Schizophrenia
What is it?
Schizophrenia is a significant mental health disorder characterised by abnormal interpretations of reality. It can manifest as a combination of hallucinations, delusions, and highly disordered thinking and behaviour, leading to impaired daily functioning and potential disability.
During active phases of the illness, individuals may struggle to differentiate between real and unreal experiences. The severity, duration, and frequency of symptoms can vary, with a decrease in severe psychotic symptoms often observed as individuals age. However, non-adherence to prescribed medications, substance abuse, and stressful situations can exacerbate symptoms.
Causes
The exact causes of schizophrenia are not fully understood, but research suggests that a combination of genetic, environmental, and neurochemical factors contribute to its development. Here are some common factors believed to play a role in the development of schizophrenia :
- Genetic Factors : Schizophrenia tends to run in families, indicating a genetic component to the disorder. Having a family member with schizophrenia increases the risk of developing the condition. However, it’s important to note that genetic factors alone are not sufficient to cause schizophrenia, and other factors interact with genes to contribute to its onset.
- Neurochemical Imbalances : Imbalances in certain brain chemicals, particularly dopamine, play a role in the development of schizophrenia. Excessive dopamine activity in certain brain regions may contribute to the positive symptoms of schizophrenia, such as hallucinations and delusions.
- Brain Abnormalities : Structural and functional abnormalities in the brain have been observed in individuals with schizophrenia. These abnormalities may affect various brain regions involved in cognition, perception, and emotion regulation. Changes in brain development during prenatal and early childhood stages have also been associated with an increased risk of developing schizophrenia.
- Environmental Factors : Certain environmental factors may contribute to the development of schizophrenia, especially when combined with genetic susceptibility. Factors such as prenatal exposure to infections or complications, maternal stress during pregnancy, birth complications, and exposure to traumatic events during childhood or adolescence may increase the risk.
- Substance Abuse : Substance abuse, particularly cannabis and psychostimulant drugs, has been associated with an increased risk of developing schizophrenia. Substance use can trigger or worsen symptoms in individuals who are already susceptible to the disorder.
- Disrupted Brain Development : Problems during brain development, such as disruptions in neuronal migration or synaptic pruning, have been implicated in the development of schizophrenia. These disruptions may occur during early brain development or adolescence when significant changes in brain structure and connectivity take place.
It’s important to note that schizophrenia is a complex disorder, and the interplay of these factors can vary among individuals. The exact cause of schizophrenia is likely to involve a combination of genetic vulnerability, environmental triggers, and neurobiological abnormalities.
Symptoms
The symptoms of schizophrenia can be categorised into three main groups :
- Positive symptoms : These involve the presence of abnormal experiences, such as hallucinations (e.g., hearing voices or seeing things that aren’t real), paranoia, and distorted perceptions, beliefs, and behaviours. Delusions are false beliefs that lack a basis in reality, while hallucinations involve sensory experiences of things that do not actually exist.
- Negative symptoms : These entail a reduction or loss of abilities, including difficulty initiating plans, diminished speech, decreased emotional expression, and reduced capacity for experiencing pleasure. Negative symptoms also contribute to a decline in overall functioning. Schizophrenia also affects cognitive functioning, leading to difficulties with attention, concentration, memory, and declining educational performance.
- Disorganised symptoms : This category includes disordered thinking and speech, impaired logical thinking, and occasionally, bizarre behaviour or abnormal movements. Disorganised thinking and speech can impair effective communication, with answers to questions being partially or completely unrelated. Extremely disorganised or abnormal motor behaviour may range from childlike silliness to unpredictable agitation.
Typically, symptoms of schizophrenia first emerge in early adulthood and must persist for at least six months for a diagnosis to be made. Initial symptoms often appear in men during their late teens or early 20s, while women tend to exhibit signs in their 20s or early 30s. Subtle signs may manifest earlier, such as troubled relationships, poor academic performance, and reduced motivation.
Treatment
Before confirming a diagnosis, it is crucial for a psychiatrist to conduct a comprehensive medical examination to rule out substance misuse or other neurological or medical conditions that can mimic schizophrenia.
While there is no cure for schizophrenia, many patients experience significant symptom improvement. Diagnosing and treating schizophrenia can be complex when substance misuse is involved. Individuals with schizophrenia are at a higher risk of drug misuse compared to the general population. In cases of addiction, treatment for both the addiction and schizophrenia should be pursued concurrently.
- Pharmacotherapy : Antipsychotic medications are effective in reducing acute psychotic symptoms, preventing future episodes, and mitigating their severity.
- Psychotherapy : The primary approach involves medication, which plays a crucial role in managing the condition. Additionally, talk therapy, also known as psychotherapy, can be highly beneficial in helping patients understand their illness and adhere to their medication regimen.
- Cognitive Behavioural Therapy : During CBT, a therapist will help you examine and understand your thoughts and emotions. It aims to help the individual identify and change unhealthy emotions, thoughts and behaviours. The individual works with a mental health professional, such as a psychologist. Over several sessions, CBT can help alter harmful thoughts and stop negative habits, perhaps replacing them with healthier ways to cope.
