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.

Classification made easy

Mental disorders are traditionally classified into Neuroses and Psychoses. Psychoses are disorders with severe level of disturbance in the person's mental functions. These disorders are less frequent in the population. Neurotic disorders are more common and have less sever disturbance in the ability to live and function in the society.
Psychotic disorders include Schizophrenia, Bipolar disorder, Major depression, Schizo affective disorder and Delusional disorder. They are characterized by the presence of severe disturbance in thinking, feeling, perception, behavior and personality. These patients are unable to function and live in the society without proper support and treatment. They need long term treatment with medication along with other psychosocial therapies.
Neurotic disorders are characterized by more common symptoms like worries, fears and anxieties, sadness worries etc. Persons affected with these disorders can function fairly well, though suffering internally.

Psychiatry for Public: Dimensions of Health

Psychiatry for Public: Dimensions of Health

Certain terms...

Disease : A disease may be defined as an entity with a cluster of characteristic signs / symptoms (clinical picture), having a well defined course and response to treatment, associated with characteristic pathological changes in an organ or organ system of the body. Usually it has identifiable cause and risk factors.

Disorder : This is a group of signs / symptoms occurring together (this is called a syndrome in medical parlance) presumed to be resulting from a particular pathological process. The relationship of this process to the clinical picture is not proved beyond doubt as in the case of disease.

Illness: It is a person's subjective feeling / perception or impression that he is unwell. This may or may not be the result of underlying pathological processes.

Sick role: is the role assigned by the society to a person who is ill. S/He is expected to seek treatment and follow advice of the healing professional. He is also exempted from his usual obligations like work, caring for family etc.

Illness behavior is the behavior exhibited by a person who thinks he is ill. He abstains from work and other responsibilities.