Schizophrenia
One evening, after a hectic day at the hospital, I was resting for a while on the sofa in the drawing room and watching cricket. My mother was sitting beside me with a story book. The door bell rang and my mother opened the door for Gouri. She comes at times to our house to help my mother in the household chores. My mother loves to chat with her.
Both of them were sitting. Massaging my mother’s legs, Gouri said “Now a day, my husband is behaving strangely. He is not able to sleep. He says his heads feel heavy. Whenever he thinks of doing something, other people interfere. Many people follow him wherever he is going. They always talk about him. They steal his ideas and materialize them before he is able to do so. He even says that people from America, Pakistan, Russia are spying on him. They are trying to control him with the help of computer and other gadgets. Many Ministers, Govt. Officers and other big shots are conspiring against him. He is even suspicious of me. He accuses me of having many extra marital relationships. He speaks so confidently that many believe him. Sometimes he locks me when he goes out. I have noticed him talking to himself. He says he is able to communicate with spirits and they instruct him regarding his daily routine. I am very much worried. I don’t know what to do?”
I had stopped watching cricket and was listening carefully to their conversation. I understood that her husband was suffering from Schizophrenia. I asked “since when is he talking such irrelevant things. She was taken aback by my question. She kept quiet and then said “since last few days it’s like this, but I couldn’t understand. Today I simply felt like sharing with maam.” I explained to her about her husband’s disease. Now a days, many medicines are available to treat such problems. Your husband would be fine if he would take medicines regularly.” Gouri was amazed. She said “really, is it possible? I shall get him to meet you tomorrow. Please treat him. We are facing a lot of problems because of this.” I said “Definitely I shall prescribe medicines but you have to ensure that he takes the medicines regularly.”
Next day she came to me with her husband and son. I counseled them and gave medicines. I explained them about long term treatment of the disease. Her son asked “will he be fine after taking medicines?” I said “Definitely, but these treatment are a bit prolonged treatment. You need to have patience. It would take at least three to six weeks before you would be able to notice some marked difference in him. In between you need to be regularly in touch with me as and when advised. Doses need to be revised based on the progress of the disease. If he doesn’t take medicines, injections are available. He has to take one injection in two to four weeks.” Gouri asked “will there be any harm or reactions due to these medications?” I said “At times, few people get some side effects like stomach upset, palpitation, tremor in hand, dry mouth, blurring of vision etc. If you get any such symptom, consult me. Hospitalization is required if he does not take medications regularly.” They were quite obliged and underwent treatment regularly. Today they are a happy family and I am happy to see that.
Schizophrenia – FAQ
1.What is schizophrenia?
Schizophrenia is a complex illness or group of disorders characterized by hallucinations, delusions, behavioral disturbances, disrupted social functioning, and associated symptoms in what is usually an otherwise clear sensorium.
2.What are the symptoms of schizophrenia?
Schizophrenia involves at least a one-month period of continuous signs of the illness. Active symptoms may include:
- Delusions, which are false beliefs that (1) persist despite what most people would accept as evidence to the contrary and (2) are not shared by others in the
same culture or subculture.
- Hallucinations, which are perceptions that appear to be real when no such stimulus is actually present. Hallucinations may involve any of the five normal
senses, but in schizophrenia they are usually auditory.
- Disorganized speech.
- Grossly disorganized or catatonic behavior. Catatonia, a syndrome characterized by stupor with rigidity or flexibility of the musculature, may alternate with
periods of overactivity.
- Negative symptoms, such as (1) affective flattening or decreased emotional reactivity; (2) alogia or poverty of speech; (3) avolition or lack of purposeful action.
Usually work performance, social relations, and self-care decrease below the highest previous levels.
3.What are some additional clinical features?
Prodromal or residual phases may include social isolation or withdrawal, peculiar behavior, digressive over-elaborate speech, odd beliefs such as ideas of reference (thinking that others’ words, actions, or expressions are in reference to oneself when this is not the case) or magical thinking, unusual perceptual experiences, or marked lack of initiative, interests, or energy.
Age of onset is usually during adolescence or early adulthood. The course is highly variable, but generally involves significant functional impairment.
Violent acts sometimes receive significant attention.
Some schizophrenic patients have various somatic complaints as part of their illness, but they also may be medically ill and not complain or incorporate symptoms into their delusional system.
Life expectancy is reduced by death from suicide and other causes. Approximately 40% of schizophrenics attempt suicide at some point in their lifetime, and 10–20% succeed.
4.How common is schizophrenia?
The lifetime incidence of schizophrenia is approximately 1%. This figure is remarkably stable across racial, cultural, and national lines.
5.What medical conditions may induce psychosis and be mistaken for acute schizophrenia?
- Substance abuse and drug toxicity
- Space-occupying central nervous system lesions—tumor (especially limbic and pituitary), aneurysm, abscess
- Head trauma
- Infections—encephalitis, abscess, neurosyphilis
- Endocrine disease—thyroid, Cushing’s, Addison’s, pituitary, parathyroid
- Systemic lupus erythematosus and multiple sclerosis
- Cerebrovascular disease
- Huntington’s disease
- Parkinson’s disease
- Migraine headache and temporal arteritis
- Pellagra and pernicious anemia
- Porphyria
- Withdrawal states, including alcohol and benzodiazepines
- Delirium and dementia
- Sensory deprivation or overstimulation states can induce psychosis, such as psychosis induced in the intensive care unit
6.Which street drugs and prescription medications may induce psychosis?
Alcohol, Cocaine, Lysergic acid diethyl-amide (LSD) L-dopa, Bromocriptine, Mescaline, Amantadine, Psilocybin Ephedrine, Marijuana, Phenylpropanolamine, Cimetidine and other antihistamines
Disulfiram, Metronidazole, Carbamazepine and other anticonvulsants
Digoxin, propranolol, ,Thyroid hormones, Various medications with strong anticholinergic effects
7.What causes schizophrenia?
A number of factors have been implicated in the pathogenesis of schizophrenia, which often is conceptualized as a group of disorders with common symptoms.
Genetic factors
Endocrine factors
Brain structural changes
Viral and immune factors
Neurochemical changes
Neurophysiological changes
Brain structural studies CT, MRI, and postmortem studies have found changes in frontal, temporal, limbic, and basal ganglia areas, as well as in brain symmetry, in schizophrenic patients. Some of these findings have been corroborated by changes in regional cerebral blood flow, functional MRI, and positron emission tomographic (PET) studies.
Multiple neurochemical changes also have been implicated in schizophrenia. It has been long noted that an excess in dopaminergic activity in the central nervous system is central to the development of schizophrenic symptoms. Compelling data also implicate norepinephrine, serotonin, and cholinergic (muscarinic and nicotinic),
glutamatergic, GABAergic, and neuropeptide systems.
Neurophysiological changes have been shown through various neuropsychologic and physiologic measures.
Endocrine factors have long been suspected. Females tend to develop schizophrenia later and often have less severe symptoms than males. In males, the onset of schizophrenia typically is during puberty. Changes in prolactin, melatonin, and thyroid function have been found in schizophrenia.
Viral and immune factors also have been implicated. Although the search for a causative virus in schizophrenia has thus far been unfruitful, various factors point to
this possibility. For example, a number of immune changes have been found, including IgA, IgG, and IgM. Furthermore, a larger than expected number of schizophrenic patients are born in late winter and early spring, leading to the hypothesis that perinatal viral infections may be involved in causing schizophrenia.
Psychosocial factors clearly play a role in the course of the illness.
8.What is the role of genetics in schizophrenia?
Genetic factors play a significant role, but are not sufficient alone to account for the development of schizophrenia. In the general population, the lifetime risk of developing schizophrenia is approximately 1%. A child born with one schizophrenic parent has about a 14% chance of developing schizophrenia. Genetic linkage studies to date have implicated chromosomes 5, 6, 8, 10, 13, and 15 in schizophrenia. Although such data support a strong role for genetics in the etiology of schizophrenia, they also clearly show that other factors play a significant role in determining who does and does not develop schizophrenia.
9.What are the treatments for schizophrenia?
Antipsychotic medications are the cornerstone of the treatment of schizophrenia. Inpatient treatment in a therapeutic milieu may be crucial in the early and acute phases. Residential treatment settings, group homes, and day hospital programs may help patients to remain outside the hospital. Supportive individual and group psychotherapy can help patients to understand and come to terms with their illness and need for treatment, to identify factors that influence symptoms, and to develop strategies to deal more effectively with the illness. Family therapy sessions also may help families of schizophrenic patients to understand the illness and to help the patient. Families may have a negative impact if they are high in expressed emotion, hypercritical, or overtly hostile toward the patient. Schizophrenic patients often have extremely poor social skills. Social skills training have been shown to be highly effective in helping to improve quality of life. Vocational rehabilitation helps some stabilized patients to return to more productive roles in society.
10.What are the positive prognostic signs in schizophrenia?
Improved prognosis in schizophrenia is associated with:
- Good pre-morbid functioning, late onset, female gender, clear precipitating events, acute onset.
- Mood disturbances, brief active phase, good interepisode functioning, marriage, decreased residual symptoms, fewer chronic negative symptoms.
- Decreased structural brain abnormalities, normal neurologic functioning.
- Family history positive for mood disorder, negative for schizophrenia.
- What is schizoaffective disorder?
Schizoaffective disorder has been defined in numerous ways, but essentially it is an illness that combines symptoms of schizophrenia with a major affective disorder, i.e., major depression or manic-depressive illness.
12.What are paranoid disorders?
The term paranoid disorders refers to a variety of conditions characterized by delusions and related behavior. One of the earliest described of these disorders was paranoia, now called delusional disorder. The cardinal psychopathologic feature is the delusion. In recent years paranoid has referred to a multitude of behaviors, from ordinary suspiciousness to persecutory delusions. It also has been used to characterize grandiose, litigious, hostile, jealous, and even angry behavior, regardless of the fact that these behaviors may be within the normal spectrum.