Schizophrenia is a complex, long-term brain disorder that usually appears in young adults during their first episode of hallucinations and delusions.
### Causes
Both genetic and environmental factors can lead to schizophrenia. It tends to run in families; if a close family member has it, your risk is higher. For example, there’s a 10% chance for first-degree relatives and a 40-65% chance for identical twins of someone with schizophrenia. Environmental triggers might include exposure to viruses, malnutrition before birth, and complications during birth. The interplay between genetics and environment is crucial for the disorder to develop.
### Brain Structure and Chemistry
Brain chemistry and structure also play roles. Imbalance in neurotransmitters like dopamine and glutamate may lead to schizophrenia. The brain may also show physical differences such as larger ventricles, less grey matter, and varied activity in certain areas.
### Risk Groups
Several groups are at higher risk:
– People with a family history of schizophrenia
– Those exposed to toxins, viruses, or malnutrition in the womb
– Individuals with autoimmune diseases or inflammation
– Children of older fathers
– Those who use psychoactive or psychotropic drugs in teenage years or adulthood
Men and women are equally likely to develop schizophrenia, but men tend to show symptoms earlier. It’s uncommon after age 45 or in childhood, and diagnosing it in teenagers can be tough since symptoms may resemble normal teenage behavior. Schizophrenia occurs at similar rates across all ethnic groups.
### Symptoms
#### Positive Symptoms:
– **Hallucinations:** Only the person experiences these, often hearing voices that are critical or abusive.
– **Delusions:** False beliefs not based on reality, including persecution, reference, grandeur, and control.
– **Thought Disorders:** Odd or dysfunctional thinking, like disorganized speech or making up new words.
– **Movement Disorders:** This may range from resistance to movement to excessive or agitated movements.
#### Negative Symptoms:
These involve disruptions in normal emotions and behavior, such as:
– Lack of emotional response (flat affect)
– Social withdrawal
– Lack of initiative or pleasure in everyday life
#### Cognitive Symptoms:
These are subtle, making them hard to spot and include:
– Poor executive functioning
– Trouble focusing or thinking logically
– Memory problems
– Disordered speech
These symptoms can hinder daily functioning and cause emotional distress. They typically appear in early adulthood, emerging in the early 20s for men and the late 20s to early 30s for women.
### Diagnostic Criteria
According to the DSM-5, diagnosing schizophrenia involves ruling out other mental disorders and confirming the symptoms are not due to substance abuse or other medical conditions. The criteria include:
– At least two of the following symptoms for a significant time over one month: hallucinations, delusions, disorganized speech, disorganized or catatonic behavior, and negative symptoms.
– A significant drop in social or occupational functioning since symptoms began.
– Continuous signs of disturbance for at least six months.
– Exclusion of schizoaffective and major mood disorders, as well as substance-related or medical conditions.
– If there’s a history of autism or other childhood communication disorders, hallucinations or delusions must be present for at least one month.
### Treatment
#### Antipsychotic Drugs:
1. **Typical Drugs:** First-generation drugs that control positive symptoms.
2. **Atypical Drugs:** Second-generation drugs that manage both positive and negative symptoms, with fewer side effects. Common ones include risperidone, clozapine, olanzapine, quetiapine, ziprasidone, aripiprazole, and paliperidone. Side effects can include drowsiness, dizziness, blurred vision, dry mouth, constipation, urinary retention, muscle spasms, and tremors.
#### Psychosocial Treatment:
1. **Rehabilitation:** Social and vocational training, including job counseling, money management, and communication skills practice.
2. **Family Education:** Helping family members learn how to support and care for the patient, ensuring adherence to treatment.
3. **Cognitive Behavioral Therapy (CBT):** Helps patients cope with symptoms that medication doesn’t fully control and reduces the risk of relapse.
4. **Individual Therapy:** Empowers patients to manage their illness, cope with stress, and recognize signs of relapse.
5. **Self-Help Groups:** Support groups for patients and families to help cope with the disorder together.
### Prognosis
– Full recovery is rare.
– There is a 5% lifetime risk of suicide among patients.
– Positive symptoms usually respond well to medication, but other symptoms often persist.
– Poor prognosis is associated with a family history of schizophrenia, early onset of symptoms, brain abnormalities, and prominent cognitive issues.