In detail

Schizophrenia, a distortion of thought

Schizophrenia, a distortion of thought

Schizophrenia is a serious mental illness that is characterized by a distortion of thinking with hallucinations and loss of contact with reality. Those who suffer from it often have the feeling of being controlled by strange forces. They have delusional ideas that can be extravagant, with impaired perception, abnormal affection unrelated to the situation and autism understood as isolation.

The deterioration of mental function in these patients has reached such a degree that strongly interferes with your ability to meet some of life's ordinary demands or maintain adequate contact with reality. The psychotic does not live in this world (dissociation between reality and his world), since there is a denial of reality unconsciously. He is unaware of his illness.

The cognitive activity of schizophrenic is not normalThere are inconsistencies, disconnections and there is a great impact on language, because it does not think or reason normally.

Content

  • 1 Start and prevalence of schizophrenia
  • 2 Diagnostic criteria of Schizophrenia
  • 3 Types of Schizophrenia
  • 4 Schizophrenia Forecast
  • 5 Treatment of Schizophrenia

Start and prevalence of schizophrenia

The onset of the disease can be acute, that is, it can start from one moment to another with a delusional crisis, a manic state, a depressive condition with psychotic contents or a confused dream state. It could appear in a cunning way or progressive.

The average age of onset is in men between 15 and 25 years old, and in women between 25 and 35 years old. However, it may appear before or after, although it is rare to arise before 10 years or after 50 years.

The prevalence of this disease is between 0.3% and 3.7% depending on the area of ​​the world where we are. A certain hereditary prevalence has been observed, if one of the parent parents suffers from schizophrenia, the child has a 12% chance of developing said disorder and if both are schizophrenic, the child has a 39% chance. A child with healthy parents has a 1% chance of suffering from this disorder, while a child with a brother with this disorder has an 8% chance. Therefore the causes of schizophrenia are both biochemical and environmental.

Schizophrenia may occur mainly associated with Substance Related Disorders. From 30 to 40% of schizophrenics have alcohol abuse problems; 15-25% problems with cannabis; 5 to 10% abuse or depend on cocaine. Nicotine abuse is also included, very common in these patients. Drugs and alcohol reduce anxiety levels and depression caused by schizophrenia.

Diagnostic criteria of Schizophrenia

There is no single clinical picture, but there are multiple characteristic symptoms; emotional, cognitive, personality and motor activity symptoms.

Symptomatology must be present for at least 1 month and persist for at least 6 months.

Positive symptoms of Schizophrenia

Excess or distortion of normal functions such as:

  • Hallucinations: perceptions that do not exist that can be auditory, visual, tactile, olfactory or gustatory (the first 2 are the most common).
  • Delusional ideas: alterations of thought, false and irreducible ideas to argument reasoning.
  • Disorganized and incoherent language (They are usually ideas of persecution, greatness, religious, jealousy and hypochondriacs).
  • Seriously disorganized behavior (agitation, inability to organize and maintain personal hygiene) or catatonic (with a decrease in psychic and motor activity until a total lack of attention and rigidity).

Negative symptoms of Schizophrenia

They seem to reflect a decrease or loss of normal functions. Negative symptoms include restrictions:

  • Affective dullness: no reaction to emotional stimuli.
  • Speech poverty (praise).
  • Abulia or apathy: lack of will, inability to persist or to start an activity.
  • Anhedonia: inability to enjoy pleasures.

Negative symptoms alter the ability to function in the daily life of patients, they are people who end up isolating themselves and losing friends.

The course of the disease is characterized by exacerbations and remission phases of symptoms, although some patients have a stable course. As time passes, the negative symptoms accentuate more, while the positive symptoms subside.

There is also a depersonalization where psychic phenomena such as perception, memory or feelings appear as strangers to oneself: mirror syndrome.

Another characteristic is the derealization or feeling of strangeness in front of the external world, which due to its proximity and co-ownership should be recognized. The environment appears as hazy, unreal, strange and unusual.

Physiologically, an increase in the size of the cerebral ventricles can be observed in schizophrenic patients. There is also an excess of the activity of dopaminergic neurotransmitters.

Schizophrenia affects people in the social and work area. They usually have problems in interpersonal relationships, at work and even present difficulties in caring for themselves.

There are certain drugs that can induce psychosis in people with a special vulnerability to suffering from schizophrenia: amphetamines (the most common), cannabis, hallucinogens (LSD), cocaine and alcohol.

For diagnosis requires a complete clinical and neurological examination.

Types of Schizophrenia

Paranoid schizophrenia

  • Concern for one or more delusions of greatness or persecution.
  • Frequent auditory hallucinations.
  • There is no disorganized language, no catatonic or disorganized behavior, no flattened or inappropriate affectivity.
  • They can also present anxiety, anger, tendency to argue and violence.

Disorganized Schizophrenia

  • Disorganized language and behavior.
  • Flattened or inappropriate affectivity.
  • You can present delusional ideas that revolve around an incoherent theme.
  • It is usually early onset.

Catatonic Schizophrenia

  • Marked psychomotor alteration that may include motor immobility or excessive motor activity.
  • Extreme negativism, or mutism.
  • Peculiarities of the voluntary movement with strange postures, stereotyped movements, grimaces.
  • Copy what someone else says or does.

Simple Schizophrenia

  • It is a type of schizophrenia without hallucinations or delusions, but the patient loses his abilities, not enough.

Hebephrenic Schizophrenia

  • It has an early start (between 12-13 years), in principle it seems mental retardation.
  • Suffer behavior disorder.
  • Flattened affectivity.
  • Delusions

Residual or defect states

  • Negative symptoms predominate, it occurs when the previous alterations are chronicled.

Schizophrenia Forecast

From 20 to 30% of patients manage to lead a relatively normal life. The other 20-30% experience moderate symptoms. And the remaining 40-60% lead a life disturbed by the disorder.

Good prognostic factors

  • Late age of onset.
  • Acute onset of the disease.
  • Existence of precipitating factors: drugs.
  • Absence of affective dullness.
  • Precipitating factors of the disease clearly identifiable.
  • If the person had good social, sexual and occupational adaptation before the onset of the disease.
  • Favorable social and family environment.
  • Good treatment compliance.
  • Family history of mood disorders.
  • Confusion and atypical symptoms.
  • The subtype with the best prognosis is Paranoid Schizophrenia.

Bad prognostic factors

  • Start at an early age.
  • Progressive or insidious onset of the disease.
  • Prevalence of negative symptoms.
  • Social isolation or few social support systems.
  • Prior personality disorder.
  • Affective dullness.
  • Family history of schizophrenia.
  • Long evolution before the first medical contact.
  • Drugs abuse.
  • Presence of clear brain abnormalities (dilated ventricles).
  • When the disease does not subside in three years and there are multiple relapses.
  • Disorganized type schizophrenia is the most serious.

Schizophrenia Treatment

The treatment is pharmacological, the antipsychotic medications used are neuroleptics (Haloperidol, Largacil, Meleril, etc.) are very effective in the treatment of schizophrenia but have important side effects such as tremor, stiffness, internal restlessness, sweat and even seizures. It also produces undesirable non-neurological effects such as jaundice (yellowing of the skin), high fever, aplastic anemia, dermal hypersensitivity, hypotension, weight gain and in extreme cases "neuroleptic malignant syndrome" that can lead to death. The neuroleptics appeared in the fifties, there are currently new forms of presentation that reduce these side effects such as Clizamine or Risperidone, thanks to this progress patients do not abandon treatment so easily, because they do not suffer so much discomfort.

Frequently, the patient is admitted to stabilize the medication, avoid getting hurt or hurt others, protect him from suicidal or homicidal ideas, to provide basic care, food, hygiene, reduce the level of stress and help him structure his daily activities. The duration will depend on the severity of the condition and the availability of resources for outpatient treatment.

Initially, individual psychotherapy is contraindicated, but not group or family therapy that are usually very beneficial. The psychosocial interventions reinforce the person's ability to cope with stress or adapt to the effects of the disease.

Group psychotherapy is very useful for social skills training. They allow the social and occupational rehabilitation of the patient, who learns to interact with others and to manage themselves in everyday life after contracting the disease. The important thing is that they can have adequate behavior within the home as well as a better social life.

References

Díaz Marsá M, Facing Schizophrenia. Guide for patients and family. Enfoque Editorial S.C. 2013

APA Clinical Guidelines. American Psychiatric Association Practice guidelines for the treatment of patients with schizophrenia. 2004

Lemos, S. (2009). CPG assessment on Schizophrenia and Early Psychotic Disorder. Infocop Online

López M, Laviana M, Fernández L, López A, Rodríguez AM, Aparicio A. The fight against stigma and discrimination in mental health. A complex strategy based on the available information. Rev Asoc Esp Neuropsi. 2008; 101: 43-83.

Travé, J. and Pousa, E. (2012). Efficacy of Cognitive Behavioral Therapy in patients with recent onset psychosis: a review. Roles of the Psychologist, 33, 48-59

//www.aepcp.net/arc/esquizofrenia-completa%202009.pdf

//www.infocop.es/pdf/comprenderpsicosis.pdf

//www.nimh.nih.gov/health/publications/espanol/la-esquizofrenia/sp-15-3517_156292.pdf

//www.sepsiq.org/file/Royal/21-Esquizofrenia.pdf

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