A long-term mental disorder of
a type involving a breakdown in the relation between thought, emotion, and
behaviour, leading to faulty perception, inappropriate actions and feelings,
withdrawal from reality and personal relationships into fantasy and delusion,
and a sense of mental fragmentation.
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Patient
with schizophrenia disorder may hear voices other people don't hear. They may
believe other people are reading their minds, controlling their thoughts, or
plotting to harm them. This can terrify people with this illness and make them
extremely agitated. Schizophrenic patient may not make sense when they talk.
They may sit for hours without moving or talking. Sometimes they seem perfectly
fine until they talk about what they are really thinking.
Causes
1. Genes
& Environment Factors:
Scientists have long known that
schizophrenia runs in families. The illness occurs in 1 percent of the general
population, but it occurs in 10 percent of people who have a first-degree
relative with the disorder, such as a parent, brother, or sister. The risk is
highest for an identical twin of a person with schizophrenia. He or she has a
40 to 65 percent chance of developing the disorder. We inherit our genes from
both parents. Scientists believe several genes are associated with an increased
risk of schizophrenia, but that no gene causes the disease by itself. In addition, it probably takes more than genes
to cause the disorder. Scientists think
interactions between genes and the environment are necessary for schizophrenia
to develop.
Many
environmental factors may be involved, such as
·
Exposure
to viruses or
·
Malnutrition
before birth,
·
Problems
during birth,
2.
Brain Chemistry &
Structure:
Scientists
think that an imbalance in the complex, interrelated chemical reactions of the
brain involving the neurotransmitters dopamine and glutamate, and possibly
others, plays a role in schizophrenia. Neurotransmitters are substances that
allow brain cells to communicate with each other. Scientists are learning more
about brain chemistry and its link to schizophrenia. Studies of brain tissue
after death also have revealed differences in the brains of people with
schizophrenia. Scientists found small changes in the distribution or
characteristics of brain cells that likely occurred before birth. Some experts
think problems during brain development before birth may lead to faulty
connections. The problem may not show up in a person until puberty. The brain
undergoes major changes during puberty, and these changes could trigger
psychotic symptoms. Scientists have learned a lot about schizophrenia, but more
research is needed to help explain how it develops.
Who Is At Risk?
Schizophrenia
affects men and women equally. It occurs at similar rates in all ethnic groups
around the world. Symptoms such as hallucinations and delusions usually start
between ages 16 and 30. Men tend to experience symptoms a little earlier than
women. Most of the time, people do not get schizophrenia after age 45.
Schizophrenia rarely occurs in children.
Signs & Symptoms:
The
symptoms of schizophrenia fall into three broad categories:
1)
Positive
symptoms,
2)
Negative
symptoms,
3)
Cognitive
symptoms.
Positive symptoms: are psychotic behaviours
not seen in healthy people. Patients with positive symptoms often "lose
touch" with reality. They include the following:
1) Hallucinations
A
patient sees, hears, smells, or feels that no one else can see, hear, smell, or
feel. "Voices" are the most
common type of hallucination in schizophrenia. Many people with the
disorder hear voices. The voices may talk to the person about his or her behaviour,
order the people to do things, or warn the person of danger. Sometimes the voices
talk to each other. Other types of hallucinations include seeing people or
objects that are not there, smelling odours that no one else detects, and
feeling things like invisible fingers touching their bodies when no one is
near.
2) Delusions
False
beliefs that are not part of the person's culture and do not change. The person
believes delusions even after other people prove that the beliefs are not true
or logical. People with schizophrenia can have delusions that seem bizarre,
such as believing that neighbours can control their behaviour with magnetic
waves. They may also believe that people on television are directing special
messages to them, or that radio stations are broadcasting their thoughts aloud
to others. They may have paranoid delusions and believe that others are trying
to harm them, such as by cheating, harassing, poisoning, spying on, or plotting
against them or the people they care about. These beliefs are called "delusions of persecution."
3) Thought
disorders
Are unusual or dysfunctional ways of thinking.
One form of thought disorder is called "disorganized thinking." This
is when a patient has trouble organizing his or her thoughts or connecting them
logically. They may talk in a garbled way that is hard to understand. Another
form is called "thought blocking." This is when a person stops
speaking abruptly in the middle of a thought. When asked why he or she stopped
talking, the patient may say that it felt as if the thought had been taken out
of his or her head.
4) Movement
disorders
It
may appear as agitated body movements. A patient with a movement disorder may
repeat certain motions over and over. In the other extreme, a person may become
catatonic. Catatonia is a state in which a patient does not move and does not
respond to others.
Negative symptoms: are associated with
disruptions to normal emotions and behaviours. These symptoms are harder to
recognize as part of the disorder and can be mistaken for depression or other
conditions. These symptoms include the following:
1)
Flat
affect (a person's face does not move or he or she talks in a dull or
monotonous voice)
2)
Lack
of pleasure in everyday life
3)
Lack
of ability to begin and sustain planned activities
4)
Speaking
little.
People with negative symptoms
need help with everyday tasks. They often neglect basic personal hygiene. This
may make them seem lazy or unwilling to help themselves, but the problems are
symptoms caused by the schizophrenia.
Cognitive symptoms: are subtle. Like
negative symptoms, cognitive symptoms may be difficult to recognize as part of
the disorder. Often, they are detected only when other tests are performed.
Cognitive symptoms include the following:
1)
Poor
"executive functioning" (the ability to understand information and
use it to make decisions)
2)
Trouble
focusing or paying attention.
3)
Problems
with "working memory" (the ability to use information immediately
after learning it).
Cognitive symptoms often make it
hard to lead a normal life and earn a living. They can cause great emotional
distress.
Treatments
Because
the causes of schizophrenia are still unknown, treatments focus on eliminating
the symptoms of the disease
1) Antipsychotic
medications
Antipsychotic
medications have been available since the mid-1950. The older types are called
conventional or "typical" antipsychotics. In the 1990's, new
antipsychotic medications were developed. These new medications are called
second generation, or "atypical" antipsychotics.
2) Psychosocial
treatments
Psychosocial
treatments can help patients with schizophrenia that is already stabilized on
antipsychotic medication. Psychosocial treatments help these patients deal with
the everyday challenges of the illness, such as difficulty with communication,
self-care, work, and forming and keeping relationships. Learning and using
coping mechanisms to address these problems allow people with schizophrenia to
socialize and attend school and work.
3) Illness
Management Skills.
Patient
with schizophrenia can take an active role in managing their own illness. Once
patients learn basic facts about schizophrenia and its treatment, they can make
informed decisions about their care. If they know how to watch for the early
warning signs of relapse and make a plan to respond, patients can learn to
prevent relapses.
4) Integrated
treatment for co-occurring substance abuse.
Substance
abuse is the most common co-occurring disorder in people with schizophrenia.
But ordinary substance abuse treatment programs usually do not address this
population's special needs. When schizophrenia treatment programs and drug
treatment programs are used together, patients get better results.
5) Rehabilitation.
Rehabilitation emphasizes social and
vocational training to help people with schizophrenia function better in their
communities. Because schizophrenia usually develops in people during the
critical career-forming years of life (ages 18 to 35), and because the disease
makes normal thinking and functioning difficult, most patients do not receive
training in the skills needed for a job.
6) Family
education.
Patients
with schizophrenia are often discharged from the hospital into the care of
their families. So it is important that family members know as much as possible
about the disease. With the help of a therapist, family members can learn
coping strategies and problem-solving skills. In this way the family can help
make sure their loved one sticks with treatment and stays on his or her
medication.
7) Cognitive
behavioural therapy.
(CBT) is a type of psychotherapy that focuses
on thinking and behaviour. CBT helps patients with symptoms that do not go away
even when they take medication. The therapist teaches people with schizophrenia
how to test the reality of their thoughts and perceptions, how to "not
listen" to their voices, and how to manage their symptoms overall.
8) Self-help
groups.
Self-help groups for people with
schizophrenia and their families are becoming more common. Professional
therapists usually are not involved, but group members support and comfort each
other. People in self-help groups know that others are facing the same
problems, which can help everyone feel less isolated. The networking that takes
place in self-help groups can also prompt families to work together to advocate
for research and more hospital and community treatment programs.
How can you help a person with
schizophrenia?
People
with schizophrenia often resist treatment. They may not think they need help
because they believe their delusions or hallucinations are real. In these
cases, family and friends may need to take action to keep their loved one safe.
Laws vary from state to state, and it can be difficult to force a person with a
mental disorder into treatment or hospitalization. But when a person becomes
dangerous to himself or herself, or to others, family members or friends may
have to call the police to take their loved one to the hospital.
It can be difficult to know how
to respond to someone with schizophrenia who makes strange or clearly false
statements. Remember that these beliefs or hallucinations seem very real to
the person. It is not helpful to say they are wrong or imaginary. But going
along with the delusions is not helpful, either. Instead, calmly say that you
see things differently. Tell them that you acknowledge that everyone has the
right to see things his or her own way. In addition, it is important to
understand that schizophrenia is a biological illness. Being respectful,
supportive, and kind without tolerating dangerous or inappropriate behaviour
is the best way to approach people with this disorder.
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Are schizophrenic patient violent?
People
with schizophrenia are not usually violent. Most violent crimes are not
committed by people with schizophrenia. However, some symptoms are associated
with violence, such as delusions of persecution. Substance abuse may also
increase the chance a person will become violent. If a person with
schizophrenia becomes violent, the violence is usually directed at family
members and tends to take place at home. The risk of violence among people with
schizophrenia is small. But people with
the illness attempt suicide much more often than others. It is hard to
predict which patient with schizophrenia is prone to suicide. If you know
someone who talks about or attempts suicide, help him or her find professional
help right away.
Schizophrenia and smoking
Addiction to nicotine is the
most common in people with schizophrenia. They are addicted to nicotine at
three times the rate of the general population .The relationship between
smoking and schizophrenia is complex. People with schizophrenia seem to be
driven to smoke, and researchers are exploring whether there is a biological
basis for this need. In addition to its known health hazards, several studies
have found that smoking may make antipsychotic drugs less effective. Quitting
smoking may be very difficult for people with schizophrenia because nicotine
withdrawal may cause their psychotic symptoms to get worse for a while.
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Dr. Imtiaz Syed, M.B,B.S, MBA, CRA, PCQI, CPC
Redditch, Gloucestershire. UK.
Ref: National institute of mental
health , http://www.nimh.nih.gov/index.shtml
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Never studied schizophrenia in such a detail..that's too knowledgefull.thank you :-)
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