SCHIZOPHRENIA

What Is Schizophrenia? Schizophrenia is a widely misunderstood psychiatric disorder characterized by disturbed thought, perception, mood and behaviour: as a group, these are known as psychotic symptoms. Schizophrenia tends to be a chronic illness with active and latent phases, and is most often diagnosed in late adolescence or early adulthood. Worldwide prevalence of the disease is estimated between 0.5% and 1%; it is equally common in men and women, and shows no preference for any race or socioeconomic class.

What Are The Signs And Symptoms Of Schizophrenia? The cardinal features of schizophrenia are psychotic symptoms. Psychosis is essentially a loss of contact with reality, manifest as delusion (an irrational, false belief), hallucination (perception of something not really there: hearing voices or seeing things), and paranoia (irrational fear). Many schizophrenics have delusions of grandeur, and may believe, for example, that they have been sent to Earth with a special mission. Delusions of reference are also common; in this case the patient believes that newspaper headlines or TV programs have hidden messages intended for them. A third common delusion is one of persecution: belief that one is being followed or hunted. In addition to psychosis, altered speech, mood, and movement are often recognized. As well as the psychotic symptoms, a group of negative symptoms are also prominent in schizophrenia. These include disorganized thought and speech (nonsensical, rambling conversation), flat affect (appearing emotionless in facial expression and tone of voice), and abnormal movement (either grossly exaggerated or diminished almost to the point of catatonia). It is very common for the schizophrenic patient to become socially withdrawn and completely isolated. Different subtypes of schizophrenia (paranoid, catatonic, disorganized) are defined by the most predominant symptoms. Clearly, any combination of the above symptoms leads to a decreased level of social functioning.

How Is Schizophrenia Diagnosed? Schizophrenia is diagnosed based on a thorough history of the patient's problems as described by the patient and, if possible, their close contacts. There are no laboratory tests useful in schizophrenia. If symptoms of schizophrenia have been present and persistent over a six-month period, are not due to drug use, an underlying physical illness, or a psychiatric mood disorder, then the diagnosis of schizophrenia can be made.

What Causes Schizophrenia? Little is understood about the cause of this disease; it is thought to result from the interplay of biological and external factors. Certainly, there is a genetic component: if 2 parents have schizophrenia, then the likelihood of their child developing the disease is 40%. It is thought that an excess of dopamine, a neurotransmitter chemical in the brain, contributes to schizophrenia; since dopamine-blocking drugs can eliminate psychotic symptoms, there is evidence to support this theory. The roles of other neurotransmitters (e.g. serotonin, norepinephrine and GABA) are currently under investigation. Distorted brain anatomy may contribute to the development of schizophrenia and hormonal abnormalities (e.g. of cortisol, prolactin and testosterone) have also been demonstrated. There is some evidence linking schizophrenia to viruses, geographical locations, and other external factors. Clearly, much remains to be learned about the cause of this complex disease.

What Is The Treatment For Schizophrenia? Schizophrenia can be treated quite successfully with medication. Often hospitalization is required with the first episode to allow for thorough evaluation, stabilization, and determination of an appropriate drug regime. In the long term, anti-psychotic drugs are the mainstay of treatment for schizophrenia. They act by blocking the dopamine receptors in the brain, thus counteracting the presence of dopamine excess. While highly effective, anti-psychotic drugs have an unfortunate list of possible side effects. The most significant of these is Parkinsonism, a syndrome of tremor, rigid muscles, and decreased voluntary movement (not unlike Parkinson's Disease). Side effects may be eliminated by trying an alternate anti-psychotic drug, by lowering the dose, or with further medications. Although drugs do not cure schizophrenia, it is often possible to provide almost complete symptomatic relief and maintain the patient in a state of normal functioning; usually a higher dose is administered during a symptomatic episode, and a lower dose is continued afterward as maintenance therapy. The chance of relapse is much lower if medication is continued in this manner.

What Is The Role Of Psychosocial Treatment In Schizophrenia? While anti-psychotic medication is highly effective in reducing hallucinations and delusions, it generally has little effect on the negative symptoms of the disease (disorganized thought, flat affect, abnormal movement); this is where non-drug therapy is useful. Psychotherapy, involving one-on-one dialogue with a health care professional, social skills training and vocational counselling may help to improve the patient's ability to function normally in a social environment.

What Is The Outcome For Schizophrenic Patients? Schizophrenia follows a variable course. Some patients will recover fully from their first symptomatic episode never to be afflicted again. A small proportion will remain symptomatic and never quite return to normal. Approximately half of all schizophrenic patients will deal with a chronic relapsing-remitting (on-again, off-again) pattern throughout their lives. The presence of any of the following factors makes a positive outcome more likely: sudden onset of illness, preserved intellectual function, no family history, and normal brain anatomy. In addition, patients who respond well to drug treatment and who have a good social support system are more likely to maintain a reasonable quality of life. Many people with schizophrenia die prematurely from heart or lung disease; the link between the illnesses is not understood.

Are Individuals Who Have Schizophrenia Dangerous? The gravest danger that schizophrenic patients pose is to themselves; 10% will attempt suicide within 20 years of the onset of illness. Those at highest risk are males under 30 who have concurrent symptoms of depression. There is a high incidence of substance abuse among people with schizophrenia, likely due to impaired judgement and an inability to resist temptation, plus a desire to self-medicate with mind-altering drugs. Unfortunately, illicit drugs may act as a trigger and initiate an acute symptomatic episode. Some people with schizophrenia may have difficulty adhering to their medication regime, either because they are unable to comprehend their sickness, or because disorganized thinking renders them forgetful. (A solution to this problem is the administration of long-acting injections of anti-psychotic drugs, eliminating the need for regular pill-taking.) It is a misperception that people with schizophrenia commit violent crimes. Psychotic symptoms are far more likely to render the patient fearful and withdrawn than violent and predatory. Crimes committed by schizophrenics are more likely related to illicit drug use than to the illness itself; drug addiction is also a strong predisposing factor to crime in the rest of the population.