"Roses are red, violets are blue, I'm schizophrenic, and so am I." Oscar Levant

What is it

Schizophrenia is a chronic, severe, and disabling brain disorder that has been recognized throughout recorded history. It has been called the worst disorder known to man. It effects 1% of human population irrespective of country or region. It seems to be commoner amongst the poor and those living in inner city areas. It usually starts in early twenties. It does not start in childhood and its rare for it to start after 45. Schizophrenia is equally common amongst men and women.

What are the symptoms

Psychiatrists like to divide the symptoms of Schizophrenia in three groups:

POSITIVE SYMPTOMS

Hallucinations. A hallucination is something a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel. "Voices" are the most common type of hallucination in schizophrenia. Many people with the disorder hear voices that may comment on their behavior, order them to do things, warn them of impending danger, or talk to each other (usually about the patient). They may hear these voices for a long time before family and friends notice that something is wrong. Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects (although this can also be a symptom of certain brain tumors), and feeling things like invisible fingers touching their bodies when no one is near.

Delusions. Delusions are false personal beliefs that are not part of the person's culture and do not change, even when other people present proof that the beliefs are not true or logical. People with schizophrenia can have delusions that are quite bizarre, such as believing that neighbors can control their behavior with magnetic waves, people on television are directing special messages to them, or radio stations are broadcasting their thoughts aloud to others.

Thought Disorder. People with schizophrenia often have unusual thought processes. One dramatic form is disorganized thinking, in which the person has difficulty organizing his or her thoughts or connecting them logically

NEGETIVE SYMPTOMS

These are less obvious than positive symptoms.

Loss of interest in life, energy, emotions.
It’s hard to feel excited or enthusiastic about anything.
Person may stop going out and mixing with others.
It can be difficult to wash or tidy up.

COGNITIVE SYMPTOMS

They include the following:

Poor "executive functioning" (the ability to absorb and interpret information and make decisions based on that information),inability to sustain attention, and problems with "working memory" (the ability to keep recently learned information in mind and use it right away)

What Causes it

It is not clear what causes people to get Schizophrenia. There are various theories but none is conclusive. We do know however that it can run in families and children of schizophrenic parents have a much higher (10 times if one parent is schizophrenic and 50 times if both parents are schizophrenics) chance of getting it. Latest research is uncovering various defects in the brains of schizophrenics which may help us to one day screen people.

How is it treated

Schizophrenia is an incurable illness. However mordern medicines can help control it and prevent relapse. The current medications are based on the dopaminergic theory of schizophrenia and try to block off the excess dopamine that these patients seem to have. These are called antipsychotic medication.

ANTIPSYCHOTICS

Classified into two types: Typical (Older) and Atypicals (Newer)

I will limit myself to the newer ones as these ore the ones that are used as a routine nowdays.

These are reputed to improve both positive and negative symptoms of schizophrenia and include drugs like Olanzapine, Risperidone, Amisulpiride, Quetiapine, Aripiprazole and Clozapine. Clozapine is the only drug liscenced for treatment resistant schizophrenia which means that patients who have symptoms despite having had two antipsychotics (one being an atypical) “for adequate length of time and in adequate doses” should be prescribed clozapine. With older antipsychotics the main side effects seen are movement disorders called EPSE in medical terms. These include Dystonia, Akathisia, Parkinsonism and Tardive Dyskinesia.
With atypicals the main side effects are sedation, weight gain and impaired glucose metabolism. This can lead to diabetes and other cardiovascular problems. Olanzapine and Clozapine are the worst offenders. The patients should get their waist, weight, blood suger and lipids checked regularly.
Side effects specific to clozapine are a lowering of infection fighting (white blood) cells and rerely myocarditis. It can also cause hypertension and excessive salivation. For this patients on Clozapine should have regular blood tests.
Recently there has been a warning against using olanzapne and risperidone in the elderly asthese have been noted to increase the incidence of a CVA.

Medication should be taken for an adequate length of time even after resolution of symptoms. Discuss it with your psychiatrist.

PSYCHOSOCIAL TREATMENT

Numerous studies have found that psychosocial treatments can help patients who are already stabilized on antipsychotic medications deal with certain aspects of schizophrenia, such as difficulty with communication, motivation, self-care, work, and establishing and maintaining relationships with others.
Illness Management Skills. People with schizophrenia can take an active role in managing their own illness. Once they learn basic facts about schizophrenia and the principles of schizophrenia treatment, they can make informed decisions about their care. If they are taught how to monitor the early warning signs of relapse and make a plan to respond to these signs, they can learn to prevent relapses. Patients can also be taught more effective coping skills to deal with persistent symptoms.
Integrated Treatment for Co-occurring Substance Abuse. Substance abuse is the most common co-occurring disorder in people with schizophrenia, but ordinary substance abuse treatment programs usually do not address this population's special needs. Integrating schizophrenia treatment programs and drug treatment programs produces better outcomes.
Rehabilitation. Rehabilitation emphasizes social and vocational training to help people with schizophrenia function more effectively in their communities. Because people with schizophrenia frequently become ill during the critical career-forming years of life (ages 18 to 35) and because the disease often interferes with normal cognitive functioning, most patients do not receive the training required for skilled work. Rehabilitation programs can include vocational counseling, job training, money management counseling, assistance in learning to use public transportation, and opportunities to practice social and workplace communication skills.
Family Education. Patients with schizophrenia are often discharged from the hospital into the care of their families, so it is important that family members know as much as possible about the disease to prevent relapses. Family members should be able to use different kinds of treatment adherence programs and have an arsenal of coping strategies and problem-solving skills to manage their ill relative effectively. Knowing where to find outpatient and family services that support people with schizophrenia and their caregivers is also valuable.
Cognitive Behavioural Therapy. Cognitive behavioral therapy is useful for patients with symptoms that persist even when they take medication. The cognitive therapist teaches people with schizophrenia how to test the reality of their thoughts and perceptions, how to "not listen" to their voices, and how to shake off the apathy that often immobilizes them. This treatment appears to be effective in reducing the severity of symptoms and decreasing the risk of relapse.