What is Schizophrenia?

Schizophrenia is a neurobiological disease that usually occurs in youth due to genetic and environmental factors; affects emotion, thought, perception and behaviour; and is seen with different clinical tables.

History of Schizophrenia

The disease was accepted as a medical condition worth investigating and treating during the second half of 1800s. Schizophrenia was first described by Benedict Morel in 1853 and called Dementia Precox (early dementia), but in 1911, Swiss scientist Eugen Bleuler published a book titled “Dementia Precox” or “Group of Schizophrenics”, emphasizing that it is not necessary for the disease to start at an early age and result in dementia. In the same book, Eugen Bleuler proposed the term schizophrenia, which we use today to describe this disease.

The word schizophrenia translates roughly as “splitting of the mind” and is Modern Latin from the Greek roots schizein (σχίζειν, “to split”) and phrēn, (φρεν, “mind”)

Prevalence of Schizophrenia 

According to the 2011 data of the World Health Organization, approximately 21 million people have been affected by schizophrenia. More than half of schizophrenia patients cannot receive appropriate treatment. The important reasons for not receiving appropriate treatment are the difficulty in accessing mental health services, the social low and middle income level, and the fact that schizophrenic patients do not ask for help for treatment.

  • Schizophrenia occurs in approximately 1% of the whole society.
  • It usually starts in the youth years.
  • It occurs 5 years later in women than in men
  • The incidence of the first attack decreases with age in men and women, while only women experience a second increase during the menopausal period.

Symptoms of Schizophrenia

Symptoms of schizophrenia are basically examined under three main headings;

  • Positive Symptoms: Positive symptoms means the emergence of thoughts or perceptions that do not exist. No positive or negative meaning should be given to the disease.
  • Hallucinations: Thinking that one perceives sensations that are not in the reality of the outside world. The most common hallucinations in schizophrenia patients are hearing voices (auditory). These sounds can be simple sounds such as ringing, wind humming, leaf rustling, or organized sounds that give orders to the person, criticize their behaviour, and form sentences. Other hallucinations are visual, olfactory, tasteful and tactile hallucinations.
  • Delusions: Though proven otherwise, they are unchanging intellectual beliefs in the person. Delusions frequently seen in schizophrenic patients are being followed up, damaged, and delusions of grandeur. The person thinks that he/she is a very important person, that he/she is being followed and that he/she can be harmed. Apart from these, many delusions have been defined.
  • Negative Symptoms; Symptoms that cause deterioration of emotions and behaviours. Since negative symptoms are similar to depression or other conditions, their relationship with the disease is more difficult to notice. Negative symptoms include;
  • The patient’s frozen or monotonous speech or inability to move his/her facial muscles while speaking,
    • Not being able to enjoy daily life
    • Having difficulty starting planned activities or continuing activities,
    • Even when trying to communicate, there is little talk.
  • Change in behaviours; Disorganized speech, disorganized behaviour, catatonia.

Cognitive Symptom: In addition to the three main headings that diagnose schizophrenia, schizophrenia causes many cognitive losses in the form of attention, information processing, memory problems, problem-solving, verbal learning, and impairment in social functionality.

Symptoms are usually distinguished more clearly after diagnosis, as it is difficult to recognize its association with the disease. Cognitive symptoms are symptoms that prevent life from continuing normally.

Among the cognitive symptoms;

  • Disruption in the ability to understand and use information to make decisions,
  • Difficulty in concentration, difficulty in focusing,
  • Short-term memory (the ability to use information immediately after learning).

Types of Schizophrenia

All subtypes were removed in the DSM-5 diagnostic criteria published by the American Psychological Association (APA) in 2013. In this section, the subtypes included in the DSM-4 TR will be explained.

Paranoid Type: It is a type accompanied by delusions. Paranoid delusions are grandiose, reference, and persecution. In paranoid schizophrenia, inappropriate affect and disorganized behaviour are not seen. The most common problem in the treatment process is the compliance of the family and the patient with the treatment. Since the functionality partially exists, it is difficult to observe the symptoms of the disease. It usually occurs as insidious.

Hebephrenic Type: In this type of schizophrenia, a very rapid deterioration in emotions, thoughts and behaviours is observed. Affect is constantly changing, (lability) primitivity in the thinking structure is seen and they behave childishly. Unreal (bizarre) and asystematic (unfounded) delusions predominate. There is no meaning integrity in speech, sentence structure is broken, there is invention of new words (neologism), and there is repetitive stereotype speech. The patient cannot even perform simple organized tasks such as self-care, eating, drinking and paying attention to his/her clothes. It usually occurs at a young age and quickly.

Catatonic Type: The main problem of this type is movement disorders. The person seems to have lost touch with the external environment, but continues to receive information without breaking his/her perceptual and intellectual bond with the external environment. He/she can respond to external stimulus with simple gestures without talking. There may also be symptoms such as sudden outburst in his/her behaviour, resistance to making a move. It is usually seen in young people and young adults. Vital activities such as eating, drinking, and defecation are impaired; they need to be treated very quickly.

Residual Type: It is the type of schizophrenia that can occur after one or several attacks of schizophrenia. In general, negative symptoms such as indifference, social withdrawal, flattening in emotion, reluctance to start a job are at the forefront. There may be delusions or hallucinations, but the diagnosis of schizophrenia is much vaguer than it was when it was diagnosed.

Unseparated (Simple) Schizophrenia: It is a type of schizophrenia that does not have a history of significant psychotic episodes, does not fit paranoid, disorganized, catatonic schizophrenia types, and has predominately negative symptoms.

Causes of Schizophrenia

Schizophrenia is a disease with a chronic course and biological basis. It does not occur only under the influence of external stressors such as being affected by general living conditions, being unemployed, being subjected to ill-treatment. There must be a biological basis.

  1. Genetic (Inherited) Causes: 10% of people with a history of schizophrenia in one of their parents and approximately 50% of those with a history of schizophrenia in two of their parents are diagnosed with schizophrenia at some point in their lives. The risk of schizophrenia in siblings is increased 8 times. These give important clues about the transition of schizophrenia from parent to child.
  2. Brain Biochemistry: The emergence of schizophrenia has been shown in changes in brain biochemistry with dopamine, glutamate, serotonin-noradrenaline hypotheses. Likewise, the presence of sedation in the symptoms of schizophrenia with drugs that will balance these biochemical markers indicates the importance of brain biochemistry.
  3. Disorders in Brain Structure and Functionality: In recent years, great progress has been made in brain imaging studies. In these studies, it has been found that there is a connection between structural impairment or dysfunction in certain parts of the brain and schizophrenia.
  4. Environmental Factors: In genetically and structurally predisposed individuals, schizophrenia occurs more frequently with environmental factors such as viral infection, stressful situations, and reduced social communication.

Schizophrenia Treatment in Turkey

  • Drug Therapy
  • Psychotherapies
  • Psychological Education
  • Somatic Therapies

1.Drug Treatments

The central point in the treatment of schizophrenia is drug therapy. Drugs used in the treatment of schizophrenia are called “Antipsychotic Drugs”.

The goal in antipsychotic treatment is the rapid regression of symptoms. Since antipsychotic drugs act by regulating biochemical changes in the brain, they do not act as quickly as a painkiller used for headache. Therefore, medication should be continued in schizophrenia, patience should be exercised, and doctor controls should not be interrupted in order to observe the effects and side effects.

One of the causes of recurrence of schizophrenia is treatment incompatibility. Family support is especially important in this process. Due to its effects such as increased appetite and sleep, patients’ discontinuation of their treatment is a common cause of recurrence of the disease.

2. Psychotherapies

Psychotherapies can be applied to cope with schizophrenia, to recognize symptoms, to identify them early and to increase treatment compliance and social-occupational functionality. Individual psychotherapies, family therapies, group therapies are the leading therapeutic methods that can be applied in schizophrenia.

3.Family Education

Today, the psychological education of the family and the person is given great importance in understanding the psychological reactions that may occur during the treatment process of schizophrenia, recognizing the effects caused by the drug and managing these problems without disrupting the treatment compliance. Thus, it has been shown that the rates of discontinuation of treatment of the patients decrease and the intra-family adaptation increases by defining the dilemmas in the relationships of the family with the patients.

4. Somatic Treatments

ECT (Electro Convulsive Therapy) is the main somatic treatment used in the treatment of schizophrenia. ECT, also known as electro-shock, is performed under general anesthesia by administering electro-shock to the anterior part of the brain in cases of treatment-resistant, catatonic, disorganized, intense suicidal thoughts. Since the person is under anesthesia, he/she does not experience ECT treatment exactly. With this treatment, rapid release of brain biochemicals is seen. Although it varies depending on the clinical condition, ECT is applied for at least 4-6 sessions.

What Can Patients Do to Reduce the Effect of Symptoms?

  • Using drugs regularly.
  • Being in constant contact with the doctor and treatment team
  • Not disrupting sleep patterns; not sleeping enough to disrupt their daily work.
  • Receiving support from their relatives to continue or be able to continue their daily activities (eating, bathing, cleaning).
  • Avoiding alcohol and substance. (Drug use reduces the effect of drugs and shortens the recovery period of the disease.)
  • Increasing ways to cope with stress and avoiding stress
  • Exercising
  • Keeping in touch with friends and family

Actions to Do to Prevent Recurrence of the Disease

Schizophrenia is a disease that is divided into periods of exacerbation and recovery and its symptoms change over time. It is called “recurrence” if the symptoms seen in the past reappear or if there is a significant deterioration in the decreasing symptoms. These periods may be periods that may require hospitalization for treatment. Therefore, it is crucial to understand and prevent the beginning of these periods in order to prevent recurrences or to avoid them at a lesser level. While not all of these symptoms can be seen together, which symptoms may occur vary depending on the person.

Some of the Symptoms of Recurrence Period in Patients

  • Distance from society, being completely isolated, feeling lonely
  • Ignoring appearance, clothing, self-care
  • Sleep problems
  • Anger over small things, feeling constantly tense
  • Internal anxieties, getting into an intense depression
  • Beginning of psychotic symptoms (hearing voices, seeing images, thinking people are looking at or talking about themselves)
  • Decreased or increased appetite
  • Difficulty remembering events, inability to focus attention
  • Inactivity or inability to stand still

Recommendations for Schizophrenia Patient Relatives

  • To have knowledge about the disease and to know the disease well
  • To follow the regular use of drugs
  • To share the information that may affect the treatment process with the doctor as a member of the treatment team, to stay in constant contact
  • To follow the symptoms that will start recurrence periods and to take precautions
  • To support the patient to strengthen his/her coping skills
  • To encourage the patient to do something on
    his/her own
  • To talk about non-disease issues and take time for different activities
  • To express his/her trust in his/her relatives, to remind him/her what he likes to do, what he/she enjoys by talking to him/her
  • To celebrate special days without interruption, to ensure the participation of patients, to plan in advance and to take precautions in celebrations or to keep celebrations short if there is a situation that will make them nervous.
  • To inform children about the disease if patients have their own children or other children living at home
  • To neglect their own self-care and appearance, taking time for themselves, not breaking social ties and taking time for what they like

SCHIZOPHRENIA IS A DISEASE THAT CAN BE CONTROLLED WITH APPROPRIATE AND REGULAR TREATMENT.

The information on this page has been prepared by the Moodist Psychiatry and Neurology Hospital Medical Team.

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