CONDITIONS
Schizophrenia
Schizophrenia
What are the symptoms of Schizophrenia?
Schizophrenia usually presents itself in late teens or early 20s in men and early 20s or 30s in women. It is uncommon in children and in age groups of more than 45. It could be difficult to spot the disorder as symptoms may be subtle and only subtle behavioural changes might be noticed. The initial period between first symptom occurrence and before full psychosis is known as the prodromal period. It may last from days to weeks, or even years. It can be hard to spot because there’s usually no specific trigger.
The signs and symptoms may vary in type and severity over time, but usually are as follows:
Delusions: False beliefs without any basis or occurrence. For example – a person with schizophrenia may think that they are being harmed or harassed; any gestures or comments are directed at them; or a belief that they have an exceptional ability; are famous like celebrity, or another person is deeply in love with them. Delusions is most prominent in people with schizophrenia.
Hallucinations: Experiencing, seeing, or hearing things that don’t exist in reality. Although present with any of the senses, hearing voices is the most common hallucination.
Disorganized thinking (speech): Disorganized speech is a direct result of the disorganized thinking that occurs in schizophrenia. In patients with schizophrenia, effective communication may be impaired when a person usually talks in a partially or complete unrelated manner about a topic.
Extremely disorganized or abnormal motor behavior (physical actions): May manifest as childlike behaviour to unpredictable agitation. Some motor symptoms include non-comprehension of instructions and complete ignorance and non-response to a question. Sometimes useless and excessive movement may also be seen.
Negative symptoms: The ability of normal functioning may be reduced or completely ignored. Examples include – Neglecting personal hygiene, appearance of lack of emotion (patient avoids eye contact and does not change their expressions for a very long time; speaks in a monotone), loss of interest in everyday activities, social withdrawal with loss of ability of participate in pleasurable activities.
What are the causes of Schizophrenia?
The exact cause of schizophrenia isn’t known. But like cancer and diabetes, schizophrenia is a real illness with a biological basis. Researchers have uncovered several things that appear to make someone more likely to get schizophrenia, including:
Genetics (heredity): Schizophrenia can run in families, which means a greater likelihood to have schizophrenia may be passed on from parents to their children.
Brain chemistry and circuits: Certain chemicals in the brain called neurotransmitters control certain pathways, or “circuits,” of nerve cells that affect thinking and behavior. People with schizophrenia may be unable to regulate these chemicals (dopamine, glutamate).
Brain abnormality: People with schizophrenia may have an abnormal brain structure but this is strictly not necessary in schizophrenia and can also affect people without the disease.
Environment: Schizophrenia may be triggered by some viral infections, exposure to toxins like marijuana, or highly stressful situations in people genetically more inclined to it.
How is schizophrenia diagnosed?
Ruling out other mental health disorders is a way to diagnose schizophrenia. Diagnosis may also involve the following:
Physical exam: Ruling out other problems causing similar symptoms and checking for complications.
Tests and screenings: MRI or CT scan may be suggested by the doctor to rule out other conditions.
Psychiatric evaluation: Mental health status may be evaluated by observing body language and behaviour, asking about thoughts, moods, delusions, hallucinations, substance use, and checking signs of violence or suicide.
Diagnostic criteria for schizophrenia: The criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association may be used by a mental health profession or a doctor.
How is schizophrenia treated?
Lifelong treatment is required in people with Schizophrenia, even in the absence of symptoms. Medications and psychosocial therapy are the prescribed treatment for management of schizophrenia. Hospitalization may be needed in some cases.
Medications: Antipsychotic medications are the most commonly prescribed drugs as they are thought to control symptoms by affecting the brain neurotransmitter dopamine. Effective management of symptoms at lowest possible dose is the goal of treatment. Several weeks may be required for the improvement in symptoms. Since these medications have serious side effects, not many patients are willing to take them. Injections may be given to people who do not accept tablets.
Second-generation antipsychotics
Second-generation, newer medications pose a lower risk of serious side effects and hence, are generally preferred over the first-generation antipsychotics. Some of the second-generation antipsychotics include aripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lurasidone, olanzapine.
Long-acting injectable antipsychotics – normally given as an intramuscular or subcutaneous injection for every two to four weeks, depending on the medication.
Common medications that are available as an injection are aripiprazole, fluphenazine decanoate, haloperidol decanoate among others.
Psychosocial interventions:
Along with medications, psychological and social (psychosocial) interventions include:
Individual therapy such as psychotherapy is advised to help normalize thought patterns and learn to cope with stress, identify early warning signs of relapse.
Improving social skills such as communication and social interactions.
Family therapy helps in understanding and supporting families dealing with schizophrenia.
With appropriate treatment, most people with schizophrenia can manage their illness. Some form of daily living support is required for people with schizophrenia.
Hospital Admission:
Severe symptom occurrence may require hospitalization to ensure prevention of harm, proper nutrition, adequate sleep and basic hygiene.
Electroconvulsive therapy:
In case of non-responsiveness to other treatment options, electroconvulsive therapy (ECT) may be considered.
References
- Smitha Bhandari, MD. Schizophrenia: An Overview. (November 2023). WebMD. https://www.webmd.com/schizophrenia/mental-health-schizophrenia
- Schizophrenia. (November 2023). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443
- Loganathan S, Murthy RS. Living with schizophrenia in India: gender perspectives. Transcult Psychiatry. 2011 Nov;48(5):569-84.
