Schizophrenia

Schizophrenia is a serious mental illness that alters the thinking, behaviour and perception of those affected. Most importantly, it is often very difficult for sufferers to distinguish between reality and delusions. In addition, many people who suffer from schizophrenia report hearing voices in their head and having strong delusions of persecution.

Contrary to popular belief that personality splitting occurs in schizophrenia, this disorder does not result in the formation of multiple personalities. The development of schizophrenia is largely based on genetic predisposition and is therefore counted among the endogenous psychoses.

Approximately 1 percent of all people suffer from the mental illness at least once during their lifetime, so schizophrenia is not that rare. The peak of the disease is between the ages of 18 and 35, with approximately the same number of women as men affected by the disease. However, on average, schizophrenia occurs a few years earlier in males. Thus, the male age peak is between the ages of 15 and 30, and the female age peak is between the ages of 25 and 35.

With intensive treatment, schizophrenia can be brought under control and relatively stable living conditions can be created for most sufferers. Some people are even able to return to work. However, complete recovery occurs in only one-fifth of all sufferers.

The exact cause of schizophrenia has not yet been fully explained, but it is known that certain neurotransmitters, i.e. chemical signal molecules in the brain, contribute to the development of the disease. The theory that an increased production of the transmitter dopamine is responsible for schizophrenia had to be discarded, as it has now been discovered that the overproduction of dopamine alone cannot cause the disease.

In addition, certain parts of the brain are restructured in schizophrenia. For example, in many sufferers there is an expansion of the ventricles, which are fluid-filled cavities of the brain, and a reduction in the size of an area of the brain called the hippocampus.

Genetic component

It is considered clear that the genetic constellation plays an important role in the development of schizophrenia. The probability of developing schizophrenia oneself if one of the grandparents suffers from the disease is 3 percent. If one parent is affected by the disease, the risk of developing the disease is about 10 percent. However, schizophrenia is a multifactorial disease, i.e. it develops through a combination of genetic predisposition and environmental factors. This is why only 40 to 60 percent of twin pairs have both siblings affected.

Vulnerability stress-coping theory

Stressful events can promote the development of schizophrenia. For example, birth complications, serious chronic illnesses, or a stressful childhood can potentially contribute to the development of the mental illness. In addition, stress at work or stressful situations in the family can become triggers for schizophrenic episodes. In about half of cases, stress or stressful events can be linked to the onset of the disorder.

The ability to cope with stressful and distressing situations varies greatly from person to person. For example, people who are more sensitive to stress have a lower stress coping potential. Therefore, strengthening the stress coping potential in the therapy of schizophrenia is one of the basic treatment strategies of psychotherapy.

The symptoms of schizophrenia can be very diverse, as various functions of the psyche can be affected. Furthermore, the extent and the course of the symptoms can vary greatly, so several mental functions can change at the same time and cause a combined complaint (syndrome). In schizophrenia, basic symptoms must be distinguished from additional symptoms.

Basic complaints

Basic complaints are the symptoms that result from the basic mental changes:

- Thus, in schizophrenia, thinking and speech are disturbed. The way of thinking is very erratic, illogical and confused, sentences or thoughts are abruptly interrupted. In addition, the affected person uses words with a different meaning or mixes two words into one.

- Furthermore, affective disturbances and listlessness occur in schizophrenia. It is noticeable that the mood of schizophrenic people often does not match the current situation. In addition, several contrary emotions may be present at the same time, for example, the sufferers may cry and laugh at the same time.

- Typically, sufferers also lose touch with reality and live in their own world.

- Schizophrenic individuals most often have self-perception disorders. They see themselves as unrelated and divided. Even their own person is not always seen as real.

Additional symptoms

Additional symptoms may occur as a result of processing what they have experienced or trying to cope with the illness, as schizophrenic people are unable to adequately process what they have perceived due to their illness:

- Again, changes in thinking may occur. Thus, many affected persons believe that strange thoughts are put into their heads and that their own thoughts have been robbed.

- When it comes to changes in emotional state, fear is most prevalent. The emotional state is typically quite depressive with helplessness and a need for affection, but in some cases exuberant emotions, disinhibition and a boisterous mood can also be dominant. Furthermore, schizophrenics have an increased risk of suicide.

- Many patients report massive delusions of persecution. They think that they are constantly being persecuted and that the rest of the world is against them. It can even get to the point where they think other people want to hurt them or even kill them. Even with good coaxing, it is usually almost impossible to dissuade schizophrenics from their delusional thoughts.

- Furthermore, many schizophrenics suffer from hallucinations. They hear voices, smell things that others do not smell, or see things that are not real. The hallucinations can add to the schizophrenic's constant feeling of being followed and threatened. Even in this case, logical reasoning can hardly calm the sufferer.

- From time to time, schizophrenia may also cause motor impairment. The patients can then only move very slowly and in a restricted manner and become completely rigid (stupor). This can even go so far that schizophrenic people no longer move at all or assume very agonizing-looking positions. The latter is called catalepsy. If fever is added to the uncomfortable body postures, this is called pernicious catalepsy, which can be life-threatening. In situations where the affected person is very agitated and restless, a constant, steady repetition of a certain movement can often be observed. Very often, sufferers can be seen throwing their hands together over their heads, pacing nervously or doing gymnastic exercises.

Slow or acute

The disease can take either a gradual course or an acute one. If the schizophrenia progresses gradually and insidiously, the affected person withdraws more and more from their social circles and family, seems more and more listless, until they finally stop pursuing their work or hobbies. Other symptoms such as sleep problems, reduced concentration, indecisiveness and sudden mood swings can also occur.

The acute course is understood as a flare-up of the disease, which usually happens very abruptly and is accompanied by strong hallucinations and delusions.

Only in some cases the schizophrenic symptoms are always fully developed, mostly the disease progresses in phases with schizophrenic episodes. Between the episodes, the affected person hardly shows any symptoms, but the processing of the schizophrenic episodes can in turn cause serious changes in the personality.

Medical history

The most important measure for diagnosing schizophrenia is an intensive, in-depth medical interview. The diagnosis of schizophrenia is usually determined by a set of criteria that are defined very uniformly worldwide. However, a standardized questionnaire can also be used for the case history, which is designed to facilitate the diagnosis by asking specific questions.

Exclusion of other diseases

Even if there is a strong suspicion of schizophrenia, the attending physician should always check whether other causes could be responsible for the schizophrenic symptoms. For example, the consumption of medicines or drugs, brain tumours or other diseases of the nervous system can cause similar complaints.

To rule out the above causes, the following tests are usually performed:

- A basic physical examination and extensive testing of many nervous system functions, a psychological test, and testing of higher brain cognitive abilities such as reasoning, memory, and attention.

- A blood draw with testing of inflammatory and metabolic parameters.

- A test of the blood and urine for certain medications or drugs.

- Imaging procedures such as CT or MRI to show any changes in the brain.

- If there is a suspicion of meningitis, a lumbar puncture with examination of the cerebrospinal fluid should be performed.

For a good treatment success, a trusting doctor-patient relationship is crucial, which can often prove to be very difficult due to the strong persecutory delusion of many schizophrenics.

The therapy of schizophrenia is very extensive and the treatment concept should be determined in consultation with the affected person himself, since ignoring the patient can only make the situation more difficult. Important treatment steps include educating the sufferer about schizophrenia, drug therapy, as well as various forms of psychotherapy, group therapy with family or partners. A rehabilitation concept to restore a relatively normal everyday life with resocialisation of the affected person is also an important part of the treatment.

Drug therapy

Neuroleptics

The mode of action of many neuroleptics is the antagonisation of the neurotransmitter dopamine in the central nervous system. This mode of action is used in the treatment of schizophrenia. In particular, symptoms such as delusions and hallucinations are improved by this group of drugs, which also gives them the name antipsychotics.

The neuroleptics are very popularly used in early stages of schizophrenia to treat the basic symptoms. However, they have a wide range of side effects, such as motor disturbances (tremor, muscle stiffness), twitching. Furthermore, they have a very depressant effect, lead to fatigue, an increase in body weight and listlessness.

More modern representatives of the group of neuroleptics are suitable not only for the treatment of the basic symptoms, but also for the treatment of additional symptoms, and they also have fewer side effects.

The dosage is determined primarily by the symptoms and the extent of the symptoms, whether there is currently a flare-up of the disease or whether the drug therapy is used to prevent a new flare-up.

Most patients tolerate neuroleptics quite well, although they can have many side effects. The side effects often improve a few days after stopping the medication, except for some form of muscle twitching, which usually does not go away.

Antidepressants

Antidepressants improve the basic mood of schizophrenic persons and reduce their listlessness. Their field of application in schizophrenia is primarily the additional administration of neuroleptics for depressed moods.

Sedatives

This group of drugs is mainly used to treat anxiety and relaxes the patient. However, tranquilizers are not suitable for long-term therapy, as they have a high tolerance development and their dependence potential is very high.

Psychotherapies

The basic psychological changes and the basic symptoms of schizophrenia can hardly be controlled by psychotherapy alone. However, efficient psychotherapy can improve the processing of the perceptions experienced as threatening and thus positively intervene in the disease process.

Important pillars of psychotherapy for schizophrenia are:

- promote self-confidence

- increase the patient's own initiative

- Strengthening the ability to concentrate

- the development of individual coping strategies

- possible reintegration into professional life

- counteracting social segregation

In the context of psychotherapy, a concept should also be sought for how the affected person can be treated as closely as possible to the family.

In most cases, schizophrenia has a protracted course and places a heavy burden on all those involved and their relatives. However, if we look at the results of various studies, we see that the prognosis of the disease is better than many people think.

One fifth of schizophrenics can be completely cured of the disease. At what intervals and how often schizophrenic episodes occur in the remaining four-fifths can be highly variable. In some cases, the disease may take a more severe course and be permanently accompanied by symptoms.

Positive prognostic factors prove to be an abrupt onset and recognizable triggers of the disease.

Individual prognosis

The course of the disease is also strongly influenced by the individual coping potential of the sufferer. However, the most important influence on the prognosis is a consistent, well-controlled drug therapy, even in periods between schizophrenic episodes. This can reduce the risk of relapse to 30 percent.

One third of all patients with chronic schizophrenia show a mild course of the disease in terms of symptoms and only rarely have schizophrenic episodes. In some cases, however, the disease takes a more severe course and can even lead to personality changes.

More than 50 percent of patients can be treated to the extent that they are able to work again and can be integrated into their social environment.

Nevertheless, schizophrenia must be regarded as a serious mental illness that can make many people unable to work or even live.

More severe courses of the disease are often accompanied by a reduced life expectancy. This is mainly caused by an increased accident rate with reduced concentration and an increased suicide rate.

It is very important that the schizophrenics themselves, but also their relatives, intensively deal with schizophrenia, its treatment options and causes. The more one knows about the illness, the better one can make difficult decisions that are pending with schizophrenia. In addition, those affected and their relatives can take measures themselves to counteract a renewed outbreak of the illness.

Furthermore, strict and correct intake of prescribed medication, avoidance of stress factors, and abstention from drugs should be taken care of to reduce the relapse rate.

It is also mostly up to the relatives to recognize an imminent relapse early on, because this is often not recognized by the affected person himself due to the illness, in order to take adequate measures in time.