Schizophrenia

Schizophrenia is one of the most difficult to define and describe among all psychiatric disorders. In schizophrenia, person loses his ability to think, judge and act rationally

People with schizophrenia often have trouble telling the difference between reality and fiction. Cardinal features of schizophrenia are basically divided into two groups.

Positive symptoms: These are delusions and hallucinations and almost always present in a schizophrenic patient.

Negative symptoms: They are called negative because they signify loss of normal functioning. Alogia (decreased speech), Avolition (decreased motivation), Affective flattening (lack of emotions) and Anhedonia (lack of interest) are four As listed under negative symptoms.

Paranoid schizophrenia: This is the most common form, characterized by persecutory delusions, persecutory auditory hallucinations.

Hebephrenic schizophrenia: also called disorganized schizophrenia, in which thought and affect are disturbed significantly. Mannerisms become common and speech is incoherent.

Catatonic schizophrenia: features of catatonia are significant and prognosis is poor. At times the person may appear to be in dream like state.

Simple schizophrenia: characterized by odd behaviour, social withdrawal and poor performance at work.

Symptoms of schizophrenia usually come on slowly and get worse over time. It can start at early age and presentation can be completely different which can occur as “Prodromal Phase”. Person can come with symptoms like anxiety or depression and OCD. However, core symptoms of schizophrenia develop slowly in later part of their lives.

Delusions, Hallucinations, Disorganized speech, disorganized behaviour are few core symptoms of schizophrenia.

Schizophrenia is diagnosed when symptoms or signs have been present for six months. Before a person can be diagnosed with schizophrenia, they must have had symptoms for at least one month.

Hallucinations are perceptions in absence of external stimuli. However, for the person experiencing them, they may appear to be extremely real, pressing, and vivid. Approximately 70% of persons diagnosed with schizophrenia experience hallucinations.

People with schizophrenia are more likely to experience auditory hallucinations, including hearing voices or other sounds, such as whispering or murmuring. Sometimes, voices can give running commentary to person’s behaviour or they can also command them to do some task.

When someone is experiencing a visual hallucination, they may perceive non-existent objects, persons, lights, or patterns. It can be pretty distressing for a person to see deceased family members, friends, or other intimate acquaintances.

Olfactory hallucinations involve a false experience of smell, which can be pleasurable or unpleasant depending on the individual experiencing the hallucination.

Person can feel someone touching them or insects crawling on or within the body are instances of tactile hallucinations.

Delusions are false, firm and fix believes that stand in direct contrast to the objective world and person continues to believe them despite giving them evidence to contrary. The experiencing of delusions is one of the most common symptoms of schizophrenia. These may consist of the following:

When a person believes they are being mistreated or damaged by another person, group, or organization. They think someone is trying to harm them or kill them and plotting against them.

A person incorrectly believes that another person loves them, despite the lack of evidence to support such a conviction. This other individual is frequently a prominent or influential figure.

A person insists that they have an illness which is serious or life threatening.

When a person believes they possess remarkable qualities or characteristics (such as talent, fame, or wealth). This type of delusion is usually seen in bipolar disorder.

They are considered to be incredibly strange and improbable. Additionally, they may be deemed unsuitable. As in person can say he is being followed and tracked by aliens.

Treating schizophrenia is challenging as there are various factors which can affect the outcome of treatment like family support, insight about the illness and genetic predispostion. Antipsychotic drugs are mainstay of treatment along with psychological and psychosocial interventions.

Antipsychotic group of medicines are first line of treament for individuals suffering from schizophrenia. In acute phase, initiation of preferably second generation antipsychotics is recommended because of their efficacy and better tolerability. Maintanance and relapse prevention is equally important and medicines to be continued at least for a year or longer and should be tapered slowly.

Admission is required is patient is restless, aggressive or impulsive. At times patient act on their hallucinations and they can harm themselves or others. ECT administration becomes imperative in such situation.