schizophrenia

Schizophrenia | causes and treatment

People with schizophrenia may experience delusions, hallucinations, disorganized speech or behavior, and impaired cognitive ability.

Schizophrenia is a serious and lifelong neurodevelopmental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may experience delusions, hallucinations, disorganized speech or behavior, and impaired cognitive ability. They may hear voices or see things that aren’t there. They may believe other people are reading their minds, controlling their thoughts, or plotting to harm them. These behaviors can be scary and upsetting to people with the illness and make them withdrawn or extremely agitated. It can also be scary and upsetting to the people around them. 

  People with schizophrenia may sometimes talk about strange or unusual ideas, which can make it difficult to carry on a conversation. They may sit for hours without moving or talking. Sometimes people with schizophrenia seem perfectly fine until they talk about what they are thinking.    Recovery from schizophrenia is a gradual process that is unique to each person. The symptoms usually improve and become easier to manage over time, though they do not always disappear. A recovery-oriented approach to the treatment of schizophrenia promotes the values of hope, empowerment and optimism. The illness can usually be managed effectively with a combination of medications and psychosocial supports, such as psychotherapy, education and peer support. People with schizophrenia can and do recover, and lead meaningful and fulfilling lives.

What causes schizophrenia?

No single cause of schizophrenia has been identified, but several factors have been shown to be associated with its onset. Men and women have an equal chance of developing this mental illness across the lifespan, although the onset for men is often earlier. 


Genetic factors
A predisposition to schizophrenia can run in families. In the general population, only one percent of people develop it over their lifetime, but if one parent has schizophrenia, the children have a 10 percent chance of developing the condition – and a 90 percent chance of not developing it.  

Biochemical factors

Certain biochemical substances in the brain are believed to be involved in schizophrenia, especially a neurotransmitter called dopamine. One likely cause of this chemical imbalance is the person’s genetic predisposition to the illness. Complications during pregnancy or birth that cause structural damage to the brain may also be involved.

Family relationships
No evidence has been found to support the suggestion that family relationships cause the illness. However, some people with schizophrenia are sensitive to any family tension, which for them may be associated with recurrent episodes. 

 
Stress
It is well recognised that stressful incidents often precede the onset of schizophrenia. These may act as precipitating events in vulnerable people. People with schizophrenia often become anxious, irritable and unable to concentrate before any acute symptoms are evident. This can cause problems with work or study and relationships to deteriorate. Often these factors are then blamed for the onset of the illness when, in fact, the illness itself has caused the stressful event. It is not, therefore, always clear whether stress is a cause or a result of schizophrenia.


Alcohol and other drug use
Harmful alcohol and other drug use, particularly cannabis and amphetamine use, may trigger psychosis in people who are vulnerable to developing schizophrenia. While substance use does not cause schizophrenia, it is strongly related to relapse.  
People with schizophrenia are more likely than the general population to use alcohol and other drugs, and this is detrimental to treatment. A considerable proportion of people with schizophrenia have been shown to smoke, which contributes to poor physical health.

Symptoms

POSITIVE SYMPTOMS

“Positive” symptoms are referred to as positive because the symptoms are additional behaviors not generally seen in healthy people. For some people, these symptoms come and go. For others, the symptoms become stable over time. These symptoms can be severe— but at other times—unnoticeable.  

Positive symptoms include
• Hallucinations: When a person sees, hears, smells, tastes, or feels things that are not real. Hearing voices is common for people with schizophrenia. People who hear voices may hear them for a long time before family or friends notice a problem. 
• Delusions: When a person believes things that are not true. For example, a person may believe that people on the radio and television are talking directly to him or her. Sometimes people who have delusions may believe that they are in danger or that others are trying to hurt them. 
• Thought disorders: When a person has ways of thinking that are odd or illogical. People with thought disorders may have trouble organizing their thoughts. Sometimes a person will stop talking in the middle of a thought or make up words that have no meaning. 
• Movement disorders: When a person exhibits abnormal body movements. A person may repeat certain motions over and over—this is called stereotypies. At the other extreme, a person may stop moving or talking for a while, which is a rare condition called catatonia. 

NEGATIVE SYMPTOMS

“Negative” symptoms refer to social withdrawal, difficulty showing emotions, or difficulty functioning normally. People with negative symptoms may need help with everyday tasks.  Negative symptoms include:
 • Talking in a dull voice
• Showing no facial expression, such as a smile or frown
• Having trouble experiencing happiness
• Having trouble planning and sticking with an activity, such as grocery shopping
• Talking very little to other people, even when it is important These symptoms are harder to recognize as part of schizophrenia and can be mistaken for depression or other conditions.

COGNITIVE SYMPTOMS

Cognitive symptoms are not easy to see, but they can make it hard for people to have a job or take care of themselves. The level of cognitive function is one of the best predictors of a person’s ability to improve how they function overall. Often, these symptoms are detected only when specific tests are performed. 
Cognitive symptoms include:

• Difficulty processing information to make decisions

• Problems using information immediately after learning it

• Trouble paying attention

Molecular mechanisms of Schizophrenia

Neurodevelopment hypothesis 

The neurodevelopment hypothesis of schizophrenia postulates that effects during an embryonic or fetal stage in brain development lead to defective neural activity and altered neuronal functioning later in life.

The alterations observed in post mortem of a schizophrenic patient that neuro developmental disturbances mainly related to the hippocampal formation and in the superior temporal lobe. The neurodevelopmental abnormalities developing in utero as early as late first or early second trimester and which leads to in young adulthood appear the positive and negative symptoms or both.


Dopamine hypothesis 
The most widely contemplated neuro chemical hypothesis of schizophrenia is the dopamine hypothesis, which theorizes that symptoms of schizophrenia may results from excess dopaminergic neurotransmission particularly in mesolimbic and striatal brain regions which lead to positive symptoms and finally changes into schizophrenia. There are many clinical shreds of evidence about schizophrenia that provides support for the dopamine hypothesis.

In this hypothesis, the different evidence has appeared. The first evidence that in schizophrenia patient’s dopamine came from amphetamine users. Amphetamine showed that too produces more dopamine and produces psychotic symptoms related to schizophrenia.


Glutamate hypothesis 

In this Hypothesis, it is noted that dopaminergic dysfunctioning may be associated with glutamatergic dysfunctioning. In this concept glutamate, dysfunctioning will lead to opening effect in the thalamocortical loop which causes to appear psychotic symptoms and well-known dopamine concentration changes. Glutamatergic receptors consist of two groups which can perform different functions and finally lead to schizophrenic symptoms appear. In these receptors, major receptors are NMDA (N-methyl, D-Aspartate) receptor which causes schizophrenia among most patients by changing dopamine level from the normal range.

Treatment

Treatment for schizophrenia often begins with medication. Psychosocial supports, such as psychotherapy, education and peer support, can also promote recovery. Treatment needs to address other health concerns, too—regular check-ups with a family doctor are important.Families can play an important role in a person’s recovery. Family counselling can help people with schizophrenia and their families to understand and manage challenges related to the illness. 
Understanding the treatments and supports offered will allow you to discuss them with your treatment team, and to develop your own recovery plan. 
 • Psychotherapy such as cognitive behavioral therapy (CBT) or cognitive enhancement therapy (CET). 


• Psychosocial Treatments. 

People who engage in therapeutic interventions often see improvement, and experience greater mental stability. Psychosocial treatments enable people to compensate for or eliminate the barriers caused by their schizophrenia and learn to live successfully. If a person participates in psychosocial rehabilitation, they are more likely to continue taking their medication and less likely to relapse. Some of the more common psychosocial treatments include assertive community treatment (ACT).

Antipsychotic agents for Schizophrenia 
First generation antipsychotics (FGAs) drug, Chlorpromazine which was discovered in 1950 and used commonly because at that time this only antipsychotic drug and used for the treatment of schizophrenia. Chlorpromazine’s intensity will reduce the intensity of schizophrenia. Also in this class may other agents was also discovered by changing structure and activities which are loxapine, fluphenazine, perphenazine, and haloperidol, but these all agents have a major side effect, extrapyramidal symptoms and this can’t be neglected. Therefore these drug no use longer.

These FGAs drugs also called as typical or conventional drug 
Clozapine is another medication of second generation antipsychotic agents which was discovered in 1970 and is much better than other agents. It is dopamine receptor blocker but blocks in less extent. Second generation antipsychotics (SGAs) are used as a first line treatment for schizophrenia and effective for this treatment. After this number of SGAs was also discovered which can also have good efficiency for to reduce the severity of this disease.  

This class first called as atypical antipsychotic drugs, but now known as second generation antipsychotics, was heralded as the first major advance in the therapeutics of schizophrenia for 40 years. These drugs seem to have more advantages on first generation antipsychotics


Augmentation and combination therapies 
Augmentation therapy is given with second generation antipsychotics combine with electroconvulsive therapy (ECT) or mood stabilizing agents on the other hand combination therapy is given with other antipsychotic agents. Lithium is commonly used as mood stabilizing agent.
Lithium may improve the mood and behavior but doesn’t have any antipsychotic effect

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