Everything You Need To Know About Schizophrenia

Introduction

There is a lifetime morbid risk for developing schizophrenia. 1 out of every 100 people has chances of having schizophrenia in their lifetime. But the risk of having schizo increases when parents also have schizo as compared to people who have no family history of schizophrenia. There is also another group of people who have chance of schizophrenia i.e. fathers who have their child at an older age, between 45-50. The majority of cases began in late adolescence and early adulthood. It also tends to begin earlier in men than in women. The onsets in men are from the age of 25 and for women, it’s from the age of 29. But it is also seen that after about age 35, the number of men developing this disorder goes markedly less but this is not the case with women. Women are said to have a less severe form of schizophrenia than men and due to low severity a lot of times it goes undiagnosed as symptoms of depression are more and hence they gets diagnosed by depression and schizophrenia. In women, a hormone called estrogen plays a protective role, when levels of estrogen are low the symptoms of schizophrenia increase. So, the protective effect of estrogen may therefore help in the delayed onset of schizophrenia in women and the declining level of estrogen during menopause explains the late onset of schizophrenia in women.

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Clinical picture

1. Delusions: delusion is any belief that a person has even after the presence of contradictory evidence. It involves a disturbance in the content of thought. It occurs in 90% of the patient with schizophrenia at some point in their illness. Prominent among these are beliefs that one’s thoughts and feelings or actions are being controlled by external agents, that one’s private thoughts are being broadcasted to others(thought broadcasting), that thoughts are being inserted into one’s brain(thought insertion), or that some external agency has robbed one’s thought(thought withdrawal).
2. Hallucinations: it is a sensory experience that occurs in the absence of any external perceptual stimulus. It is different from illusion which is a misperception of a stimulus that exists. Hallucinations can be sensory, visual, olfactory, tactile, or gustatory. Auditory hallucinations are the most common with presence in around 75% of cases. These hallucinations are often relevant for the patient at an affective, conceptual, or behavioral level. The person can become emotionally involved in his hallucinations and often incorporates then into their delusions. The majority of patients reported that the voices they heard talked to them is at a normal conversational volume and these voices are usually of someone they know and sometimes of God or the Devil. Most of the patients also reported hearing more than one voice and the hallucinations get worse when the person is alone. Imaging studies show that hallucination patients show increased activity in Broca’s area (involved in speech production).
3. Disorganized speech: it is the external manifestation of a disorder in thought-form. Patients fail to make sense, despite having the knowledge of rules governing verbal communication. The failure to produce speech is not attributed to low intelligence, poor education, or cultural deprivation. Sometimes the patient uses newly made-up words known as a neologism .
4. Disorganized and catatonic behavior: the ability to perform a goal-directed activity is disrupted. The person is unable to perform daily functioning like work, social relations, and self-care. The person may no longer take care of their personal hygiene and have profound disregard for their own safety. In other cases, disorganized behavior may include unusual dressing.

Catatonia is a more striking behavioral disturbance. The patient shows an absence of movements and speech and be in what is called a catatonic stupor. Also, the patient may hold an unusual posture for an extended period of time without any seeming discomfort.

• Negative symptoms: there are mainly two kinds of symptoms that are negative and positive symptoms. Negative symptoms mean absence or deficit of something and they include distorted speech and disorganized behavior.
• Positive symptoms: they reflect an excess or distortion in normal behavior and include experiences like delusions and hallucinations.

Subtypes of schizophrenia

1. Paranoid type: they have a history of increasing suspiciousness and difficulties in interpersonal relationships. They carry absurd, illogical ideas and beliefs. They have the delusion of grandeur where they think that they have something special and hence, people are following them and keeping an eye on their everyday activities. The overall function at a higher level and have more intact cognitive skills than the patient with other subtypes. The prognosis for these patients is generally better than the prognosis of patients of other types of schizophrenia.
2. Disorganized type: this occurs at an earlier age and has a gradual, insidious onset. It is characterized by disorganized speech, disorganized behavior, and flat or inappropriate affect. This subtype was also called “hebephrenic schizophrenia.” The person becomes more occupied with his fantasies. As the disorder progresses, the patient is not able to differentiate between his emotions and acts like an infant. Speech becomes difficult to understand and include baby talks, childish giggling, and repetitive use of similar-sounding words. Hallucinations and delusions are present but unlike paranoid type, these are not coherent or organized into a story. There is a severe disruption in their ability to take care of themselves and are unable to perform routine tasks. The prognosis is generally poor for people who develop disorganized schizophrenia.
3. Catatonic type: there is pronounced motor signs, either of an excited or a stuporous type. These patients are highly suggestible and will automatically start following commands or imitate the actions of others (echopraxia) or mimic their phrase (echolalia). They can stand in an awkward position for hours and may not feel the discomfort. They resist any effort to change their positions, may become mute, resist all attempts at feeding and refuse to comply with even the slightest of request. A catatonic patient may pass suddenly from extreme stupor to a state of great excitement and may become violent. Because of this sudden shift in their mood it is sometimes indistinguishable from some bipolar manic patients.
4. Undifferentiated type: it meets the usual criteria of schizophrenia including symptoms like delusions, hallucinations, disordered thoughts, and bizarre behavior. They do not clearly fit into any one type because of these mixed symptoms.
5. Residual type: it is a category of people who have had at least one episode of schizophrenia but do not know show any prominent positive symptoms but mostly contains negative symptoms.