Schizophrenia is a mental disorder that affects 1% of the general adult population. Schizophrenia begins in young adulthood between the ages of 16 and 30 years of age, and in most cases, patients never get better. It is believed schizophrenia is an accumulation of several mental and psychological disorders because most patients also suffer from obsessive-compulsive disorder, major depressive disorder, or anxiety disorder.
Causes of schizophrenia
The cause of schizophrenia is genetic and environmental factors. The risk of being schizophrenic increases if a person has a:
- First degree relative with the disease (risk is 6.5%).
- If one parent is affected, the risk factors are 13%, and if both parents are affected, the risk is up to 50%.
- Identical twins (risk is 40%)
What environmental factors can cause schizophrenia?
The environmental factors that could cause schizophrenia or increase the risk are:
- Cannabis use in adolescence
- A living environment such as in an urban area
- Poor prenatal nutrition
- Prenatal maternal stress
- Intrauterine hypoxia
- Maternal infections during pregnancy such as viruses, chlamydial or Toxoplasma gondii
- Maternal obesity
- Trauma in childhood
- Abused or being bullied
- Loss in the family
Signs and Symptoms of Schizophrenia
The symptoms of Schizophrenia are grouped into:
- Positive symptoms (psychosis such as hallucinations, abnormal thinking and delusions )
- Negative symptoms (Reduced in feelings of pleasure in daily life, lack of motivation, avoiding people and reduced in the expression of emotions)
- Cognitive symptoms (cognitive deficits such as poor concentration)
The manifestations start gradually in some people, while in others, it manifests rapidly. Most schizophrenic patients have to rely on others because they can’t carry out daily activities, some patients do not believe they are sick and require medical attention despite gradual signs of insanity, while some patients do not look sick. These last groups of people are properly dressed and look mentally healthy until they begin to discuss their thoughts and how they see the world.
Major Schizophrenia signs are:
- Hallucinations (hearing voices, having a full-blown conversation with the voice, seeing things that are not physically present, feeling, and smelling things that others cannot smell, e.t.c.).
- Delusions (having beliefs that others are out to get them, believing that they have supernatural powers and abilities e.t.c)
- Solitude: withdrawing from social activities.
- Difficulty expressing emotions: inability to properly express feelings verbally or to show emotions in the circumstances that require certain emotions
- Apathy: the lack of motivation (avolition), interest, and feeling to life in general.
- Disorganized thinking (thought disorder): is expressed as a problem with speech formulation, poorly used words (poverty to speech), writing random words that do not make up a correct sentence, or can be understood by the reader.
- Inability to feel pleasure
- Neglecting daily hygiene (self-neglect)
- Poor quality of life
- Cognitive deficits: In working memory, verbal memory, long term memory, episodic memory, semantic processing (inability to process a word heard and decoded the meaning of that word), the deficit in attention, the deficit in speech, and deficit in the speed of processing.
- The patient does not believe he or she is sick (hallucinations and delusions appear real to patients).
Diagnosis of schizophrenia
There is no specific test to make a diagnosis of schizophrenia. However, there are positive and negative symptoms assessment scales that are used to assess symptoms in a patient, and there are also two specific diagnostic criteria system created to diagnose patients:
1. Diagnostic and Statistical Manual of Mental Disorders (DSM) created by the American Psychiatric Association: the new criteria, also known as DSM-5, uses the presence of:
- Disorganized speech,
- Disorganized/catatonic behaviors
- Negative symptoms
The patient must have at least two main symptoms over the period of 1 month with a significant deficit in social or occupational function for at least six months to make a diagnosis.
2. International Classification of Diseases (ICD) by the World Health Organization: ICD – 10 uses Symptom such as;
- Thought echo and thought insertion or withdrawal.
- Passivity and delusional perception.
- 3rd person auditory hallucinations and running commentary.
- Persistent bizarre delusions
- Persistent hallucinations
- Thought disorder
- Catatonic disorder
- Negative symptoms
- Significant behavior change
Diagnosis with ICD-10 criteria is made based on the duration of symptoms:
- The presence of 2 or more symptoms with a duration of at least one month but less than six months is diagnosed as a schizophreniform disorder.
- The presence of at least two symptoms with a duration of more than six months is diagnosed as SCHIZOPHRENIA.
- Psychotic symptoms lasting less than one month are diagnosed as brief psychotic disorder.
- Psychotic symptoms with a mood disorder (bipolar disorder or depression) are diagnosed as Schizoaffective disorder.
Treatment of schizophrenia
- Antipsychotic medications (Risperidone, amisulpride, olanzapine and clozapine). They are regularly taken everyday.
- Psychotherapy: Family therapy, group therapy, cognitive behavioral therapy, metacognitive training, and cognitive remediation.