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Schizophrenia – Article series: “How to treat the soul?” Part 19!

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During a visit to a psychiatrist, one of the questions that, as if by the way, you have to hear from the patient in a uncertain and worried voice is – “Doctor, but I don’t have schizophrenia?!”
There are still myths, stereotypes and fears about this disease, although a much wider range of information is now available. The vivid portrayal of patients in films and stories leaves an indelible impression.

What is schizophrenia ?

Although science has developed rapidly, the reasons for the development of schizophrenia have not yet been fully clarified. It is known to affect up to 1 in 100 people. The development of schizophrenia is more often observed among men than among women. The reasons for its development are a set of different circumstances, which, moreover, will be different for different people. Among the risk factors should be mentioned – mental disorders among relatives, brain damage during pregnancy or infancy, marijuana smoking (especially from adolescence and frequent use), long-term stress.
Usually, this disease develops between the ages of 16 and 30, and is manifested by a psychotic episode. It should be mentioned here that a psychotic episode is often not the first manifestation of the disease. When questioning the patient and relatives, it often turns out that even several years before this event, “something changed” – the person became more withdrawn, friends, hobbies, interests gradually disappeared, sometimes they mention that it became uninteresting or difficult to study, for various reasons they changed various workplaces where something did not satisfy until they stopped working altogether; in other cases, patients radically change their lifestyle, diet, suddenly turn strongly to religion.
Schizophrenia is not a fixed set of symptoms, its manifestations are individual for each patient. How then can you arrive at this diagnosis?
First of all, despite the individual course of the disorder, all symptoms of schizophrenia can be divided into positive and negative :
Positive symptoms – nightmares (beliefs, often of an impossible, fantastic nature, which cannot be corrected by facts that prove the contrary), the feeling that the thoughts and/or body are being controlled, controlled from outside, hallucinations, movement disorders (strange, uncharacteristic movements, freezing) and disorganized speech and/or behavior;
Negative symptoms , for example, decrease or loss of emotions and motivation, interest in life in general. It is difficult or even impossible to force yourself to do something, it is difficult to concentrate, to think; indifference to external appearance, hygiene; isolation from others, even family members.
In order to determine this illness, the psychiatrist must carefully question the patient and his relatives, rule out that psychosis is caused by the action of narcotic substances, other brain damage, metabolic disorders (endocrinological diseases, disorders of metabolic organs), the action of some medication.
After excluding other causes, the diagnosis is based on the diagnostic criteria of schizophrenia:

At least one of the following symptoms that has been present for more than a month:

  • echoes of thoughts, subtraction of thoughts, putting thoughts into the head, transmission of thoughts;
  • exposure nightmares – exposure to thoughts, movements, feelings, nightmarish perception of surroundings;
  • hallucinatory voices commenting on the patient’s behavior or discussing the patient among themselves; pseudo-hallucinatory voices that the patient hears in some part of the body;
  • long-lasting nightmare ideas that do not correspond to cultural norms, with unusual and completely impossible content, for example, about superhuman abilities to influence and change the course of humanity and nature.

At least two ("minor") symptoms that persist for more than a month:

  • long-term hallucinations of any kind, which the patient has for more than a month; voices accompany corresponding, often unformed, nightmare ideas without affective saturation;
  • formal thinking disorders – incoherent, jerky thinking, neologisms, which are observed as jerky or incomprehensible speech;
  • catatonic agitation or stupor, waxy pliability, mutism and negativity;
  • primary negative symptoms – apathy, poor speech, autism, pallor or inadequacy of emotions, as well as social isolation,
    • decreased activity of the will, ambivalence; these disorders are not a consequence of antipsychotic therapy or depression;
  • behavioral disorders, passivity, inactivity, loss of interest and motivation.
The course of schizophrenia is diverse – it can be continuous or with remissions, but in any case it should be understood that this is a chronic disease and that means that promises to “cure” it are rather a marketing trick. But that doesn’t necessarily mean it shouldn’t be treated. Stabilization of the condition can be achieved as a result of targeted and continuous drug therapy.

How to help?

The first encounter with the diagnosis of schizophrenia often worries and scares relatives even more than the patient. Patients often worry that others will find out about their diagnosis, but here it must be understood that the patient is the one who determines who can get information about his health condition (except when it is officially requested by law enforcement bodies in accordance with the law). One has to hear the question from relatives – “how should I talk to him?”, “how should I behave?” We advise the patient’s relatives to ask and try to explain the symptoms of the disease, the progress, how we arrived at this diagnosis, how the treatment is going, what are the options.
Schizophrenia treatment is complex – it means that different specialists are involved in the process and different methods are used – medications, psychological help, physiotherapy, occupational therapy, art therapy.
During exacerbations, more emphasis is placed on drug therapy. Medicines called neuroleptics are mainly prescribed in therapy. Their action is aimed at treating perceptual disturbances (hallucinations), thought disorders (eg, nightmares, disorganized thinking), but due to their sedative properties, they are also often used to reduce anxiety, restlessness and sleep disorders. In the treatment of schizophrenia, mood-stabilizing drugs and, less often, antidepressants are also used.
Non-drug therapy (psychologist, occupational therapist, physiotherapist, etc.) helps to understand the nature of one’s illness, to recognize changes in the condition and the need for treatment, to improve coexistence, for patients with a longer course of the disease – promotes the return to everyday life, helps to reduce the manifestations of negative symptoms – to improve the ability to concentrate, to promote involvement in productive activities activities, communication with others.
An exacerbation does not always mean hospitalization. There are quite a lot of patients who, both during exacerbations and remissions, continue to receive outpatient treatment from their psychiatrist. However, each case must be evaluated separately, because no two people are the same, which also depends on how long the aforementioned symptoms have existed and how severe they are. It depends on what and where – outpatient or inpatient – the treatment will be sought and carried out, and whether the patient will be able to resume his work.
Today, new generation neuroleptics are available, which are significantly different from the old generation drugs that eliminate negative symptoms, which have a much smaller effect on cognitive functions. If they are applied already in the early phases of the disease, there is a high chance of a stable remission against the background of medication.
Authors of the article: doctor psychiatrist Juta Jaudzema psychiatrist Pēteris Zālīt is

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