Schizophrenia is a disease of diverse characters where there are features of mal adaptation of inner harmony characterized by significant social, vocational, behavioral thought and emotional disability. There are no characteristic symptoms and it can manifest with any of the symptoms of disintegration of emotional and cognitive functions.
Schizophrenia is widely prevalent all over the world and affects adolescents and young adults of both sexes equally. The annual prevalence of the disease ranges from 1-2%.
A number of factors ranging from genetic, biological to psychological factors have been incriminated with Schizophrenia
Studies on twins and family members of patients have shown a possible genetic basis. There is 40% risk for children of both affected parents while it is 5-10% if one parent is schizophrenic. Monozygotic twins have a 50-65% concordance rate while dizygotic twins have a 12% concordance rate. Molecular studies have shown linkage of schizophrenia to chromosome 5 and possibly X.
Patients show slight peculiarities in their behavior from early years. They are often shy, quiet, submissive model child who are given more today dreaming. There is often a form of schizophrenic personality who has a higher risk of developing the disease under conditions of stress and a host of stress factors like intoxicants, medical illness and psychosocial events may precipitate the disease.
Recent mental stress may be the starting point of an attack and this includes over work, disappointment in love or other painful experience. The onset of the disease is often insidious. Socio economic stress may precipitate the disease in vulnerable persons.
Dopamine and seratonin are the two neuro transmitters implicated in the causation of schizophrenia. Dopamine agonists exacerbate the condition while withdrawal of dopamine antagonists causes rebound of symptoms.
Dopamine hypothesis is further corroborated by therapeutic potency of all neuroleptics which is directly related to their dopaminergic blocking capacity. Role of serotonin is significant since drugs blocking serotonin are useful in relieving negative symptoms.
High risk children may have a significantly increased incidence of morbidity in utero, at birth and in the prenatal period. Studies of schizophrenic patients have shown abnormally increased ventricle brain ratio (enlargement of lateral ventricles and widening of cerebral fissures and sulci) suggesting increased ventricular fluid volume and atrophy of brain. There is also decreased frontal lobe activity in patients of schizophrenia.
Schizophrenia disorders are classified as criteria laid by DSM-III R.
1. Catatonic: A rare type with features of stupor, excitement, rigidity or posturing.
2. Paranoid: Preoccupation with delusions and auditory hallucinations.
3. Disorganized: A type characterized by incoherence of speech and flat or grossly disorganized affect.
4. Undifferentiated: A type which is difficult to classify into any of the types. There are delusions, hallucinations, incoherence or disorganized feature not meeting the criteria for other types.
The commonest symptom of schizophrenia is disorder of thinking where patients’ thinking is incoherent, rumbling. Inconsistent thoughts are present in a way which is not expected in normal people. Delusions may arise out of the thought disorder. Fixed delusions usually of paranoid complexion may develop and are often mixed with hallucinations.
The matter of patients delusions will be intimately dependent on his I her emotional attachments and sufferings. Speech and writing may betray the extent of thought disorder. Emotional incongruity may be important sign of disturbed behavior. The person may receive any moving news without any sign of being touched by it.
Hallucinations are extremely common. Person may hear queer sounds and auditory ones are the most common. The actions and bearing of the patient may derive attention. Speech may become disorganized. Negativism, talking and acting beside the point may be seen at any stage of the illness.
Often the most important effect of illness is on person’s personality. Not only be becomes outwardly different but is also peculiar and less understandable in his / her behavior.
The symptoms of a person suffering from schizophrenia may be positive (Hallucinations, paranoid ideation) or negative (social withdrawal inappropriate mood, poverty of speech and motor activity. Lack of spontaneity and loss of interest and drive). Patient with negative symptoms do not respond well to antipsychotic medications.
Cases of schizophrenia may present in an acute or chronic form. Differentiation from metabolic disorders, substance abuse disorders may be difficult in the absence of any specific signs and symptoms. Organic psychiatric, affective and personality disorders are some of the conditions which confuse the picture.
Affective disorders have sustained disturbances of mood and hallucinations and delusions. Absence of depression and sadness differentiates a person of depression from schizophrenic disorder.
In elderly any acute brain syndrome may produce a picture of schizophrenia.
It is variable. Patient’s psychosocial environment plays important role in the progress of disease. Some may occasionally show acute symptoms and then remain asymptomatic. Though majority of people recover yet in some morbid changes may produce damage to psychic life. Heredity, a narrow and rigid previous personality with chronic course make for poor prognosis while an abrupt onset of illness, an adequate cause for its occurrence and a well adopted non-schizoid personality auger good prognosis.
It depends upon the schizophrenia stage at which the patient presents. Antipsychotic medications are the main stay of treatment in addition to other therapies like cognitive therapy, counseling and psychotherapy. Every patient requires family support. Reassurance, inter personal relationship and sympathetic attitude of close family members plays an important role.
Commonly used drugs are of phenothiazine group (Chlor promazine 600-800 mg/day for 4 to 6 weeks) or butyrophenone group (Haloperidol 15-40 mg/day) and are effective. Because of disturbance of dopaminergic-cholinergic balance, extra pyramidal side effects may be produced for which anti Parkinsonism agents are given.
Patients who fail to respond to drugs and have high suicidal tendencies, E.C.T; (Electroconvulsive therapy) is considered and has proved beneficial.
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