What is schizophrenia? – Anees Bahji

[ad_1]

Schizophrenia is a chronic, severe brain disorder that affects a person’s thinking, feeling, and behavior. It is characterized by a range of cognitive, emotional, and behavioral symptoms that significantly impair an individual’s ability to function in daily life. It is not a split personality, but rather a disconnection from reality.

Diagnostic Criteria (Based on DSM-5):

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), outlines specific criteria for diagnosing schizophrenia. An individual must experience two or more of the following symptoms for a significant portion of time during a one-month period (with at least one of these being (1), (2), or (3)):

1. Delusions: These are fixed, false beliefs that are not amenable to change in light of conflicting evidence. Delusions can be bizarre (clearly implausible and not understandable to same-culture peers) or non-bizarre (possible but highly improbable). Common types of delusions include:

   • Persecutory delusions: Belief that one is being harmed or harassed.
   • Referential delusions: Belief that certain gestures, comments, or environmental cues are directed at oneself.
   • Grandiose delusions: Belief that one has exceptional abilities, wealth, or fame.
   • Erotomanic delusions: Belief that another person, often of higher status, is in love with oneself.
   • Nihilistic delusions: Belief that a major catastrophe will occur.
   • Somatic delusions: Preoccupation with health and organ function.

2. Hallucinations: These are perceptual experiences that occur in the absence of an external stimulus. They are vivid, clear, and involuntary. The most common type of hallucination is auditory, but hallucinations can occur in any sensory modality.

   • Auditory hallucinations: Hearing voices or other sounds. These voices may be critical, commanding, or commenting.
   • Visual hallucinations: Seeing things that are not there.
   • Olfactory hallucinations: Smelling odors that are not present.
   • Gustatory hallucinations: Tasting flavors that are not present.
   • Tactile hallucinations: Feeling sensations on the skin that are not present.

3. Disorganized Thinking (Speech): This is manifested in speech patterns characterized by incoherence, derailment (frequent topic changes), tangentiality (answers that are off-topic), or illogicality. Severity can range from mild to severe disorganization rendering communication incomprehensible.

4. Grossly Disorganized or Catatonic Behavior: Grossly disorganized behavior can manifest in a variety of ways, including unpredictable agitation, childlike silliness, problems with goal-directed behavior, or inappropriate affect. Catatonic behavior involves a marked decrease in reactivity to the environment. This can range from:

   • Negativism: Resistance to instructions or external stimuli.
   • Mutism: Complete lack of verbal response.
   • Stupor: A decrease in reactivity to the environment.
   • Catatonic excitement: Excessive motor activity without purpose.
   • Posturing: Assuming and maintaining bizarre or inappropriate postures.
   • Stereotyped movements: Repetitive, seemingly purposeless movements.
   • Echolalia: Mimicking the speech of another person.
   • Echopraxia: Mimicking the movements of another person.

5. Negative Symptoms: These symptoms reflect a diminution or absence of normal behaviors and emotions. They are often more persistent and debilitating than positive symptoms. Common negative symptoms include:

   • Diminished emotional expression (flat affect): Reduction in the range and intensity of emotional expression, including facial expression, tone of voice, eye contact, and body language.
   • Avolition: Decrease in motivated self-initiated purposeful activities. The individual may sit for long periods and show little interest in work or social activities.
   • Alogia: Diminished speech output.
   • Anhedonia: Decreased ability to experience pleasure.
   • Asociality: Lack of interest in social interactions.

Other Diagnostic Considerations:

• Social/Occupational Dysfunction: For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset.

• Duration: Continuous signs of the disturbance must persist for at least six months. This six-month period must include at least one month of active-phase symptoms (i.e., the symptoms listed above), and may include periods of prodromal (early, less severe symptoms) or residual (primarily negative symptoms) symptoms.

• Exclusion of other disorders: The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. Schizoaffective disorder and bipolar disorder with psychotic features must be ruled out because schizophrenia requires psychotic symptoms in the absence of prominent mood symptoms.

Subtypes (Historically Used, Less Emphasis in DSM-5):

The DSM-IV-TR included subtypes of schizophrenia, but the DSM-5 places less emphasis on these due to their limited diagnostic stability, low reliability, and poor validity. However, they are still sometimes used descriptively:

• Paranoid type: Preoccupation with one or more delusions or frequent auditory hallucinations. There is an absence of disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect.
• Disorganized type: Prominent disorganized speech, disorganized behavior, and flat or inappropriate affect.
• Catatonic type: Predominance of catatonic symptoms.
• Undifferentiated type: Symptoms are present that meet the criteria for schizophrenia, but the person does not fit into one of the other subtypes.
• Residual type: Absence of prominent delusions, hallucinations, disorganized speech, and disorganized or catatonic behavior. There may be continuing evidence of disturbance, such as negative symptoms or attenuated forms of positive symptoms (e.g., odd beliefs).

Etiology (Causes):

The exact cause of schizophrenia is not fully understood, but it is believed to be a complex interplay of genetic, environmental, and neurobiological factors.

• Genetics: Schizophrenia has a strong genetic component. Individuals with a family history of schizophrenia are at a higher risk of developing the disorder. However, it is not a single gene disorder, but rather a combination of multiple genes that increase susceptibility.

• Neurotransmitters: Imbalances in brain neurotransmitters, particularly dopamine and glutamate, are thought to play a role in schizophrenia. The dopamine hypothesis suggests that excessive dopamine activity in certain brain pathways contributes to positive symptoms. The glutamate hypothesis suggests that decreased glutamate activity may contribute to both positive and negative symptoms.

• Brain Structure and Function: Brain imaging studies have revealed structural and functional differences in the brains of individuals with schizophrenia, including:

  • Enlarged ventricles: Fluid-filled spaces in the brain.
  • Reduced gray matter volume: Particularly in the prefrontal cortex and temporal lobes.
  • Abnormal activity in the prefrontal cortex: Which is involved in executive functions, such as planning and decision-making.
  • Abnormal activity in the temporal lobes: Which are involved in auditory processing and memory.

• Environmental Factors: Environmental factors that may increase the risk of schizophrenia include:

  • Prenatal complications: Such as maternal infections, malnutrition, and exposure to toxins.
  • Stressful life events: Such as childhood trauma, social isolation, and discrimination.
  • Substance abuse: Particularly cannabis use during adolescence.

Treatment:

Schizophrenia is typically treated with a combination of medication, therapy, and psychosocial support.

• Antipsychotic Medications: These medications help to reduce positive symptoms, such as delusions and hallucinations. They work by blocking dopamine receptors in the brain. Antipsychotics are broadly categorized as first-generation (typical) and second-generation (atypical). Second-generation antipsychotics are generally preferred because they have a lower risk of causing extrapyramidal side effects (EPS), such as tardive dyskinesia.

• Psychotherapy: Psychotherapy can help individuals with schizophrenia cope with their symptoms, improve their social skills, and develop strategies for managing their illness. Common types of therapy include:

  • Cognitive Behavioral Therapy (CBT): Helps individuals identify and change negative thought patterns and behaviors.
  • Social Skills Training: Helps individuals improve their social skills, such as communication and assertiveness.
  • Family Therapy: Helps families understand schizophrenia and learn how to support their loved one.

• Psychosocial Support: Psychosocial support services can help individuals with schizophrenia live independently and participate in their communities. These services may include:

  • Supported employment: Helps individuals find and maintain employment.
  • Supported housing: Provides safe and affordable housing.
  • Case management: Helps individuals access needed services and resources.
  • Assertive Community Treatment (ACT): A team-based approach that provides comprehensive, community-based services to individuals with severe mental illness.

Prognosis:

The prognosis for schizophrenia varies widely. Some individuals experience significant improvement with treatment and are able to live relatively normal lives. Others experience more persistent symptoms and require ongoing support. Factors that are associated with a better prognosis include:

• Early diagnosis and treatment
• Good social support
• Adherence to medication
• Absence of substance abuse
• Predominantly positive symptoms
• Good premorbid functioning

Important Considerations:

• Schizophrenia is a complex and heterogeneous disorder. Individuals with schizophrenia experience a wide range of symptoms and have varying levels of functioning.
• Stigma associated with schizophrenia can be a major barrier to treatment and recovery. It is important to challenge negative stereotypes and promote understanding and acceptance of individuals with schizophrenia.
• Research is ongoing to better understand the causes of schizophrenia and to develop more effective treatments.

source

[ad_2]