Schizophrenia

Symptoms Of Schizophrenia

Schizophrenia is a chronic mental disorder that affects how a person thinks, feels, behaves, and interacts with his/her surroundings. Symptoms such as mood changes, alterations in behavior, altered thinking, and abnormal social functioning often appear gradually before a major episode of psychosis or hallucinations. The symptoms of Schizophrenia can vary in type and severity over time, with alternating periods of worsening of symptoms and remission in symptoms.

The symptoms of Schizophrenia can be broadly classified into the following subtypes:

1. Psychotic symptoms

• Delusions: False beliefs with no base in reality, even when there is evidence to the contrary. For example, a person with schizophrenia has thoughts such as someone out there wants to hurt him/her even when no such threat exists.

• Hallucinations: Hearing, seeing, or feeling things that do not exist. For a person with schizophrenia, these altered experiences feel absolutely real.

• Abnormal or disorganized behavior: A person with schizophrenia may behave abnormally, and the behavior spectrum can range from childlike silliness to unpredictable rage and agitation.

• Abnormal motor behavior: A person with schizophrenia often does not make eye contact, lacks facial expressions, makes bizarre postures and unnecessary or excessive movements.

• Disordered thinking and speech: Often people with schizophrenia are unable to communicate effectively and may use meaningless words or out-of-context replies to questions.

2. Negative symptoms

These are symptoms that affect a person's ability to function normally. In this, a person may typically -

• Neglect personal hygiene
• Lose interest in everyday activities 
• Lack the ability to experience pleasure in everyday life
• Show reduced ability to express emotions
• Be unable to effectively communicate thoughts and struggle to frame words.

3. Cognitive symptoms

This subset of symptoms affects memory, concentration, and attention. This includes: 

• Difficulties in processing information to make decisions
• Learning new things
• Remembering information

Causes Of Schizophrenia

There is no single established cause of schizophrenia. It is likely to occur due to a complex interaction between genetic factors (such as having a family history) and certain alterations in brain structure and function. Environmental factors, such as exposure to certain toxins, neuro-viruses, substance abuse or stressful surroundings, may also contribute to the condition.

Risk Factors Of Schizophrenia

Schizophrenia is quite prevalent, however, it is difficult to estimate the exact number of people with schizophrenia due to the complexities involved in diagnosing the illness and overlap with other psychiatric disorders. As of 2019, 20 million people in the world are affected by schizophrenia and 3 out of every 1000 Indians suffer from it.

The definite cause of schizophrenia is not yet known. However, certain factors increase a person’s risk of developing schizophrenia, such as: 

• Family history of schizophrenia; however, no single gene is yet identified which can be linked directly to the disease.

• Pregnancy and birth complications.

• Exposure to toxins or viruses that affect brain development in early life or before birth.

• Consumption of psychoactive drugs during teen years or early adulthood.

• Alterations in the brain structure and function.

• Alterations in the interaction of chemical messengers called neurotransmitters.

Diagnosis Of Schizophrenia

Schizophrenia is usually suspected when a person has a major episode of psychosis and has been displaying other symptoms of schizophrenia. Diagnosis involves ruling out other psychiatric illnesses and disorders occurring due to substance abuse or medications.

Establishing a diagnosis of schizophrenia involves the following:

1. History and clinical examination

A physician usually performs a detailed examination, reviews the patient’s history, looks for characteristic schizophrenia symptoms, finds out social and occupational dysfunction, verifies the onset of symptoms to rule out other potential causes, and screens health-related complications. It is essential to rule out other conditions that may mimic the symptoms of Schizophrenia before confirming the diagnosis.

2. Lab tests and imaging studies

The following tests may be prescribed to evaluate the overall health status, screen for potential substance abuse, and study brain functioning.

1. CT Scan (Head) - to study any structural changes in the brain.

2. MRI Brain - an in-depth study to identify if any pathology in the brain is causing symptoms, such as brain tumors.

3. Alcohol Screen Blood - to rule out alcohol intoxication as a cause of the psychotic symptoms.

4. Alcohol Screen Urine - to rule out alcohol intoxication as a cause of the psychotic symptoms.

5. Drugs of Abuse Panel - 9 Drug Panel - to rule out psychotic drug abuse as a cause of the psychotic symptoms. 

6. Complete Blood Count (CBC) - to evaluate general health status. 

7. Comprehensive Health CheckUp - to evaluate overall health status.
   
   

3. Psychiatric evaluation

A detailed psychiatric evaluation comprising a study of the patient’s mental status, thoughts, moods, delusions, hallucinations, and family and personal history is essential to diagnose the disease. 

The diagnosis of schizophrenia may be considered if signs and symptoms, such as delusions, hallucinations, disorganized thoughts and speech, abnormal behavior, lack of emotions, lack of attention, etc., began more than 6 months ago and have been in an active phase for at least one month. Also, diagnosis of schizophrenia can be confirmed only when all other factors, such as substance abuse, alcohol abuse, other psychiatric disorders like bipolar disorder, have been ruled out.

DSM-5 guidelines for diagnosis of schizophrenia

The American Psychiatric Association has laid down criteria for diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, also known as DSM - 5. which states that a diagnosis of schizophrenia can be made if:

Criterion A: At least two of the following (at least one must be 1, 2 or 3) indications for at least 1 month: 1. Delusions, 2. Hallucinations, 3. Disorganized speech, 4. Grossly disorganized or catatonic behavior, 5. Negative symptoms

Criterion B: Level of functioning has to be lowered significantly and for long term compared to the previously achieved level

Criterion C: Signs of the disturbance persist for at least 6 months, must include criterion A symptoms for at least 1 month

Criterion D: Schizoaffective disorder and depressive or bipolar disorder with psychotic symptoms ruled out

Criterion E: The disturbance is not caused by substance use or medical conditions

Criterion F: If a patient has a history of autism spectrum or communication disorders from childhood, schizophrenia diagnosis can be made in case of prominent delusions/hallucinations and other required symptoms of schizophrenia are present for at least 1 month

Specialist To Visit

Patients exhibiting symptoms of schizophrenia are generally incapable of making informed health-related decisions. Thus, their family or caregivers must approach their primary healthcare physician if they suspect or observe any unexpected symptoms which last for a prolonged period of time.

The primary healthcare physician can then refer the patient to specialist doctors for detailed evaluation and treatment. Such patients may be referred to:

• Psychiatrist

• Psychologist

• Neurologist

For an active episode of psychosis, treatment at a hospital may be essential.

Treatment Of Schizophrenia

Treatment with antipsychotic medications can help alleviate symptoms and reduce the chances of unexpected complications. Lifelong treatment is essential even if the symptoms seem less or controlled.

The medications consist primarily of first or second-generation antipsychotic drugs. Other medications such as antidepressants or anti-anxiety drugs, or a combination of these drugs are also used to treat this condition.

1. Conventional antipsychotics or first-generation antipsychotics: 
Also known as typical antipsychotics or first-generation antipsychotics, these drugs help to control psychotic symptoms of schizophrenia such as delusions and hallucinations. They work by blocking the action of the neurotransmitter dopamine in the brain.

They can potentially cause frequent and significant neurological side effects such as movement disorders. They are significantly cheaper than the newer second-generation antipsychotics and this may be an important consideration in long-term treatment.

Examples include:

• Chlorpromazine

• Haloperidol

• Fluphenazine

2. Atypical antipsychotics or second generation antipsychotics
These are newer antipsychotic medicines with fewer body movement-related side effects but can affect other body mechanisms contributing to their side effect profile than the traditional first-generation antipsychotic medications. They work by blocking the receptors for neurotransmitters like serotonin (stronger blocking) and dopamine (moderate blocking).

Common examples are:

• Aripiprazole

• Ziprasidone

• Sulpiride

• Asenapine

• Clozapine

3. Long-acting injectable antipsychotics
Certain formulations of typical or atypicals are also available as long-acting intramuscular injections that need to be given every 2-4 weeks. This is useful in patients who are resistant to taking daily pills and can help with adherence.

4. Nutritional supplements
Taking Vitamin B Complex and Omega-3 fatty acid supplements like fish oil capsules can help ease the symptoms in Schizophrenic patients. Vitamin B complex is essential for normal functioning of the nervous system. Omega-3 fatty acid supplements contain DHA and other fatty acids which are important for brain health.

Living With Schizophrenia

Living with someone who has been diagnosed with schizophrenia may be challenging for the family and the caregivers as the patient needs constant care and support. However, here are a few tips that can help you to take care of someone with the condition.

1. Understand the condition

Understanding and accepting what your family member or relative is going through is the first step in managing the disease. Information about the condition will help the caregivers understand the importance of therapy and recognize warning signs if the disease worsens. 

2. Stay focused on goals of therapy
The therapy goals are different for each patient and are adjusted to suit individual requirements. Managing the condition is an ongoing process. Help your loved ones adjust to the therapy and encourage them to take responsibility towards their goals.

3. Help the patient abstain from vices

Alcohol and recreational drugs worsen the symptoms of Schizophrenia and make the condition difficult to treat. Hence, the family or caregivers need to ensure that the patient does not indulge in such activities.

4. Try relaxation and stress management techniques

It is not unusual for the family or caregivers to be stressed and anxious along with the patient themselves. Learning relaxation techniques and stress management will help cope with the disease.

5. Join schizophrenia support groups

Connecting with other people facing similar challenges may help a person come to terms with the disease. There are a few societies in India working in the field of mental health and wellness, offering support to those diagnosed with life-changing mental health disorders like schizophrenia.

Mental illnesses are quite common these days. Just being there with someone who needs help is one of the simple ways to help a patient. Need more help?
Here are 6 ways you can help your loved ones struggling with mental illness.
Click To Read

Complications Of Schizophrenia

If left untreated, Schizophrenia may severely hamper a patient’s quality of life and can potentially cause complications like: 

• Suicidal thoughts, suicide attempts, and suicide

• Anxiety disorder

• Depression

• Drug and alcohol abuse

• Aggressive behavior

• Social isolation

Severe cases may need hospitalization for treatment.

Alternative Therapies For Schizophrenia

1. Psychosocial interventions

In addition to medication, psychological therapy helps normalize the patient’s thought patterns and also helps cope with stress and anxiety. Social rehabilitation helps the patient interact with society and participate in daily activities. These are important interventional programs in managing a patient with schizophrenia.

2. Cognitive behavior therapy (CBT)

This type of psychological therapy helps teach the patient coping skills to manage their difficult conditions. The therapy focuses on the cognitive component. This helps the patient to change their thinking about a particular situation and the behavioral component which further helps them to change their reactions to any situation.

3. Electroconvulsive therapy

For adults who do not respond well to drug therapy, electroconvulsive therapy, or shock therapy (ECT) may be considered. In this, small amounts of electric currents are passed through the brain to help regulate electrical activity in the brain.

4. Deep brain stimulation (DBS)

Similar to electroconvulsive therapy, this therapy is useful in patients resistant to standard treatment. This is a type of elective surgical procedure in which tiny incisions are made near the brain to implant some electrodes in the patient’s brain areas. These electrodes generate mild electrical impulses which are thought to regulate abnormal electrical activity of the brain and improve the symptoms. 

5. Ayurveda in schizophrenia

Ayurveda treatment for Schizophrenia follows a holistic approach, combining natural medicine, massage, diet, and lifestyle regulation. Ayurvedic herbs may be beneficial when used in adjunction with antipsychotic medication. However, no studies have been proved yet on the effectiveness of Ayurvedic herbs to treat or manage this condition.