Have you ever seen a "mad" person before? I am sure you have. An average layman would think the "mad person" is spiritually possessed. It is very common in our society to disassociate ourselves with these people to avoid stigmatization.

According to world mental health report in 2001, about 24million people worldwide suffer from schizophrenia. Schizophrenia cut across race, socio-cultural background and national boundaries.

Schizophrenia is a mental disorder characterized by abnormal social behavior and failure to understand reality.[2] Common symptoms include false beliefs, unclear or confused thinking, hearing voices that others do not, reduced social engagement and emotional expression, and a lack of motivation.[2][3] People with schizophrenia often have additional mental health problems such as anxiety, depressive, or substance-use disorders.[11] Symptoms typically come on gradually, begin in young adulthood, and last a long time.[3][5]wikipedia

To understand what schizophrenia is, it is important to understand the clinical features of a schizophrenic.
schizophrenia

CLINICAL FEATURES

It is characterized by disturbances in thoughts and verbal behavior, perception, affect, motor behavior and relationship to the external world. The diagnosis is mainly clinical, and it is based on the following clinical features eg autistic thinking, loosening of association, thoughts blocking, neologism, delusions e.t.c

Schizophrenia has been argued to be the worst disease affecting mankind.

The name schizophrenia (meaning mental splitting) was coined by Eugene Blueler (1809-1939) in 1911 because his patient had a condition characterized by a characteristic change in their perception, emotion, and cognition.
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He was the one that recognized that schizophrenia consisted of a group of disorders rather than being a single entity. He first used the term “a group of schizophrenia” . He also described the 4 As of schizophrenia.

Associational disturbances – loosening of associations( a pattern of spontaneous pattern of speech in which the person doesn't make sense, thought disorders eg thoughts blocking).
Affectative disturbances (eg flattened /blunted affect).
Autism- withdrawal into self.
Ambivalence (apathy or indifference)- marked inability to make a decision.

FIRST RANK SYMPTOMS OF SCHIZOPHRENIA.(Schneider first rank symptoms).

HALLUCINATION

Audible thoughts- voices speaking thoughts aloud.
Voices heard arguing.-two or more voices discussing the subject in the third person.

voices

Voices commenting on one's action.

THOUGHTS ALIENATION PHENOMENA.

Thought withdrawal: thoughts cease and subject experiences them as removed by an external force.
Thoughts insertion: subject experiences thoughts imposed by some external force on his passive mind.
Thought diffusion or broadcasting: subject experiences that his thoughts are escaping the confines of his self and are being experienced by others around.

PASSIVITY PHENOMENA.

Made feelings or affect.
Made impulse ( subject experiences feelings or impulses as if its imposed by some external force.
Made volition or acts- the subject experiences his own acts as being under the control of some external force(the subject feels like a robot).

DELUSIONAL PERCEPTION.

Delusional perception-normal perception has a private and illogical meaning.

The cause of schizophrenia is currently unknown, however, there are some theories that have been propounded.

1. GENETIC HYPOTHESIS.

A study carried out in certain families reveal a genetic basis for schizophrenia. About 8-10% of first degree relatives, about 3% of second-degree relatives and 2 % of third-degree relatives can come down with schizophrenia.If one's parent has schizophrenia, the chances of the child developing schizophrenia are about 10%. However, if both parents have schizophrenia, the chances of a child developing schizophrenia is about 45%. Therefore, genetic factors are very important in making an individual vulnerable to schizophrenia.

2. BIOCHEMICAL THEORIES

Dopamine hypothesis –Schizophrenia is presently thought to be probably due to functional increase in dopamine at the postsynaptic receptor, Research shows that schizophrenics have a high level of dopamine and there is also increased levels of serotonin, GABA, and acetylcholine.

3. NEUROPATHOLOGY

structural brain pathology has been seen in schizophrenias with CTS AND MRI. Post moterm studies reveal enlarged ventricles(not amounting to hydrocephalus) and reduction in brain volume (cortical atrophy) in people who died of schizophrenia.

4.PSYCHOLOGICAL THEORIES

STRESS- Increased number of stressful life events before the onset or relapse has a triggering effect on the onset of schizophrenia( stress-vulnerability hypothesis)
Family theories-postulations like “lack of real parents” dependency on mother, anxious mothers, communication deviance etc.
Psychoanalytical theories-regression in the stages of psychosexual deveoplment., premature termination of ego developments resulting in ego disintegration

5.SOCIO-CULTURAL THEORIES

Schizophrenia was found to be common in lower socioeconomic status in some studies.

6. PSYCHOSOCIAL FACTORS.

This has to do with dysfunctional families. This could lead to dysfunctional communication in the family. There are marital skews and schisms. This hypothesis was not too strong because it is shown that good families have the problem of schizophrenia.

OTHERS

NEURODEVELOPMENTAL

problems in utero.

The following pieces of evidence support the neurodevelopmental theory.

STRUCTURAL BRAIN CHANGES on or before the onset of the illness.
COMMUNITY OR SOCIAL DECLINE in childhood.
NEUROPATHOLOGICAL CHANGES IN THE BRAIN- without gliosis, the changes occur in the first trimester so scarring gliosis is not seen.

CLASSIFICATION OF SCHIZOPHRENIA.

PARANOID

These have more of the positive reactions like hallucination and delusions. They occur late in life and have a good prognosis. Delusions and hallucinations affect several body systems.

HEBEPHRENIC

It has a poor prognosis.
there is significant decline in self-care,
they hoard rubbish and feces,
they have factous laughter (laugh when not necessary)
their behavior is described as silly.

UNDIFFERENTIATED

Diagnosis of this is made when there are not enough skisms for the other types.
Early onset (19-20yrs)
Nothing peculiar, but just deterioration in cognitive functioning
There are no delusions and hallucinations

POST-SCHIZOPHRENIA DEPRESSION.

Depression could arise from the development of insight.(they understand that they are ill and project the future.
Depression could also result from drugs.

CATATONIC SCHIZOPHRENIA

It presents with florid movement disorders. Mutism is very common with them. They assume awkward positions (WAXY FLEXIBILITY), eg they can assume one position for hours.

They also have fluctuating behaviors from excitement to stupor

WHY SHOULD TAKE NOTE OF SCHIZOPHRENIA

People with schizophrenia may not make sense when they talk. They may sit for hours without moving or talking or may seem like they are talking to themselves.

Families and society are affected by schizophrenia too. Many people with schizophrenia have difficulty holding a job or taking care of themselves, so they rely on others for help.

Schizophrenia affects both men and women similarly, although some research points to an earlier onset of symptoms in men. Schizophrenia is found at similar rates in all ethnic groups around the world. Symptoms such as hallucinations and delusions usually start between ages 16 and 30. It is not common for schizophrenia to be diagnosed in a person younger than 12 or older than 40.

Schizophrenia rarely occurs in children, but awareness of childhood-onset schizophrenia is increasing. Additionally, it can be difficult to diagnose schizophrenia in teens. This is because the first signs of the illness can include a change of friends, a drop in grades, sleep problems, and irritability—common behaviors among teens. A combination of factors can predict schizophrenia in up to 80 percent of youth who are at high risk of developing the illness. These factors include isolating oneself and withdrawing from others, an increase in unusual thoughts and suspicions, and a family history of psychosis. In young people who develop the disease, this stage of the disorder when symptoms are vague and easy to miss is called the prodromal period.

People with schizophrenia may display hostility or aggression. It should be noted, however, that the vast majority of people with schizophrenia are not aggressive and pose much more danger to themselves than to anyone else.

Schizophrenia is typically a chronic condition and people with this diagnosis cope with symptoms throughout life. However, many people with schizophrenia can lead rewarding and meaningful lives in their communities. Researchers are developing more effective medications and using new research tools to understand the causes of schizophrenia. In the years to come, this work may help prevent and better treat the illness.reference

People with schizophrenia are often discharged from the hospital into the care of their family, so it is important that family members understand the difficulties associated with the illness. With the help of a therapist, they can learn ways to minimize the person's chance of relapse by having an arsenal of coping strategies and problem-solving skills to support their ill relative. In this way, the family can help make sure their loved one sticks with treatment and stays on his or her medication. Additionally, families should learn where to find outpatient and family services. refrence

family

Imagine you had a family member with schizophrenia. How would you take him/her?

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