Nervous System

1. SCHIZOPHRENIA

Diksha Bhatla 01 Jan 1970

SCHIZOPHRENIA 

Schizophrenia is a severe mental disorder, characterized by profound disruptions in thinking, affecting language, perception, and the sense of self. It often includes psychotic experiences, such as hearing voices or delusions. It can impair functioning through the loss of an acquired capability to earn a livelihood, or the disruption of studies. Schizophrenia typically begins in late adolescence or early adulthood. Schizophrenia is a serious brain disorder that distorts the way a person thinks, acts, expresses emotions, perceives reality, and relates to others. Schizophrenia can leave its sufferer frightened and withdrawn. It is a life- long disorder that cannot be cured, but usually can be controlled with proper treatment. Contrary to popular belief, schizophrenia is not a split personality or multiple personality. The word “schizophrenia” does mean “split mind,” but it refers to a disruption of the usual balance of emotions and thinking. The behaviour of people with schizophrenia may be very strange and even shocking. A sudden change in personality and behaviour, which occurs when schizophrenia sufferers lose touch with reality, is called a psychotic episode. 

Schizophrenia varies in severity from person to person. Some people have only one psychotic episode while others have many episodes during a lifetime but lead relatively normal lives between episodes. Schizophrenia symptoms seem to worsen and improve in cycles known as relapses and remissions. 

Types of Schizophrenia 

Schizophrenia is a term given to a complex group of mental disorders. However, different types of schizophrenia may have some of the same symptoms. There are several subtypes of schizophrenia based on symptoms: 

Paranoid schizophrenia: People with this type, are preoccupied with false beliefs (delusions) about being persecuted or being punished by someone. Their thinking, speech and emotions, however, remain fairly normal. 

Disorganized schizophrenia: People with this type often are confused and incoherent and have jumbled speech. Their outward behaviour may be emotionless or flat or inappropriate, even silly or childlike. Often they have disorganized behavior that may disrupt their ability to perform normal daily activities such as showering or preparing meals. 

Catatonic schizophrenia: The most striking symptoms of this type are physical. People with catatonic schizophrenia are generally immobile and unresponsive to the world around them. 

Undifferentiated schizophrenia: This subtype is diagnosed when the person’s symptoms do not clearly represent one of the other three subtypes. 

Residual Schizophrenia: In this type of schizophrenia, the severity of schizophrenia symptoms has decreased. Hallucinations, delusions, or other symptoms may still be present but are considerably less than when the schizophrenia was originally diagnosed. 

Causes 

The exact cause of schizophrenia is not yet known. It is known, however, that schizophrenia like cancer and diabetes is a real illness with a biological basis. 

Genetics (heredity): Schizophrenia tends to run in families, which means a greater likelihood to develop schizophrenia may be passed on from parents to their children. 

Brain chemistry: People with schizop- hrenia may have an imbalance of certain chemicals in the brain. They may be either very sensitive to or produce too much of a brain chemical called dopamine. 

Brain abnormality: Research has found abnormal brain structure and function in people with schizophrenia. However, this type of abnormality does not happen in all schizophrenics and can occur in people without the disease. 

Environmental factors: Evidence suggests that certain environmental factors, such as a viral infection, extensive exposure to toxins like marijuana, or highly stressful situations, may trigger schizophrenia in people who have inherited a tendency to develop the disorder.

Symptoms 

In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It is uncommon for children to be diagnosed with schizophrenia and rare for those older than 45. 

Schizophrenia involves a range of problems with thinking (cognitive), behaviour or emotions. Signs and symptoms may vary, but they reflect an impaired ability to function. 

The most common symptoms of schizophrenia can be grouped into three categories: 

• Positive symptoms

• Disorganized symptoms and

• Negative symptoms
Positive symptoms are disturbances that are “added” to the person’s personality. 

• Delusions: “False ideas” individuals may believe that someone is spying on him or her, or that they are someone famous (or a religious figure).

• Hallucinations: These usually involve seeing, feeling, tasting, hearing or smelling something that does not really exist. The most common experience is hearing imaginary voices that give commands or comments to the individual.

• Disordered speech: Moving another, in a nonsensical fashion. Individuals may also make up their own words or sounds, rhyme in a way that does not make sense, or repeat words and ideas.

• Disorganized behaviour: This can range from having problems with routine behaviors like hygiene or choosing appropriate clothing for the weather, to unprovoked outbursts, to impulsive and uninhibited actions.

Negative symptoms are capabilities that are “lost” from the person’s personality. 

• Social withdrawal,

• Extreme apathy (lack of interest or enthusiasm),

• Lack of drive or initiative,

• Emotional flatness,

• Loss of pleasure and lack of ability to experience pleasure,

• Decreased talking and neglect of personal hygiene, poor hygiene and grooming habits or have a loss of interest in everyday activities,

• Speaking without inflection or monotone or not adding hand or head movements that normally provide the emotional emphasis in speech.

Treatment 

Medications: Second-generation antipsychotics 

These newer, medications are generally preferred because they pose a lower risk of serious side effects than do first-generation antipsychotics. Second-generation antipsychotics include: 

• Aripiprazole (Abilify)

• Asenapine (Saphris)

• Brexpiprazole (Rexulti)

First-generation antipsychotics: These first-generation antipsychotics have frequent and potentially significant neurological side effects, including the possibility of developing a movement disorder (tardive dyskinesia) that may or may not be reversible. 

First-generation antipsychotics include:

• Chlorpromazine 

• Fluphenazine
• Haloperidol
• Perphenazine

Psychosocial interventions: Once psychosis recedes, in addition to continuing on medication, psychological and social (psychosocial) interventions are important. These may include: 

Individual therapy: Psychotherapy may help to normalize thought patterns. Also, learning to cope with stress and identify early warning signs of relapse can help people with schizophrenia manage their illness. 

• Social skills training: This focuses on improving communication and social interactions and improving the ability to participate in daily activities.

• Family therapy: This provides support and education to families dealing with schizophrenia.

• Vocational rehabilitation and supported employment: This focuses on helping people with schizophrenia prepare for, find and keep jobs.

Prevention 

There is no sure way to prevent schizophrenia. However, early treatment may help get symptoms under control before serious complications develop and may help improve the long-term outlook. Sticking with the treatment plan can help to prevent relapses or worsening of schizophrenia symptoms.