Schizophrenia

Schizophrenia is a major psychiatric disorder, multisystemic, characterized by alteration of the whole personality and affecting approximately one in 100 people worldwide. It occurs in people of all social classes and ethnicities and affects both men and women equally. Numerous comorbidities are associated with both psychiatric (depression, addictive disorders, cognitive impairment) and somatic (hyperprolactinemia, sexual dysfunction, cardiovascular disease, diabetes, hypertension).

It is considered to be a neurocognitive disorder, affecting almost all mental domains (thinking, perception, will, affectivity, motor behaviours, personality).

Current clinical studies note a significant increase in the frequency of suicidal behavior in patients diagnosed with schizophrenia!

In men, schizophrenia generally appears around the age of 20 (15-35 years), and in women the onset of symptoms can be between 20 and 30.

The underlying cause of schizophrenia is not known, as several factors are involved:

Genetic factors: there is sufficient evidence for the involvement of several genes in the development of schizophrenia;

Neuroanatomical factors: structural brain abnormalities have been found in patients with schizophrenia;

Environmental factors: increased frequency of schizophrenia in urban areas, drug abuse (amphetamines, cannabis), exposure to stressful life events;

Neurodevelopmental factors: obstetric trauma, fetal distress;

Neurobiochemical factors: involving several neurotransmitters: dopamine (hyperactivity of the dopaminergic system), serotonin, noradrenaline and the gamma-amino-butyric acid system.
Signs and symptoms

The presence of symptoms interferes with the way the patient thinks, feels and acts, and thus falls into several categories:

  1. Positive symptoms: hallucinations (“I hear voices”, “I see things that don’t exist in reality”), delusions (represent a belief with no real basis);
  2. Negative symptoms: reduced motivation, social withdrawal, lack of concentration;
  3. Cognitive symptoms: impaired thinking, memory, speech difficulties.
Subtypes

The subtypes of schizophrenia are classified as follows:

  1. Paranoid schizophrenia: stable delusional ideation, hallucinations (most commonly auditory);
  2. Hebephrenic schizophrenia: patients exhibit prominent affective changes, fragmented delusions and hallucinations, unpredictable behaviour, behavioural mannerisms;
  3. Catatonic schizophrenia: psychomotor disorders (from stupor to hyperkinesia) predominate
Diagnosis
The positive diagnosis is made by the psychiatrist based on ICD-10 (International Classification of Mental and Behavioural Disorders) and DSM V (American Psychiatric Association manual) criteria.
Evolution

Evoluția în timp a schizofreniei poate varia foarte mult de la o persoană la alta, fiind cu deteriorare în timp, cu exacerbări acute care se suprapun pe un tablou cronic. Majoritatea pacienților au cel puțin un episod psihotic după primul lor episod psihotic. Rata de recădere este aproximativ 40% în decurs de 2 ani sub tratament medicamentos și 80% fără tratament.

Outpatient care through psychiatric clinics is particularly important and involves dispensing, treatment management, follow-up, relapse prevention, family counselling, psychotherapeutic approach, recovery and socio-family and professional reintegration.

Progression of the condition: At present, there is a good chance that patients will be able to live an independent life (they can take care of themselves, they can return to work).

Schizophrenia is a treatable illness

One in four people with this diagnosis make a full recovery within five years, and the rest of the patients show an improvement in their symptoms. After the first psychotic episode, three quarters of patients who stop medication relapse within a year. If, after remission of the first psychotic episode, the patient correctly administers his medication, this figure can be halved

The only way to control the symptoms of schizophrenia is with antipsychotic medication in combination with non-medication supportive therapies.

The therapeutic approach to the patient with a diagnosis of schizophrenia is done in a multidisciplinary team composed of a psychiatrist, a nurse, a social worker, an occupational therapist, a psychologist and community support services.

Treatment of schizophrenia:

Drug treatment
Typical antipsychotics (levomepromazine, haloperidol, flupenthixol) work by blocking dopamine receptors in the central nervous system. Their main disadvantage is the weak effect they have on the negative symptoms of schizophrenia (low motivation, emotional flattening, social isolation), as well as the onset of a large number of adverse effects (uncontrolled movements, tremors in the extremities, seizures, extreme fatigue). Atypical antipsychotics (risperidone, olanzapine, quetiapine, paliperidone) act at dopamine receptors as well as at serotonin, norepinephrine and acetylcholine receptors. Their main benefit is their effectiveness on both positive and negative symptoms and cognitive symptoms. This class of drugs has fewer side effects than typical antipsychotics. The main disadvantage of their use is weight gain and the risk of metabolic syndrome. Neglecting medication for schizophrenia can lead to a relapse of symptoms. Relapse can make it difficult for patients with schizophrenia to return to their previous level of general functioning. Medication should continue to be administered when relief of symptoms has been achieved. In some cases, the psychiatrist may recommend a “depot” injection which is given every 2-4 weeks, so it is no longer necessary to take the drug orally every day. The use of depot antipsychotics is limited to cases with a prolonged course, multiple episodes, where the targets of therapy are predominantly symptomatic.
Psychotherapy
Psychotherapy is designed to help patients explore their most difficult emotions and experiences, including feelings of anxiety or depression.
Psychoeducation
Psychoeducation involves knowledge of information about mental illness (causes, symptoms, evolution, treatment, recovery) addressed to both patient and family.
Vocational rehabilitation

Vocational rehabilitation is a complex process that aims at regaining self-esteem, increasing social competence, retraining and reintegration into work.

Progress in the treatment of schizophrenia requires that it be considered a treatment-responsive condition and thus requires appropriate management.

Psychosocial rehabilitation
Psychosocial rehabilitation is an essential part of therapeutic management and focuses on keeping the patient in the community and esteeming him as a citizen.
The ultimate goal of the interventions described above is to promote an independent life as close to normal as possible for patients with schizophrenia.

At Med Anima Clinic, these conditions are treated using genetic testing.

Find out more

Read more about schizophrenia – click on the button below to access the document.

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