Puzzling Schizophrenia

Schizophrenia is the most puzzling mental disorder. The word means 'split mind'. This is not the same as split personality or multiple personality. In schizophrenia there is a split between the different faculties of mind. The different faculties include our ability to think, feel emotions, act with purpose, perceive external realities, communicate with others etc. Psychiatrists divide the symptoms of schizophrenia into positive and negative symptoms. Positive symptoms include breaks in thinking and speech, delusions, hallucinations, excitement aggression etc. Delusions are false beliefs held by the patient without sufficient justification. Hallucinations are sensations experienced without adequate external stimuli e.g: hearing or seeing things which are not really present. Negative symptoms are more disabling as they reduce social interactions and the ability to work or enjoy life. These symptoms occur due to defects in cognition and information processing.
A patient with schizophrenia lives in his private world, cut off from the rest of us, a hapless victim of strange fears, false beliefs and unreal perceptions, lacking motivation and drive to improve his lot. Studies have shown derangement in the functions of certain brain areas in them. Most notable is the excess amount of a neurotransmitter (a chemical used by one brain cell to communicate to other cells) called dopamine. Other neurotransmitters like serotonin, glutamate etc also show abnormalities. But what causes these abnormalities is not yet conclusively known.

Causes include biological, psychological and social factors. Biological factors include genetic, neurotransmitter abnormalities (mentioned earlier ) etc. What is inherited is not the disease, but a propensity to develop the disease. If genetics is the gun, several environmental factors act as the triggers. Family, twin and adoption studies have shown that risk to develop the disease increases as one is more close (genetically) to a patient. The risk in general population is 1%; this increases to 10 - 15% if one's parent or sibling has schizophrenia. If both parents have the disease, one's risk increases to 30 - 35 %. If one has an identical twin with the illness, the concordance is 40 to 45%. Apart from genetics, other biological risk factors include winter birth, difficult birth etc. It is well known that viral infections increase during winter. The higher prevalence among winter born suggests that a hitherto unidentified virus may be responsible. Delayed or prolonged labor can cause cause subtle brain damage which increases the risk in later life. These theories await further confirmation.

Psychological factors include certain personality dispositions which result in poor interpersonal and social relationships.Social disadvantages like living in poor or underprivileged social settings can increase the risk.

Treatment of schizophrenia include anti psychotic drugs, education of the patient and family regarding how to manage the patient at home and tasks to increase the patient's cognitive skills. It is very important that relatives do not criticise the patient for his oddities. They have to deal with him with empathy and understanding. Neither should they ignore him and leave him to perish in his unreal world. Vocational training and rehabilitation assumes more importance later when the positive symptoms are under control.