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Reviewed by Dr Roger Henderson, GP
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What is schizophrenia?
It is a complex condition that defies simple description, but a distinction can be made between two broad types: acute schizophrenia and chronic schizophrenia. Acute schizophrenia This is the form that probably most comes to mind when people think of schizophrenia. Acute schizophrenia is when a previously healthy person, generally a young adult, shows increasingly odd behaviour over a fairly short period of time of perhaps a few weeks. It can take the form of hallucinations, irrational beliefs or disordered thoughts, ie illogical or incoherent thinking of any degree of severity.
Emotional responses are often inappropriate for their surroundings - for example, laughing at sad news or appearing unconcerned by important events. Generally, a schizophrenic knows where they are in time and place, but the presence of disordered thoughts may make them feel confused. Higher mental reasoning is usually impaired and they often lack insight into their condition. They find it difficult to plan things or organise themselves.
Usually a person suffering from schizophrenia will not know they are experiencing symptoms of the illness. By definition, hallucinations and delusions are experienced as real by the person having them. As a result, the person with schizophrenia may have different perceptions of the world compared with the rest of us. Often the person may feel persecuted or 'got at' in some way, which can cause fear and anxiety. Other people may notice a change in the person's behaviour, or in the content of their speech.
They may express paranoid ideas or respond to the hallucinations they experience. These hallucinations usually take the form of hearing voices that other people cannot hear. This is the longer-term state and is characterised by:
As with the acute state, hallucinations and delusions are common. Sometimes in chronic schizophrenia the person appears to become used to these disordered thoughts. For example, they might harbour the idea that someone is trying to get at them, but this does not cause any emotional reaction.
Worldwide schizophrenia is present in two to four people per 1000 of the population at any one time. One in 100 people will develop schizophrenia in their lifetime. How does schizophrenia develop? The cause of schizophrenia is unknown, but it may have a genetic component. There is no ‘gene for schizophrenia’ but a family history of the illness increases the risk of being affected:
Factors that may trigger an episode of schizophrenia include stressful life events, and the use of illegal drugs such as cannabis. What can schizophrenics and their families do to help themselves? If you think you are experiencing symptoms of schizophrenia, you should seek help from your doctor. However, one of the features of the disease is sufferers do not understand they are unwell during acute episodes of illness. It is therefore important that family and friends are able to seek help on their behalf. The first point of call should be the person's family doctor or mental health team worker. Schizophrenics who are on long-term medication should continue to take this medication, because it has a protective effect against future relapses. How does the doctor make a diagnosis? The diagnosis is based on an assessment of the history given by the patient and by any other people who are able to give further information. What is the course of the disease?
The risk of relapse is significantly improved by continuing appropriate medication for at least six months after an acute episode. Positive family intervention may also help to maintain periods without illness, as can help with social skills training and psychological therapy. People with schizophrenia have higher rates of depression than the general population. There are also high rates of suicide among people with schizophrenia. What medicines can treat schizophrenia?
They are effective against the positive symptoms of schizophrenia, eg hallucinations, but have little impact on the negative symptoms, such as lack of motivation and flat mood. Antipsychotic medicines have important short-term and long-term side-effects. Side-effects can include:
If these side-effects occur, your doctor may change your dose or prescribe other medicines to help with the side-effects, or another antipsychotic medicine can be tried that may cause less problems. A long-term movement problem known as tardive dyskinesia occurs in some patients who are on treatment for a prolonged period. Because there is a high risk that schizophrenia symptoms will recur, treatment should continue for at least one to two years. If taking medication is a problem then a GP or specialist can prescribe injectable antipsychotic treatment usually given monthly and many patients find this very useful. Is therapy helpful? Research shows interventions with the families of schizophrenics can reduce relapse rates. These family interventions usually last several weeks and consist of education about the illness and help with problem solving. Research also suggests a type of psychological therapy known as cognitive behavioural therapy may help to reduce relapse rates. Further studies are required in this area. There is limited evidence that giving people with schizophrenia help and training in social skills may help prevent relapses. |
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References Lawrie SM. Schizophrenia. Clinical Evidence Issue 9. August 2003. Drug treatments for schizophrenia. Effective Healthcare Bulletin, December 1999 Oxford Textbook of Psychiatry, 2001. |
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| Based on a text by Dr John Theilmann Larsen and Henrik Lublin, specialist |
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| Last updated 05.06.2009 |
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