Schizophrenia is a disease of the mind which is usually degenerative in nature. The complex disorder is generally characterized by delusions, auditory/visual hallucinations and disturbances in speech among a few other symptoms. These symptoms are not regular and can appear at any given point in time. So it is highly possible for a Schizophrenic to act normally in phases and then all of a sudden, exhibit symptoms of Schizophrenia.
Types of Schizophrenia
The types of Schizophrenia, as described by The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), are:
- Paranoid Schizophrenia: This type is characterized by nurturing delusions which often revolve around the belief that other people or even paranormal entities are trying to harm the person. These hallucinations can either be auditory or visual.
- Disorganized Schizophrenia: People having been diagnosed with Disorganized Schizophrenia tend to exhibit loose ended delusions as well as verbal incoherence.
- Residual Schizophrenia: This condition is characterized by general withdrawal or total absence of motivation to perform any activity, whether routine or not. This usually develops once the recurring bouts of delusions or hallucinations have come to a close.
- Undifferentiated Schizophrenia: In this type, people commonly experience hallucinations,delusions and incoherence in activities and speech.
- Catatonic Schizophrenia:Catatonic Schizophrenia is characterized by speech disturbances, unusual motor activities and catatonia (state of stupor or absolute immobility). An example of this condition would be of the individual positioning himself/herself in such a way as if he/she is resting on a pillow whereas all the while, the person never had a pillow and was actually resting with the head elevated. This could result in the neck turning blue-black in pain, which the person would be blissfully unaware of.
Catatonia causes people to lose control over the mobility of their muscles. This results in rigidity and a fixed posture, thus causing subsequent pain.
The causes of Schizophrenia include:
- Brain Dysfunction: People suffering from Schizophrenia are usually found to have abnormalities in the cerebral cortex (the cerebrum’s external part). This is due to the presence of ventricles which are generally larger as compared to the normal conditions. The decreased brain size due to enlarged ventricles is often related to the hallucinations and delusions among schizophrenics.
- Genetic Factors: Like any other psychological disorder, Schizophrenia might be a genetic disorder as well. Closer the family ties, higher the risks of passing down the disorder.
- Biochemical Factors: Some neurotransmitters such as dopamine were thought to lead to schizophrenia due to their over secretion, but research failed to prove this hypothesis. More than one neurotransmitter is being targeted by recent drugs to control schizophrenia.
Some might have a disposition to the disorder since their early formative years. But chances of the symptoms to develop in a person depend on whether the person was subject to situations and circumstances that would evoke those symptoms.Hostile family members or even overly criticizing ones can be triggers for the symptoms to start showing up gradually.
Now the symptoms of schizophrenia are broadly divided into three categories: Positive, negative and cognitive.
Positive symptoms include delusions and hallucinations, negative symptoms consist of lack of motivation and general apathy whereas cognitive symptoms include stray, disorganized thoughts and experiencing frequent lapses in concentration.
Hallucinations are sensory experiences of things that do not exist outside the mind. Hallucinations usually manifest in the form of auditory or visual images. It typically is a sensory experience wherein a person begins and continues to see, smell, hear, feel or taste something which has no physical existence or is not present at that point in time.
Delusions on the other hand are false beliefs one has about oneself. If a man sitting beside you in a metro suddenly stands up and claims to be Bhagat Singh, he is suffering from a delusion. Delusions are of 3 major types:
- Grandeur: Wherein the person imagines himself/herself to be a famous personality
- Persecution: The belief that somebody somewhere is plotting against you and is going to get you
- Control: The belief that an external force, a witch, a demon or even a duck for that matter, is controlling your actions.
These positive symptoms generally respond well to medications.
In addition to all this, schizophrenics think and speak differently than the common populace would. They switch between ideas and lose track of speech mid-way and often speak in fragmented and haphazardly joined sentences. They are, in fact, unable to fix their attention on anything in particular.
Examples of the most common negative symptoms include:
- The flat effect: The individual basically shows no facial expression and always has a flat emotionless mask on. At times, they exhibit inappropriate reactions to situations. Examples include them laughing at somebody’s death or getting angry when something good happens.
- Avolition: The condition is marked by the individual just sitting for hours doing nothing as well as behaving in a way as if they have no form of will or motivation whatsoever.
- Alogia: In this, the individual normally has little or nothing to say.
Note: For a person to be diagnosed with Schizophrenia, he/she should exhibit a minimum of two or more of the above mentioned symptoms over a prolonged span of time (at least a month).
The treatment of Schizophrenia is generally carried out throughout the course of a lifetime, even if the symptoms have ceased. Evidently, Schizophrenia cannot necessarily be cured. Being a degenerative disease, there is very little that a person can do to address the issue. The condition can be generally managed or controlled using psychological therapy and medications. If the condition has worsened to an extent of a crisis situation, hospitalization would be necessary to provide and ensure adequate nutrition, safety, basic hygiene as well as proper sleep.
An experienced psychiatrist would be needed to administer the treatment. The team should also include a social worker, a psychologist as well as a psychiatrist in case of any medical emergency that may arise. Some of the treatment methods are discussed below:
- Medication: Although medicines are the main forms of treatment for schizophrenia, they are also capable of inducing rare but serious side effects. Due to this reason, people diagnosed with schizophrenia are often reluctant to use them.
Psychiatrists commonly prescribe antipsychotic drugs for the treatment of schizophrenia. These medications affect the two brain neurotransmitters,‘serotonin’ and ‘dopamine’, which enables them to control the symptoms of the disease. Additionally, the choice of medication is also determined by the willingness of the patient to cooperate. For example, a person who consistently refuses to take medications in the form of pills may need to be administered medications with the help of injections.
The different categories of medications used for treatment of schizophrenia are:
Typical / Conventional antipsychotics: These are first-generation medicines which are frequently used to treat schizophrenia. However, these medications tend to cause a considerable amount of side effects which can be neurological (having an effect on the nervous system) in nature. An example of such a side effect would be the possibility of the development of a movement disorder, wherein the condition may be reversible or irreversible. The category of medications include:
These conventional forms of medicine generally cost lesser than their modern counterparts (discussed later). This plays an important role if the necessity for long term treatment arises.
An improvement in symptoms can only be noticed after a while, maybe even several weeks. The ultimate goal of treatment using antipsychotic medications would be to adequately control symptoms and signs while utilizing the lowest medical dosages possible. In order to attain the desirable results, the psychiatrist might utilize different dosages, different medications or even a combination of both. Other medications such as anti-anxiety medicines or antidepressants may also help.
Atypical antipsychotics: This is a newer and second-generation category of medications and generally preferred over conventional medicines because the risks that they pose, as far as serious side effects are concerned, are considerably low. Examples of these atypical antipsychotics include:
- Training in Social Skills: Improves social interactions and communications
- Individual Therapy: Helps the person manage the illness by helping them cope with stress as well as helping them identify the possible signs of relapse
- Family Therapy: Provides education and support to the family of a person diagnosed with schizophrenia
- Supported employment and vocational rehabilitation: Helps people having been diagnosed with schizophrenia in the preparation for a job as well as finding and sustaining future employment
Though Schizophrenia cannot be fully cured, with the right therapy, medications and support, an individual diagnosed with this condition can live a fulfilling life and independently function in society.
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