SCHIZOPHRENIA

Is a psychiatric illness characterized by chronic or recurrent psychosis often presenting in late teens/early 20s.  Worldwide, around 1 in 100 may suffer from this debilitating and economically catastrophic mental disorder. It is found slightly more in males than females (on the order of 1.4:1)

SIGNS AND SYMPTOMS:

POSITIVE SYMPTOMS: production of phenomenon unlikely to be experienced by a person with a sane mind. For example hallucinations (auditory in 75{d1272f9be01bb360d2e08f42defc794b644e1298a474496e050da4509a809c3c}), delusions and disorganized speech and behavior.

NEGATIVE SYMPTOMS: the negative symptoms of schizophrenia signify deficiency or absence of an important or normally occurring aspect of an individual’s behavioral repertoire.

For example, decrease in emotional range, paucity of speech and poverty of content of speech, mutism, loss of interest and drive, blunting or incongruity of affect, eg laughing at bad news.

The symptoms affect cognitive behavioral and emotional aspects of one’s life.

DIAGNOSIS

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) at least 2 of the following symptoms must be experienced by the patient

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Disorganized or catatonic behavior
  • Negative symptoms

At least 1 of the symptoms must be the presence of delusions, hallucinations, or disorganized speech.

Continuous signs of the disturbance must persist for at least 6 months (or more), during which the patient must experience at least 1 month of active symptoms (or less if successfully treated), and face social or occupational deterioration problems over a significant amount of time. These problems must not be attributable to another condition.

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Delusions: False and firm beliefs

Hallucinations: Sensory impression or perception of something without real stimuli.

Illusion: Misperception of real stimuli

Mutism: The affected individual is physically capable of speaking but doesn’t speak

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DOPAMINE – AND PSYCHOSIS

Several studies show that Dopamine, a neurotransmitter, levels are markedly raised in patients with schizophrenia which relates most closely with the symptoms of psychosis in them. Decreasing dopamine levels or blocking dopamine transmission halts psychosis in most of sufferers.

TREATMENT:

Antipsychotics are the mainstay as they reduce dopaminergic drive and attenuate the psychotic symptoms most of the times.

Cognitive behavioral therapy for psychosis has modest effects.

Living With Schizophrenia

I wonder why the almighty is upset with me

My life that was joyful is no longer free

I tend to be bound by a relative of mine

Besieged by a disorder that is far from fine

Some days he is angry and tempers flare

Some days he is sombre with a blank vacant stare

Some nights he does not let anyone sleep

Some nights he snores while all of us weep

He was a fine man some years back

A life full of color has now turned black

He was social and now prefers to be just one

He sees people when there are none

He hears voices that are not known to us

He feels others stare at him in a train or bus

He is on medicine and is better than the past

We really wonder how long this illness will last

He was working but is now without the works

He feels all jobs are bad and duties he shirks

He takes medicine and says he is drowsy

Some days he is happy and some days he is lousy

He mutters to self and he talks what he likes

Some days he is calm and sometimes he spikes

Doctors say it is a disorder with no cure

I wonder why it afflicted a mind so pure

They say it is seen in all the high and low

Some recover well and some miss the ebb and flow

The causes of such a problem are many

The treatment burden is quite a penny

This is an illness of the brain and mind

It sure is one of its kind

The story above is not a case of depression or mania

It is that of someone living with schizophrenia

(Avinash Desousa, Schizophrenia Bulletin vol. 43 no. 2 p. 233, 2017)

 

 

References:

1https://books.google.com.pk/books?id=3yP67BPsDrUC&printsec=frontcover&dq=schizophrenia&hl=en&sa=X&ved=0ahUKEwix05T7-sHSAhULtY8KHSlcCsMQ6AEIFzAA#v=onepage&q=schizophrenia&f=false

2 uptodate

3 Abel KM, Drake R, Goldstein JM. Sex differences in schizophrenia. Int Rev Psychiatry 2010; 22:417.

4Schizophrenia third edition

By Ming T. Tsuang, Stephen V. Faraone, Stephen J. Glatt

5 Medscape

6 Kaplan notes

7 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Press; 2000.

8 Oxford handbook of clinical specialties, 9th edition

9 Schizophrenia Bulletin vol. 34 no. 3 pp. 523–537, 2008 doi:10.1093/schbul/sbm114 Advance Access publication on October 25, 2007