Schizophrenia is not the same as psychosis. You can have a psychosis without having schizophrenia, but the other way around is not possible. Schizophrenia always coincides with one or more psychoses. As is often thought, schizophrenia has nothing to do with a split personality. The personality of the schizophrenic person remains the same, but certain parts of their behavior may change in such a way that they appear to be a completely different person.
Epidemiology
Schizophrenia occurs at approximately the same rate all over the world. Culture and social relationships have no influence on the disease. During wars and disasters, schizophrenia is just as common. Nearly 1 in 100 people suffer from schizophrenia. Every year there are approximately 3000 new patients suffering from schizophrenia in the Netherlands. Schizophrenia usually manifests itself between the ages of 16 and 30.
Etiology
There is no clear cause for schizophrenia yet, but it is clear that it is a combination of various factors. Personality, stress, brain development and brain processes and the environment lead to schizophrenia. Men suffer from schizophrenia more often than women. It is largely hereditary; if schizophrenia runs in a family, the chance is 10 to 50 times greater that someone in that family will also develop schizophrenia. People who live in the city are more likely to experience psychotic symptoms and perhaps more likely to develop schizophrenia. Stressful events can trigger schizophrenia.
Pathosphysiology
Recent studies have shown that the brain is not optimally developed. There are fewer gray brain cells and these are less well developed. The gray brain cells are the switching center (receivers) in the brain, the white cells serve as a conduction pathway. This could limit the functioning of the brain. Scans and an autopsy showed slight abnormalities in the structure of the brain. According to newer theories, brain cells can become disturbed early in development and form incorrect connections. Neurotransmitters ensure the exchange of information in the brain, the functioning of some of these substances (dopamine and glutamate) could be disrupted in someone with schizophrenia. Part of the problem is excessive dopamine production in the brain.
Symptomatology
Schizophrenia progresses in phases:
- promodal phase
- acute or psychotic phase
- recovery or stable phase
How long each phase lasts varies per person. Some people are almost constantly in a psychotic phase, others only suffer from this once in a while . During the promodal phase, signs of psychosis occur. The patient notices that he feels or thinks differently. This phase can last a few days, but also years. In the psychotic phases, delusions, hallucinations, thought disorders, mood disorders, behavioral and sleep problems occur. This phase can last six months, but it can be shortened by medication. After the psychotic phase, patients enter a stable phase. A number of symptoms of the psychotic phase are still present, but much less noticeable. It usually concerns symptoms such as thinking slower, withdrawing and taking little initiative. About 20% of patients continue to suffer from delusions, hallucinations and confusion.
The symptoms can be divided into 5 groups:
- delusions
- hallucinations
- confused thinking and speaking
- changes in emotional life
- changed behavior
Delusions are incorrect and uncorrectable beliefs that the patient has. The patient often occupies a central place in his delusion. The delusions are often bizarre, for example the person thinks he is someone else such as Napoleon, Mary or God. For example, he may think he is being pursued by the FBI or CIA. Hallucinations are sensory perceptions without sensory stimulation. For example, someone with hallucinations can see, hear, taste or feel things that are not there in real life. These observations are so real to the patient that they act on them. For example, someone may hear voices and think their entire body is covered in bugs. The normal thought process in someone with psychosis is disturbed, he can make very incomprehensible leaps of thought and jump from one topic to another. When someone has a psychosis, they may feel strange and like they no longer belong. Mood swings are common and a person may feel unusually excited or depressed as well as scared or suspicious. The patient may behave differently. He may be extremely active or sleepy, laugh at odd moments or become very angry, and may also repeat movements. One or more of these symptoms can cause someone with schizophrenia to do strange things. For example, he may stop eating because he thinks he is being poisoned or call the police because he is being chased. It can also be so extreme that he deliberately injures himself or someone else.
Research/diagnostics
Schizophrenia is diagnosed using the DSM-IV (Diagnostic Statistic Manual, 4th edition), the DSM is a kind of catalog for psychiatric disorders. This catalog is used internationally by doctors, psychologists and psychiatrists and ensures that everyone is talking about the same thing. A patient has schizophrenia if he has at least 2 of the above symptoms and can no longer function properly socially and at work. In some cases, one of the symptoms is enough to give the diagnosis of schizophrenia, for example if his delusions are bizarre or if he hears voices.
Therapy
Schizophrenia cannot be cured, but it can be treated. Medication reduces the psychotic symptoms. The patient must use it for a longer period of time, even if all symptoms have disappeared. If this does not happen, there is a good chance that a relapse will occur. Commonly prescribed medications are antipsychotics. If these do not help or do not help enough, neuroleptics are also prescribed. Psychological treatments are a supplement to medication treatment. They give the patient insight into the clinical picture. People with schizophrenia often do not have the idea that they are ill and stop taking medication when things get better. Then they run a great risk of developing schizophrenia again. Through treatment, an attempt is made to make the patient adherent to therapy in order to prevent relapse.
Prognosis/course
About a quarter of patients can recover permanently. Through intensive guidance and continued use of medication, they can live without relapse. Three quarters of patients continue to experience the disease to a greater or lesser extent. Some have recurring psychotic episodes and use medications to keep the symptoms away for as long as possible. Others continue to have the symptoms of psychosis permanently
Complications
The medications can cause side effects.
Anti-psychotics:
- Movement disorders (tremors, stiffness, tics, inability to sit still)
- Lots of saliva or a dry mouth
- Dry eyes
- Reduced responsiveness
- Concentration problems
- Drowsiness
- Dizziness
- Poor near vision (difficulty reading)
- Irregular menstruation
- Less desire for sex
- Weight gain
Neuroleptics:
- stiffening of the muscles
- slowed movements
- tremble
- movement disorders such as tics, involuntary cramps
- can no longer sit still
- drop in blood pressure
- weight gain
- disorders in the menstrual cycle