Schizophrenia
This disorder is characterized by disturbances (for at least 6 months) in thought content and form, perception, affect, sense of self, volition, interpersonal relationships, and psychomotor behavior. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition – Text Revision (DSM-IV-TR), recognizes paranoid, disorganized, catatonic, undifferentiated, and residual schizophrenia.
Schizophrenia affects 1% of the population worldwide and is equally prevalent in both sexes. Onset of symptoms usually occurs during adolescence or early adulthood.
The disorder produces varying degrees of impairment. Up to one-third of patients with schizophrenia have just one psychotic episode and no more. Some patients have no disability between periods of exacerbation; others need continuous institutional care. The prognosis worsens with each episode.
Causes
Schizophrenia may result from a combination of genetic, biological, cultural, and psychological factors.
Genetic evidence
Some evidence supports a genetic predisposition. Close relatives of persons with schizophrenia are up to 50 times more likely to develop schizophrenia; the closer the degree of biological relatedness, the higher the risk.
Biochemical theory
The most widely accepted biochemical hypothesis holds that schizophrenia results from excessive activity at dopa-minergic synapses. Other neurotransmitter alterations may also contribute to schizophrenic symptoms. In addition, patients with schizophrenia have structural abnormalities of the frontal and temporolimbic systems.
Other causes
Numerous psychological and sociocultural causes, such as disturbed family and interpersonal patterns, also have been proposed. Schizophrenia occurs more often among people from lower socioeconomic groups, possibly the result of downward social drift, lack of upward socioeconomic mobility, and high stress levels that may stem from poverty, social failure, illness, and inadequate social resources. Higher incidence also is linked to low birth weight.
Signs and symptoms
Schizophrenia is associated with various abnormal behaviors; therefore, signs and symptoms vary widely, depending on the type and phase (prodromal, active, or residual) of the illness.
Watch for these signs and symptoms:
ambivalence—coexisting strong positive and negative feelings, leading to emotional conflict
apathy
clang associations—words that rhyme or sound alike used in an illogical, nonsensical manner—for instance, “It’s the rain, train, pain.”
concrete associations—inability to form or understand abstract thoughts
delusions—false ideas or beliefs that the patient accepts as real (delusions of grandeur, persecution, and reference [distorted belief regarding the relation between events and oneself, such as a
belief that television programs address the patient on a personal level] are common in schizophrenia; also common are feelings of being controlled, somatic illness, and depersonalization)
echolalia—meaningless repetition of words or phrases
echopraxia—involuntary repetition of movements observed in others
flight of ideas—rapid succession of incomplete and unconnected ideas
hallucinations—false sensory perceptions with no basis in reality; usually visual or auditory but may also be olfactory, gustatory, or tactile
illusions—false sensory perceptions with some basis in reality, such as a car’s backfiring mistaken for a gunshot
loose associations—rapid shifts among unrelated ideas
magical thinking—a belief that thoughts or wishes can control others or events
neologisms—bizarre words that have meaning only for the patient
poor interpersonal relationships
regression—return to an earlier developmental stage
thought blocking—sudden interruption in the patient’s train of thought
withdrawal—disinterest in objects, people, or surroundings
word salad—illogical word groupings, such as “She had a star, barn, plant.”
Diagnosis
After complete physical and psychiatric examinations rule out an organic cause of symptoms, such as an amphetamine-induced psychosis, a diagnosis of schizophrenia is made if the patient’s symptoms match those in the DSM-IV-TR. (See Diagnosing schizophrenia.)
Treatment
With schizophrenia, treatment focuses on meeting the physical and psychosocial needs of the patient, based on his previous level of adjustment and his response to various interventions. Treatment may combine drug therapy, long-term psychotherapy for the patient and his family, psychosocial rehabilitation, vocational counseling, and the use of community resources.
Antipsychotics
The primary treatment for more than 30 years, antipsychotics (also called neuroleptic drugs) appear to work by blocking postsynaptic dopamine receptors. These drugs reduce the incidence of psychotic symptoms, such as hallucinations and delusions, and relieve anxiety and agitation.
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