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Schizophrenia

By Apollo 24|7, Published on- 01 December 2022 & Updated on -

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  • Symptoms: Delusional thought patterns, hallucinations, social withdrawal, unusual physical behaviour and gestures, disorganised or incomprehensible speech, paranoia, loss of rational thinking and general cognitive impairment
  • Causes: No conclusive causal factor (specific elements like genetic history, chemical imbalances in the brain, environmental stressors and triggers are linked to the condition)
  • Risk Factors: Congenital disabilities and developmental issues, psychoactive drug use 
  • Severity: Moderate to severe
  • Which Doctor To Consult: Clinical Psychologist

Overview

Schizophrenia is a mental disorder characterised by a general dissociation from reality, delusions and hallucinations. While the term refers to a single condition, in clinical psychology, schizophrenia comprises a spectrum of mental conditions. These include the following:

  • Schizotypal personality disorders
  • Delusional disorders
  • Brief psychosis or psychotic disorders
  • Schizophreniform disorders
  • Schizoaffective disorders

Typically, schizophrenia begins to manifest at different ages based on biological gender. Males tend to demonstrate symptoms between 15 to 25 years of age, while, in females, the clinical markers start showing up between the ages of 25 to 35 years.

In addition, male and female patients usually experience the effects differently. For example, delusions seem to be more common among females, while males are more affected by a loss of cognitive ability and rational thinking.

In the case of children, schizophrenia is rare but possible. If it develops, the disorder tends to be significantly more severe. As such, the early onset of the condition is vastly more challenging to treat.

When To Consult A Doctor?

1. Upon Manifestation of Symptoms

The initial clinical signs of schizophrenia are general paranoia, social withdrawal and mental and cognitive impairment alongside a muted emotional display. As such, if a person starts deviating significantly from their past behavioural patterns while demonstrating any of the mentioned symptoms, it may indicate schizophrenia or other related mental disorders. However, it is critical not to make assumptions and visit a clinical psychologist for a proper diagnosis.

2. Active Psychotic Break

The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists five primary markers for schizophrenia. These include delusional behaviour, hallucinations, incoherent or disorganised speech, unusual movements and gestures and negative symptoms (absence of normal standard behavioural patterns). An active psychotic break refers to the manifestation of at least two of the mentioned clinical signs.

3. Regular Counselling

General counselling is immensely helpful in dealing with daily emotional stressors and other related anxiety. However, a meaningful discussion around persistent mental stress or existing conditions can help pinpoint specific indicators for the disorder. In addition, a cursory visit to a clinical psychologist can help assess the probability of a person developing schizophrenia if the condition runs in the family.

Diagnosis

Clinical Diagnosis Based on the DSM-5

According to the DSM-5, diagnosing schizophrenia requires three specific conditions to be met. First, at least two of the five primary symptoms must be present. Second, the symptoms must persist for at least a month. The related effects must also be present for at least six months. Finally, the individual in question must have faced some form of occupational or social dysfunction, meaning their professional or personal life was affected due to the associated symptoms. Only when all three of these requirements are met can a clinical psychologist render a confirmed diagnosis for the condition.

Additional/Supplementary Tests

There are no other medical or diagnostic tests for schizophrenia. However, healthcare providers may conduct a few clinical examinations to rule out the possibility of the symptoms being caused by another condition. These include the following:

  • Imaging Tests

Medical professionals may rely on a Magnetic Resonance Imaging (MRI) or a Computerized Tomography (CT) scan to rule out issues such as strokes, traumatic brain injuries or tumours.

  • Urine, Blood & Cerebrospinal Fluid Tests

These types of clinical examinations primarily look for elevations or general alterations in bodily fluids to eliminate the possibility of the symptoms being caused by infection, poisoning or internal biological toxicity.

  • Electroencephalogram (ECG)

Used for assessing brain activity, an ECG can help determine if a specific neurological disorder, like epilepsy, is the causal factor for the manifested symptoms.

Treatment

Schizophrenia is not curable. However, the condition’s related effects and symptoms can be managed effectively through various treatment options. Unlike other mental disorders, schizophrenia requires a combination of clinical remedies. As such, these include the following:

  • Typical/First-Generation Antipsychotics

These medications affect how the patient's brain uses dopamine, a biological chemical that facilitates communication between the cells. Some examples are haldol, loxapine and fluphenazine.

  • Atypical/Second-Generation Antipsychotics

These drugs inhibit serotonin and dopamine usage in the brain. One such example is Clozapine, which is particularly effective in mitigating the symptoms of schizophrenia.

Nonetheless, most atypical antipsychotics have prominent side effects and are only ever prescribed when other medication does not work. In addition, consistent blood monitoring may be necessary to avoid serious complications related to these drugs.

  • Psychotherapy

Cognitive behavioural therapy can help schizophrenic patients better manage the condition. Long-term counselling alongside such methods is also helpful in enabling people to deal with the associated anxiety, paranoia or depression. In addition, consistent psychotherapy helps patients with treatment adherence. In most cases of schizophrenia, affected individuals do not recognise or understand that they suffer from the disorder. Thus, these therapeutic methods increase the probability of patients continuing their treatment.

  • Electroconvulsive Therapy (ECT)

Medication or psychotherapy may not be effective in more severe cases. In such instances, the patient may be at risk of harming themselves or others around them. Clinical psychologists will usually recommend ECT for such patients.

The procedure involves the application of an electric current to the scalp, which stimulates specific parts of the brain. That stimulation causes a minor seizure, alleviating some of the condition's related symptoms. ECT is highly effective for schizophrenic patients with suicidal tendencies.

Risks & Complications If Left Untreated

While there are no visible physical effects, leaving schizophrenia untreated can cause severe mental degradation and pose a risk to the patient and others around them. Typically, undiagnosed or untreated cases of schizophrenia can lead to the following:

  • Suicidal Tendencies

Due to the condition's drastic impact on a patient's mental faculties and cognitive abilities, most schizophrenic patients tend to develop suicidal thoughts. If left unaddressed through clinical counselling, this can worsen, causing an individual to attempt suicide.

  • Anxiety Disorders & Other Related Conditions

Medical experts have observed a correlation between schizophrenia and other mental disorders, such as Obsessive-Compulsive Disorder (OCD) or other anxiety-related conditions. This is primarily due to schizophrenia causing severe delusional and behavioural dysfunction. When left untreated, schizophrenic patients will experience more pronounced effects in regard to these mentioned symptoms.

  • Social Liabilities & Victimization

While there is a general misconception of schizophrenic patients being violent, it is, in fact, the opposite. Usually, people suffering from the disorder have little to no association with their immediate surroundings.
This can cause them to behave in a manner perceived as unnatural or dangerous. Consequently, this can make them a target in public settings, often leading to violence and physical altercations.

  • Drug & Alcohol Abuse

It is not uncommon for people with schizophrenia to become overly dependent on recreational drugs and alcohol. This is partly due to patients experiencing immense paranoia, social anxiety and mental stress. However, such behavioural patterns only worsen the condition's effects, impairing their mental faculties.

  • Severe Social & Occupational Dysfunction

In almost all cases, schizophrenic patients will experience some form of dysfunctionality in their personal and professional lives. However, leaving the condition unmanaged or untreated can make the situation even worse.
For example, schizophrenia negatively impacts a person’s ability to have relatively normal social relationships. However, medications and psychotherapy can prove to be effective in mitigating this specific concern.

Additional Information

Difference Between Schizophrenia and Psychosis

There are some strong connections between psychosis and schizophrenia. However, there are also specific distinctions between the two. In clinical terms, psychosis is a group of symptoms characterised by a disassociation from reality and a person's immediate surroundings. As such, psychosis may be a clinical marker in schizophrenic patients. Conversely, schizophrenia includes a broad spectrum of related disorders, all of which may have psychosis as part of their symptoms.

Underlying Cause of Schizophrenia

Certain factors have been linked to increasing a person's risk of developing schizophrenia. These include the following:

  • Genetic history
  • Environmental stressors and triggers
  • Congenital disabilities and developmental issues
  • Excessive usage of recreational drugs
  • Chemical imbalances in the brain

Regardless, medical research still has not conclusively identified the causal factor behind the condition. This compounds the issues related to a general lack of understanding of the disorder's effects, complications and risks.

Is Schizophrenia A Lifelong Condition?

Schizophrenia is incurable and lasts the entirety of a person's life. However, the treatment can alleviate the associated symptoms for some time. But the condition may return at any given time. That is why medical experts do not consider a patient to have recovered from the disorder even if they stop demonstrating the symptoms or clinical markers.

Instead, they are considered to be 'in remission'. This is why, it is necessary, if not mandatory, for affected individuals to continue with their treatment and medications even if they have stopped experiencing related signs such as hallucinations and delusions.
 

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Frequently Asked Questions

With the proper treatment and medication, schizophrenic patients can lead relatively normal and productive lives. However, it is essential to adhere to the prescribed treatment plan. Deviating from it can result in the return of symptoms and impact the person’s social and personal relationships.

Vocational training and rehabilitation can help schizophrenic patients learn skills that enable them to function in social settings. Group therapy and general counselling are also beneficial as these let patients open up and discuss their mental issues and problems without the fear of judgement.

The initial signs of schizophrenia almost always include social withdrawal, muted emotional displays and mild paranoia. Additionally, the affected person may have an active psychotic break where they demonstrate delusional thought patterns and behaviour or hallucinations. However, it is critical to not immediately jump to conclusions and seek professional help to render a proper medical diagnosis.