Diseases and Disorders

Schizophrenia: An Overview

Francesca Venditti


Abstract

Schizophrenia is a chronic, neurological, and multilateral condition that affects the behavior, emotions, and thoughts of a person [1]. Patients with this disorder are usually detached from reality, losing touch with aspects of their lives [1]. While schizophrenia is not “as common as other mental disorders, the symptoms can be very disabling” [1]. They can also affect daily functioning and other parts of life [2]. There are positive, negative, and cognitive symptoms that can potentially result from schizophrenia. Some drugs can treat certain symptoms well, and there are more treatments being developed, like clozapine and aripiprazole.

 

Positive Symptoms

Symptoms of schizophrenia can appear in different categories. They can range from hallucinations, disordered thinking and behavior, feelings of fright and paranoia, and delusions [2] [3]. Positive symptoms of schizophrenia are “psychotic behaviors not generally seen in healthy people,” including agitated, irregular movements, hallucinating, and unusual ways of thinking or delusions [1]. Most often positive symptoms are associated with losing touch with reality or abnormally interpreting reality [1]. Delusions are the most common symptoms seen in patients with schizophrenia. These patients most likely have “false beliefs that are not based in reality,” causing them to believe that, for example, there is an imminent disaster about to occur, someone is trying to harm them, they are famous, or they are being watched [2]. Hallucinations, while they are not the same as delusions, are quite similar. Most of the time, hallucinations “include a person hearing voices, seeing things, or smelling things others can’t perceive” that usually seem entirely real to schizophrenia-afflicted people [4]. Out of all hallucinations, hearing voices appears to be the most common in a lot of patients [2]. Movement disorders, where the patient shows abnormal, child-like or excessive movement, affect the body. Since the movement is not goal-based, it becomes difficult to complete tasks [2]. Bodily behaviors related to this include “resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement” [2]. On the other hand, negative symptoms strongly affect a patient’s ability to manage their emotions.

Negative Symptoms

Negative symptoms involve effects that directly inhibit a patient’s abilities, and disrupt their normal, emotional and habitual behavior [1]{4}. These symptoms include the “flat affect,” less pleasure in everyday life (avolition), difficulty with starting and finishing activities, and reduced speech (alogia) [1]. The “flat affect” includes reduced emotional expression, through either diminished or lack of facial expression and tone of voice [1]. Traditionally, these negative symptoms have been seen as resistant to treatments, responding to only “pharmacologic and social interventions” [5]. Schizophrenic patients with negative symptoms have impaired function at school, work, their relationships with close relatives or friends deteriorates, and personal interest lessens, yielding to “dampening influences of anhedonia, apathy, and inattention” [5]. Since active psychosis leads to hospitalization in most psychotic patients, treatments aim to reduce or eliminate positive symptoms, but even these treatments barely restore functional capacity [5]; negative symptoms are challenging to treat because of “their modest therapeutic response, pervasiveness, and diminution of patients’ quality of life” [5]. Besides affecting emotional and mental health, schizophrenia can also cause various cognitive difficulties for patients.

 

Cognitive Symptoms

Cognitive symptoms of schizophrenia vary from patient to patient. Some may have more severe cognitive impairments, like loss of memory or “other aspects of thinking,” as a result of the disorder in comparison to other disorders [1]. Symptoms that fall under this category include poor executive function, or the ability to process events and make decisions based on the information, trouble with concentration or focusing, problems with working memory, or “the ability to use information immediately after learning it” [1]. A more severe case of cognitive schizophrenia might include dementia. Like the negative symptoms, cognitive symptoms may only be noticeable after “dominance of psychotic episodes or positive symptoms have either been controlled with medication or diminished with age” [6]. Over time, the subtle cognitive symptoms may gradually worsen to a note-worthy point. For example, where once reading a book was a pleasurable and intellectual activity, a schizophrenic patient may blankly stare at its pages as it is upside down, without noticing the words [6]. Typically, schizophrenic symptoms must be reported by familial connections, as patients themselves may have no idea that they are ill. Studies have found a relationship between the onset of schizophrenia and dementia in old age, although some prove that the “cognitive dysfunction in schizophrenia to be relatively stable,”  suggesting that schizophrenia may or may not be related to exacerbated cognitive decline over time [6]. Treatments for cognitive symptoms are not specific, although “it has been argued that there are chemical and structural Alzheimer-type changes that take place in the brain from long term antipsychotic treatment” [6]. However, many patients with schizophrenia also have pre-existing abnormalities such as “a comparatively reduced brain or cerebral volume and larger than normal structures known as ventricles” [6]. Schizophrenic patients, as a whole, may have a range of symptoms, but there are multiple causes and risk factors that may lead to contracting schizophrenia in the first place.

 

Causes and Risk Factors

Several factors heighten the chances of contracting schizophrenia. While most are genetic, others can be environment-based [1]. Although schizophrenia does run in some families, scientists have found that different genes may augment the risk of schizophrenia as opposed to a single gene [1]. However, interactions with the environment “are necessary for schizophrenia to develop,” including exposure to viruses, poor nutrition before birth, complications during birth, and psychosocial factors [1]. Changes during puberty could trigger psychotic symptoms because of genes or because of a difference in brain chemistry and structure [1]. Faulty connections from imbalanced neurotransmitters, like dopamine and glutamate, as well as from brain development problems at birth [1]. In addition, mind-altering substance use “during teen years and young adulthood can increase the risk of schizophrenia...the younger and more frequent the use, the greater the risk” [4]. Just as there are various causes and factors, diagnosing a patient with schizophrenia can be difficult due to the differences between patients.

 

Diagnosis

Schizophrenia, as it appears to vary between patients, is not easily diagnosable. In addition to an overall lack of awareness, there may be different causes for a patient’s schizophrenia, making the disease difficult to diagnose [4]. Moreover, drug use can sometimes cause a person to have “schizophrenia-like symptoms” but not necessarily schizophrenia [4]. Schizophrenia is usually thought of as a late-onset disorder, with symptoms showing between the ages of 16 and 30 [1]. Nevertheless, children can also be diagnosed with schizophrenia. Only about “1 in 40,000” children have it, “compared to 1 in 100 in adults” [7]. Often, persistently hearing voices “saying derogatory things about him or her, or...conversing with one another, talk[ing] to himself or herself, star[ing] at scary things—snakes, spiders, shadows—that aren't really there, and show[ing] no interest in friendships” may be signs of schizophrenia in children of 7 years or older [7]. Although there is no lab test or specific procedure to diagnose schizophrenia, “a health care provider who evaluates the symptoms and the course of a person's illness over six months can help ensure a correct diagnosis” after ruling out other possible factors, like a brain tumor or other psychiatric illnesses [4]. A person must have two or more symptoms of schizophrenia “in the context of reduced functioning,” including “delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms [4].”  The most prominently recognized symptoms leading to diagnosis of schizophrenia are mainly delusions and hallucinations [4][8]. Early identification can “improv[e] a person’s chances of managing the illness, reducing psychotic episodes, and recovering” [4]. However, because patients are usually unaware of their illness, it “often falls to family or friends to get them help” [2]. Once recognized, schizophrenia can be treated with methods from therapy to drugs.

 

Treatments

Unfortunately, there is no cure for schizophrenia so far. Treatments, however, can be used to reduce symptoms of schizophrenia. These treatments include: antipsychotics, “taken daily in pill or liquid form… [or as] injections that are given once or twice a month,” psychosocial treatments, “coping skills” patients use after finding a medication that works, and coordinated specialty care, which “integrates medication, psychosocial therapies, case management, family involvement, and supported education and employment services” [1]. Besides these three treatments, the National Institute of Mental Health (NIMH) launched a research project in 2008 called Recovery After an Initial Schizophrenia Episode (RAISE). Its overall aim is to use “coordinated specialty care treatment in the earliest stages of the disorder...to reduce the likelihood of long-term disability that people with schizophrenia often experience and help them lead productive, independent lives” [1]. Nami.org also writes that treatments include “antipsychotic medications, psychotherapy, such as cognitive behavioral therapy and assertive community treatment and supportive therapy, [and] self-management strategies and education” [4]. In general, typical, or “first generation,” antipsychotic medications can block dopamine, a chemical which is responsible for basic feelings and communication between control centers in the brain, and “inhibi[t] the ability for control centres and cells in the brain to send or receive signals” [6]. Newer and atypical, or “second generation,” drugs act more selectively in blocking dopamine and can also affect serotonin, a chemical associated with feelings of happiness or love, “pathways in the brain” [6]. Serotonin is also responsible for feelings of anxiety and depression. A new drug called aripiprazole is the “new hope” that, “instead of blocking receptors, is what is known as a ‘partial agonist’ thus stimulating certain receptors and increasing activity” [6]. As previously stated, many positive symptoms respond well to treatment, while “negative and cognitive ones are not as well treated” [6]. On the other hand, an alternative drug treatment called clozapine may “remai[n] the only drug with proven efficacy in patients who are poor or partial responders” [9]. It also seems, according to research, to help schizophrenic patients in reducing suicidal behaviors, but many clinicians hesitate to use it due to “perceived risks and the burden of blood monitoring” [9].

 

Conclusion
Schizophrenia is not just about patients you’ve never met. They could be your neighbors, family members, schoolmates, teachers, coaches, and colleagues. 1 in 100 people have schizophrenia, and it’s likely that you, if you have not already, someone with schizophrenia in your lifetime. Luckily, science is constantly evolving and growing. Going into the future, genetic engineering could be a revolutionary way to treat patients with schizophrenia. New technology and a renewal of interest in the field of scientific research will be beneficial in promoting the development of treatments for schizophrenia, amongst other disorders. While the developments will take time and research, “the promise of further discoveries in genetics leading to new treatment targets and better predictors of treatment response (both therapeutic and adverse) is enormously exciting” [9]. A cure for schizophrenia or similar illnesses may even be discovered, what with the thrilling prospects that genetic engineering provides. Meanwhile, funding scientific research is a large part of fueling the efforts to treat schizophrenia. In the future, these treatments will hopefully prove more effective and provide patients with new possibilities for recovery.


References


  1. National Institute of Mental Health. (02/2016). Schizophrenia. National Institute of Health. https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml. Retrieved: 31/12/2019.

  2. Mayo Clinic Staff. Schizophrenia. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443. Retrieved: 31/12/2019.

  3. Bhandari, Smitha. (05/2018). Schizophrenia Types and Spectrum. WebMD. https://www.webmd.com/schizophrenia/schizophrenia-types. Retrieved: 31/12/2019.

  4. National Alliance on Mental Illness. Schizophrenia. NAMI.org. https://www.nami.org/learn-more/mental-health-conditions/schizophrenia. Retrieved: 31/12/2019.

  5. Tandon, Rajiv; Jibson, Michael. (09/2002). Negative symptoms of schizophrenia: How to treat them most effectively. MDedge. https://www.mdedge.com/psychiatry/article/66140/schizophrenia-other-psychotic-disorders/negative-symptoms-schizophrenia-how. Retrieved: 31/12/2019.

  6. Living With Schizophrenia. Cognitive Symptoms of Schizophrenia. LivingWithSchizophreniaUK.org. https://www.livingwithschizophreniauk.org/cognitive-symptoms-schizophrenia/. Retrieved: 31/12/2019.

  7. Schizophrenia.com. Childhood Schizophrenia. Schizophrenia.com. http://schizophrenia.com/family/childsz.htm#. Retrieved: 31/12/2019.

  8. Clarke, Jodi. (12/08/2019). The Signs and Symptoms of Schizophrenia. Verywellmind.com. https://www.verywellmind.com/what-are-the-symptoms-of-schizophrenia-2953120. Retrieved: 31/12/2019.

  9. Kane, J. M., & Malhotra, A. (2003). The future of pharmacotherapy for schizophrenia. World psychiatry : official journal of the World Psychiatric Association (WPA), 2(2), 81–86. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525084/citedby/. Retrieved: 20/3/2020

Francesca Venditti

Francesca Venditti


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