(Updated at Mar 23 / 2023)
What is schizophrenia and how is it diagnosed and treated?
Schizophrenia has been known to mankind throughout the history of existence. Despite this, diagnosis remains challenging. Not every psychotherapist is able to recognize an ailment. The disease is characterized by significant clinical polymorphism, i.e. variety of symptoms. Globally, 1% of people have a diagnosis, regardless of gender, race and continent. The indicator may be higher due to the true morbidity with mild or erased forms that are not taken into account in official statistics.
Short information about schizophrenia
Manifestation of symptoms
Schizophrenia symptoms and signs are of three types: positive, negative, and cognitive. They are equally manifested in both women and men. Some symptoms are hard to recognize as signs of this mental illness. They are like laziness, depression, psychosis. If you look in more detail, then the state of psychosis is really typical for people with this disease. Schizophrenia in women or men manifests itself at different ages. Schizophrenia in men usually starts to show itself at the age from 15 to 35 years old, and in women from 27 to 37 years old.
Description of positive symptoms
At this stage, abnormal judgments and obsessions are noted. Patients can philosophize unnecessarily and lead meaningless discussions on topics of an immense and global nature. The topic of conversation is often devoid of not only meaning, but also disordered in the style of narration, there is a constant jumping from topic to topic. Positive signs of schizophrenia in women and men are accompanied by delusional states, motor and thought disorders, and hallucinations.
Description of negative symptoms
This group includes signs of schizophrenia with deeper emotional disorders. A person loses the ability to enjoy life. They fall into a depressive state or simply try to shield oneself from society. The majority of time, a person has is a neutral or bad mood, but in rare cases the opposite occurs – a person is mainly in unnaturally increased mood. People with emotional distress are not interested in the feelings of others and spending time alone is much more comfortable for them. Schizophrenia manifests symptoms and signs of a negative type in the aspect of a decrease in sexual desire, ignorance of the rules of hygiene, and also in excessive consumption of alcohol.
Description of cognitive symptoms
Cognitive signs are characterized by impaired concentration and certain types of memory. A person cannot adequately plan, organize their own life, and make decisions. It is possible to precisely identify that these are disorders only with the help of neuropsychological tests. Schizophrenia can disguise symptoms as depression, psychosis. Tests allow finding the truth.
Most common schizophrenia symptoms
The most pronounced symptoms are emotional and volitional disorders, dysfunctions of perception and thinking, which last at least a month:
- Apathy, depression, decreased mental and physical activity;
- Echo of thoughts - the sound of your own thoughts;
- De Clerambault syndrome - delusion of perception, impact. It seems to the patient that he or she is being watched, possessed, influenced in various ways, from magic to atomic energy, laser, etc.
- Auditory hallucinations. The patient hears conflicting voices that have an impact on their thoughts, feelings and actions;
- Olfactory, gustatory, somatic hallucinations;
- Expression of inappropriate emotions. The patient may cry or laugh out of place;
- Wrong beliefs of the patient. The patient considers themselves a great person who rules the world and thinks that most everyday events have great meaning.
- The patient's speech is incoherent, fast, they jump from one topic to another;
- Deteriorating concentration of attention;
- Patients with schizophrenia often retire, avoid communication, become lethargic and apathetic, may neglect personal hygiene;
- The disease can develop both gradually and suddenly.
What are the reasons for schizophrenia development?
The disease does not arise from one factor. It can be said unequivocally that it is in most cases hereditary. If someone from close relatives had such a diagnosis, it will most likely pass to children. And for this, the gender of the carriers does not matter. Having second-line relatives (uncles, aunts, grandparents, etc.) also raises the risk. In medical practice, identical twins are also observed, where one of them has mental disorders. The second has a 65% risk. In addition to the fact that schizophrenia is inherited by close relatives, it is necessary to take into account the influence of other factors. They can provoke a trigger in the body for the development of mental pathology:
- Viral infections;
- Stressful situations;
- Social factors;
- Prenatal infections;
- Lack of vitamins.
Risk factors and complications
Signs of schizophrenia in men and women at different stages may not appear or periodically disappear. This is especially possible with adherence to treatment. There are patients who lead a normal professional and social life, although this diagnosis is characterized by a desire to protect themselves from society.
Risk factors or complications include the following conditions:
- Autism. The patient does not make contact, refuses to interact in society;
- Dementia - impaired brain function, memory impairment;
- Extrapyramidal disorders (tremor, parkinsonism, tic, dystonia) that develop as a result of neuroleptic therapy;
- Diseases of the cardiovascular system;
- Abdominal obesity;
- The risk of developing diabetes;
- Suicidal tendencies. About 30% of patients with schizophrenia have attempted suicide at least once in their lives;
- Alcohol abuse;
- Outbursts of aggression;
- Drug addiction.
The main types of disease
In the medical classification, there are 9 main types of schizophrenia. Some of them have subtypes. Experts identify several of them that are most common. Paranoid schizophrenia manifests itself in increased suspicion of others. The person is haunted by the feeling that they are constantly being watched, have delusions and hallucinations. With the catatonic form of the disease, there are movement disorders. And it can be either complete immobilization or chaotic disorderdaughter excitement. Simple schizophrenia does not have a history of acute psychoses, but negative symptoms intensify over time. The hebephrenic form manifests itself in the form of dementia and foolishness.
At different stages of schizophrenia, symptoms range from baby talk and delusions with hallucinations to suicidal attempts. It is necessary to conduct a medical examination to determine the exact clinical picture. The following methods are used for diagnosis:
1. History collection from the patient and their family.
2. Pathopsychological research.
3. Instrumental and laboratory methods - Neurotest and Neurophysiological test system.
Clinical and history examination is carried out by a psychiatrist at the reception. A doctor identifies symptoms, obvious and latent, records the person's complaints and clarifies the causes of the disorder. Although schizophrenia begins due to a disruption in the connections between nerve cells, external conflicts and difficult situations (overload, stress) can aggravate the illness and delay recovery.
Modern diagnostic techniques in psychiatry include Neurotest and Neurophysiological test system. Neurotest is an analysis of certain markers (indicators) of inflammation in the blood, the level of which is in direct proportion to the severity of the condition. The study requires a few drops of capillary blood (from a finger). The analysis helps to confirm the diagnosis in doubtful cases and shows how effective the treatment is. So the doctor can, if necessary, promptly prescribe another drug.
The neurophysiological test system is the study of a person's reactions to certain stimuli, light and sound. According to the movement of the eyes, the speed of the response and the extent to which a person's indicators deviate from the standard, the doctor makes a conclusion. NTS can accurately confirm the diagnosis, unlike EEG in schizophrenia.
Changes in the brain in schizophrenia are insignificant. Does MRI show schizophrenia? Some doctors of science can recognize its signs on a tomogram, but they do not make a diagnosis based on one study - the diagnosis should be comprehensive.
A clinical psychotherapist conducts a pathopsychological study of schizophrenia. This is a series of tests for logic, attention, memory, problem solving, questions that relate to the emotional and volitional sphere. It can be short and detailed. The psychotherapist does not make a diagnosis, but his conclusion is important for the differential diagnosis with other mental illnesses.
The right treatment for schizophrenia has good results. In 50% it is possible to achieve remission, and 25% of patients completely get rid of the diagnosis, provided that the forms of schizophrenia were amenable to correction.
Treatment of schizophrenia
The first signs of schizophrenia are the ideal time to start therapy. In most cases, this does not work, since the symptoms are ignored or mistaken for other pathological conditions. If a schizophrenia test confirms the diagnosis, the doctor will prescribe appropriate treatment. In the event of acute symptoms, medical correction is recommended. This mainly applies to such conditions: depression, anxiety, sleep problems, severe apathy, thinking disorders.
1. Drug treatment is made with modern neuroleptics (antipsychotics, for instance, Ziprasidone), tranquilizers, antidepressants (Clomipramine and others), nootropics.
2. Psychotherapy - when symptoms subside, psychotherapy is recommended to the patient to consolidate the result. The psychotherapist can use it in individual, family and group formats.
Schizophrenia has a positive prognosis if the treatment plan is followed. For this, social rehabilitation should also be carried out. In the course of treatment, it is necessary to ensure that the symptoms of schizophrenia of the negative group are reduced in severity. In the future, it is important to maintain the condition in order to avoid relapses.
People with schizophrenia cannot be treated with home remedies. In some sources, you can read about taking herbal decoctions or changing your diet, but a person with mental problems and behavioral disorders, perception of the environment must not refrain from scientifically proven treatment methods in favor of such mythical cures. Only the professional accompaniment of the treatment process by a psychiatrist can give a positive result.
Disease prevention methods
Disorder of normal life provokes schizophrenia not only in a person with a diagnosis, but also in his family, close people. The disease is inherited, therefore prevention is aimed at leveling this aspect. It is necessary to reduce the risk of stress, maintain hormonal balance, do not drink alcohol, do not take drugs. All possible risk factors must be stopped for the diagnosis of schizophrenia to become a reality. It is recommended to do something that helps to stabilize the psyche: physical labor, drawing and other manual creativity. It is better to understand the risks and carry out prevention than to undergo treatment for schizophrenia later.
Diet and lifestyle
The diet for schizophrenia involves eating healthy, natural foods. Preservatives, colorants, artificial food additives should be avoided. The main diet should consist of fruits, vegetables, dairy products, cereals.
Patients should try to lead a healthy lifestyle, spend time in the fresh air. Relatives should pay as much attention to patients as possible, communicate with them, try to evoke positive emotions.
Post by: John De Vries, clinical pshychiatrist, Amsterdam, Netherlands
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