What is schizophrenia?
Symptoms of schizophrenia include :
Delusions,
Disordered thoughts and
Hallucinations.
Schizophrenia is a major mental illness that causes changes in perception, thoughts and behaviour. It is a complex condition that defies simple description, but a distinction can be made between two broad types: acute schizophrenia and chronic schizophrenia.
Acute schizophrenia
This is the form that probably most comes to mind when people think of schizophrenia. Acute schizophrenia is when a previously healthy person, generally a young adult, shows increasingly odd behaviour over a fairly short period of time of perhaps a few weeks. It can take the form of hallucinations, irrational beliefs or disordered thoughts, ie illogical or incoherent thinking of any degree of severity.
'Positive' symptoms
Ø Positive psychotic syimptoms include hallucination, delucions, and bizarre behavior. Hallucinations are typically auditory ( the patient hears voice and commonly converses with a biliefe that one’s thoughts and actions are being controlled by some outside agency. Bizarre behavior may include physical aggression in response to the hallucinations or delucions. The positive symptoms are believed to originate in the temporal lobe. Although positive symptoms may cause great alarm, they are much more responsive to treatment than the negative ones.
The most common symptoms of acute schizophrenia are:
· lack of insight
· auditory hallucinations (hearing sounds, voices or music)
· delusions of persecution
· suspiciousness
· flat mood
· thoughts spoken aloud.
These symptoms are called the positive symptoms of schizophrenia. Not all patients with acute schizophrenia experience all of these symptoms. Mood disturbance often accompanies acute schizophrenia and can be of any type, such as depression, anxiety, irritability or euphoria. Emotional responses are often inappropriate for their surroundings - for example, laughing at sad news or appearing unconcerned by important events.Generally, a schizophrenic knows where they are in time and place, but the presence of disordered thoughts may make them feel confused. Higher mental reasoning is usually impaired and they often lack insight into their condition. They find it difficult to plan things or organise themselves.
Spotting the signs
Usually a person suffering from schizophrenia will not know they are experiencing symptoms of the illness. By definition, hallucinations and delusions are experienced as real by the person having them. As a result, the person with schizophrenia may have different perceptions of the world compared with the rest of us.Often the person may feel persecuted or 'got at' in some way, which can cause fear and anxiety. Other people may notice a change in the person's behaviour, or in the content of their speech.
Delusions
The following delusions are strongly suggestive of schizophrenia:
· the belief they are under the control of another influence
· that thoughts are being put into or taken out of their mind.
If a person has delusions of persecution, they may be suspicious of any questions about their mental state.Sufferers may become preoccupied with certain issues that seem bizarre to those around them. They may express paranoid ideas or respond to the hallucinations they experience. These hallucinations usually take the form of hearing voices that other people cannot hear.
Chronic schizophrenia
This is the longer-term state and is characterised by:
· a lack of drive
· underactivity
· social withdrawal.
Left to their own devices, schizophrenics may spend long periods of time doing nothing, or engage in repeated and purposeless activity. Sometimes they can neglect themselves quite markedly.As with the acute state, hallucinations and delusions are common.Sometimes in chronic schizophrenia the person appears to become used to these disordered thoughts. For example, they might harbour the idea that someone is trying to get at them, but this does not cause any emotional reaction.
'Negative' symptoms
Negative (deficit) synptoms are those of withdrawal from society into a private world. The patient has little to say,and in conversation rambles from one inconsequential theme to another. There is a loss of emotional responsiveness ( flattening of affect), including inability to experience pleasure (anhedonia). The negative symptoms are attributed to ‘hypofrontality’,i.e. to diminished frontal lobe function. Positron emission tomography scns support this idea by demonstrating failure of the normal responses of the left dorsolateral prefrontal cortex to standar test of cognitive function
The most common symptoms of chronic schizophrenia are:
· social withdrawal
· underactivity and slowness
· lack of conversation or interests
· odd ideas or behaviour
· neglect of appearance
· depression.
These symptoms are often called the negative symptoms of schizophrenia.
Not all people with chronic schizophrenia experience all of the symptoms.
How does schizophrenia develop?
The cause of schizophrenia is unknown, but it may have a genetic component. There is no ‘gene for schizophrenia’ but a family history of the illness increases the risk of being affected:
· if a grandparent had the illness, the risk rises to 3 per cent.
· if one parent was affected, the risk is as high as 10 per cent.
· this rises to 40 per cent if both parents have schizophrenia.
Other predisposing factors in the development of schizophrenia include complications during pregnancy or childbirth and difficulties in childhood development.Factors that may trigger an episode of schizophrenia include stressful life events, and the use of illegal drugs such as cannabis.
What can schizophrenics and their families do to help themselves?
If you think you are experiencing symptoms of schizophrenia, you should seek help from your doctor.However, one of the features of the disease is sufferers do not understand they are unwell during acute episodes of illness. It is therefore important that family and friends are able to seek help on their behalf.The first point of call should be the person's family doctor or mental health team worker.
Schizophrenics who are on long-term medication should continue to take this medication, because it has a protective effect against future relapses.
What is the course of the disease?
· About a quarter of the people diagnosed with schizophrenia will have one episode of illness, make a good recovery and have no further problems.
· A further 25 per cent will develop a long-term chronic illness with no periods of remission.
· The remaining 50 per cent of those diagnosed will have a long-term illness that comes and goes with periods of remission and relapse.
The long-term outcome may be worse in people:
· with poor social support
· with a strong family history of schizophrenia
· in whom the illness came on slowly
· in whom treatment was delayed.
Male sex and continuing use of illicit drugs are also associated with a poorer outcome.The risk of relapse is significantly improved by continuing appropriate medication for at least six months after an acute episode.Positive family intervention may also help to maintain periods without illness, as can help with social skills training and psychological therapy.People with schizophrenia have higher rates of depression than the general population. There are also high rates of suicide among people with schizophrenia.
References
Lawrie SM. Schizophrenia. Clinical Evidence Issue 9. August 2003.
Drug treatments for schizophrenia. Effective Healthcare Bulletin, December 1999 Oxford Textbook of Psychiatry, 2001.
Based on a text by Dr John Theilmann Larsen and Henrik Lublin, specialist
Last updated 05.06.2009
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