words each time. Do not shout at a patient. If the patient does not appear to be listening, it may be because other voices are louder.

During a psychotic episode the patient may be in an altered state of reality and may act out of the hallucination or delusion. In such situations, the caregiver should try to protect all concerned from physical harm.