What is Schizophrenia ?
Schizophrenia is a mental disorder within the schizoid spectrum. It is characterized by a deterioration of cognitive processes and emotional functioning poorly. This condition usually manifests as auditory hallucinations, paranoid or bizarre delusions, or incoherent thinking and speaking and is associated with poor functioning socially.
The symptoms are usually first visible in young adults (between the 15th and 30th year of life) and has a worldwide prevalence of about 0.3-0.7%. The diagnosis is based on observed behavior and the experiences reported by the patient.
An important feature is that there is at least once a psychotic episode has occurred during the course of the disease. Typically, these episodes are more common. They are associated with a different perception of reality (an abnormal cognition), resulting in illogical thought patterns, delusions, hallucinations, and to varying degrees emotional, thinking and behavior disorders. Often occurs even cognitive decline (ability to learn) on. Historically, this condition was also used the term dementia praecox (= dementia at a young age). Meanwhile, the terminology is important refined.
The cause has always been the subject of many speculations. Genetic factors, childhood environment, neurobiological and psychological factors and social processes appear to be the main causes. Some medications or drugs can also cause or worsen symptoms. Current research focuses on the role of neurological processes, although no precise biological cause is found. The many possible combinations of symptoms have led people to wonder whether the diagnosis refers to one disorder or a number of distinct syndromes.
Despite the etymology of the term "schizophrenia" schizophrenia is not a "split mind" and it is not the same as dissociative identity disorder — also known as "multiple personality disorder" or "split personality" — a condition where schizophrenia is often confused by laymen.
There is a possible genetic relationship between schizophrenia and schizotypal personality disorder. Recently is primarily an integrated vulnerability-stress model worked. Both the genetic relationship between schizophrenia and autism if the aspect of the basically genetically identical twins are strong in the interest of researchers from the aspect of copynumbervariaties.
The most important part of treatment is antipsychotic medication, which the activity of dopamine (and sometimes serotonin) receptors suppressed. Psychotherapy, occupational therapy and guidance in return to society are also important parts of treatment. In severe cases-when there is risk for the patient or to others-can forced recording are needed, although the recording is shorter and less common nowadays than it used to be.
Untreated schizophrenia is a disease that to many suffering (at patient and environment) can lead and can cause disability.
The disorder does not only affect cognition, but also usually causes chronic problems in the field of behavior and emotion. People with schizophrenia often have also suffered from (comorbid) conditions, such as depression and anxiety disorders; in almost 50% of the cases there is substance abuse. Social problems, such as long-term unemployment, poverty and homelessness are common. The average life expectancy of people with schizophrenia is 12 to 15 years less than other people. This is caused by more physical problems and the more frequent occurrence of suicide (about 5%).
Schizophrenia Diagnosis
The diagnosis of schizophrenia is made on the basis of the criteria in either the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association, and the International Statistical Classification of Diseases and Related Health Problems (ICD-10) of the World Health . These criteria are based on experiences reported by patients themselves and by other reported abnormalities in their behavior, followed by a clinical assessment by a psychiatrist. In Europe, is generally based on the criteria in accordance with the ICD-10, while in the United States and the rest of the world the DSM is used. Also in scientific research is mostly based on the latter instrument. In ICD-10, increased emphasis on symptoms defined by Schneider of the first order. In practice, however, the two systems are very similar.
The symptoms of schizophrenia come on a sliding scale in the general population and therefore must reach a certain level of seriousness before the diagnosis of schizophrenia is made. There is no objective test available.
symptoms
People suffering from schizophrenia have experienced one or more psychoses. Such a period may take a few days to many years. Psychosis can run very severe with the person often is confused except also very busy. This is also referred to as an acute psychosis. If a psychosis lasts longer, it expires usually quieter. We call this a chronic psychosis.
The most characteristic symptoms of schizophrenia are hallucinations (usually hear voices), delusions (often bizarre nature or persecutory delusions) and chaotic thinking and speaking. The latter can range from losing the thread of the conversation, to sentences that barely have anything to do with each other, and in severe cases incoherent speech known as 'wort salat' (Logorrhoea). Social withdrawal, carelessness in dress and hygiene, disinterest and impaired judgment also associated with schizophrenia.
Often there is also a visible pattern of emotional problems, such as not responding to other people. Impaired social cognition is associated with schizophrenia, as well as symptoms of paranoia. Social isolation is common. Problems with memory and long term memory, attention, executive functions and processing speed are also possible. In an uncommon subtype may prevent the patient says virtually nothing remains motionless in a bizarre posture or aimless excitement spreads on display, all signs of catatonia.
Schizophrenia often begins in late adolescence or early adulthood, during the most important years of social development and career. In 40% of men and 23% of women with schizophrenia, the disease prior to the 19th year of life manifested itself. To minimize the disruption of development caused by schizophrenia, are working hard to identify and treat the prodromal (herald) phase of the disease, which has been detected up to 30 months before the symptoms become visible. Those who continue the schizophrenia, can get in the prodromal phase transient psychotic symptoms and non-specific symptoms such as social withdrawal, irritability, dysphoria and clumsiness.
Positive and negative symptoms
Schizophrenia is often described in terms of positive and negative symptoms. Positive signs indicate the presence of unusual perceptions, thoughts, and behaviors such as delusions and hallucinations. Negative symptoms indicate the absence or lack of certain behavioral domains such as energy loss, no pleasure in things may have (anhedonia) and lethargy.
Positive symptoms are symptoms that most people do not normally, but that occur in people with schizophrenia. This can include delusions, disordered thinking and speech and hallucinations in touch, hearing, sight, smell and taste, symptoms are usually seen as manifestations of psychosis. Hallucinations usually related to the content of the delusions experienced. Positive symptoms usually respond well to medication.
Negative symptoms it comes to disturbances in normal emotional reactions or other thought processes. The issues are often flattened affect and emotion, poverty of speech (alogia), inability to experience pleasure (anhedonia), lack of desire to engage in social contacts (asociality) and lack of motivation (avolition). Research suggests that negative symptoms contribute more than positive symptoms to a poor quality of life, functional disability and burden of others. Negative symptoms often respond less well to medication. For the newer atypical antipsychotics is that they may be more effective in the control of negative symptoms, as compared with the conventional means. People who suffer from negative symptoms often have a history of inappropriate behavior before the disease manifests itself.
Characteristic of schizophrenia is that it is a progressive process involving episodes with positive symptoms follow each other, wherein the more such episodes are made by the more negative symptoms are decisive for the well-being of the patient. In other words; the more psychotic episodes experienced by the patient, the more severe affective flattening is.
Classification according to Schneider
In the early 20th century, the psychiatrist Kurt Schneider a list of psychotic symptoms that he thought that schizophrenia distinguished from other psychotic disorders. These are referred to symptoms of the first order or Schneider's symptoms of the first order. These symptoms include the delusion that you are sent by an external force, the belief that thoughts are planted in your subconscious mind, or be removed from the belief that your thoughts are transmitted to other people, and hearing voices that comment on your thoughts or your actions or having a conversation with other hallucinated voices. Although they have made an important contribution to the current diagnostic criteria, the specificity of the symptoms of the first order is questioned. A discussion of diagnostic scientific studies conducted between 1970 and 2005, shows that the claims of Schneider neither confirmed nor can be refuted and Recommended that the symptoms of the first order should receive less attention in future revisions of diagnostic systems.
Differential diagnosis
Psychotic symptoms can occur at various other mental illnesses, such as bipolar disorder, borderline personality disorder, drug intoxication and drug-induced psychosis. Delusions (of the "not strange" type) also occur in delusional disorders, and social withdrawal we see in people who suffer from social phobia, avoidant personality disorder and schizotypal personality disorder. Schizophrenia is so common in combination with obsessive-compulsive disorder that may be no coincidence, although it can be difficult to distinguish obsessions in obsessive-compulsive disorder delusions that occur in schizophrenia.
Sometimes a more general medical and neurological examination necessary to exclude certain medical illnesses that can in rare cases cause schizophrenia-like symptoms, such as metabolic disorders, systemic infections, syphilis, infection with HIV, epilepsy and brain damage. Possible delirium must be excluded. Delirium is characterized by visual hallucinations, acute onset and variable level of consciousness, and indicates an underlying medical condition. At relapse, studies are usually not repeated unless there is a specific medical indication or if there may be side effects of antipsychotics.
Schizophrenia Causes and Risk Factors
In causing schizophrenia plays a combination of genetic and environmental factors play a role. In people with a family history of schizophrenia, who receive a transient psychosis, a year later, the diagnosis of schizophrenia in 20-40% of cases.
Also in monozygotic twins (which have the same gene), however, no complete concordance (as one half of a twin has it, the other has in the 50-70% of the cases), which is an indication that in addition to the heredity also the environment may play a role in the etiology of the disease.
Important risk factors include: male gender, depression and a high IQ.
Genetic factors
Estimates of heredity vary because it is difficult to separate the genetic influences and the environmental influences. The greatest risk factor for the development of schizophrenia is having a relative in the first degree is schizophrenic (risk is 6.5%); get more than 40% of monozygotic twins schizophrenia if the other also. There are probably many genes involved, each gene has a small effect, and it is not clear how they are transmitted and reflected. There are many possible candidates proposed, including some copy number variations, NOTCH4 and places where chromosomes are histone proteins. A number of genome-wide association, such as zinc finger protein 804a have also been associated with schizophrenia. There seems to be a large overlap between the genetics of schizophrenia and bipolar disorder.
Assuming that there is a genetic basis, developmental psychology asks why there are genes arise that increase the risk of psychosis, because this condition from an evolutionary viewpoint is a maladaptation. One theory suggests that genes are involved in having to do with the evolution of language and to human nature, but so far these are no more than theoretical ideas.
Risk of getting schizophrenia for relatives of a patient:
-Monozygotic twins 48%
-Twin 17%
-Child 13%
-Brother / sister 9%
-Older 6%
-Uncle / aunt / nephew / niece 2%
-Baseline Baseline 1%; the risk of developing schizophrenia, for any individual, or in other words: the percentage of the world's population with schizophrenia.
Environmental factors
Environmental factors that have been associated with the development of schizophrenia, the environment, drug use and prenatal stress. Education does not seem to have a major impact, although people who stimulating parents develop better than those with critical or hostile parents. It has been shown that living in an urban environment during childhood or as an adult doubles the risk of schizophrenia, even taking account of drug use, ethnicity and size of the social group. Other factors are important, social isolation and emigration because of social adversity, racial discrimination, family dysfunction, unemployment and poor housing.
Drug use
A number of drugs have been associated with the onset of schizophrenia, including cannabis, cocaine, and amphetamines. About half of the people suffering from schizophrenia use a lot of drugs and / or alcohol. Cannabis could cause schizophrenia, but other drugs likely to be used only with depression, anxiety, boredom and loneliness to go.
Cannabis has been associated with an increase in the risk of the onset of a psychotic disorder: the risk of psychosis and schizophrenia is twice as large when cannabis is often used. Many scientists believe that the use of cannabis can also cause schizophrenia, but the research is still too limited to draw any definitive conclusions as to causation. The use of amphetamine, cocaine and, to a lesser extent, alcohol can cause a psychosis that closely resembles schizophrenia.
Smoking
Although nicotine is not a known cause of schizophrenia, in various global studies a strong association between schizophrenia and smoking. Cigarette use is particularly high among people with schizophrenia has been observed: an estimated 80% to 90% smoked regularly, compared with 20% of the overall population. Those who smoke are often heavy smokers and also use cigarettes with high nicotine content.
Development factors
Factors such as hypoxia and infections, as well as stress and malnutrition in the mother during pregnancy, the risk of schizophrenia in later life increase slightly. Schizophrenia Patients are (at least in the northern hemisphere) more often born in the winter or spring, which could have to do with an increased exposure to viruses during pregnancy. The difference is about 5 to 8%.
Treatment for Schizophrenia
Schizophrenia is initially treated with drugs for psychosis, often in combination with psychological and social support. A supportive, emotionally environments (low expressed emotion), which provides security and predictability, along with structure, are helpful.
In severe episodes, a patient voluntarily or (where the law allows) are forced hospitalization. Prolonged recordings come since the fifties of the last century deployed deinstitutionalization not much more, but they are not completely past.
In the Netherlands mental health patients are increasingly being cared for at home and increasingly seeks cooperation with municipalities and other civil society organizations such as housing associations, UWV, law enforcement, education, reintegration companies, debt settlement, but also general practitioners and home care. There is evidence that regular exercise has a positive effect on physical and mental health of schizophrenia patients.
Medication
Psychiatric treatment of schizophrenia consists primarily of administration of anti-psychosis (antipsychotics), allowing the positive symptoms of psychosis may diminish within 7 to 14 days. There are also drugs and the positive symptoms (especially hallucinations and thought disorder) suppress pretty good, with adverse consequence as a clear flattening of emotional life. As incentives, verbal and non-verbal cues from the environment, by antipsychotics (medications) are somewhat muted, events are often less intense polite. Both pleasant and unpleasant events make less "impression". However, this type of resource has little effect on the negative symptoms and cognitive dysfunction. The prolonged use decreases the risk of relapse.
There are two groups of antipsychotics: The typical and atypical drugs. It varies from person to person, which means work. It is often a matter of trying any means at a particular person works best. The choice of a particular antipsychotic is made by the benefits, risks and costs to weigh. On whether typical or atypical antipsychotics are better, is no simple answer. When typical antipsychotics are used in a low or moderate dose, the percentage of patients with self-medication stops or gets a relapse, the same as at atypical antipsychotics. 40-50% of patients respond well and 30-40% partially on medicines, while 20% appears insensitive to this treatment. Of the latter occurs when the symptoms after six weeks not respond to two or three different antipsychotics. In people who do not respond well to other medicines work clozapine often. However, this agent may have a dangerous side effect: 1 to 4% of users having to deal with agranulocytosis (decrease in the number of white blood cells).
Typical antipsychotics have more extrapyramidal side effects, such as salivation, dry mouth, muscle tone, movement unrest, look cramp and lockjaw. Use of the atypical variant often leads to a significant weight gain, diabetes and metabolic syndrome. Although atypical antipsychotics have fewer extrapyramidal side effects, but the difference is not very large. The side effects are dose dependent. Some atypical antipsychotics such as quetiapine and risperidone, bring a higher death risk-taking than the atypical antipsychotic perphenazine, clozapine while giving the lowest mortality. It is still unclear whether the newer antipsychotics risk of neuroleptic malignant syndrome, a rare but serious neurological side effect, limit.
People who are not able or willing to take regular medications, may be given a depot injection with a prolonged duration. The risk of relapse is further reduced by the depot preparations than with oral medication. Moreover, they can, in combination with psychosocial treatments may improve compliance.
Alternative approaches
In particular client organizations exists opposition to the view that schizophrenia is a mental illness (biological) or against the view that the condition should be treated, particularly with medication. The anti-psychiatry sixties looked schizophrenia from deep psychological side (eg, the theory of schizophrenogenic mother). Dr. McKenzie assumes a traumatic origin: separation of parents at a young age caused him as schizophrenia. This view has been abandoned, because there is no clear link has been demonstrated between education and schizophrenia. There is growing evidence that schizophrenia has a biological basis with hereditary components.