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Schizophrenia

Schizophrenia

Christopher Reist (Academic Psychiatrist, Co-Author of “Psychiatry”) gives expert video advice on: What are the most common dangers associated with schizophrenia?; How will a psychiatrist determine whether I suffer from schizophrenia?; What are the common treatments for schizophrenia? and more...

What is "schizophrenia"?

Schizophrenia is a devastating mental disorder that affects approximately 1 percent of the population worldwide. Schizophrenia has a devastating effect on a person's functioning and the World Health Organization has ranked it in the top ten cases of disability among all medical disorders. Schizophrenia typically has it's onset in late adolescence or early adulthood. Schizophrenia is characterized by problems with thinking, problems with managing emotions, difficulties interpreting reality correctly and difficulties stringing thoughts and ideas together in a logical and coherent manner. Most patients with schizophrenia suffer chronically over their lifetime. They typically have a pattern of remission and relapse. In fact, patients with schizophrenia don't always owe their condition to bad parenting or have split personalities, nor do they always have a particular predisposition to violence. It is really important that we all have a good understanding of this common and devastating illness, schizophrenia.

What are the symptoms of schizophrenia?

The symptoms of schizophrenia can be divided into a couple of different categories. These groups include positive, negative, and cognitive symptoms. I don't mean positive or negative in a good or bad sense, but more of the presence or absence of certain features. The positive symptoms include hallucinations, delusions, and changes in the ability to think logically about ideas. Hallucinations are perceptions of various sensory functions that occur, such as a voice when there's nobody around. Delusions are fixed beliefs that a person strongly holds to even when there's evidence to the contrary. Finally, the ability to think logically refers to putting together ideas in a coherent manner to really express a complex concept. People with schizophrenia often have a great deal of difficulty with that. The second group of symptoms are the negative symptoms and this means more a lack of certain features that are normally present in a person. Negative symptoms include anhedonia, or the ability to enjoy normal, pleasurable activities. We see deficits in speech; typically, people with schizophrenia have speech that is brief and doesn't really amount to a lot. We also see problems with motivation; often patients with schizophrenia have difficulty starting or sustaining new activities. The final cluster of symptoms is what we call cognitive deficits and these refer to a variety of mental processes, such as attention, memory, and the ability to make judgments.

What are the most common causes of schizophrenia?

A lot of effort has gone into trying to understand what most commonly causes schizophrenia. People have started to look at genetics. There's been a lot of work looking at the structure of the brain and how the cells are organized in efforts to understand the most common causes of schizophrenia. People have also started to look at how environmental factors may be important in the development of schizophrenia. This includes some ideas that a viral infection during certain parts of the pregnancy may predispose a newborn to developing schizophrenia. We know there are a couple neurotransmitter systems that are very relevant in schizophrenia. This includes dopamine which is important in regulating motor activity as well as some of the cognitive processes in the frontal lobe, and also glutamate, which is another neurotransmitter system that is also the focus of a lot of research today. Another focus has been to look at the actual structure of the brain. We know that in schizophrenia we have changes in volume of certain regions of the brain. We also know that if you look very carefully at the structure of the neurons in certain areas of the brain you can see that that the structure is disorganized compared to what it should look like.

What are the most common dangers associated with schizophrenia?

With schizophrenia, people will often have trouble with maintaining relationships and maintaining successful long-term work. It's very important to realise that the degree of symptom severity can vary widely in this disorder, and there are a lot of patients with schizophrenia who with treatment can actually achieve a very high level of functioning; they can marry, they can be a parent, and they can work. However, at the other end of the spectrum, we have people that have a lot of difficulty even being able to maintain independent living and often will require a living setting that's structured and supervised, and in which a lot of the basic needs are provided to them. There are a number of other dangers that are relevant to schizophrenia; among them is suicide. A significant proportion of patients with schizophrenia, about 15%, will eventually commit suicide. Schizophrenia can also have an impact on overall physical health. We know that patients with schizophrenia tend to have poorer nutrition, they tend to be at higher risk for developing substance abuse, and they are less aware of the need to take care of their physical health, that is, the usual preventive health care measures. So, in patients with schizophrenia we see a much higher rate of coronary artery disease and diabetes, and in fact patients with schizophrenia have an average 10-year shorter life span compared to other people.

How will a psychiatrist determine whether I suffer from schizophrenia?

There aren't specific tests for schizophrenia in use currently, so determining schizophrenia really is based on an interview and the recognition of a certain set of symptoms and a historical pattern. Sometimes it can be mistaken for <a href="http://www.videojug.com/interview/post-traumatic-stress-disorder">post traumatic stress</a>, and vice versa.

What are the common treatments for schizophrenia?

The treatment for schizophrenia really depends on how severely ill the individual is. If a person is suffering a severe exacerbation of their symptoms, and is experiencing a lot of positive symptoms and disorganization of thought, it may be necessary to hospitalize that individual to make sure that food and shelter is provided for. However, the mainstay of treatment for schizophrenia over time is the use of anti-psychotic medications. These include drugs that were used in the past, such as Haldol. However, now we have what are called the atypical anti-psychotics such as risperidone, quetipine or lanzopine, that have far fewer side effects than the older medications. On top of the use of medication as treatment for schizophrenia, we're realizing that psychotherapies and education are very important. We know that cognitive behavioral therapy can help with reducing symptoms, and we know that education around social skills can really help prepare an individual with schizophrenia to be more successful in social circumstances or in the workplace. It really requires a comprehensive, multi-disciplinary effort to provide the best care to patients with schizophrenia.

Who is most at risk for developing schizophrenia?

Since we don't know the specific cause of schizophrenia, it's hard to predict who's going to develop it. We do know there is a substantial genetic risk. For example, if you have a first-degree relative or a parent with schizophrenia, the likelihood of you developing schizophrenia increases dramatically. There are some ongoing studies that are attempting to identify what we call prodromal symptoms in children and adolescents. If these certain types of symptoms are present, then there's a feeling that these individuals may be at risk for developing the full-blown disorder later on. The big question that remains is: if you intervene early on, can you affect whether or not these individuals go on to develop the disease?

Is there anything I can do to avoid developing schizophrenia?

There very little that can be done to prevent schizophrenia. We know that this disease is a medical disorder just like diabetes or coronary artery disease. There's not much you can do to prevent it other than somehow screening your parents for any heredity factors that we're aware of. What we can do, however, is ensure that we treat the disease as aggressively as possible and use all those therapies and medications that are at our disposal to maximize recovery and maximize function.