Schizophrenia

Schizophrenia is a mental disorder which affects a person’s perception of reality and the surrounding things. The most direct impact of schizophrenia may be seen in a person’s ideas, definitions, processes, responses, relationships and interactions. An increased rate of mortality, higher rates of suicide, related health conditions, and expensive treatment and care are just some of the considerations often associated with schizophrenia.  A broadminded outlook is essential when dealing with people with schizophrenia, as the condition requires a lifelong intervention.

The average age for the diagnosis of schizophrenia is between the early teens and early thirties. Often, some signs may persist for a while. Based on observable traits and the age at which schizophrenia has been diagnosed, the disorder is classified into the following types:

• Childhood or early-onset schizophrenia
  This form is characterized by symptoms that develop before the age of 10, which is extremely rare. When occurring in childhood, it can have serious implications and must be treated aggressively.
• Paranoid schizophrenia
  This is one of the common forms of schizophrenia. It usually develops later than the other types. It is marked by delusions and hallucinations, rarely affecting the speech or emotional component.
• Hebephrenic schizophrenia
  Perceived mostly in people between 15 and 25 years of age, the characteristics include disorganised thought and behaviour, short spells of delusion, health ailments, and playing pranks.
• Catatonic schizophrenia
  This is among the rarer forms, where an abnormal behaviour is observed. Massive twitching, lack of speech, and spurts of intense activity and stillness mark this type.
• Undifferentiated schizophrenia
  People with this type don’t fall into any one of the above kinds but show some mixed traits from each of these.
• Cenesthopathic schizophrenia
  In this type, people experience unusual body sensations.

There may also be instances of schizo-affective disorder, where people experience the typical symptoms of schizophrenia along with other ailments like depression or mania.

Some people may believe the onset of schizophrenia to be sudden, but it never really manifests in such a manner. Symptoms may sometimes be really mild and hence dismissed for something else. They begin to appear gradually and get pronounced with time. The stages of schizophrenia are:

• Prodromal
  This is the time when the illness actually starts building up. Minor manifestations can be noticed in this stage before the classic symptoms start. In this stage, the person stays indoors or isolated, preferring little or no contact with others. There is a general lack of interest, even in those things which were once their favourites. Performance at work and school start dipping. This is a tricky stage, because, although friends and family can observe changes in the behaviour and personality, it is hard to pinpoint whether these are precursors to schizophrenia, the result or alcohol or drug abuse, or signs leading to ailments like depression.
• Acute
  Symptoms that are more of psychotic start to show in this stage. The disorder is said to be activated when the person is clearly disorganised and experiences hallucinations and delusions. Once these are observed, and there is little chance that it may be any other disorder, treatment must be started immediately. If left untreated, the symptoms may persist for much longer, or even indefinitely.
• Residual
  In this final stage, the person demonstrates symptoms similar to the prodromal phase. There may be a lack of enthusiasm, withdrawal symptoms and also a lack of zeal.

It isn’t always that a set course is followed for each of the stages. Some people may have one full blown incident; while others may have recurrent episodes. Certain people with schizophrenia may recover entirely while others may continue to have residual symptoms who remain in the residual stage.

The symptoms of schizophrenia are varied, and being a mental illness, it is hard to find two cases that are entirely alike. However, there are some symptoms that are typical of this condition. Some of these symptoms are:

Among teens

Unlike their adult counterparts, teenagers with schizophrenia are less likely to have delusions and have a greater tendency to hallucinate. There is a general sense of irritability and lack of motivation, trouble sleeping, withdrawal from friends and family as well as a dip in the performance noticed at school.

Among adults

• Delusions are very common. These are beliefs that have no base in reality. Feelings of someone being in love with you, being harassed or being conspired against are some common delusions.
• Hallucination is another common symptom which is characteristic of schizophrenia. Having a sensory experience of something that doesn’t exist is what hallucinations are. While hallucinations may be of many types, hearing voices is most commonly experienced.
• An impaired communication in various forms may be experienced in people with schizophrenia, including giving irrelevant answers to questions, making garbled sounds for speech, and also forming sentences which lack structure or don’t make sense.
• Unorganised behaviour may include regressed childishness, sudden bursts of anger and agitation, resistance to comply or take instructions, excessive and pointless movement, and improper posture.
• Loss of interest in general activities like interacting with people, maintaining personal hygiene, being emotionally expressive and seeking pleasure.

Causes

It is difficult to pinpoint the root cause of schizophrenia because there is still nothing conclusive to show what really causes it. What has been established is that schizophrenia is an illness of the brain, and is most likely caused by several factors acting together. Differences in the structure of the brain and nervous system have been observed in people with schizophrenia. Some of the probable causes include problems with brain chemicals and neurotransmitters, and complications during birth and genetics. Consumption of cannabis has a strong correlation to the occurrence of schizophrenia.

Risks factors

Certain factors seem to predispose a person to an increased risk of schizophrenia. These include:

• Prevalence of a family history of the disease.
• Complications during pregnancy or at birth, including malnutrition or exposure to viruses or toxins.
• Consumption of psychotropic or psychoactive drugs during teenage or early in adulthood.
• Fathering a child at an older age.

The key to diagnosis lies first in ensuring that there is no other disorder accompanying schizophrenia and that it has not been confused for any other ailment. Sometimes other medical conditions and even substance abuse can result in similar symptoms, and it is essential to eliminate these before coming to a diagnostic conclusion. In diagnosing schizophrenia, the various investigations that are carried out include:

• Checking for diagnostic criteria
  Checking against DSM-5 criteria (Diagnostic and Statistical Manual) is usually the norm. This is usually performed by a doctor or a practitioner of mental health.
• Physical Examination
  This is carried out to check for other problems, related ailments and also complications present or likely to arise.
• Tests and Screeners
  These are performed to check for confusion with other similar disorders, for the presence of alcohol or substance abuse, and also to ascertain any other potential issues. Among other tests, CT scans and MRI may also be conducted.
• Psychiatric Evaluation
  Mental status and faculties are noted through evaluation. Complete family history and all previous events are recorded, following which the individual is noted for his mannerisms and appearance. The psychiatrist tries to probe the patient in order to understand his/her thought pattern, mood, and to assess the likelihood of substance abuse. A complete check-up to record instances of delusions and hallucinations is made, with a close watch for tendencies like suicide and violence.

Treatment of schizophrenia uses a multi-pronged approach, considering the layers of the issue that need to be dealt with. Treatment modalities include:

• Medication
  This is the first and most important aspect of treatment since it addresses and manages the symptoms manifested as a result of the disease. The most commonly suggested remedy involves prescribing antipsychotic drugs. Depending on various factors, a first or a second-generation antipsychotic drug may be prescribed. The idea is to suggest a form and dosage which is optimum for the state. A more conservative approach is taken keeping in mind the sensitivity of the patient and the side effects of such drugs. The prescription of drugs is different for first-time episodes, for cases of relapse and for those who are in maintenance therapy. There are also modified forms of treatment for those who haven't responded to any kind of medication. In cases where the person is unwilling to take the drug orally, injectables may be used. In some cases, hospitalisation may also become necessary. Simultaneous medical treatment for issues like smoking may even be begun.
• Other treatments
  In cases of limited or no response to drugs, electroconvulsive therapy may be advised. For people who experience hallucinations, magnetic stimulation in some parts of the brain may be helpful.
• Psychosocial intervention
  This is usually carried out simultaneously with medication and is of great value. Several factors are worked upon, and the idea behind this therapy is to ensure that the person may live an inclusive life in society.
• Cognitive behaviour therapy
  It is recommended for at least six months to help understand the psychology and to work around the symptoms by employing strategies and coping mechanisms.
• Alcohol and substance abuse intervention
  It is done to ensure that both these problems are addressed, and the person does not lapse back into these addictions which could trigger a relapse. This also aids in coping with stress, enhancing motivation and reinforcing the behaviour.
• Token economy intervention
  While there are several forms of therapy which look to limit undesirable elements of the personality, this form emphasises reward for the adaptive behaviour displayed and for social skills learnt.
• Skill training
  It is a program which helps people with schizophrenia to develop skills required for functioning and working as a part of society. This empowers them to live independently and interact socially. This is done through a combination of individual training and home-based exercises.
• Supported employment
  In an attempt to try and make people with this condition more self-sufficient, this intervention helps to understand their preferences and vocational skill sets. Based on these, they are provided support on the job front.
• Family services
  Involving the family in therapy is critical when handling those who have schizophrenia. Extensive treatment that includes the family and enhances family contact has shown to reduce the incidence of relapse among people with schizophrenia.

Lifestyle management

In addition to treating it, schizophrenia requires lifelong intervention to ensure that the person manages to adjust, cope and live a productive life. The role of family and friends in managing and supporting the person struggling with schizophrenia is of paramount importance. The most important things to keep in mind while managing people with schizophrenia include:

• Avoiding relapse
  It takes a lot to prevent the relapse of schizophrenia. The most important factors in this process include ensuring regular and timely medication, observing for any symptoms that may reappear, and being more around friends and family who can form a support system.
• Counselling and social intervention
  This can also help build emotional strength and address adjustment issues that may be faced. It can prove invaluable to remain in these programs even after completing treatment. The incidences of relapse also reduce significantly.
• Adopting a healthier lifestyle
  It can help improve fitness levels, maintain better health, and also address some associated issues like weight gain that often manifests itself as a side-effect of the antipsychotic drugs.
• Keeping away from smoking and alcohol
  There is a greater tendency to use drugs, smoke and drink excessively in schizophrenics, and maintaining a healthier environment helps in recovery, ensuring that the schizophrenics stay clean and in preventing relapses.

Prognosis

People with schizophrenia can live a healthy and independent life. However, the chances of relapse are over 50%, and the incidence of suicide is also common. Owing to associated factors of smoking, obesity and lack of exercise, life expectancy is lowered by over a decade. Community care and support are most essential, and there is enough evidence to show that people with this condition can, in fact, live well in society.

Complications

There are many complications associated with schizophrenia. Some of these revolve around its treatment, some around a possible relapse and others on the side-effects of treatment.

• The problem of smoking and substance abuse is reported in an alarming number of people with schizophrenia. This not only aggravates the severity of the condition but also increases the chances of other heart and lung diseases.
• Side effects of treatment including high blood pressure and body temperature, muscular rigidity and disorientation can add to the already existing issues faced.
• Accompanying mental disorders like depression and suicidal tendencies impact individuals severely and can often be fatal.
• Unemployment is a widespread issue faced by people with schizophrenia. Inability to keep jobs, volatile temperaments and lack of social adjustments make it difficult to make a career and provide for oneself. Poverty is a common fallout, which may, in turn, lead to other psychological issues.
• Lack of acceptance, isolation and the stigma associated with such individuals makes it difficult for them to integrate with society. Combined with a lack of understanding of the symptoms that may continue to manifest even after treatment, the chances of treating the condition completely gets compromised.