Schizophrenia is a psychiatric disorder characterized by recurrent episodes of psychosis. Classic symptoms include, delusions, disorganized thinking and speech, paranoia, and auditory hallucinations. Classically, symptoms are categorized into positive and negative symptoms. Schizophrenia also leads to a significant impairment in ones everyday social life. Typically, the age of onset occurs in late adolescence early adulthood, and has a chronic course and often a poor outcome.
Studies have shown several risk factors for the development of schizophrenia, they include genetics, winter birth, older parental age, and early developmental insults. Genetics seem to have the biggest influence on the development, as schizophrenia is observed in 60% of first-degree relatives (Harrison’s, 2008).
Four main types of schizophrenia haven been described, and they are catatonic, paranoid, disorganized and residual. In catatonic type patients are characterized by changes in their motor activity, negativism, echolalia, and echopraxia. Patients suffering from paranoid type have a preoccupation with a specific delusion; in disorganized type patients suffer from disorganized speech and behavior as well as have a superficial/ silly affect. In the final type of schizophrenia, residual type, patients suffer from negative symptoms with the absence of delusions, hallucinations, or a decrease in motor activity.
As stated previously patients suffering from schizophrenia suffer from a combination of positive and negative symptoms. Positive symptoms are so termed because they are an exaggeration of normal processes. Positive symptoms include the delusions, hallucinations, and disorganized thought and speech. Hallucinations are the perceptions in the absence of a real stimuli; they are created by ones own mind. They may be auditory, olfactory, or gustatory. Auditory hallucinations are the most common in schizophrenic patients, with prevalence between 40-80% in patients suffering from schizophrenia (Fischer & Buchanan, 2013). Of all the symptoms of schizophrenia, auditory hallucinations are the most responsive to anti-psychotic medication. Delusions are another positive symptom present in patients with schizophrenia, affecting approximately 80% of patients. Delusions are defined as a fixed, false belief and are categorized as being bizarre or non-bizarre. The content of the delusions can also be categorized as grandiose, paranoid, nihilistic, and erotomanic. People that suffer from schizophrenia generally display some form of disorganized speech or thinking. The most common type of abnormal speech seen in patients are tangentiality and circumstantiality; other forms of disorganized speech include, derailment, neologism, and world salad. In a patient suffering from tangential speech, the person gets further and further off topic when asked a simple question. Circumstantial speech occurs when the person answers the question asked to them, but in a roundabout manner (Fischer & Buchanan, 2013).
Negative symptom may be primary or secondary. Primary negative symptoms occur when they are the core symptoms of schizophrenia. On the other hand negative symptoms may be secondary to other manifestations of the disease or even to treatment. Negative symptoms include, cognitive impairment, mood and anxiety symptoms, and physical and neurological manifestations.
Diagnostic criteria for schizophrenia according to the DSM-5 include the presence of two or more of the following symptoms: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and the presence of negative symptoms. These symptoms must also disrupt one or more areas of everyday functioning such as, work, social relationships, and personal care. When the onset is in adolescence the symptoms must also disrupt academic life. Signs of the disease must be present for at least six months with one month of active symptoms, meaning delusions, hallucinations, etc. During the other months negative symptoms may predominate. Presence of a mood disorder or schizoaffective disorder must be ruled out and symptoms cannot be due to the presence of drugs or another general medical condition, before a diagnosis of schizophrenia is made (DSM -5, 2013).
Differential diagnosis of schizophrenia include schizophreniform disorder wherein all the symptoms are the same as in schizophrenia but the time course is less then six months. Schizoaffective, mood, and bipolar disorders may have mood symptoms similar to schizophrenia. Finally, substance – induced psychosis may manifest as psychotic symptoms seen in schizophrenia.
Antipsychotic drugs are used for acute and chronic maintenance treatment in schizophrenic patients. For the most part, these drugs work by binding to D2/D3 receptors, and blocking their downstream pathways. The typical, first generation, antipsychotics provided relief of positive symptoms within 8-15 days, but failed to provide relief to the negative symptoms or cognitive dysfunction. The newer atypical, second-generation, antipsychotics showed to equally reduce positive symptoms but also reduce the adverse effect of extrapyramidal signs, better then the typicals (Stroup & Marder, 2012). Drugs from the first generation antipsychotics include chlorpromazine, perphenazine, and haloperidol; second generation drugs include risperidone, olanzapine, and airpiprazole. All of these drugs are not without serious side effects such as seizures, agranulocytosis, steven – johnsons syndrome, among many others (Stroup & Marder, 2012).
Schizophrenia is a chronic disorder that requires careful medical treatment with long term follow-up for the patient and their psychiatrist. Social problems associated with the disease also require careful follow up and the patients family needs to be helped as proper social support by the patients family may greatly improve their long term outcome.
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Stroup, S. & Marder, S. “ Pharmacotherapy for schizophrenia: acute and maintenance phase treatment”. UpToDate. (2012) n.pag. Retrieved from: http://www.uptodate.com/contents/pharmacotherapy-for-schizophrenia-acute-and-maintenance-phase-treatment?detectedLanguage=en&source=search_result&search=schizophrenia+medications&selectedTitle=1~150&provider=noProvider
Fischer, B. & Buchanan, R. “ Schizophrenia: clinical manifestations, course, assessment, and diagnosis. UptoDate (2013) n.pag. Retrieved from: http://www.uptodate.com/contents/schizophrenia-clinical-manifestations-course-assessment-and-diagnosis?detectedLanguage=en&source=search_result&search=schizophrenia&selectedTitle=1~150&provider=noProvider
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5], American Psychiatric Association, Arlington, VA 2013.