All About Schizophrenia
Schizophrenia is a serious mental illness characterized by a disrupted experience of reality. Symptoms include hallucinations, delusions and disorder of thought and speech. Schizophrenia is a chronic disease that most often requires a lifelong treatment.
Although schizophrenia can happen at any age, it rarely occurs during childhood or in people older than 40 years. In men it usually occurs in adolescence or early twenties. In women it typically appears somewhat later, in their late twenties or early thirties.
It occurs in about 1% of the population. The disease can start suddenly or be preceded by the prodromal period or occurrence of non-specific symptoms such as sleep disturbances, irritability, isolation, fear, and loss of interest in usual activities, problems at school or in college, suspiciousness, unusual ideas and thoughts...
Symptoms of schizophrenia include disorders of thoughts, emotion and behavior. Delusions are beliefs that have no basis in reality. They occur in most patients. Patients may have ideas that they are being persecuted and threatened, idea of the impact (of other people on the patient), nihilistic ideas, idea of the greatness and importance ... That person can think that s/he is threatened by an organization or an individual, that s/he is victim of a conspiracy, that s/he is influenced by TV, special rays ... s/he can be convinced that s/he is loved by some important person, that is a topic on the TV or in the newspaper or have special or invention powers, prophetic gift, etc. It can have a general idea of the apocalypse, etc...
Hallucinations can affect all senses, but they most commonly affect the sense of hearing. The patient experiences them as real and they are often very unpleasant. They can comment the behavior or actions, give orders ... Sometimes the conduct of the person (discussion, placing hands on the ears, playing loud music ...) shows that s/he has hallucinations.
Disorder (disorganization) of thought manifests itself as a disorder of speech. It can occur in a range from complete cessation of speech (mutism) over the blocks in the train of thought and, consequently, to a speech resulting in a complete disorganization in the form of "word salad." The speech often has no goal, it is too broad and incoherent, and the associations are illogical. A person may pointlessly repeat one and the same sentence, word or the last thing interlocutor said. Opinion changes from abstract to concrete.
Disorders of emotions manifest in the form of emotional emptiness. Emotional response to the situation is often unmodulated and inadequate. Conduct disorders are perceived as disorganized or inappropriate behavior. They can occur in a range from "childlike" to the sudden motor agitation. Behavior is not directed toward the target, and is often pointless. Improper behavior may be perceived as a refusal to carry out an action, inappropriate or bizarre positions of the body, and the complete lack of motor response or useless, bizarre or exaggerated movements.
Negative symptoms are related to the inability or reduced ability to function. A person does not establish eye contact during communication, there is no change in expression during the speech, and the speech is monotonous and not accompanied by gestures that usually give the emotional tone of what is being said. The will and initiative are disturbed or lacking. There is no interest in usual activities or experiencing the pleasure. The ability of planning and executing the plan is reduced.
The person is isolated from society; there is a passivation and withdrawal. The condition can lead to neglect of personal hygiene and hygiene of housing.
The cause of the disease is not completely clarified, but it is thought that it happens due to a combination of genetic and environmental factors. It is believed that the disturbance at the neurotransmitter level (dopamine, glutamate) is significant for the formation of schizophrenia. The risk factors are: the existence of a schizophrenic illness in the family, exposure to viruses, toxins or malnutrition during pregnancy, older age of a father and taking psychoactive substances in the teenage and adolescent age.
Diagnosis is based on data from personal and family history and on the discussion with the patient when looking at the appearance and behavior of the patient. Thinking, attention, mood, presence of hallucinations, delusions, suicidal thoughts are assessed.
Emotional response is observed, functioning and degree of insight into one`s own state is estimated. Laboratory analyses which exclude conditions with similar symptoms and the existence of abuse of alcohol and psychoactive substances are helpful. If necessary, they can be supplemented by computed tomography or magnetic resonance imaging. Psychological exploration is of great diagnostic and differential diagnostic significance.
The goal of treatment of schizophrenia is to control symptoms and improve quality of life. It may take several weeks of treatment to get the symptoms under control. The basis of treatment consists of medicines. Specific drugs to treat schizophrenia are called antipsychotics. They are in the forms of tablets and injections. Injections can be immediate or long-acting (ie. depot preparation). It is believed that the antipsychotics act on neurotransmitters dopamine and serotonin.
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Antipsychotics are divided into typical and atypical.
Typical antipsychotics are the older generation of antipsychotics. They have strong antipsychotic effects but also greater potential to cause side effects, particularly neurological (trembling of the hands, blurred vision ...).
Atypical antipsychotics are newer generation of drugs and have fewer side effects.
Antidepressants, mood stabilizers and anxiolytics are also used in the treatment. People with schizophrenia often refuse to take any treatment because of lack of insight or because of side effects.
In this case they may be given long-acting preparations which are administered usually every 14 or 30 days. In addition to regular and often life-long treatment, important role in the treatment have psychotherapy and social support. Psychotherapy helps patients to control stress, to recognize signs of the disease and their possible reoccurrence, to improve communication with other people and get back into society, organize their day and obligations...
People with schizophrenia often do not have insight that their problems occur due to mental illness which requires psychiatric treatment. Therefore, it is difficult for family members, friends or doctors to provide them with help and treatment. Forced hospitalization is implemented when there is a danger to a patient or the environment. The final decision on the justification of forced hospitalization is made by the judge after the expert testimony, and it has a time limit. The decision on the physical restraint in the department is made by a psychiatrist and it is also time limited.
Untreated schizophrenia affects all aspects of life (emotions, thinking, behavior), and can lead to financial problems and problems with the law. The most serious complication caused by the disease is suicide. It can occur under the influence of commanding auditory hallucinations, because of depressive reactions, insight into one`s own condition...
Self-harm also occurs. There may be anxiety and phobias, depressive reaction, alcohol abuse, substance or medication abuse. Conflicts with family members and social isolation are not rare. These patients are often existentially threatened because of their incapability.
Improper behavior may be perceived as a refusal to carry out an action, inappropriate or bizarre positions of the body, and the complete lack of motor response or useless, bizarre or exaggerated movements.
The cause of the disease is not completely clarified, but it is thought that it happens due to a combination of genetic and environmental factors. It is believed that the disturbance at the neurotransmitter level (dopamine, glutamate) is significant for the formation of schizophrenia.
Delusions are beliefs that have no basis in reality. They occur in most patients. Patients may have ideas that they are being persecuted and threatened, idea of the impact (of other people on the patient), nihilistic ideas, idea of the greatness and importance...
People with schizophrenia often do not have insight that their problems occur due to mental illness that requires psychiatric treatment.
Aggressive behavior toward others is much less than what the public believes. It is usually related to substance abuse, lack of treatment and the manifestation of aggressive behaviors before the onset of the disease.
Adherence to therapy and compliance with the treatment plan prevents recurrence or worsening of symptoms. With proper treatment, most patients have a relatively good quality of life.
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