My grandmother - a mother of my father - developed schizophrenia when I was a child. She passed away due to her illness 15 years ago.
Schizophrenia, earlier “dementia” praecox (“premature weak-mindedness”) is a polymorphic mental disorder or a group of mental disorders, connected with the disintegration of the processes of thinking and emotional reactions. Schizophrenic frustrations as a whole are characterized by the fundamental frustration of thinking and perception, and also the inadequate or reduced affect.
“Schizophrenia is a complex disease of uncertain etiology, afflicting approximately 1% to 2% of all populations worldwide, including three million Americans. It causes untold suffering for patients as well as their families. In the United States, direct and indirect costs of schizophrenia are more than $30 billion annually, and this figure does not include the costs associated with homelessness (an estimated 33% to 50% of homeless Americans are chizophrenic)”.
The most frequent manifestations of an illness are acoustical hallucinations, paranoid or fantastic nonsense or a speech and thinking dezorganization against considerable social dysfunction and working capacity violation.
Schizophrenia is one of the main reasons resulting in disability. In the research, which was carried out in 14 countries in 2009, it was shown that the condition of active psychosis takes the third place after a full paralysis (quadriplegia), surpassing paraplegia and blindness by invalid influence. However, the clinical course is of a considerable variety and is not connected with inevitability of chronic development or progressing increase of defect. In certain cases, the frequency varies in different cultures and populations; recovery can be full or nearly full.
At heavy option of a disease course if the patient represents the risk for oneself and people around, involuntary hospitalization may be necessary, but in Western Europe frequency and terms of stay in clinic decreased in comparison with the previous years.
The descriptions of schizophrenia symptoms are met in 2000 B.C. in “the Book of Hearts” - a part of the ancient Egyptian papyrus Ebers. Studying of the ancient Greek and Roman sources says that, possibly, societies of that time were informed about psychotic frustration, but does not meet the descriptions which would satisfy today’s criteria of schizophrenia.
At the same time the symptoms reminding schizophrenia are noted in the Arab medical and psychological texts dated back to the Middle Ages. For example, in the Medical Canon Avicenna describes the condition partly reminding schizophrenia which it calls “heavy madness” and separates from other forms of madness and mania, rage and maniac-depressive psychosis.
Although the general concept of madness existed throughout the millennia, schizophrenia was accepted as an independent mental disorder only in 1893 by Emil Kraepelin. He was the first who divided the psychotic frustration that he then called dementia praecox (literally - “an early dementia”, a syndrome described in 1853 by Benedict Morel under the name “démence précoce”) and maniacal depression. This dichotomy remains the important concept in a modern science.
“The idea that some cases of schizophrenia originate in events that take place prior to birth or during the delivery of the individual is not a new one. Genes were claimed by many researchers to be important contributors to the cause of schizophrenia in the earliest years of this century. The effects of chemicals and infectious agents, specifically alcohol and syphilis, on the developing fetus were proposed as possible causative factors for schizophrenia by Emil Kraepelin”.
In 1908, the Swiss psychiatrist Eygen Bleyler described schizophrenia as an independent disease, different from dementia; later it was entered into psychiatry under this term. The illness does not necessarily occur in youth, it may also develop at mature age. Its main feature is not weak-mindedness, but “unity violation” of mentality, including violation of associative thinking.
The following symptoms of schizophrenia are distinguished:
A person, sick with schizophrenia, may have thinking and speech disorganization, their singularity, acoustical hallucinations, and crazy ideas. Owning to a variety of causes, the disease is often accompanied by social isolation; it is accompanied by the violation of social knowledge and the paranoid semiology connected with nonsense and hallucinations, and also negative symptoms: apathy and abulia. In rare cases, the patient can keep silence, stiffening in strange poses or, on the contrary, run into a condition of aimless excitement: these are catatonia signs. Any of the signs, taken separately, is not sufficient for schizophrenia diagnostics as all of them can accompany other pathological conditions.
According to the existing classification of psychoses, the symptoms of schizophrenic psychosis should be present at least within a month against disorder of the functioning, lasting no less than half a year; less long episodes belong to schizophrenic frustration.
More often schizophrenia begins at a late teenage age or in an initial stage of an adult life, quite often causing a serious damage of the identity of the person at the most important stage of social and professional development. Extensive research work on early diagnostics of the disease for the purpose of minimization of its harmful effects has been carried out recently.
In this period nonspecific signs - social isolation, irritability and a disforiya - can be revealed at patients. In the process of psychosis they have transit (short-term) or limited psychotic symptoms.
Positive and Negative Symptoms
Schizophrenia symptoms are often divided into positive (productive) and negative (deficient). The productive symptoms include nonsense, acoustical hallucinations and thinking frustration - all these are the manifestations which are usually testifying to the existence of psychosis. In its turn, negative symptoms tell a loss or a lack of normal traits of a character and abilities of a person: decrease in brightness of endured emotions and emotional reactions - decrease in affect, poverty speeches, inability to enjoy - an anhedonia, a motivation loss.
Recent researches, however, say that despite external loss of affect, patients with schizophrenia are often capable to have emotional experiences, in particular after stressful or negative events. Often the third group of symptoms, the so-called syndrome of disorganization, includes chaotic speech, chaotic thinking and behavior. There are also other symptomatic classifications.
The causes and mechanisms of schizophrenia development, which were absolutely unknown earlier, have started to be revealed recently due to the achievements of neurobiology. However, nevertheless, they remain not clear and confused. Important pathogenic factors, according to the presumable data received in researches, include genetic predisposition, living conditions in the early childhood, neurobiological violations, psychological and social interactions. At present, neurobiological mechanisms of a disease are actively studied; however, the uniform organic cause has not been established yet.
Although a low reliability of diagnostics represents the problems at calculation of a relative contribution of genetic variations and environment influences (for example, the heavy form of bipolar frustration can be crossed on symptoms with a clinical depression), there are evidences that the illness can be caused by a combination of these two groups of factors. These data say that the diagnosis is substantially caused by heredity, but the onset of the illness considerably depends on the factors of environment and stressor.
The idea assuming existence of congenital predisposition (“diathesis”), proving under the influence of biological, psychological or environmental stressor, received the name “a model of a stress diathesis”. The idea of importance of biological, psychological and social factors was embodied in the concept called “biopsychosocial model”.
The causes of schizophrenia and the mechanisms of its development are insufficiently studied. The leading role belongs to hereditary factors. Sex and age play an important role in the disease development. Men and women have different clinical course; more often it proceeds continuously with less favorable outcomes. Attack-like course of a disease is more characteristic for women; it is cased in a certain degree by the recurrence of neuro and endocrine processes (menstrual function, pregnancy, childbirth), and the forecast as a whole is more favorable. Malignant forms of a disease usually begin at children’s and teenage age.
A Clinical Course
A clinical course of schizophrenia is presented by a big range of psychopathological manifestations. The violations of intelligence and emotions are the most typical. At thinking frustration patients complain of the impossibility to concentrate their thoughts, difficulties in material assimilation, and uncontrollable stream of thoughts, obstruction or a stop of the thoughts. At the same time the ability to catch a special sense in words, sentences, and works of art is characteristic.
They can create new words (neologisms), use own thoughts and a certain symbolics in creativity, only clear abstraction. Their speech is difficult for understanding, in connection with florid, logically inconsistent statement of thoughts. At patients, with a long adverse clinical course, the broken up speech (a loss of semantic communication between separate parts of a sentence) or its incoherence (mere verbiage) can be noted. Besides, the patients may have the fixed ideas. They include a persuasive reproduction in the memories of dates, names, terms, persuasive fears, representations, reasonings. A person sick with schizophrenia can spend much time in the speculations about life and death.
Therapy and Support
The concept of treatment of schizophrenia remains the object of disputes as the standard definition of this concept is not developed though the rational criteria of remission which are easily applicable in the researches and in clinical practice which can become consensus in recent years, and there are a lot of standardized techniques of treatment assessment. The correction of the symptoms and increase of the level of functioning are represented by more realistic purposes, rather than complete healing. The revolutionary changes in therapy were connected with the introduction of chloropromazin in the 1950s. At present, the model of the restoration emphasizing the hope for improvement, expansion of possibilities and public integration receive the most recognition.
Hospitalization can be demanded at heavy episodes of schizophrenia. It can be voluntary or involuntary. In many countries outside of the Western world local communities are very important for the treatment of this disease. Actually, the results of therapy can be better in these countries than in the West. At present, the causes of such statistics are not clear, cross-cultural researches are carried out for the purpose of their examination.
Diagnostics includes the story of the person about the experiences, with possible addition of this information by the relatives, friends or colleagues, with the subsequent clinical assessment of the patient by a psychiatrist, a social worker, a clinical psychologist or another expert in the field of psychiatry. At a psychiatric assessment there is the analysis of a mental status and drawing up of the psychiatric anamnesis. The developed standard diagnostic criteria consider the existence of certain signs and symptoms, their severity and duration.
Sometimes at diagnostics the general medical or neurologic surveys for an exception of the somatic diseases occasionally leading to psychotic shizofrenopodobny conditions are carried out: the violations of a metabolism, system infections, syphilis, HIV, epilepsy and injuries of a brain. Sometimes it is necessary to exclude delirium, being allocated with the existence of visual hallucinations, a sharp beginning, fluctuations of the level of consciousness, and indications of the latent somatic disease.
“The treatment of schizophrenia genuinely combines psychological and biological approaches. Clearly, the most common method of treating schizophrenia is neuroleptic medication, more or less combined with rehabilitative measures”.
The modern psychiatry has various and rather effective remedies for the treatment of the patients with schizophrenia. It is enough to tell that about 40 % of the patients, who received medical treatment, are discharged from hospitals in a good condition and come back to a former place of work. Treatment, depending on a condition of the patient, is carried out in out-patient or stationary conditions. The extra hospital help appears to be in a psychoneurological clinic (psychoneurological consultation), where the patients are treated in small aggravations, and also are observed in remission period.
“Clozapine was the first drug for which qualitative and quantitative differences to traditional antipsychotics could be convincingly demon- strated. Not only is clozapine more efficacious in patients suffering from treatment-resistant schizophrenia, but it has also been shown to have advantages in terms of the treatment of negative symptoms.
Psychological and Social Therapy
The psychotherapy is widely recommended and used at schizophrenia, though sometimes the possibilities of therapy are limited to pharmacology because of the problems with financing or insufficient preparation of the personnel. Except for the treatment of the illness, it is also directed at social and professional rehabilitation of patients.
Cognitive and behavioural therapy (CBT) is applied for the alleviation of the symptoms and improvement of the related aspects - self-esteem, social functioning and understanding of own condition.
Another approach is cognitive remediation therapy, the methods of which are directed at the fight against the cognitive violations which sometimes are present at schizophrenia. The first results speak about cognitive efficiency of this direction based on the techniques of neuropsychological rehabilitation, and some positive motions are accompanied with the changes of nature of brain activation, noted at scanning. The similar approach under the name “therapy of cognitive improvement”, directed, except neurocognitive sphere, at social knowledge also showed efficiency.
Family therapy or training, the approaches directed as a whole at family system, a sick person is a part of which, usually admit useful researches, at least at long-term intervention. Besides, actually therapy, recognition is received by a serious impact of an illness on a family and a heavy burden that lays down on the shoulders caring for the patient. Some evidences say about the advantage of training to social skills, but in this direction there were also considerable negative results. In some works the possible advantage of a music therapy and other creative forms of therapy is considered. Art therapy showed inefficient results at treatment of schizophrenia.
The movements organized by the “clients of psychiatric services” became an integral part of the process of restoration in Europe and America; such groups as Hearing Voices Network and Paranoia Network developed the techniques of the self-help aimed at ensuring of support and the help beyond the framework of traditional medical model, accepted by the majority of psychiatrists. Avoiding consideration of personal experience in terms of a mental illness or mental health, they strive for the destigmatization of these experiences and to inspire the person for the acceptance of an individual responsibility and finding of positive self-perception. The partner connections between hospitals and the organizations of patients is even more often established; thus, the work of doctors promotes return of people to society, an operating time of social skills and decrease in the frequency of repeated hospitalizations.
Summing up the paper, it is necessary to say that schizophrenia is a chronic mental disease causing characteristic changes of the personality (schizophrenic defect). Due to the high prevalence, a considerable influence of this disease on the quality of life of patients and unsatisfactory results of schizophrenia treatment represent a serious medico-social problem all over the world.
At present, there are a lot of approaches to the schizophrenia treatment. However, all of them are studied mainly experimentally. The features of metabolism depending on polymorphism of certain genes are widely investigated; however, they should be applied in practice.
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