Content

Introduction

Schizophrenia is a psychiatric disease that seriously affects the emotional sphere, social relationships and self-perception of those affected. The word schizophrenia comes from the Greek and means split mind; in fact, those who suffer from it often cannot distinguish reality from imagination and lose contact with the world around them by isolating themselves in one of its dimensions (Video).

Although it is not as widespread as others psychopathological disorders, schizophrenia is highly disabling, capable of limiting social relationships and the performance of normal daily activities. The family of the person affected by schizophrenia is usually extremely involved and is faced with a heavy load of anxiety and worry, also associated with the prejudices associated with the disease.

Schizophrenia usually occurs between the ages of 18 and 28 in similar rates in men and women. In women, it appears at a later age, with an average delay of 3-4 years compared to males.

The onset is usually preceded by a period in which the person withdraws into himself, appears less and less interested in the surrounding world with consequent loss of work or interruption of school attendance.

Schizophrenia has a prevalence (prevalence) estimated at around 4 per thousand and is present both in the most industrialized countries and areas as well as in developing countries and rural areas, without distinction of social class. Therefore, we cannot speak of a disorder caused by marginalization or social unease.

Symptoms

The disorders (symptoms) caused by schizophrenia, in general, are divided into positive and negative: the former are new and abnormal manifestations of behavior that express a profound alteration of the reality test; the second consist in the impoverishment or loss of capacity at least in part present before the onset of the disease.

Positive symptoms

The positive symptoms (symptoms) of schizophrenia they include:

  • hallucinations, can manifest themselves involving different sensory modalities and can concern hearing, sight, smell, taste, touch. Auditory ones occur most frequently: voices that talk to each other or comment on the person's actions. By means of magnetic resonance examinations at the level of the brain, functional activations at the level of the language control area were noted in schizophrenic people. This activation generally occurs in conjunction with the appearance of voices: this means that the brain exchanges the voices generated internally, through thoughts, with the real ones coming from the external environment and heard through the ear. The experience of hearing voices for the schizophrenic, therefore, is real
  • delusions, beliefs to which the person strongly adheres that persist despite stringent arguments to the contrary or evidence of their lack of foundation

Other disorders (symptoms) that can be included among the positive or, according to other methods of classification, in a third category called disorganization, include:

  • inability to organize one's thinking in a logical way
  • bizarre behavior and disorganized, people with schizophrenia may behave poorly or become extremely agitated for no apparent reason. They may also feel that their thoughts are being controlled by someone else

Negative symptoms

The negative symptoms (symptoms) of schizophreniathey usually appear a few years before the first acute episode of the disease occurs. The schizophrenic person tends to lose interest in what surrounds him and to reduce his social relationships more and more, to the point of completely isolating himself. As a rule, these symptoms appear gradually and worsen slowly. They may include:

  • apathy, in many cases it is necessary to stimulate sick people to perform even simple activities such as, for example, taking care of personal hygiene
  • emotional flattening
  • little or no search for social relationships
  • impoverishment of language
  • inability to make decisions
  • difficulty maintaining concentration
  • lack of interaction with the interlocutor

THE negative ailments they are the most difficult to identify because they have a slow and gradual evolution and, at least at the beginning, can be confused with a normal adolescent crisis.

In schizophrenia, to a more pronounced extent than in other psychoses, there may also be thought disturbances and evident limitations in the functioning of the mind (cognitive limitations), especially in memory, attention and the ability to solve problems.

Causes

The causes of schizophrenia are still uncertain. Most experts believe that it does not have a single cause but is instead the result of a number of factors in combination.

In recent years, research has focused on various elements such as possible genetic causes, alterations in the biochemical processes of the organism, viral infections, alterations in the development of the brain in the fetus or complications of childbirth.

Genetic factors are estimated to contribute significantly to the risk of developing the disease. In fact, while the probability of being affected is less than 1% for the general population, it reaches 6.5% for first degree relatives of a sick person and exceeds 40% in the case of identical twins.

Research also suggests that among the main causes of schizophrenia there are also alterations in the function of two important chemicals, normally present, which allow the transmission of information between the cells of the brain: the dopamine and the serotonin. This belief derives mainly from the "observation of the efficacy of the psychotropic drugs that regulate the activity of these two neurotransmitters in alleviating some of the main disorders (symptoms) of the disease (read the Hoax).

It is also believed that a number of factors, adverse events or trauma occurring at the time of delivery (for example, reduced birth weight, premature birth, reduced oxygen supply to the fetal brain during delivery) may impair the brain of the baby in some way. unborn child, with possible long-term consequences.

All these elements could form the biological basis of a kind of individual predisposition to develop the disease. If, in the course of the life of predisposed people, further traumatic or, in any case, negative events occur, schizophrenia could manifest itself.

Among the "precipitating" events that are hypothesized to play a role in the onset of the disease in predisposed people are:

  • marked stressful situations (such as bereavement, job loss, divorce, abuse)
  • massive use of some drugs, especially some types of cannabis, cocaine, LSD or amphetamines

Diagnosis

There is no blood test (biological test) for schizophrenia and the disease is usually ascertained (diagnosed) after an evaluation by a psychiatric doctor.

If you have any disorders that can be traced back to schizophrenia, you should see your family doctor as soon as possible.It plays an important role since it is the figure of the National Health Service (SSN) who, first, has the responsibility of assessing whether the observed disorders may suggest the initial phase of the disease, or, if they concern alterations in mood, or behavior, related to the growth phase as occurs, for example, in the case of adolescents and young adults.

If the presence of schizophrenia is suspected, the family doctor will instruct the patient to contact the Mental Health Centers (CSM) present in each Local Health Authority (ASL). They include professionals (psychiatrists, psychologists, social workers, etc.) with experience in the management and treatment of schizophrenia who will be able to better follow the patients and their families.

Rapid detection (diagnosis) of the disease is of fundamental importance; immediate intervention, carried out during the first psychotic episode, can improve the future evolution of the disease. Unfortunately, in many cases, the first disorders (symptoms) are difficult to manage. differentiate from a normal adolescent crisis and, furthermore, those affected are not aware that they suffer from a mental disorder.

To arrive at the "assessment (diagnosis) of schizophrenia, a specialist psychiatric visit is necessary, a series of investigations to exclude organic causes, including laboratory tests (blood and urine tests) and, in some specific cases, neuroradiological investigations: computed tomography (CT scan) or MRI of the brain (RM).

According to the influencer Diagnostic and Statistical Manual of Mental Disorders (DSM 5), which is the manual of the American Association of Psychiatry, in order to be able to consider schizophrenia ascertained the person must have at least two of the main disorders (symptoms) caused by the disease, including:

  • delusions
  • hallucinations
  • disorganized thinking and language
  • movement abnormalities
  • negative ailments (symptoms)

In addition, at least one of the first symptoms on the list must be present. The signs of the disease must persist continuously for at least 6 months and, during this period, active disorders (symptoms) must be present for at least one month. Finally, the disorders must be present for at least one month. adversely affecting the person's ability to work, study or carry out normal daily activities.

It is very important to rule out other psychiatric diseases that can cause similar disorders such as, for example:

  • bipolar disorder, those affected alternate periods of exceptionally high mood with periods of profound depression
  • affective schizoid disorder, not to be confused with schizophrenia because it is classified in its own right (which includes symptoms belonging to both the psychotic spectrum, ie schizophrenic, and that of mood disorders)

You should also be evaluated for post-traumatic stress disorder (PTSD), depression, anxiety, and substance abuse.

Therapy

Since the causes of schizophrenia are still poorly known, the treatments (therapies) available are mainly based on the alleviation of the main disorders (symptoms). Pharmacological therapy (with the use of so-called antipsychotic medicines) is usually used, together with psychotherapy and rehabilitation interventions, to help the sick recover the social skills lost due to the disease (read the Hoax).

Antipsychotic drugs

As regards pharmacological treatment, first and second generation antipsychotics (also defined as atypical, with greater efficacy and better tolerability), are used both in the acute phases of the disease and in the subsequent and maintenance phases. It is very important that the medications are taken regularly, even if the disorders have disappeared, and that the dosage is not changed unless indicated by the psychiatrist.Antipsychotics can be given in combination with other medications such as antidepressants or anxiolytics.

Treatment with antipsychotic drugs can have some unwanted effects (side effects) which generally disappear after a few days and include:

  • drowsiness
  • dizziness when changing body position
  • blurred vision
  • rapid heartbeat
  • heightened sensitivity to sunlight
  • skin rashes
  • menstrual problems

First generation antipsychotic drugs

First-generation antipsychotic drugs can also cause movement-related side effects, such as:

  • muscle stiffness
  • muscle spasms
  • tremors
  • restlessness and difficulty staying still

Second generation antipsychotic drugs

Second generation antipsychotic drugs, on the other hand, are often associated with weight gain and alterations in metabolism that expose you to a greater risk of diabetes and the presence of high cholesterol levels.

Along with drug therapy, psychological and social interventions are fundamental. These include cognitive behavioral psychotherapy for delusions and hallucinations, social skills retraining interventions that help people with schizophrenia regain basic and social skills (such as washing and dressing), psychological interventions that help manage stress and to control problematic behaviors such as, for example, aggression, self-harm or hyperactivity (read the hoax). Family psychotherapy and psychoeducation interventions can help patients and their families manage problems, and reduce conflict and stress levels in families. An important role is also played by work rehabilitation interventions, work support in protected forms, and in general the work and social reintegration projects.

The modality of treatment can also include the participation of those family members who play an important role in recognizing the signs of a possible relapse and in making sure that the patient continues to take the prescribed drugs. One of the problems, in fact, is the tendency to interrupt treatment, due to the appearance of unwanted effects (side effects) or a condition of distrust, with the risk of relapses and a worsening of the situation.

Prevention

No schizophrenia prevention measures are currently available. The detection of the disease in the initial stages (early diagnosis) is of fundamental importance because it allows you to start treatment immediately, to keep the first disorders (symptoms) under control and to avoid the development of serious complications, thus improving the prospects of being able to have a regular life Following your treatment plan carefully can help prevent relapse and avoid worsening of the condition.

Complications

Schizophrenia is highly disabling, both for the person affected and for his family. Both ailments, positive and negative, cause social problems because, in addition to the difficulty in having relationships due to the prejudices associated with severe mental illness, they often lead to unemployment and, consequently, to precarious economic conditions.

Furthermore, the schizophrenic person has little awareness of his own illness and therefore generally follows pharmacological treatments with difficulty and is subject to frequent relapses.

Left untreated, schizophrenia can cause serious problems that affect every area of ​​life.

Complications caused by, or associated with, schizophrenia can be:

  • suicidal thoughts, attempts to commit suicide and even death by suicide, the risk of dying from suicide is much higher than in the general population, people who take antipsychotic drugs as prescribed by their doctor are less likely to have suicidal thoughts and attempts than those who do not cure themselves. )
  • self-harm, a tendency to physically hurt themselves
  • depression
  • alcohol or drug abuse
  • inability to work or study
  • having legal and financial problems
  • social isolation

Living with

After having been confirmed (diagnosed) of being sick with schizophrenia, a state of "anxiety" about the evolution of the disease over time or concern for the prejudices associated with it may appear (read the Hoax). It is important, however, to remember that the diagnosis represents a first important step towards a greater personal knowledge of the disease, of the type of management and treatment to be followed, of the services available in the National Health Service (NHS).

Schizophrenia is a persistent (chronic) disease and requires lifelong care because, even if effectively controlled, the disorders can recur (relapse). By following the treatments you are able to manage it so that it does not have a too heavy impact on daily life. It is important to take care of physical and mental health in order to reduce anxiety, depression and fatigue.

It is also fundamental to learn to recognize the signs of a possible relapse including:

  • loss of appetite
  • intense feeling of anxiety or stress
  • sleep disorders
  • feelings of suspicion or fear
  • fear of surrounding people
  • hear voices occasionally
  • have difficulty concentrating

Recognizing the initial signs of an episode of schizophrenia is important because it allows you to keep it under control with the use of antipsychotic drugs and additional psychological intervention.To this end, it is advisable to confide in people you trust and ask them to be careful and to warn them if they notice a change in behavior that could lead to suspicion of a relapse.

Schizophrenia is a challenging disease even for the family members of the affected person. To maintain a positive attitude despite daily difficulties, people living with, or caring for, a person with schizophrenia should:

  • inquire about the characteristics of the disease and on the treatments available to keep it under control
  • attend support groups psychological
  • learn relaxation techniques and stress management to ease the tension of constantly having to deal with the disease

Bibliography

EpiCentro (ISS). Schizophrenia

National Guideline System (SNLG). Early interventions in schizophrenia

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