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This is a major psychiatric disorder where the patient experiences a multitude of strange symptoms such as loss of contact with reality, false beliefs, false perceptions of sounds and images, abnormal thinking, reduced motivation and flattened affect. As a result these patients, when untreated live in their own world, find it extremely difficult to communicate and to trust people around them, which makes it awkward for loved ones, friends and strangers to understand them. This leads then to social isolation, work disturbances and often marital conflicts and divorces. Secondary depression often sets in and frequently leads to suicide. ADVERTISEMENT Adoption and twin studies have shown that the major factor is the genetic component, but there is a significant environmental component, which is also effective. What are the causes for schizophrenia ? The exact cause is not known, but there is a biological basis. The popular model at present is a vulnerability model, where there is an underlying minimal neurological vulnerability. On top of this come environmental stressors such as a broken marriage, leaving home to go to the army, moving to another town to find work, the loss of a loved one etc. , which then causes the brain metabolism to derail. Often the disease itself can feed into this negative cycle by causing loss of work or relationships and leading to homelessness and poverty. This will then tend to make schizophrenia chronic and very difficult to treat. Among schizophrenics brain studies over the years have consistently shown some structural changes such as an enlarged ventricular system(= the fluid filled chambers in the center of the brain). Certain parts of the brain such as the hippocampus and the temporal lobes are smaller, but the basal ganglia are enlarged. This can be detected with imaging studies. The cerebral cortex in patients with schizophrenia tends to be small in size. With the help of the PET scanner, where brain function can be visualized such as glucose utilization, abnormalities in the prefrontal cortex can be shown in schizophrenics, but not in normal controls. ADVERTISEMENT Another patient may have auditory hallucinations (hearing voices that are not really there), where everything that is happening is commented on. In this patient a soft voice that she trusts may tell her: " You know , you have taken these pills long enough. Don't you think you should give your system a break?" The patient often is aware that these voices are not really there, but they are incorporated into judgments, decisions and actions. So, this patient did stop the pills and within 2 days she ended up in hospital with a florid psychosis and flare-up of her schizophrenia, which lead to a 4-week psychiatric hospitalization and a follow-up program, where the psychiatric nurse at the outpatient psychiatric clinic gives her an injection with a long-acting antipsychotic medication every three weeks. Hallucinations can happen in all the senses: the auditory ones are the most common, but visual hallucinations are also fairly frequent, less frequent are hallucinations that affect smell, taste or tactile sensations. What the patients are not aware of is that all of these sensations are generated within their own brains.
Bizarre delusions are another symptom complex. This is best told in a story:
Other symptoms of schizophrenia are disorganized thinking and speech. The person interacting with the patient will notice that the topic is frequently switched, before the thought has been expressed completely. It comes across as "incoherent", or as "jumping from one topic to another". The most severe form would be "word salad", where the listener cannot make out any meaning. Grossly disorganized behavior is another important symptom complex: The patient may be grossly underdressed on a cold winter day or dressed in several layers of clothing on a hot summer day. Unacceptable behavior is also common: The patient may masturbate in a street car. Another patient may shout in anger at a person that passes him on the street, even though the person has no connections to the patient. There may not be any explanation for his behavior or the patient may later explain to the psychiatrist that he thought that this woman was a former teacher of his who gave him corporal punishment for several years and he thinks that this caused his mental illness. If the psychiatrist were to do research of the school records, there probably was never such a teacher or such corporal punishment. However, for the patient all of these thoughts, beliefs and behaviors "are very real and make sense". So far all of the above mentioned symptoms are called "positive symptoms" as they positively identify schizophrenia. There is a smaller number of "negative symptoms", so called, because something is lost from "normal" in the case of schizophrenia. There are three broad categories of negative symptoms: affective flattening, alogia(=poverty of speech) and avolition(=lack of decision). Affective flattening The schizophrenic patient finds it difficult to express emotions and this is apparent during a conversation. The face stays unresponsive, does not express emotion, there is poor eye contact and reduced body language. Alogia The speech is poor, there are expressive problems with only brief, empty replies. The decreased fluency and productivity of speech seems to reflect the thought inhibition that is going on inside. As normal people can also go through similar phases, this needs to be observed over a period of time and by interviewing relatives and friends that have close contact with the patient. Avolition The schizophrenic patient finds it difficult to initiate a project, plan it and see it through to completion. This is a common occurrence in a person's life. But for the schizophrenic this becomes an insurmountable task. The lack of will and the inability to make a decision is what is meant with "avolition". Because of this symptom of schizophrenia the patients may sit there for a long period of time and may refuse to start new projects, even though on another occasions they had indicated that this is what they wanted to do. For the same reason the y appear to not want to participate at work or in social situations. According to Ref.2 the patient must have at least two of the 5 major categories of symptoms for 1 month or more to be called"schizophrenia" and the symptoms must persists for at least 6 months (or at least 1 month, if treated successfully). There are a number of subtypes of schizophrenia (see Ref.2), which you can link to through the right column of this table:
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