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Chronic Schizophrenia

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Schizophrenia is a mental illness that can incapacitate and even kill a person. Schizophrenia is not the same as 'split personality' or 'multiple personality' disorder. Instead, it refers to disruption of the usual balance of emotions and thought process.

About 2.4 million schizophrenics live in America estimates the National Institute of Mental Health. Approximately 1% of the entire population of the world is schizophrenic.

Schizophrenia results in hallucinations, delusions and disordered thinking and behavior. Schizophrenics withdraw from both people and activities around them. Instead, they seem to retreat to an inner world marked by psychosis.

Causes of Schizophrenia

Although the exact cause of schizophrenia is not clearly established, there could be a combination of factors that can differ from person to person. Some well known causes include genetics, changes in the brain chemistry, brain damage before or during birth, stress, family problems, childhood deprivation and substance misuse, which is known as drug induced psychosis. Although some may be born with a genetic predisposition toward schizophrenia, stress and life experiences can trigger the onset of symptoms.

Signs and symptoms of Schizophrenia

About one in hundred are diagnosed with schizophrenia and two to four people per thousand are schizophrenic worldwide. Symptoms of schizophrenia can begin at any age although it is most likely to develop between the ages 20 and 30. Schizophrenia affects young men and women equally although young men tend to get diagnosed earlier than women. The most prominent symptoms of schizophrenia include

  • Delusions such as belief that there is a conspiracy hatched against him/her

  • Disordered thoughts

  • Hallucinations, that is seeing or hearing especially voices that does not exist

  • Incoherent speech

  • Lack of emotions

  • Angry outbursts

  • Catatonic behavior

  • A persistent feeling of being watched over

  • Social isolation

  • Clumsy and uncoordinated movements

Whereas schizophrenia can range from mild to severe; there are people who may be able to go about their daily life reasonably well while others may require specialized intensive treatment.

Over a period of time it would become difficult to function in daily life with schizophrenia. Relationships could get troubled due to inability to read social cues and other's emotions.

Acute and chronic schizophrenia

Acute schizophrenia is the one that is most common. It occurs in a young adult who has been previously healthy and who exhibits increasingly odd behavior over a short span of time. Symptoms of acute schizophrenia include

  • Auditory hallucinations

  • Irrational beliefs or disordered thoughts

  • Lack of insight and illogical and incoherent thinking

  • Delusions of persecution

  • Suspiciousness

  • Flat mood and mood disturbances and swings including depression, anxiety, irritability and euphoria

  • Inappropriate emotional responses, for example, laughing at sad news.

Schizophrenics generally are aware of the time and place they are in but sometimes they may become confused due to disordered thoughts. They could lack insight into their condition and it would become difficult to organize them.

Schizophrenics suffer a delusion that they are under control of another influence. They feel that thoughts are being put into or taken out of their mind. Unfortunately, a schizophrenic never knows he/she is experiencing such symptoms of illness.

Chronic schizophrenics exhibit certain negative symptoms including:

  • Social withdrawal
  • Underactivity and slowness
  • Lack of interests and conversation
  • Odd behavior
  • Neglect of appearance and
  • Depression

It is not necessary that all chronic schizophrenics should experience these negative symptoms. As such chronic schizophrenia is a longer term state and it is characterized by lack of drive, underactivity and social withdrawal

Chronic schizophrenics may do nothing for long periods of time, or engage in purposeless activity repeatedly. Their self neglect is quite marked. Hallucinations and delusions are common in acute condition.

Hereditary schizophrenia

Even extensive research has not been able to clearly reveal if schizophrenia can be hereditary as the causes still remain generally unknown. Schizophrenia is caused by a combination of both genetic and social factors and much depends on the individual's circumstances. While genetic makeup can put a patient at a higher risk, a stressful life can trigger possible symptoms of the illness.

Although there is 'no gene for schizophrenia,' a family history of the illness can increase the risk of being affected. Schizophrenia is seen to run in families and it is established that

  • the risk rises to 3 % if a grandparent had the illness
  • the risk is as high as 10 % if one parent was affected by the illness
  • the risk rises to 40 % if both the parents had the illness

Types of schizophrenia

Schizophrenia types depend largely on the specific symptoms a person experiences. Since the symptoms are bound to change over time, it is possible to have more than one type of schizophrenia in a patient's lifetime.

Paranoid schizophrenia is the most common form of the illness and the primary symptoms include grandiose delusions and hallucinations. Disorderly thought, disorganized behavior and affective flattening are some of the prominent symptoms. Auditory hallucinations of hearing voices and a strong belief that others are deliberately cheating, harassing, poisoning, spying or plotting against them indicate paranoid schizophrenia.

Disorganized schizophrenia results in unusual thought processes. Garbled speech, illogical thoughts, 'thought blocking,' where a person stops abruptly in the middle of a thought and unintelligible words or 'neologisms,' are symptoms of disorganized type.

Catatonic schizophrenia can be clumsy and uncoordinated behavior and involuntary movements and unusual mannerisms. Repetitive motions, which could be catatonic in extreme cases, may result. Catatonia as such, is a state of immobility and unresponsiveness which is very rare these days.

Residual schizophrenia seems to occur in those with long term schizophrenia. These patients exude negative symptoms such as flat effect, with immobile facial expressions, lack of pleasure in life, disability to any planned activity and infrequent talk even when forced to interact. They lack any positive symptoms and neglect basic hygiene and need help in performing everyday life activities as well.

Undifferentiated schizophrenia is when the patient exhibits symptoms not consistent with any other form of the illness.

Treatment for schizophrenia

Schizophrenia is usually treated by a professional psychiatrist and a team consisting of psychologist, social worker and psychiatric nurse.

Medications are considered the cornerstone in the treatment of schizophrenia. But some medications for schizophrenia could have serious and rare side effects. A medication regimen that would ideally suit the patient with fewer side effects has to be chalked out.

Anti psychotic mediations are normally prescribed to treat schizophrenia. These can control the neurotransmitters in the brain. Anti psychotic medications are of two main types:

  • Conventional or typical anti psychotics
  • New generation, atypical anti psychotics

The conventional anti psychotics have remained effective traditionally in managing positive symptoms of schizophrenia. They could have potentially severe neurological side effects. The newer atypical antipsychotics are effective in managing both positive and negative symptoms. But these pose a risk of metabolic side effects like weight gain, diabetes and high cholesterol.

Possible side effects of antipsychotic medications:

  • Increase in risk of diabetes

  • Weight gain

  • High cholesterol

  • High blood pressure

  • Changes in white blood cell count

  • Serious health problems in older adults

  • Some antipsychotic medications can pose dangerous interactions with other substances as well.

Incase a medication does not work well for a patient and he/she has intolerable side effects, the treating doctor recommends combining and switching of different medications and sometimes adjusts dosage. The danger here is that if one stops taking medications, the relapse of psychotic symptoms could occur. Antipsychotic medications needs to be tapered off and cannot be stopped abruptly.

Psychosocial treatments: Psychotherapy and psychosocial treatments are important in treatment of schizophrenia in addition to the medications. These treatments include in their purview:

  • Individual therapy provided by a skilled mental health provider.

  • Family therapy provides education and support to the families of the patient. This way the family members can understand the symptoms better and recognize stressful situations which may cause relapse. The family can also communicate better with the patient and help reduce the distress.

  • Above all, rehabilitation to live independently is the key of recovery from schizophrenia. The schizophrenic should learn skills as good hygiene, cooking and better communication. There are communities that help schizophrenic with jobs, housing and self help during times of crisis.

Treatment for schizophrenia is not without its challenges. As such, it is difficult for schizophrenic to stick to their treatment plans. They may assume that medications is not necessary or forget to take the medications or attend therapy sessions.

Many schizophrenics smoke and they may require an additional dosage of medication as nicotine interferes with medications. Alcohol and drug abuse can worsen schizophrenia symptoms. A positive family intervention should help maintain periods without illness. It can also help with social skills and psychological therapy allowing schizophrenics to lead productive and enjoyable lives.

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