SCHIZOPHRENIA

The word schizophrenia comes from the Greek word skhizein meaning "to split" and
the Greek word Phrenos (phren) meaning "diaphragm, heart, mind". In 1910, the Swiss
psychiatrist, Eugen Bleuler (1857-1939) coined the term Schizophrenie in a lecture in
Berlin on April 24th, 1908.
Schizophrenia is a mental disorder that generally appears in late adolescence or early
adulthood - however, it can emerge at any time in life. It is one of many brain diseases
that may include delusions, loss of personality (flat affect), confusion, agitation, social
withdrawal, psychosis, and bizarre behaviour.

What is schizophrenia?
Individuals with schizophrenia may hear voices that are not there. Some
may be convinced that others are reading their minds, controlling how they
think, or plotting against them. This can distress patients severely and
persistently, making them withdrawn and frantic.
Others may find it hard to make sense of what a person with schizophrenia is
talking about. In some cases, the individual may spend hours completely still,
without talking. On other occasions he or she may seem fine, until they start
explaining what they are truly thinking.

The effects of schizophrenia reach far beyond the patient - schizophrenia

does not only affect the person with the disorder. Families, friends and society
are affected too. A sizable proportion of people with schizophrenia

have to rely on others, because they are unable to hold a job or care for
themselves.
Schizophrenia most commonly strikes between the ages of 15 to 25 among
men, and about 25 to 35 in women. In many cases the disorder develops so
slowly that the sufferer does not know he/she has it for a long time. While,
with other people it can strike suddenly and develop fast.
Schizophrenia, possibly many illnesses combined - it is a complex,
chronic, severe, and disabling brain disorder and affects approximately 1% of
all adults globally. Experts say schizophrenia is probably many illnesses
masquerading as one. Research indicates that schizophrenia is likely to be
the result of faulty neuronal development in the brain of the fetus, which later
in life emerges as a full-blown illness.

Symptoms of schizophrenia
There is, to date, no physical or laboratory test that can absolutely diagnose
schizophrenia. The doctor, a psychiatrist, will make a diagnosis based on the
patient's clinical symptoms. However, physical testing can rule out some
other disorders and conditions which sometimes have similar symptoms,
such as seizure disorders, thyroid dysfunction, brain tumor, drug use, and
metabolic disorders.
Symptoms and signs of schizophrenia will vary, depending on the individual.
The symptoms are classified into four categories:

Positive symptoms - also known as psychotic symptoms. These

are symptoms that appear, which people without schizophrenia do not have.
For example, delusion.

Negative symptoms - these refer to elements that are taken away

from the individual; loss or absence of normal traits or abilities that people
without schizophrenia normally have. For example, blunted emotion.

Cognitive symptoms - these are symptoms within the person's

thought processes. They may be positive or negative symptoms, for
example, poor concentration is a negative symptom.

Emotional symptoms - these are symptoms within the person's

feelings. They are usually negative symptoms, such as blunted emotions.

Major symptoms:

Delusions - The patient has false beliefs of persecution, guilt of

grandeur. He/she may feel things are being controlled from outside. It is not
uncommon for people with schizophrenia to describe plots against them.
They may think they have extraordinary powers and gifts. Some patients
with schizophrenia may hide in order to protect themselves from an
imagined persecution.

Hallucinations - hearing voices is much more common than

seeing, feeling, tasting, or smelling things which are not there, but seem very
real to the patient.

Thought disorder - the person may jump from one subject to

another for no logical reason. The speaker may be hard to follow. The patient's
speech might be muddled and incoherent. In some cases the patient may
believe that somebody is messing with his/her mind.

Other symptoms schizophrenia patients may experience include:

Lack of motivation - the patient loses his/her drive. Everyday

automatic actions, such as washing and cooking are abandoned. It is

important that those close to the patient understand that this loss of drive is
due to the illness, and has nothing to do with slothfulness.

Poor expression of emotions - responses to happy or sad

occasions may be lacking, or inappropriate.

Social withdrawal - when a patient with schizophrenia withdraws socially it

is often because he/she believes somebody is going to harm them. Other
reasons could be a fear of interacting with other humans because of poor
social skills.
Unaware of illness - as the hallucinations and delusions seem
so real for the patients, many of them may not believe they are ill. They may
refuse to take medications which could help them enormously for fear of sideeffects, for example.

Cognitive difficulties - the patient's ability to concentrate,

remember things, plan ahead, and to organize himself/herself are affected.
Communication becomes more difficult.

What causes schizophrenia?

Nobody has been able to pinpoint one single cause. Experts believe several
factors are generally involved in contributing to the onset of schizophrenia.
Evidence does suggest that genetic and environmental factors generally act
together to bring about schizophrenia.

Factors that are thought to contribute towards the onset of

schizophrenia:

Your genes
If there is no history of schizophrenia in your family your chances of
developing it are less than 1%. However, that risk rises to 10% if one of your
parents was/is a sufferer.
A gene that is probably the most studied "schizophrenia gene" plays a
surprising role in the brain: It controls the birth of new neurons in addition to

their integration into existing brain circuitry.

A Swedish study found that schizophrenia and bipolar disorder have the
same genetic causes.
Chemical imbalance in the brain
Experts believe that an imbalance of dopamine, a neurotransmitter, is
involved in the onset of schizophrenia. They also believe that this imbalance
is most likely caused by your genes making you susceptible to the illness.
Some researchers say other the levels of other neurotransmitters, such
as serotonin, may also be involved.
Changes in key brain functions, such as perception, emotion and behaviour
lead experts to conclude that the brain is the biological site of schizophrenia.

Family relationships
Although there is no evidence to prove or even indicate that family
relationships might cause schizophrenia, some patients with the illness
believe family tension may trigger relapses.

Environment
Although there is yet no definite proof, many suspect that prenatal or prenatal
trauma, and viral infections may contribute to the development of the
disease. Prenatal means "occurring about 5 months before and up to one
month after birth".
Stressful experiences often precede the emergence of schizophrenia. Before
any acute symptoms are apparent, people with schizophrenia habitually
become bad-tempered, anxious, and unfocussed. This can trigger
relationship problems, divorce and unemployment. These factors are often
blamed for the onset of the disease, when really it was the other way round the disease caused the crisis. Therefore, it is extremely difficult to know
whether schizophrenia caused certain stresses or occurred as a result of
them.

Some drugs
Cannabis and LSD are known to cause schizophrenia relapses. According to
the State Government of Victoria6 in Australia, for people with a predisposition
to a psychotic illness such as schizophrenia, usage of cannabis may trigger the
first episode in what can be a disabling condition that lasts for the rest of their
lives.

Schizophrenia tests and diagnosis

A schizophrenia diagnosis is carried out by observing the actions of the
patient. If the doctor suspects possible schizophrenia, they will need to
know about the patient's medical and psychiatric history.
Certain tests will be ordered to rule out other illnesses and conditions
that may trigger schizophrenia-like symptoms. Examples of some of the
tests may include:

Blood tests - to determine CBC (complete blood count) as well as

some other blood tests.

Imaging studies - to rule out tumours, problems in the structure of

the brain, and other conditions/illnesses

Psychological evaluation - a specialist will assess the patient's

mental state by asking about thoughts, moods, hallucinations,
suicidal traits, violent tendencies or potential for violence, as well as
observing their demeanour and appearance.

Schizophrenia - Diagnostic Criteria

Patients must meet the criteria laid down in the DSM (Diagnostic and
Statistical Manual of Mental Disorders). It is an American Psychiatric
Association manual that is used by health care professionals to
diagnose mental illnesses and conditions.
The health care professional needs to exclude other possible mental
health disorders, such as bipolar disorder or schizoaffective disorder.

It is also important to establish that the signs and symptoms have not
been caused by, for example, a prescribed medication, a medical
condition, or substance abuse.
Also, the patient must:

Have at least two of the following typical symptoms of

schizophrenia - Delusions
- Disorganized or catatonic behaviour
- Disorganized speech
- Hallucinations
- Negative symptoms that are present for much of the time during the
last four weeks.

Experience considerable impairment in the ability to attend school,

carry out their work duties, or carry out every day tasks
Have symptoms which persist for six months or more

Sometimes, the person with schizophrenia may find their symptoms

frightening, and conceal them from others. If there is severe paranoia,
they may be suspicious of family or friends who try to help. There are
many elements in disease that make it difficult to confirm a
schizophrenia diagnosis.