This is a major psychiatric disorder where the patient experiences a multitude of strange symptoms such as loss of contact with reality, false beliefs, false perceptions of sounds and images, abnormal thinking, reduced motivation and flattened affect.
As a result these patients, when untreated live in their own world, find it extremely difficult to communicate and to trust people around them, which makes it awkward for loved ones, friends and strangers to understand them. This leads then to social isolation, work disturbances and often marital conflicts and divorces. Secondary depression often sets in and frequently leads to suicide. Insomnia is often also present, which only makes the symptoms of paranoia worse.
The worldwide prevalence is 1%. Both men and women are equally affected with schizophrenia, however it starts earlier in men(peak is from age 18 to 25 years) than in women (peak is between 26 and 45 years of age). It is rare in childhood or early adolescence, but does occur in 4 to 10 children out of 10,000. First degree relatives of schizophrenic patients have a 10-fold higher incidence of schizophrenia than the general population.
'Adoption and twin studies have shown that the major factor is the genetic component, but there is a significant environmental component, which is also effective.
What are the causes for schizophrenia ?
The exact cause is not known, but there is a biological basis. The popular model at present is a vulnerability model, where there is an underlying minimal neurological vulnerability. On top of this come environmental stressors such as a broken marriage, leaving home to go to the army, moving to another town to find work, the loss of a loved one etc. , which then causes the brain metabolism to derail. Often the disease itself can feed into this negative cycle by causing loss of work or relationships and leading to homelessness and poverty. This will then tend to make schizophrenia chronic and very difficult to treat.
Among schizophrenics brain studies over the years have consistently shown some structural changes such as an enlarged ventricular system(= the fluid filled chambers in the center of the brain). Certain parts of the brain such as the hippocampus and the temporal lobes are smaller, but the basal ganglia are enlarged. This can be detected with imaging studies. The cerebral cortex in patients with schizophrenia tends to be small in size. With the help of the PET scanner, where brain function can be visualized such as glucose utilization, abnormalities in the prefrontal cortex can be shown in schizophrenics, but not in normal controls.
The patients differ a fair amount and not all of the following symptoms are present in every patient. A patient with persecutory thoughts will interpret all of the actions around him as meaning that something or someone is after the patient. For instance, when a schizophrenic patient witnesses a scene on the road where one worker is yelling to another worker to drop a load of poles from a truck, where the intention is to build a fence at the side of the road, this would be interpreted as : "He said to the other guy: drop every thing and let's chase after me..." (persecutory hallucinations).
Another patient may have auditory hallucinations (hearing voices that are not really there), where everything that is happening is commented on. In this patient a soft voice that she trusts may tell her: "You know , you have taken these pills long enough. Don't you think you should give your system a break?" The patient often is aware that these voices are not really there, but they are incorporated into judgments, decisions and actions. So, this patient did stop the pills and within 2 days she ended up in hospital with a florid psychosis and flare-up of her schizophrenia, which lead to a 4-week psychiatric hospitalization and a follow-up program, where the psychiatric nurse at the outpatient psychiatric clinic gives her an injection with a long-acting antipsychotic medication every three weeks. Hallucinations can happen in all the senses: the auditory ones are the most common, but visual hallucinations are also fairly frequent, less frequent are hallucinations that affect smell, taste or tactile sensations. What the patients are not aware of is that all of these sensations are generated within their own brains. Insomnia is another non specific symptom that is often present. Sleep deprivation associated with insomnia tends to make schizophrenia worse.
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