Schizophrenia: Causes, symptoms, and treatment

Schizophrenia is a mental disorder that affects a person’s perception of reality, characterized by hallucinations and delusions. Equipping knowledge about this disorder will help you be more proactive in early detection and examination. This makes treatment easier and reduces the effects of the disease.

Schizophrenia is characterized by hallucinations and delusions that greatly affect quality of life

What is schizophrenia?

Schizophrenia is a progressive severe psychotic illness that often causes difficulty distinguishing between reality and fiction, managing emotions, thinking clearly, relating to others, and functioning normally. The disease affects the way a person thinks, behaves and sees the world around them.

Schizophrenia tends to be chronic, causing the sufferer to gradually withdraw from the outside world and withdraw into the inner world. The patient’s emotions become dry, the study and work are getting worse and worse. Many people also have strange and confusing thoughts and behaviors. This disease accounts for about 0.3 – 0.5% of the population, the disease tends to start at the age of 18-40.

According to ICD-10, schizophrenia has the following clinical forms:

• Paranoid body
• Youth body
• Tension body
• Unspecified body
• Post-schizophrenic depression
• Can sequelae
• Simple body

Schizophrenia usually develops in episodes. Most people get better over time, not worse. Treatment options are always improving, and there are many things you can do to manage your symptoms.

The periods of remission are the ideal time to adopt self-care solutions to limit the frequency of future episodes. With the right medication and therapy, many people with schizophrenia can manage their symptoms well. Especially being able to function independently and enjoy a full and rewarding life.

Causes of schizophrenia

The exact cause of schizophrenia is still unknown. Research indicates that a combination of physical, psychological, genetic and environmental factors can make a person more likely to develop the condition.

Some people may be prone to schizophrenia. A stressful or emotional life event can also trigger an episode of psychosis. However, it remains unclear why some people develop symptoms while others do not.

Some of the risk factors thought to increase the risk of the disease include:

1. Genetic factors

Schizophrenia tends to develop in families. However, no single gene has been shown to be responsible. Most likely, different combinations of genes make a person more susceptible to the condition. However, having these genes also does not necessarily mean that you will develop the disease.

Evidence that the disorder is hereditary comes in part from research on twins. In identical twins, if one develops schizophrenia, the other is also at risk. This is true even if the two children are raised separately.

If you have a close relative with schizophrenia, your risk is higher than normal

In non-identical (fraternal) twins, whose genetic makeup is different, if one develops schizophrenia, the other has only a one-eighth chance of developing it.

2. Development of brain structure

Studies of people with schizophrenia have shown that there are slight differences in the structure of their brains. These changes are not seen in all patients and may still occur in people without mental illness. However, researchers suggest that the development of schizophrenia may in part be due to a disorder of the brain.

3. Neurotransmitters

Neurotransmitters are chemicals that transmit information between brain cells. Research has found a link between neurotransmitters and schizophrenia, because drugs that change the levels of neurotransmitters in the brain are known to reduce some symptoms of schizophrenia. schizophrenia.

Experts say schizophrenia can be caused by changes in the levels of two neurotransmitters, serotonin and dopamine. Some studies indicate an imbalance between both of these substances may be the basis of the problem. In addition, a change in the body’s sensitivity to neurotransmitters can also be a cause of the disease.

4. Pregnancy and childbirth complications

Some studies show that people who develop schizophrenia are more likely to experience complications before and during childbirth. Such as:

• Premature birth
• Low birth weight babies
• Lack of oxygen (suffocation) during birth

Complications during pregnancy and delivery can significantly affect brain development. This increases the risk of mental illness.

5. Trigger factors for schizophrenia

Triggers that cause schizophrenia to develop more strongly in people at high risk for the disease. Consists of:

– Stress:

Stress is considered to be the main psychological trigger of schizophrenia. Common stressful life events include:

• Relatives passed away
• Job loss
• End a relationship
• Divorce
• Physical, emotional or sexual abuse

Stress may promote the activation of schizophrenia

Drug abuse:

Drugs do not directly cause schizophrenia. However, studies have shown that drug abuse can increase the risk of developing schizophrenia or another similar condition.

Marijuana, cocaine, and amphetamines can cause schizophrenia symptoms in susceptible individuals. Use of amphetamines or cocaine can lead to psychosis or relapse in people recovering from a previous episode.

Research has also shown that adolescents who use marijuana regularly are more likely to develop schizophrenia in later adulthood.

Early warning signs of schizophrenia

In some people, schizophrenia can come on suddenly and without warning. For the most part, however, it will happen gradually with subtle warning signs. This is accompanied by a gradual decline in function, long before the first severe episode. Often, a friend or family member will soon know that something is wrong but not exactly what.

In the early stages, the person may seem eccentric, emotionless, unmotivated, and reclusive from others. You may begin to isolate yourself, neglect your appearance, say strange things, or appear indifferent to life. You can give up hobbies and activities. At the same time your performance at work or school may deteriorate.

The most common early warning signs include:

• Depression, withdrawal from society
• Hostility or suspicion
• Extreme reactions to criticism
• Reduce personal hygiene
• Insensitivity
• Inability to cry
• Inappropriate expressions of joy, laughter or cry
• Insomnia or oversleeping
• Forgetful, can’t concentrate
• Strange or unreasonable talk
• Use unusual words or expressions

The patient may react extreme to criticism

Although these warning signs can be related to a number of other problems, not only schizophrenia, but also very worrying. When unusual behavior is causing problems in your life or that of a loved one, take the initiative to see a doctor. If the cause is schizophrenia or another mental problem, early treatment is helpful.

Symptoms of schizophrenia

The symptoms of schizophrenia vary widely from person to person, both in terms of presentation and severity. Not everyone has all symptoms, and symptoms can also change over time.

Here are the main symptoms of schizophrenia:

1. Illusion

Hallucinations refer to a condition in which a person sees, hears, smells, tastes, or feels things that do not exist outside of their mind. The most common hallucination is hearing voices. Hallucinations are very real to those who experience them. Although people around cannot hear voices or experience sensations.

A study using brain scans showed changes in the speech region of the brains of people with schizophrenia when they heard voices. This study shows that the experience of hearing a voice is lifelike, as if the brain mistook thoughts for a real voice.

Voiceovers can describe ongoing activities, discuss the listener’s thoughts and behaviors, give instructions, or speak directly to the person. Voices can come from many different places or from one place, such as the TV.

2. Delusion

An illusion is a belief that is fully believed whether it is based on a strange, false, or unrealistic point of view. It can affect the way the person behaves. Delusions may begin suddenly or may develop over weeks or months.

Some people develop a delusional idea to account for a hallucination they are experiencing. A person experiencing delusions may believe that they are being harassed or persecuted. They may believe that they are being pursued, followed, resisted, or poisoned. Usually by friends or a family member.

Delusions are one of the main symptoms experienced by many patients

Some people who experience delusions find different thoughts from everyday events or events. They may believe that the people on TV or in the newspapers are delivering the message to them alone.

3. Thought Disorders

People experiencing schizophrenia often have trouble keeping track of their thoughts and conversations. Some people find it difficult to concentrate, drifting from one idea to another. They may have trouble watching TV shows or reading newspaper articles.

People sometimes describe their thoughts as vague or hazy. Their thoughts and words may become confused or confused. This makes the conversation difficult and confusing for others.

4. Changing thoughts and behaviors

The behavior of a person with schizophrenia can become more disorganized and unpredictable. Some people describe their thoughts as being controlled by others. The thought is no longer their own or it has been planted in their mind by someone else.

The person also has another sensation that thoughts are disappearing. As if someone was erasing them from their mind. Some people even feel their bodies are being taken over and others are directing their movements.

5. Negative symptoms

Negative symptoms often appear several years before a person experiences their first episode of acute schizophrenia. These early negative symptoms are often referred to as the prodromal period of schizophrenia.

Lack of concentration is one of the negative symptoms of schizophrenia

Symptoms during the prodromal period tend to come on gradually and get progressively worse. Negative symptoms may include:

• Patients become more withdrawn from society. Increasingly unconcerned about their appearance and personal hygiene.
• Loss of interest and motivation in life, including relationships and sexual problems.
• Lack of concentration, change in sleeping habits and unwillingness to leave the house.
• Less likely to initiate a conversation. At the same time feel uncomfortable with people or feel like there is nothing to say.

It can be difficult to distinguish whether this symptom is part of the development of schizophrenia or is caused by something else. Negative symptoms often lead to problems in relationships with friends and family. Because they are sometimes confused with laziness or intentional rudeness.

Diagnosis of schizophrenia

Early diagnosis of schizophrenia is essential for early treatment. Thereby helping to control symptoms well and limit risks to health as well as quality of life.

1. Definitive diagnosis

To make a definitive diagnosis of schizophrenia, doctors often base themselves on the ICD-10 criteria. There are 9 groups of symptoms including:

• 1. Thinking out loud, thinking on radio, thinking stolen.
• 2. Delusions of being dominant or passive are markedly related to body or limb movement. Or associated with particular thoughts, behaviours, sensations, paranoid perceptions.
• 3. The hallucinogens often comment on behavior and discuss the patient. Or other types of phantom sound coming from a certain part of the body.
• 4. Other types of persistent delusions that are not culturally appropriate. At the same time, there is absolutely no uniformity in religion and politics. Or supernatural powers and abilities. For example, being in contact with people from another world or having the ability to control the weather.
• 5. Persistent hallucinations, sometimes with transient or incomplete delusions, and without clear emotional content. Or it can be followed by too persistent ideas that appear on a daily basis for weeks or months.
• 6. Disruptive thinking, or adding words when speaking, leads to irrelevant thinking, inappropriate speech, or fabricated language.
• 7. Tense behavior such as negation, agitation, not speaking, maintaining posture or touching horns.
• 8. Negative symptoms such as marked apathy, blunt emotional responses, inadequate, poor language. These often lead to social isolation, reducing labor productivity. It should be clear, however, that these symptoms are not caused by depression or neuroleptics.
• 9. Frequent changes in the overall quality of behavior with manifestations such as lack of purpose, loss of interest, self-absorbed attitude, laziness and social isolation.

In order to make a diagnosis, there should be at least one obvious symptom in groups 1 to 4 or at least 2 symptoms in groups 5 to 9 above. The symptoms above should be evident for most of the time. It could be a month or so.

When you notice suspicious symptoms, it is necessary to visit a doctor soon for a timely diagnosis

Do not be diagnosed as schizophrenic if symptoms of major depressive or mania are present. Unless schizophrenia symptoms are identified as preceded by affective disturbances. In addition, the diagnosis is not made when there is obvious encephalopathy or the patient is in a state of drug intoxication.

2. Differential diagnosis

Schizophrenia needs to be differentially diagnosed with some of the following conditions:

• Aggressive psychosis: This is a condition that can have schizophrenia-like symptoms. However, schizophrenia does not fully meet the diagnostic criteria for schizophrenia. Neurological and laboratory examination will reveal obvious signs of organic disease.
• Psychosis due to psychoactive substances (drugs, alcohol): Occurs during or after taking psychoactive substances. Characterized by vivid hallucinations (typically vocal hallucinations, often persecutory delusions), psychomotor disturbances (shock or agitation), intense feelings of fear or bewilderment . Symptoms usually subside within 1 month and disappear completely within 6 months. Physical examination and laboratory tests will detect intoxication, drug or alcohol use.

3. Subclinical

Your doctor will perform a number of laboratory tests and examinations to help diagnose, monitor, and treat the disease. Consists of:

Basic tests:

• Blood tests: Hematology, microbiology (HIV, HCV, HBV), biochemistry
• Urine test
• Drug testing
• Syphilis serology

Diagnostic imaging and functional exploration:

• Cardiopulmonary X-ray
• Abdominal ultrasound
• Electroencephalogram
• ECG
• Save blood pressure
• Transcranial doppler ultrasound
• Some cases also use CT scan of the brain, MRI of the brain …

Psychological tests:

• Psychometric tests for positive and negative symptoms
• Personality test: MMPI, EPI
• Other psychological tests: BDI, HDRS, HAD, HARS, MMSE,…

Guidelines for the treatment of schizophrenia

Schizophrenia is a disease of unknown etiology, which should be detected and treated as soon as possible. Symptomatic treatment was identified as the primary goal. The following rules should be adhered to:

Chemotherapy is a very important therapy. Especially with positive symptoms.
It should be combined with many other therapies such as psychotherapy, occupational therapy and social re-adaptation. Especially for negative symptoms.
Initially monotherapy may be used. However, if the response is poor or there is no response, polytherapy with two different types of neuroleptics is needed. It is necessary to limit the combination of 3 or more types of neuroleptics.
Closely monitor the medication process in order to detect and promptly handle any side effects of neuroleptics.
Educating families and communities to change attitudes towards patients with schizophrenia (avoid stigmatizing patients). There should be close coordination between doctors, families and the community in caring for patients.
Timely detection and treatment of factors that promote disease recurrence.
Maintenance treatment after the first psychotic episode, management and monitoring of relapse prevention in the community.

Here are the methods used to treat schizophrenia:

1. Pharmacotherapy

Pharmacotherapy is believed to be the cornerstone of schizophrenia treatment. Among them, antipsychotic drugs (neuroleptics) are the most commonly prescribed by doctors. You may choose one or two or three of the following drugs:

Drug use is believed to be the cornerstone of treatment for schizophrenia

Classic antipsychotics:

• Chlorpromazine (25mg tablet or 25mg tube): Dosage 50 – 250mg / 24 hours.
• Levomepromazine (25mg tablet): Dosage 25-250mg/24 hours.
• Haloperidol (1.5mg tablet, 5mg tablet or 5mg tube): Dosage 5 – 30mg/24 hours.
• Thioridazine (50mg tablet): Dosage 100-300mg/day.

– Atypical antipsychotics (new):

• Amisulpride (50mg, 200mg or 400mg tablets): Dosage 200 – 800mg / 24 hours.
• Risperidone (1mg or 2mg tablets): Dosage 1 – 12mg / 24 hours.
• Quetiapine (50mg, 200mg or 300mg tablets): Dosage 600-800mg/day.
• Olanzapine (5mg or 10mg tablets): Dosage 5 – 30mg / 24 hours.
• Aripiprazole (5mg, 10mg, 15mg or 30mg tablets): Dosage 10-15mg/day (maximum 30mg/day).
• Clozapine (25mg or 100mg tablets): Dosage 50-800mg/24 hours.

Long-acting antipsychotics:

Long-acting neuroleptic drugs should be used for patients who do not adhere to regular daily drug treatment. Before administering slow-acting neuroleptics, a corresponding rapid-acting neuroleptic should be used to assess the patient’s response to medication.

• Haldol decanoate (tube 50mg/ml): Dosage for deep intramuscular injection of 25-50mg/time (4 weeks for booster injection).
• Flupentixol decanoate (20mg/ml ampoules): Dosage for deep intramuscular injection 20-40mg/time (2-4 weeks booster injection).
• Fluphenazine decanoate (25mg/ml tube): Dosage for deep intramuscular injection 12.5-50mg/time (maximum 100mg/day), 3-4 weeks repeat injection.
• Aripiprazole: 300mg or 400mg injection, 4 weeks booster.

COMBINATION TREATMENT: Depending on each specific case, combination treatment with the following drugs:

• Benzodiazepines: alprazolam, diazepam, lorazepam, bromazepam, non-benzodiazepines,…
• Group of beta-blockers: propranolol, …
• Antidepressants: SSRIs, SSRIs, TCAs, etc.
• Mood stabilizers: ginkgo biloba, vinpocetin, choline alfoscerate, piracetam, nicergoline, etc.
• Drugs to support the liver, drugs to enhance cognitive function, …

Pharmacotherapy for schizophrenia requires close monitoring. Monitoring and treatment will help detect and treat side effects immediately. The most common are extrapyramidal syndromes (acute dystonia, Parkinson’s-like syndrome, drug-induced restlessness) or metabolic disorders.

2. Psychosocial therapy

While pharmacotherapy can help relieve the symptoms of schizophrenia, psychosocial therapies help address the psychological, behavioral, social, and occupational problems associated with schizophrenia. this disease.

Through psychosocial therapies, people can also learn to manage their symptoms. Also come up with a relapse prevention plan and identify early warning signs of a relapse.

Therapies that may be used include:

Psychotherapy:

Psychotherapy can help people with schizophrenia cope better with the symptoms of hallucinations or delusions. Psychotherapy works best when they are combined with antipsychotics. Commonly used methods include:

Cognitive-behavioral therapy (CBT): Helps patients identify thought patterns that are causing them to have unwanted emotions and behaviors. Also learn how to change this mindset with more practical and helpful thoughts.
Family therapy: Caring for someone with schizophrenia can be stressful for any family. Family therapy is a better way to cope with the patient’s condition. It may include discussing information about the disease, learning about ways to support the sick person, and deciding how to deal with real problems caused by the illness.

Occupational therapy and rehabilitation:

The principle is for the patient to begin functioning at a level that their ability allows in order to rebuild trust. Then gradually increase the level of activity to the highest capacity without the patient feeling stressed. Occupational rehabilitation should take into account the social, economic and cultural environment in which they live.

3. Electroconvulsive Therapy (ECT)

To perform this therapy, electrodes will be attached to the patient’s scalp. While they’re under general anesthesia, doctors deliver a small electric shock to the brain.

A course of ECT will usually consist of two to three treatments per week for several weeks. Each electric shock treatment can cause a controlled seizure. A series of treatments over time will help improve mood and thinking.

Researchers don’t fully understand exactly how beneficial ECT and the controlled seizures it causes are. However, some researchers believe that ECT therapy has the potential to affect the release of neurotransmitters in the brain.

In fact, ECT has been shown to be less effective in treating schizophrenia than depression and bipolar disorder. This therapy is therefore not routinely used in the absence of accompanying mood symptoms. It can be helpful when the medication is no longer working. Or severe depression that makes treatment difficult.

4. Self-care

To be able to help with the treatment of discriminatory mental illness, you need to take good care of yourself. Here are some helpful solutions:

Regular physical activity has many benefits for patients with schizophrenia

• Manage stress: High levels of stress can trigger episodes of schizophrenia by increasing the body’s production of the hormone cortisol. You can reduce your stress levels by practicing relaxation exercises regularly. Such as yoga, meditation or deep breathing.
• Exercise regularly: Physical activity has many physical and mental benefits. Furthermore, it may help reduce the symptoms of schizophrenia. Specifically, it helps you improve your energy, focus and feel calmer.
• Get plenty of sleep: While taking this medication, you may need more than the standard 8 hours of sleep. Many people with schizophrenia often have trouble sleeping. Regular exercise and avoiding caffeine can help.
• Avoid alcohol, drugs, and nicotine: Substance abuse can complicate treatment for schizophrenia. Namely making the symptoms worse. Even smoking can interfere with the effectiveness of some medications. If you are having a problem with substance abuse, you should seek help from your doctor.
• Eat healthy: This helps to avoid worsening symptoms caused by blood sugar changes. Omega-3s from fatty fish, fish oils, flaxseeds and walnuts can help improve focus. It also helps you to dispel fatigue and balance your mood.

5. Prevention of schizophrenia

The cause of schizophrenia is not clearly defined, so there is no absolute method to prevent the disease. However, there are a few issues to pay attention to:

• Children should be trained in teamwork, knowing how to adapt to the environment as well as the difficult conditions of life.
• Monitor people with genetic factors (father, mother, grandfather, grandmother and close relatives) with schizophrenia for early detection and treatment.
• Patients and families need to learn and be equipped with more knowledge about the disease, the factors that cause the disease to recur in order to better cooperate and adhere to treatment.
• Continue to monitor the patient after discharge from the hospital. Attention should be paid to persistence in treatment, consolidation, and detection of risk factors. At the same time, actively treat infections or body diseases to prevent recurrence.

Schizophrenia can have a lot of negative effects on a person’s life. Hopefully the information shared above will help you better understand the disease for early detection and treatment intervention. Seeing your doctor early when you notice suspicious symptoms will make treatment easier.