Schizophrenia: definition, causes, course and treatment

Much has been written and spoken about schizophrenia, but the reality is that deep down is the great unknown, or rather, those who suffer from it are. We could give many bibliographical reviews, but with this article I intend an approach and global vision of this disease, so I do not want to extend too much in technical questions that we can find in any manual of psychopathology. Keep reading this Psychology-Online article if you want to know more about Schizophrenia: definition, causes, course and treatment.

Index

1. Definition of the disease
2. Positive symptoms
3. Negative symptoms
4. Types of schizophrenia
5. Course of the disease
6. Vulnerability-stress model and treatments

People who have a mental illness have their affective tone, their behavior and the way they communicate with other people affected. We are more prepared to accept and understand the case of physical illness. Other elements that tend to be confusing are that these disorders do not have a known or easily recognized cause or causes, they vary from one person to another and their treatment is also confusing.

Mental health and mental illness depend on our lifestyle, of the quality of the affective relationships that we have, of our capacity to love and accept others, to give trust and support, and to receive them, of our tolerance.

East set of values, attitudes and skills They can admit a variety of definitions, there are no absolute parameters and each culture and each human group and each family and individual elaborates its own.

Anyone who behaves and acts like the majority of women could be considered psychically normal. people around him, if someone does not behave like most people, he is said to be sick. From a medical perspective, a mental disorder would be that maladaptive behavior that does not lead to any concrete result, that departs from reality. From the social point of view, a mentally ill person would not adjust to his environment.

The term schizophrenia was introduced by the Swiss psychiatrist Bleuler in 1911. But this disorder was already identified by the German psychiatrist Kraepelin in 1896 under the name of "precocious dementia", meaning that affected people necessarily suffer serious cognitive and behavioral impairments, It is similar to the dementias experienced by some elderly people, but in this case it would occur at a youthful age.

However Bleuler observed that it was not like that in all cases and he considered it more appropriate to give the name of schizophrenia as a split in the association of ideas or as a withdrawal from reality and social life. The term schizophrenia itself means "split mind."

The age of onset is between 15 and 45 years old, Although they usually begin at the end of adolescence, there are also cases of onset in childhood, which are often masked by school problems or bad behavior.

Who suffers from schizophrenia experiences a distortion of thoughts and feelings. What characterizes schizophrenia is that it affects the person in a total way, so that whoever suffers it begins to feel, think and speak differently than they did before. This person may start to be more isolated, may avoid going out with friends, sleep too little or too much, talk to yourself or laugh for no apparent reason (although these symptoms do not have to appear in all patients.)

It is very important not to forget that the person who has schizophrenia cannot explain what is happening to him, you are afraid to do it or to believe that you are sick and therefore will not ask for help or complain in most cases about what is happening to you. For all this most of them and especially at the beginning of the disease they do not accept to take medication or go to the specialist.

Symptoms are those manifestations of the subject that announce an anomaly or disease. Pain, inflammation, changes in biological rhythms would be symptoms. The problem with schizophrenia is that most of the symptoms are subjective, they depend on what the patient refers to. There are two types of symptoms in schizophrenia:

Positive symptoms: are those manifestations that the patient does or experiences and that healthy people do not usually present.

Negative symptoms: are those things that the patient stops doing and that healthy individuals can perform on a daily basis, such as thinking fluently and logically, experiencing feelings towards other people, having the will to get up every day.

Hallucinations: they are delusions of the senses, inner perceptions that occur without an external stimulus. He is not in a position to recognize that what is perceived arises only from his inner experiences and does not is present in the external world., They can be auditory, tactile, visual, taste and olfactory.

Delirium: it is an erroneous conviction of pathological origin that manifests itself despite contrary and sensible reasons. The scope with reality is restricted. The patient sees delirium as the only valid reality. Although the thoughts themselves are contrary to the laws of logic, the patient is inaccessible to this objection. When this state is noticed, sometimes it is not necessary to think about the initiation of a treatment or the hospitalization, since the hopelessness that it can produce in the patient leads to attempts suicidal. types: persecution, guilt, greatness, religious, somatic, reference ...

Thought disorders: the manner of speaking often gives us significant clues about disturbed thinking. They often report that they have lost control over their thoughts, that they have been withdrawn, imposed or directed by strange powers or forces related to language we have: derailment, tangentiality, illogicality, pressure of speech, distractibility ...

In psychotic crises, these symptoms described above may be accompanied by:

Positive symptoms in the area of ​​feelings: distress, excitability

Positive vegetative symptoms: insomnia, palpitations, sweats, dizziness, gastrointestinal disorders, respiratory disorders

Positive symptoms of motor skills: aggressive and / or agitated behavior, body restlessness, strange and absurd movements, repetitive behavior.

In schizophrenia there are also another series of symptoms, less alarming but that are often mistaken as signs of laziness or bad behavior, they are the so-called symptoms negative symptoms such as apathy, lack of energy, lack of pleasure, unsociability, etc., which should be treated in the same way as active symptoms or positive.

All these symptoms affect all areas: social, work, family. In some aspects, the schizophrenic patient has less capacity for action than a healthy person. We call these deficiencies negative symptoms.

These symptoms can be seen before hallucinations and delusions appear, but in their clearest form they manifest only after the disappearance of positive symptoms. We would talk about the residual phase of the disease.

It should be emphasized that not all people with schizophrenia have these impairments or symptoms. About a third of patients do not have it at all or in such a slight way that it hardly bothers them in daily life.

Affective poverty:It manifests as an impoverishment of the expression of emotions and feelings, diminishes the emotional capacity; It manifests itself in aspects of behavior such as: Immutable facial expression: the face seems frozen, wooden, mechanical., Movements diminished spontaneous movements and lack of expressive gestures: he does not use his hands to express himself, he remains immobile and seated..., Scarce eye contact: can avoid looking at others, remains with a lost gaze, Affective inconsistency: the affection expressed is inappropriate. Smile when talking about serious topics. Silly laughter, Absence of vocal inflections: Speech has a monotonous quality and important words are not emphasized by changes in tone of voice or volume.

Praise: It refers to the impoverishment of thought and cognition. It is manifested through: Poverty of language: restriction of the amount of spontaneous language, the answers are brief and there is rarely additional information. Poor language content: although the answers are long, the content is poor. Language is vague, repetitive and stereotyped, blocking: interruption of language before a thought or idea has been completed. After a period of silence that may last a few seconds, you cannot remember what you were saying or what I mean, Increased Response Latency: the patient takes longer than normal to respond to the question.

Abulia - Apathy:Apathy manifests itself as a lack of energy, of drive. Apathy is lack of interest. Unlike the lack of energy in depression, in schizophrenia it is relatively chronic and is usually not accompanied by sad affectivity. manifests itself in: Problems with toilet and hygiene, Lack of persistence at work, school or any other task, Feeling of tiredness, sluggishness, Propensity to physical exhaustion and mental.

Anhedonia - unsociability:Anhedonia is the difficulty in experiencing interest or pleasure in things that you used to like to do or in activities normally considered pleasant: has few or no hobbies, they tend to show a decrease in sexual activity and interest depending on what would be normal according to the age and state of the himself, may show inability to create close and intimate relationships appropriate to his age, sex and family status, relationships with friends and peers restricted. They make little or no effort to develop such relationships.

Cognitive attention problems:Problems in concentration and attention, Is only able to concentrate sporadically, Is distracted in the middle of an activity or conversation: it manifests itself in social situations; His gaze fades, he does not follow the plot of a conversation, he is not very interested in the topic; Abruptly ends an apparent discussion or task.

We have pointed out the individual character of the picture of the disease, for this reason the subordination to one of the different types of the pathology often means a simplification. In addition, there are often mixed tables, which can be difficult to classify. It is also observed many times that the picture of the disease varies over time.

• Paranoid schizophrenia: it is characterized by the predominance of delusions and hallucinations, especially auditory ones. Delusions and hallucinations sometimes constitute a unit. It is the most frequent, it usually begins between the ages of 20 and 30 and it is the one that evolves the best despite the spectacular nature of the picture.
• Catatonic schizophrenia: movement disorder or motor movements predominate. Experts speak of "catatonic stupor." Despite having an awakened conscience, the patient does not react to attempts to come into contact with him. His face remains immobile and expressionless, no inner movement is perceived, and even strong pain stimuli may not elicit any reaction. In the most severe cases, they may not speak, eat, or drink for periods long enough to endanger their lives. However, inside the patient there can be true storms of feelings, which often only manifest themselves in a rapid pulse. There are also constant repetitions of the same movement (automatisms) and grimaces. Extremely serious pictures, in which the patient, for example, stands on one leg for a few weeks, it is only seen very rarely thanks to the current treatment. They only occur when no one cares for the sick or when treatment is not effective. The prognosis for this type of schizophrenia is usually poor.
• Disorganized or hebephrenic schizophrenia: an absurd, inappropriate affection predominates (they tend to laugh when bad news is given to them, behaviors are usually childish, the mood is absurd, there is disinhibition in the feelings. They tend to have strange behaviors, such as laughing for no apparent reason and making faces. They often show a lack of interest and participation. There are cases in which hallucinations and delusions are manifested, although this is not an equanimous condition in this type of schizophrenia, most of the cases the outbreaks are not clearly delimitable. It usually begins at an early age such as puberty, which is why they are called juvenile schizophrenias and there are even cases in which the disease comes from childhood (infantile psychosis). Slow and unnoticed hepatic development due to few symptoms are classified as simple schizophrenia. Due to the absence of symptoms, it is difficult to recognize it (the signs are usually personal carelessness, solitary behaviors ...). The prognosis is usually unfavorable compared to the other schizophrenias, due to the immature personality of the patient.
• Undifferentiated schizophrenia: It is a type of schizophrenia in which a specific symptom does not predominate for the diagnosis, it is like the mixture of the previous ones.
• Residual schizophrenia: in these cases there must have been at least one episode of schizophrenia previously, but at the present time there are no significant psychotic symptoms. It is the phase in which the negative symptoms are most evident. It does not appear in all patients.

When symptoms of schizophrenia appear for the first time in a person's life and disappear completely afterwards in a short time, there is talk of a schizophrenic or psychotic episode, in general after these episodes there are no symptoms negatives.

We can speak of a schizophrenia when the manifestations of the disease are maintained for a period of time the first time it occurs. more or less long time, when symptoms reappear after some time and when the disease leads to symptoms negative. Three phases can be distinguished:

1st prodromal phase: It is the phase in the life of the person that occurs before the onset of the disease. It can be seen that some people who suffer from the disease had already been different in childhood and youth, lonely, quiet, poor performance. But it does not necessarily have to be this way, there are cases in which no abnormality is detected in the person suffering from schizophrenia. The prodromal phase is called the phase that occurs before a crisis, therefore there are a series of symptoms that can help us in some cases have to detect them: tension and nervousness, loss of appetite or disorganization in meals, difficulty concentrating, difficulty sleeping, enjoys things less, does not remember accurately, depression and sadness, preoccupied with one or two things, sees his friends less, thinks he is laugh or speak ill of him, loss of interest in things, feels bad for no clear reason, feels very agitated or excited, feels useless, others changes...

2nd active phase: It is the phase where the disease is triggered, they are called outbreaks or crises, the symptoms that occur are positive, hallucinations, delusions, thought disorders... It is in the phase in which the family becomes alarmed and usually asks for medical help. These crises can flare up suddenly and develop the whole picture in a few days. In other cases, the onset of the disease can occur very slowly and unnoticed. The duration of outbreaks varies from person to person and can range from a few weeks to a year. The same patient usually has outbreaks of similar duration. The same occurs with the intervals between outbreaks, depending on the characteristics of the person it can range from months to several years and are generally of the same duration in the same person.

3rd residual phase: not all patients suffer from it, in this phase the negative symptoms reach their culmination and the personal, social and work deterioration is serious.

Three-thirds theory: 1/3 recover, 1/3 continue to have certain limitations after an outbreak, 1/3 severe course of disease and cannot live autonomously.

Causes of schizophrenia:It is logical that intensive research has been carried out on such a serious and conspicuous disease as schizophrenia. The investigations have obtained important partial results, which are situated in very diverse fields. That is why we can say with enough security that there is no cause for some people to suffer from this disease, but that responsibility must be attributed to a whole set of causes.

There is supposed to be a special psychic vulnerability so that schizophrenia can occur. The first responsibility is due to certain hereditary conditions. Schizophrenias are known to be common in some families, while in others they are not. Due to this predisposition a person may be vulnerable to suffering from the disease but this it is not a fair condition to develop it. As a trigger for the disease, a special emotional charge (stress) must be added. The pathological symptoms of schizophrenia must be understood as an attempt to escape in some way from this excessive burden.

What are these charges? They may be stressful life events, usually unpredictable, such as the death of a close person, military service, the loss of a job... also a happy event, such as the birth of a child, a wedding, that is, situations that involve a change in life. Above all, a permanent emotional burden can mean an excessive demand for a vulnerable person: excessively worried attitude of the family or partner inhibits the person and reduces their autonomy, there are cases in which the person who suffers from schizophrenia is, by itself, more withdrawn, due to this they cause others to want help you.

Another attitude would be when family members have an attitude of disguised rejection, that is, no talk about the problem but it manifests itself in expressions and attitudes, the affected person criticizes and devalues. Excessive emotional charges trigger the first outbreaks, but later outbreaks are also caused by stressful situations, even if they are lightly charged.

It is necessary to mention the existence of other medical models such as: the genetic model, neurochemistry, alterations cerebral, functional, electrophysiological and neuropsychological alterations, complications in childbirth, infections by virus.

At the moment, none of these possible causes have been proven definitive and research is continuing to confirm them.

Treatment

The treatment of schizophrenia is mainly based on drugs called antipsychotics, which control active symptoms, but it is necessary and at the same time complementary that the patient receives psychosocial treatment (psychological, occupational and social), it is essential that the person stops hallucinating, delirious, but It is also important for him to regain his life habits, to be busy throughout the day, to have his group of friends, that is, integration into society, standardization.

Antipsychotic medication

The pharmacological treatment of schizophrenia is carried out using drugs called at the beginning neuroleptics (nl) for their cataleptic effects and more modernly there is a certain consensus in calling them antipsychotics (ap).

Since the introduction of the antipsychotic chlorpromazine in 1954, psychotropic medications have become the mainstay of treatment for schizophrenia and other psychiatric illnesses. Numerous studies have documented the efficacy of antipsychotics in treating schizophrenia and lithium and antidepressants in treating affective disorders. Antipsychotics or neuroleptics have shown their efficacy both in the acute treatment of psychotic symptoms and at the level of relapses.

Antipsychotics are also called neuroleptics. They were discovered in the early 1950s. They are especially helpful for the characteristic symptoms of schizophrenia. They come from five chemical families but all offer the same therapeutic effects. There is no difference in efficacy between one type of antipsychotic versus another. Only thanks to pharmacological treatments have the possibilities of rehabilitation and a quick return to the social environment.

Schizophrenia is accompanied by an alteration of brain metabolism, it is an excessive functioning of dopamine. Antipsychotics block the excessive effect of dopamine and restore balance in brain metabolism. However, neuroleptics also modify other brain metabolic areas, of which result, in addition to the desired effects, unfortunately also side or side effects undesirable.

The effect of AP is described as reassuring for cases of motor restlessness, aggressive behaviors and internal tensions. Hallucinations, delusions, and schizophrenic perceptual disorders virtually disappear with drugs. When disease flare-ups recur, permanent neuroleptic treatment offers significant and relatively safe protection against relapses to acute attacks.

Two large groups of aps are distinguished: the so-called classic or typical that are characterized by blocking dopamine d2 receptors, are very effective in positive symptoms, but they cause quite a few side effects and the atypical ones that act on serotonergic receptors, producing fewer side effects and being more effective in the symptoms negatives.

An important innovation is depot or injectable neuroleptics, which are injected into the buttock and act over many days. Its advantage lies in the fact of guaranteeing the release of the substance, possibility of reducing the dose to be administered, level of predictable and consistent plasma drug and patients with absorption difficulties can be treated with medication oral.

In the same way that those affected can react in each case very differently to life situations, reactions to neuroleptics also vary greatly. Patients respond to treatment in many different ways, and sometimes milder or stronger side effects can occur.

We distinguish between side effects that appear in the first phase of treatment with neuroleptics and the side effects of these in cases of long-term medication. Most of the side effects appear in the first weeks of treatment. Particular mention should be made of fatigue, dry mouth, dizziness and lightheadedness, visual and circulatory disorders, constipation and difficulties urinating.

Some other side effects can last longer or even start later. All side effects are described in the instructional papers included in the medication packages. Often, these descriptions cause deep insecurity to those affected and their families, so it is very important to give them accurate information.

Other side effects that may appear are: muscle spasms, Parkinson's syndrome produced by medication, Akathisia, tardive dyskinesias, the Neuroleptics increase sensitivity to sunlight, Weight gain, Limitations in the sexual sphere: loss of excitability belongs to them normal. But some medications can also cause the opposite, that is, constant arousal. For women, it is especially important to bear in mind that taking neuroleptics leads to menstruation irregularities or even amenorrhea.

It should be mentioned that there are counteractives to address the side effects, in addition to drug therapy, for the treatment of Schizophrenia is not based solely on antipsychotics, these are usually accompanied by antidepressants, anxiolytics, humor.

Psychosocial Rehabilitation

Psychopharmacological treatment is essential in the treatment of schizophrenia and other psychoses, but it is necessary a good therapeutic support for the good evolution of the disease, this support is psychosocial rehabilitation. To give an example, I comment that it is useless for the patient to take his treatment if her only activity is to be in bed all day, or that have prescribed a medication and due to lack of awareness of the disease and control, do not take it, these are some examples of the many that We see what we work on in the rehabilitation of these patients who have a diagnosis and do not know what is happening to them and why their life cannot be the same than before.

Having a psychotic disorder cannot be the obstacle that prevents the development of valuable social roles, such as work or at least one occupation, housing, interpersonal and affective relationships, social consideration and use of resources community. Rehabilitation is understood today as proportion of the help that the person requires for psychosocial performance.

Psychosocial rehabilitation centers are framed within the community model, they work with the patient in their family context and not in an institution.

It will try to reduce or eliminate the deficit or deterioration in the different areas that prevent a normal integration of the patient in their environment, training the skills that allow greater autonomy and social integration, improving the quality of life of the patient and their social environment and family.

For each patient a different individualized rehabilitation plan is carried out depending on their illness, condition, deterioration, problem behaviors and social and work situation.

the following areas are worked on:

Psychoeducation of the patient and the family

Provide updated and understandable information about mental illness, teaching to discriminate the symptoms, prodrómos, importance of antipsychotic medication, becoming aware of disease, accepting it and learning to live with her.

Social skills

Work through group activities that are rewarding and educational techniques for social interaction. its progressive staging goes from the configuration of small groups to play or perform cooperative tasks to training in specific social skills, such as asking for favors, accepting criticism, skills conversational ...

Education for health

Promote health as an asset that can be actively obtained. It works through modules, which are: Sexuality, diet, sleep, anxiety prevention, self-esteem and self-image, cognitive abilities.

Orientation and tutorial

Guide and advise on any doubt, problem that the user presents and cannot be dealt with from the programs developed in the group setting, evaluate the achievement of the previously set objectives for Username.

Daily life activities

The intervention refers to provoking the acquisition and maintenance of a wide range of skills necessary to daily life, this is done through programs such as personal care, household activities, and counseling cultural

Personal development

Development of the patient in his community environment: carry out procedures of daily life, favor their orientation to the social, cultural, sports, political reality, teach resources to to look for a job.

Sport activities

Physically stimulate the user through sports techniques while working on coordination, group work, grooming and hygiene techniques.

Other areas

Socio-economic and health benefits, job training, residential alternatives, use of free time, education of the affected person, occupation and support.

As I mentioned at the beginning, all the points presented here would need more words and time to fully develop, but I think that with What has been said here we can make a general scheme of this disease that unfortunately and despite all the scientific advances made, marks and it changes the lives of many people who suffer it, because they suffer it or because their son, wife, father or mother began one day to listen voices.

This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

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