Schizophrenia
"That's schizophrenic!" This phrase is often heard when someone behaves paradoxically. The expression is used in its original meaning "split mind". But schizophrenia is by no means the phenomenon of a split personality. Rather, it is a serious mental disorder associated with hallucination and paranoia. Find out here what other symptoms schizophrenia brings with it, how many people suffer from it, and what therapy makes the most sense.
Sometimes more, sometimes less crazy?
Schizophrenia progresses in relapses. In retrospect, precursor symptoms can be identified years before the first acute episode. During a relapse, the so-called "positive symptoms" predominate. During this time, the affected persons primarily stay in closed psychiatric institutions. After weeks or months, when the positive symptoms subside, negative and disorganized symptoms usually remain.
The disease can take different courses: Classic is the alternation of relapses and symptom-free phases. However, a kind of cure or permanent freedom from symptoms is also possible. In severe cases, a chronic course sets in, in which the positive symptoms permanently have the upper hand.
Now you're probably wondering what exactly these different symptoms are all about. Here comes the answer:
Disorganization: He's funny!
One symptom of disorganization is bizarre behaviors. These include talking to oneself, hoarding certain things, or collecting trash. Catatonia, another sign of disorganization, can manifest itself in uncomfortable-seeming postures that may well be maintained for hours. Another form of catatonia is wild jumping around and flailing uncontrollably. When someone speaks in a "disorganized" manner, the connections between words and sentences are so loose that the listener can hardly follow. Disorganization also includes inappropriate emotional reactions. For example, a person with disorganization bursts into laughter at the news of a death or cries when asked what they had for lunch.
Positive symptoms: There's something...
This group includes the best-known symptoms of schizophrenia, such as delusions and hallucinations. For those affected, these phenomena are particularly dramatic, as they lose touch with reality.
Delusions involve beliefs that are definitely false when viewed objectively. For example, some schizophrenics believe that strangers read their thoughts. Others think that their feelings or movements are controlled from outside. Hallucinations involve sensory impressions that are not based on any real stimulus. About 75% of schizophrenics hear voices that are not there. For example, these voices argue or comment on what the affected person is doing. A relatively harmless symptom, on the other hand, is formal thought disorder. Here, incoherent thoughts run through the head.
Negative symptoms: Nothing works anymore
This group of symptoms is not as "spectacular" as the previous two. Nevertheless, the negative symptoms impose the greatest burden on the sufferer because they are permanently present. For example, negative symptoms include apathy, alogia, anhedonia, flat affect, and attention problems.
In apathy, there is a lack of interest as well as energy for certain activities. This can affect everyday tasks such as eating or washing. It goes hand in hand with anhedonia, in which sufferers do not find pleasure in any activity. When someone suffers from alogia, they speak very little to not at all. It can also happen that someone speaks a lot, but hardly conveys any content. Flat affect affects about two-thirds of sufferers. In this case, no emotional reactions are outwardly recognizable, although the feelings are quite intense internally.
What many people commonly refer to as "schizophrenic" has a completely different name among experts. The phenomenon of several personalities in one person actually exists, but it is called "multiple personality disorder" or "dissociative identity disorder. There is lively discussion in psychology about how seriously this rare clinical picture should be taken. Some experts suspect a different cause when affected persons speak with a different voice from one moment to the next, write with different handwritings and react to different names.
What is schizophrenic and what is not?
In psychology, the division into different types of schizophrenia has become established. These are by no means exclusive categories. Rather, they focus on the predominant symptoms of the particular sufferer. The following three types exist: disorganized, catatonic, and paranoid.
The correct diagnosis of schizophrenia is not easy, despite the noticeable symptoms. This is because many symptoms can occur in the same way in other disorders, such as bipolar, schizotypal, dissociative, acute delusional, and persistent psychotic disorder. In addition, organic causes such as epilepsy, brain disease, and metabolic disorders must always be ruled out. Some drugs or their withdrawal can also cause psychosis that resembles schizophrenia. This point is particularly critical because about half of all schizophrenics abuse substances during the course of the illness.
Who becomes schizophrenic?
The probability that a person will develop schizophrenia in the course of his or her life is only 0.5 % - 1 %. The majority of patients experience the first acute episode between puberty and their 30th birthday. If the disorder does not set in until after the age of 40, experts refer to it as "late-onset schizophrenia". This occurs somewhat more frequently in women than in men. On average, however, both sexes are affected by schizophrenia with equal frequency.
Contrary to assumptions made in the mid-20th century that parents were primarily to blame for their children's schizophrenia, genetic components are now the focus of causal research. Thus, the familial clustering of the disease has been clearly proven. For example, the identical twin of a schizophrenia patient has a 50% chance of also developing the disease himself. This means that his risk is up to 100 times higher than that of other people. The fact that the risk is not 100% speaks for the additional influence of environmental variables. Stress in particular can promote the onset of the disease.
With medication and targeted training to independence
The therapy of schizophrenics is extremely difficult and often begins as an inpatient. In particular, the paranoid type quickly resists treatment, as they show increased fear of the therapist and clinic staff. The success of therapy is primarily expressed in the patient's independence and long-term freedom from symptoms.
In schizophrenia, the focus is on drug therapy. Antipsychotics (neuroleptics) are used. However, the older "typical" neuroleptics in particular cause severe side effects such as dizziness, restlessness and Parkinson's-like symptoms. Up to three quarters of those affected therefore discontinue them on their own initiative within two years. Actually, the drugs must be taken permanently. The doctor adjusts the dose individually so that symptoms no longer occur when the amount is as low as possible. Other drugs used in the treatment of schizophrenia are antidepressants, lithium, tranquilizers such as Valium, and anticonvulsants.
Psychotherapy only makes sense when the acute episode has run its course. Then targeted training of everyday tasks, social behavior and problem-solving skills is a great help. Both the affected person and the family of origin should be involved. The ultimate goal is to enable the patient to live as relaxed and independent a life as possible after the hospital stay.
Early diagnosis of schizophrenia is always important. The sooner suitable therapy begins, the greater the chances of success. While 75% of patients return for inpatient therapy two years after their first hospital stay, about half of patients are able to take care of themselves permanently 20 to 30 years after the first symptoms appear.
Schizophrenia is a severe mental illness in which the affected person suffers from very distressing symptoms at times. They may develop delusions and hallucinations. They sometimes find it difficult to follow their own thoughts. During an acute episode, patients are often unresponsive. When these so-called positive symptoms subside, negative and disorganized symptoms take over. These manifest themselves on a linguistic as well as on a motor and affective level. For example, affected individuals talk little or incoherently. They do not move or move only in a bizarre way and suffer from depression. With therapy, the disease may improve over the years but very rarely remits completely. </p>
Antipsychotics are given to alleviate the positive symptoms. These drugs, also called „Neuroleptics“, are distinguished between the äolder „typical“ and the newer „atypical“. In particular, the typical antipsychotics, such as chlorpromazine, haloperidol, and Truxal, cause severe side effects such as dizziness, restlessness, motor phenomena älike Parkinson's disease, and sexual dysfunction. Nevertheless, neuroleptics should be taken constantly to efficiently prevent recurrence of shock. However, about 30% of patients do not respond to them at all. The somewhat better tolerated atypical neuroleptics include clozapine, olanzapine, and risperidone. Additionally, treating psychiatrists prescribe antidepressants, lithium, or sedatives, depending on the predominant symptoms. </p>
In schizophrenia, there are fundamental malfunctions in the human brain. Therefore, only a doctor, i.e. a psychiatrist, can be consulted in an acute phase. Furthermore, for their own protection and that of their fellow human beings, those affected should stay in a closed facility during an episode. When the positive symptoms subside and in the phases between the acute episodes, psychotherapists can promote quality of life and self-sufficiency with targeted measures. In addition, networks for people with schizophrenia and self-help groups are also a useful supplement for relatives of people with schizophrenia. </p>
The first acute episode usually occurs between puberty and the age of 30. Only a few affected individuals become clinically apparent for the first time at an older age. There is a certain underlying genetic predisposition, but this is not deterministic. The concrete trigger for a relapse is usually stress. After a dramatic event or during a very stressful phase of life, the body can become unbalanced and schizophrenia can break out. The use of certain drugs is also known to precipitate psychotic schübe. Retrospectively, many sufferers notice that they had early precursor symptoms of schizophrenia in adolescence. </p>
Schizophrenia is very difficult to recognize in oneself. Since the hallucinations and delusions seem coherent, it is hard to believe that one is ill. Bizarre behavior, such as talking to oneself or neglecting personal hygiene, is most noticeable to the social environment. Many sufferers are confronted with the diagnosis for the first time when they are admitted to a closed psychiatric ward during an acute episode. From the outside, the disease is easiest to identify during the acute episode. However, a layperson can hardly distinguish the symptoms from those of other psychotic illnesses. Between episodes, the sufferer is likely to appear depressed, withdrawn, or strange. The cause of this, however, seems rather unclear to an outsider. </p>
Conclusion
Schizophrenia classically consists of repeated psychotic episodes. These can last for weeks or months and are defined by the occurrence of positive symptoms such as hallucinations or delusions. In between the episodes, the patients suffer from negative symptoms such as lack of drive and listlessness. In addition, there are so-called "disorganized" symptoms, which include strange movements and bizarre behavior. Schizophrenia affects only about 1% of people and recognizing it requires a lot of experience. In particular, similar mental illnesses and organic causes must be ruled out at diagnosis. Stress is a significant triggering factor. However, there is always a genetic predisposition in the background. Therapy focuses on antipsychotics, while psychotherapy can help improve quality of life, especially between episodes.
