Schizophrenic people go through scary things
What are schizophrenias?
When people have schizophrenia, they may experience the environment differently than before and different from most of the people around them. You may hear, see, smell or feel things that other people do not notice. You may also have scary thoughts, or feel that people read their minds, control their thinking, or want to harm them.
The term schizophrenia is made up of the ancient Greek words schizo (= split) and phren (= mind or psyche), but does not mean “a split in the brain”, but rather a disruption of the integration of various psychological functions and perceptions. Schizophrenia is not a single disease entity, but a group of disorders with similar symptoms.
Different causes play a role in the development of the disease, but schizophrenia cannot be traced back to a single cause. As with other common chronic diseases such as diabetes, asthma or high blood pressure, it is assumed that several factors play a role in different development phases and lead to the disease that is only diagnosed later. There is therefore an interaction of genetic factors, early childhood risk factors and risk factors that occur during pregnancy with later environmental factors that occur during adolescence. This can e.g. B. early social exclusion experiences, growing up in big cities, early cannabis use or migration experiences.
Symptoms of Schizophrenia
Many symptoms of schizophrenia can be traced back to disorders of the transmission and processing of information in the brain. It is assumed that the finely synchronized communication between the nerve cells of the brain, which occurs via the release of chemical messenger substances, no longer functions optimally. A filter disorder is also often referred to, so that important and unimportant stimuli are no longer well separated and what are actually secondary perceptions can become excessively important.
Symptoms of schizophrenia are therefore often a combination of disorders of perception, thinking, behavior and emotional processing. Newly occurring changes in perception, behavior or thinking are classified according to the so-called positive symptoms (something new is experienced) and the so-called negative symptoms (a decrease or loss of previously existing functions).
Typical positive symptoms in schizophrenia are:
- Cognitive disorders or hallucinations describe sensory impressions that are not triggered by an external stimulus, but which those affected experience as real. For example, over half of those affected often experience acoustic hallucinations as voices. While hearing voices is the most common perception disorder, hallucinations can affect all five senses: hearing, sight, touch, taste, and smell.
- Delusional or substantive thought disorders: Thinking can seem incoherent and incomprehensible to others. Due to changed perceptions, those affected can also come to beliefs that they can no longer correct, even if other people attempt to convince them accordingly. Affected can z. B. be convinced that you are being manipulated, observed, influenced or listened to.
- Ego disorders encompass a changed experience of oneself. Those affected are then no longer able to distinguish themselves, and thus their own thoughts or actions, from their environment. Affected then mean z. E.g. that thoughts are given to them by others or that their behavior is controlled from outside.
The other group of negative symptoms, that are characterized by a loss of functions, as would be expected in social interactions, include, for example:
- Lack of motivation and initiative. Affected people often spend a lot of time at home or in bed without having any motivation to do anything. In doing so, the appearance and the need for self-care can decrease. In contrast to depression, those affected do not have any feelings of guilt, self-reproach or depressed mood. Disturbances in concentration, the ability to structure the day and the ability to act in a complex, planned manner can also be counted as negative symptoms.
- Depression. With schizophrenia, too, there is often a depressive syndrome associated with a loss of interest, depressed mood, self-reproach, hopelessness and social withdrawal.
- Affect disorders means that the feelings or expressions of feelings of those affected often do not match the experienced situation for outsiders. In the eyes of the others, they react with inappropriate, sometimes contradicting feelings or they are experienced by those around them as having poor feelings. A lack of emotional reaction and a so-called affective flattening with disturbances in the expression of the experienced emotionality, which other people often perceive as if the person concerned could neither be really happy nor sad.
Occurrence and frequency
Schizophrenias typically first appear in adolescence and / or early adulthood, but sometimes they appear for the first time in people over 40 years of age. Both men and women get about the same frequency, although the first symptoms in men tend to appear at a younger age. About one percent of the population is diagnosed with schizophrenia at some point in life, but the disease is not always chronic. In 75% of cases, schizophrenia begins with a preliminary stage (prodromal phase) that can last for several years until the diagnosis is made on the basis of positive symptoms such as delusions, hallucinations and thought disorders. In this preliminary stage, many sufferers suffer from unspecific symptoms such as depression, withdrawal, inner restlessness, insomnia and difficulty concentrating.
How is the disease going?
The course of schizophrenia varies greatly. Some people only experience one psychotic episode in their life. The majority of people with schizophrenia will experience few psychotic episodes with positive symptoms during their lifetime, while others will have many episodes. Between the episodes, treatment often leads to an extensive disappearance of the psychotic symptoms and an improvement in psychosocial functions. Those affected can, for example, continue to study, work or maintain relationships. However, as with other diseases, some of the patients are permanently impaired, with the negative symptoms then predominating over the course of the disease. However, early and sustained treatment can significantly reduce the occurrence of future episodes.
What treatment options are there?
The earlier treatment begins, the greater the likelihood that the disease will have a favorable prognosis. Successful treatment of complex diseases such as schizophrenia always involves a combination of different methods.
- Psychotropic drugs: Medications such as antipsychotics can help reduce symptoms such as hallucinations, delusions, and thought disorders. Often times, they can eliminate these symptoms altogether for many people. There are different types of antipsychotics that must be individually tailored to the symptoms of those affected. It is therefore important that psychiatrists and patients work well together to find an effective medication with as few side effects as possible.
- Psychotherapy: Resource-oriented interventions and cognitive behavioral therapy have proven to be particularly effective in treatment. Among other things, the patient's self-esteem is strengthened and he learns strategies for coping with stress and problems as well as social skills. Relapse prevention and psychoeducation, in particular, are an important part of treatment. The patient learns to recognize early warning signs and thus becomes an expert on his illness himself. There are also therapies such as metacognitive training that focuses on the structures and perception of thinking.
- Sociotherapy: Social workers and social pedagogues can offer support in the case of difficulties in the areas of coping with everyday life, work, training or in the area of housing.
- Further psychosocial measures: To promote social and societal reintegration and rehabilitation, those affected can take advantage of psychosocial measures, e.g. B. Individual residential care or vocational and medical rehabilitation. Occupational measures in occupational therapy can, among other things, support you to increase your resilience, to structure your days better and to improve your drive.
- Relatives work: The disease not only changes the lives of those affected, but also that of their relatives. In relatives groups, family members and partners can exchange ideas with other affected persons.
Dr. Eric Hahn (Charité CBF, Clinic for Psychiatry and Psychotherapy, Senior Physician)
Dr. Thi Minh Tam Ta (Charité CBF, head of the special clinic for Vietnamese migrants)
Thi Main Huong Nguyen (Charité CBF, psychologist)
Selten, J.P., van Os, J. & E. Cantor-Graae. The social defeat hypothesis of schizophrenia: issues of measurement and reverse causality. World Psychiatry15, 3 (2016).
Kahn, RS. et al. Schizophrenia. Nature Reviews Disease Primers 1 (2015).
Ripke, S. et al. Biological insights from 108 schizophrenia-associated genetic loci.Nature 511, 421–427 (2014).
Owen, M. J. New approaches to psychiatric diagnostic classification.Neuron 84, 564–571 (2014).
Howes, O.D., R.M., Murray. Schizophrenia: an integrated sociodevelopmental-cognitive model.Lancet 383, 1677–1687 (2014).
Leucht, S. et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis.Lancet 382, 951–962 (2013).
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