Schizophrenia

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Overview

Schizophrenia is a group of mental disorders in which reality is interpreted abnormally. Schizophrenia is characterized by hallucinations, delusions, disordered thinking and behavior. People with schizophrenia are isolated from other people and activities around them, retreating into an inner world marked by psychosis.
Contrary to popular belief, schizophrenia is not the same as split personality or multiple personality. While the word “schizophrenia” means “mind-split”, it refers to a disturbance of the emotional balance and thinking.
Schizophrenia is a chronic disease requiring lifelong treatment. But thanks to new medications, schizophrenia symptoms can be relieved, allowing the patient to have a productive and enjoyable life.
 


Signs and symptoms:

There are several types of schizophrenia, so that signs and symptoms vary.
Generally, these symptoms include:
- Beliefs that are not based on reality (delusions), such as patient belief that someone is plotting against him
- Auditory or visual hallucinations (the patient hears and sees things that do not exist), most common are the auditory hallucinations
- Incoherent speech
- Neglect of personal hygiene
- Lack of emotions
- Emotions that do not fit the context
- Aggressive manifestations
- Catatonic behavior
- A persistent feeling that the patient is being followed
- Operational problems at school or work
- Social isolation
- Clumsiness, uncoordinated movements.
Schizophrenia ranges from mild to severe. Some patients may be able to function well in everyday life, while others need intensive care, specialized. In some cases, schizophrenia symptoms seem to appear suddenly. In other cases the symptoms develop gradually over several months, and may not be observed from the beginning.
In time, it becomes difficult for the patient to function well. The person will be unable to attend school or work. Relational problems may occur, partly due to difficulties in decoding correctly the messages or emotions of others. He may lose interest in activities that previously enjoyed. May become anxious or agitated or fall into a trance-like state and not respond to others.
In addition to general symptoms, they are divided into three categories to facilitate diagnosis and treatment.
 
Negative symptoms and signs
This represents a loss or reduction in emotional and behavioral skills:
- Loss of interest in daily activities
- Affective flattening
- Reducing the ability to plan and carry through activities
- Neglect of hygiene
- Social isolation
- Lack of motivation.
Positive symptoms and signs
These are thoughts and perceptions distorted, showing lack of contact with reality. They may include:
- Hallucinations, or feeling things that are not real, in schizophrenia hearing voices is a common hallucination; these voices may seem to give instructions to the pacient on how to behave, and sometimes may include harming others
- Delusions, or beliefs that are not based in reality; for example, the patient may believe that the TV directs his behavior or external forces are controlling his thoughts
- Disorders of thinking, or difficulty speaking and organizing thoughts, such as stopping in mid sentence or utterance spoken in nonsense words, known as “word salad”
- Movement disorders such as repetitive movements, clumsiness or involuntary movements.
 
Signs and symptoms of cognitive
These include problems with memory and attention. They can be most debilitating in schizophrenia, because they interfere with the ability to accomplish daily activities. It includes:
- Problems in understanding the meaning of information
- Difficulty in maintaining attention
- Memory problems.

Causes

The causes of schizophrenia are unknown. However, studies show that there is an interaction of genetic and environmental factors that cause schizophrenia. Disorders of certain neurotransmitters such as dopamine and glutamate, may also contribute to the development of schizophrenia. While researchers are not sure of the significance of these changes they are evidence that schizophrenia is a brain disease.

Risk Factors

Schizophrenia affects 1% of the population. In the case of people who have a close relative with schizophrenia, the disease is more common – about 10%. In men, schizophrenia symptoms typically appear in adolescence or young adult. In women, this occurs after 20 years or 30 years.
Although the precise cause of schizophrenia is unknown, certain factors were identified that appear to increase risk of developing or triggering the disease:
- Family history of schizophrenia
- Exposure to viruses in the womb
- Malnutrition in the womb
- Stressful life circumstances
- Increased parental age
- Use of psychoactive drugs in adolescence.

Consult a specialist

You should see the specialist as early in the event of symptoms of schizophrenia. This condition does not improve by itself, on the contrary, in time, they get worse without treatment. However, there are people who experience these symptoms, but do not recognize as they have or need help. Family and friends or work colleagues or school can be the first to suggest that the patient needs help.

Consultation for treatment of a specialist experienced in treating schizophrenia may help the patient learn new ways to cope with symptoms and thus increase the chances of having a productive and happy life. If the patient does not want professional help, it’s good to try to find a reliable person to open up to, whether it is a friend or relative, a doctor, a priest or other person the patient has trust. They can help the patient make the first step toward successful treatment.
 
How to help a person who may have schizophrenia

When a close person show symptoms of schizophrenia, it is good for family and friends to wear an open and honest discussion about these concerns. Many people with schizophrenia do not think they need help because to them, delusions and hallucinations are real. Nobody can be forced to seek professional help, but the closest we can do is encourage, support and help to find a qualified doctor.
If the patient endangers himself or others, tutors should call the police or seek urgent help. In some cases you may need emergency hospitalization.
 
Thoughts of suicide

Suicidal ideation and suicidal behavior are common in patients with schizophrenia. If this occurs, it is recommended that the patient:
- Contact a friend or family member
- Contact the medical staff
- Contact the priest or another person in the religious community
- Go to the emergency room of the nearest hospital
- Call Emergencies for help.

Diagnosis

For diagnosis, the doctor who suspects that a patient has schizophrenia will undertake a full medical and psychological tests. Therefore they can remove the other medical conditions that can have the same symptoms, and can diagnose and check if there are complications.
These general exams and tests include:
- Physical exam: may include measuring height and weight, checking vital signs such as pulse, blood pressure and temperature, listening to the lungs and heart and abdominal examination
- Laboratory tests: they include a complete blood count, screening tests for alcohol or drugs, imaging tests such as MRI or CT
- Psychological evaluation: the doctor will talk to the pacient about his way of thinking, feeling and behaving. Will ask about delusions or hallucinations and will check for signs of psychosis. The patient may be asked to fill out psychological self-assessment questionnaire. He will be asked about drug and alcohol abuse. And, with the patient’s approval, family members and close friends may be asked to provide information about the patient’s symptoms.

Diagnostic criteria for schizophrenia
To be diagnosed with schizophrenia, a patient must meet certain criteria in the diagnostic manual.

Diagnostic criteria for schizophrenia are:
- Presence of at least two of the following: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or the presence of the negative symptoms
- Significant dysfunction in the ability to work, attend school or perform daily tasks
- These signs are present for at least six months
- There are other mental disorders.

The patient may be diagnosed with one of the five types of schizophrenia, although not all patients fit a specific category. These five subtypes are:
- paranoid
- catatonic
- disorganized
- undifferentiated
- residual.
The patient can talk to the doctor about the type of schizophrenia that he is diagnosed with to learn more about the disease and about treatment solutions.


Complications

Left untreated, schizophrenia can cause severe emotional problems, behaviorial and health, and even legal and financial problems that can affect all areas of life. Complications that schizophrenia may cause or be associated with are:
- suicide
- Self-destructive behavior such as self-mutilation
- depression
- Abuse of alcohol, drugs or prescription drugs
- poverty
- Lack of housing
- Family conflict
- Inability to work or attend school
- Medical problems caused by antipsychotic drugs
- The patient may be the victim or the creator of criminal acts
- Heart disease, often linked to heavy smoking.

Treatment

Schizophrenia is a chronic disease that requires treatment throughout their lives, even if the patient feels better and the symptoms are not obvious. Treatment with medications and psychosocial therapy can help patients keep their disease under control and become active and informed in their own care. In times of crisis or those with severe symptoms, hospitalization may be necessary for patient safety and for him to enjoy food, sleep and proper hygienic conditions.
Usually, the treatment of schizophrenia is led by a psychiatrist experienced in treating this condition. But the team can be therapeutic and other professionals: psychologist, social worker, psychiatric nurse, because the disorder can affect many areas of life. Perhaps there is also a case manager, who will ensure that patients get the best treatment and his care is well coordinated within the team.
Medications

Drug treatment is the most important in schizophrenia. Because this medication may have rare but serious side effects, the patient may be reluctant to take. It is important to discuss these things with the psychiatrist to find treatment that is accepted by the patient, with fewer side effects.
Antipsychotic medication is most commonly prescribed to treat schizophrenia. It can control symptoms through effects on brain’s neurotransmitters dopamine and serotonin. There are two main types of antipsychotic medications:

Conventional or typical antipsychotics: These medicines are traditionally effective to control the positive symptoms of schizophrenia. They have common neurological side effects and potentially serious complications, including tardive dyskinesia and parkinsonian symptoms. This group of drugs includes:
- Haloperidol
- Thioridazine
- Fluphenazina
These are often cheaper typical antipsychotics, especially generic versions, which is especially important if long-term treatment is necessary.

New generation antipsychotics, called atypical antipsychotics. These newer antipsychotics are effective in both negative symptoms and positive ones. This group includes:
- Clozapine
- Risperidone
- Olanzapine
- Quetiapine
- Ziprasidone
- Aripiprazole
- Paliperidone.

Risperidone is the only drug approved to treat schizophrenia in children aged between 13 and 17 years. Atypical antipsychotics may have metabolic side effects such as weight gain, diabetes and cholesterol level.
Choice of drug depends on each patient. It may take several weeks from the introduction of medication to notice an improvement in symptoms. In general, treatment with antipsychotic medications is to effectively control the signs and symptoms with the lowest dose possible. It can be very helpful other drugs too, such as antidepressants and antianxiety drugs.

If the drug is not effective for the patient or intolerable side effects occur, the doctor may recommend a combination of drugs, change to another drug or dosage adjustment. It is recommended that patients not stop taking treatment without talking to the doctor, even if feeling better. If the patient suddenly stops taking medication, may occur the relapse of psychotic symptoms. In addition, antipsychotic medication should be decreased gradually and not stopped abruptly, to prevent withdrawal symptoms.
Be sure to know that any antipsychotic side effects and can be a health risk. Some antipsychotic medications, for instance, may increase the risk of diabetes, weight gain, high cholesterol and hypertension. Clozapine can cause a dangerous decrease of white blood cells. Some antipsychotics can cause serious health problems in older people and should be avoided.
Patients should talk to the doctor about all possible side effects and be monitored for all diseases that may occur while taking medication. Also, antipsychotic medications may have dangerous interactions with other substances. Your doctor should know about all medications and substances you take, including vitamins, minerals or herbal supplements.

Psychosocial treatment

Although medication is the treatment of schizophrenia, psychotherapy and other psychosocial therapies are also important.

These treatments may include:
 
Individual therapy
Therapy led by an experienced professional can help the patient cope better with everyday problems caused by schizophrenia. Therapy can help to improve communication skills, relationships, ability to work and motivation to continue treatment. Learning about schizophrenia can understand it better and understand how important it is to take medication. Also, it can help them cope with the stigma related to having schizophrenia.
Family therapy
The patient and his family can benefit from therapy that provides support and education to families. Symptoms have a greater chance of improvement if family members understand the illness, can recognize stressful situations that can lead to disease relapse and may help patients not to abandon the treatment plan. Also, family therapy can help the patient and family to communicate better and understand family conflicts.
Rehabilitation
Learning social and vocational skills to live independently is an important part in the treatment of schizophrenia. With the therapist, the patient can learn different skills such as maintaining hygiene, cooking and efficient communication. Today, few patients with schizophrenia require long-term hospitalization because of the effective treatments available.
 
Treatment’s problems

If the patient has an appropriate treatment plan and respects the plan he has a good chance to lead a productive life and to function well in daily activities. But sometimes may appear problems that interfere with the treatment.
For example, it is difficult for patients with schizophrenia to stick with your treatment plan. They may come to believe they do not need medication or other treatment. On the other hand, if they can’t think clearly, can forget to take take the treatment or go to therapy sessions. Regarding medication, there are formulations with prolonged administration, as a shot. Even with good treatment, the patient may have a relapse, so it’s better to have an action plan in case this happens.

Many patients with schizophrenia smoke, often heavily. Patients who smoke needs a higher dose of antipsychotic because nicotine interferes with antipsychotics, decreasing their effect.
Similarly, use of alcohol and drugs can make schizophrenia symptoms worse. A patient who has problems with alcohol or substance abuse, may have greater benefit if integrated into a program that treats both schizophrenia and alcohol and drug abuse.

Prevention

There is no sure way to prevent schizophrenia. However, early treatment can help control symptoms before the occurrence of serious complications and may help improve long term prognosis. Following the treatment plan can help prevent relapses or worsening symptoms of schizophrenia. Scientists hope that learning more about risk factors for schizophrenia, the disease can be diagnosed and treated early.
For people at high risk of schizophrenia, the result of active steps such as avoiding illicit drug use, reducing stress, getting enough sleep and the introduction of antipsychotic treatment as early as necessary, can help minimize symptoms and prevent them getting worse.

Lifestyle and home remedies

Schizophrenia is a disease that is treatable at home. But you can do several things to help treat:
- Correct administration of medication. Even if the patient feels better, it is recommended to resist the temptation of not taking the drugs. If you stop to take them, most likely schizophrenia symptoms will return.
- Pay attention to warning signals. Patient and doctor and should identify the factors leading to the onset of schizophrenia symptoms, cause a relapse or prevent the patient to carry out daily activities. It’s good for the patient to make a plan to know what to do if symptoms return, to contact their doctor or therapist if they notice any change in symptoms or in how they feel. It may involve family members and friends to observe warning signs.
- Avoid drugs and alcohol. Alcohol and illicit drugs can worsen schizophrenia symptoms and interfere with the treatment’s efficacy.
- Consult physician before taking other medications. We recommend consulting the physician before taking medications prescribed by another physician or non-prescription or dietary supplements such as vitamins, minerals or herbal supplements. They can interfere with antipsychotic medication.

Psychological support

Coping with serious illness such as schizophrenia can be challenging. Medications can have unwanted side effects, the pacient may feel angry because he has a condition that requires lifelong treatment. At times he feels better, and may be tempted to stop treatment, which can trigger a relapse.
Here are some ways to cope with schizophrenia:
- Education: learning as much about the condition can help the patient to be motivated to follow treatment plan
- Support group: support groups can help patients with schizophrenia to meet people that face the same problems
- Maintaining attention on the goals of therapy: recovery from schizophrenia is an ongoing process, maintaining motivation can be done by remembering therapy goals
- Finding healthy hobbies: finding a healthy way to channel their energy and can be useful in patients with schizophrenia
- Learning relaxation techniques: the patient can try stress reduction techniques such as meditation, yoga or tai chi
- Structuring time: it is recommended that patients plan their day and activities. This way they can stay organized. For this purpose, he can try to make a list of daily activities.
 
Living with schizophrenia

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