Schizophrenia

Schizophrenia is a common and heterogeneous disorder that currently has no known cure. There is often a combination of positive symptoms, which are the production of abnormal actions and thoughts, and negative symptoms, which are the absence of usual occurring interests, thoughts, gestures, and actions. According to the DSM-IV, six major criteria must be present to establish the diagnosis, including the provision that symptoms must be present for at least 6 months. The prevalence of schizophrenia in the general population has been fairly constant at -0.5 %.

Schizophrenia has five subtypes-paranoid, disorganized, catatonic, undifferentiated, and residual-that are defined by the prominent symptomatology and signs at the time of evaluation. Prodromal symptoms of depression, perplexity, and fear are often present before onset. As the diagnosis is partially dependent on a time course of symptoms, it is not unusual (>70%) to fail to achieve a definitive diagnosis on initial presentation.

To establish the diagnosis, the patient must fit six DSM-IV diagnostic criteria. (DSM criteria are noted below in italics, A-F.)

Causes

Researchers haven't identified the cause or causes of schizophrenia, although they believe genetic factors play a role. About 1 percent of the general population develops schizophrenia compared with 10 percent of those with a close family relative who has the disease. Chemical or subtle structural abnormalities in the brain may contribute to causing this illness.

Symptoms

Characteristic, or type A, symptoms define the illness. Two or more of the following need be present for 1 month (or less if treated):

• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behavior
• Negative symptoms: (e.g., anhedonia, avolition)

One or more major areas of functioning including work, relationships, or self-care are significantly diminished (B), with continuity for at least 6 months of this worsening (C).

Other mood or schizoaffective disorders are not concurrently diagnosed (D), and a substance abuse or medical condition is not the direct cause (E).

If the patient has an underlying developmental disorder, there must be a development of prominent hallucinations or delusions (F).

Signs

• Positive signs: disorganized speech, disorganized or catatonic behavior, excessive motor activity that is apparently purposeless, echolalia or echopraxia
• Negative signs: flat affect, motor immobility, mutism, and maintenance of a rigid posture

Treatment

• Antipsychotic or neuroleptic medications work by changing the balances of chemicals in the brain and are used to control the symptoms of the illness. These medications are effective, but are also associated with side effects that may discourage a patient from taking them regularly.
• Treatment includes counselling, social support and rehabilitation.
• Medication, hospitalisation, and rehabilitation are the best forms of treatment. Hospitalisation is only necessary during crises; normal living can resume once symptoms subside.
• Relatives and friends can also assist in rebuilding the person's social skills. Such support is very important.