Schizophrenia, Mental Disorders
Schizophrenia is a complex chronic psychiatric pathology which schematically results in a disturbed perception of reality, productive manifestations, such as delusions or hallucinations, and passive manifestations, such as social and relational isolation.
In practice, it can be very different from one patient to another, depending on the nature and severity of the different symptoms he presents.
Three types of symptoms can manifest chronically or episodically (period of psychosis)
1. Those called productive (or positive) are the most impressive
they bring together delusions and hallucinations and can result in a feeling of persecution (paranoia), megalomania, implausible and eccentric delusions, or even sensory hallucinations, often auditory (the subject hears voices) but also visual, olfactory, tactile or gustatory.
2. Negative (or deficit) symptoms correspond to affective and emotional impoverishment
The patient withdraws and gradually isolates himself from his family, friends and social circle. He communicates less, has a limited will and shows reduced emotionality. It exhibits less interest and willpower and more apathy, which can resemble depression.
3. Finally, dissociative symptoms correspond to a disorganization of thoughts, words, emotions and bodily behaviors
Coherence and logic of speech and thoughts are disrupted. The patient is less attentive, has difficulty concentrating, memorizing, understanding or being understood. He may have difficulty planning simple tasks such as doing his job or shopping, which can be a source of major handicap in daily life.
Schizophrenia begins following an inaugural psychotic episode which is unfortunately not always identified or taken care of. It then follows a fluctuating course, with chronic symptoms to which are sometimes added phases of acute psychosis. It can then stabilize with residual symptoms of varying intensity depending on the person. The prognosis varies according to the characteristics of the disease and the earliness of treatment.
A dangerousness especially against oneself
Despite the emphasis given to certain news items, schizophrenic patients dangerous to society are a minority. Only rare cases give rise to outbursts of violence during a crisis, and this aggressiveness is most often directed towards the patient himself.
About half of patients with schizophrenia make at least one suicide attempt in their lifetime. Between 10 and 20% die from it, especially in the first years.***
How is schizophrenia diagnosed?
The diagnosis of schizophrenia is difficult and often late. It is often posed after a first psychotic or delusional episode. Today, there are three criteria, the combination of which makes it possible to define schizophrenia.
The distortion of reality, characterized by delusional thoughts and hallucinations, emotional damage and finally a disorganization of thought. The exclusion of other pathologies with which schizophrenia shares a certain number of symptoms, such as bipolar disorder or certain neurological pathologies, also represents an important issue in the management of this disorder.
The variety of symptoms and their similarity with other psychiatric pathologies and their fluctuation over time makes the diagnosis difficult with sometimes significant wandering before schizophrenia is declared.
What treatments for schizophrenia?
Treatments exist to help patients, but the plurality of symptoms makes management difficult. Schizophrenia is treated primarily with neuroleptics, drugs that control positive and negative symptoms, but are not effective against “cognitive” deficits.
Up to a third of patients do not respond to these therapies. Thus, new therapeutic targets are actively sought to improve the treatment of schizophrenia and particularly cognitive deficits. Cognitive-behavioral therapies are very useful for working with the patient on the cognitive deficits and the risks of desocialization of which he may be a victim, in order to stabilize him in his daily life.
A clinical trial in progress at the Paris Brain Institute seeks to treat auditory hallucinations resistant to drug treatment by repeated Transcranial Magnetic Stimulation and, on the other hand, to identify the cerebral mechanisms involved in the effect of this treatment by MRI.
Causes and mechanism
Today many questions remain unanswered regarding the origin and pathophysiology of this disorder. Although important elements concerning the role of genetics and the environment have been provided, the clear mechanisms of the development of the disease have yet to be elucidated.
Genetic risk factors, increasing the susceptibility of developing the disease have been identified as well as point mutations with probable effects on brain plasticity, the dynamics of brain connections and their adaptation to learning and life experiences.
Can this disease be cured?
Schizophrenia is a disease like diabetes, a long-term chronic disease. This disease requires long-term treatment for most patients. We can then go into remission, so we are not talking about healing. We speak of healing when we no longer need treatment.
The most important thing is to create a connection with the patient, a therapeutic alliance, so that he adheres to the treatment and learns to understand his disease and its symptoms. Then, there can be a pharmacological approach, with neuroleptics and antipsychotics which make it possible to rebalance the concentrations of neurotransmitters – including dopamine – and thus reduce the symptoms of the disease.
Unfortunately, these pharmacological treatments are not very effective for the so-called “negative” symptoms. The most effective is the stimulation of positive emotions and motivation through psychotherapeutic treatments.
These treatments are more effective if implemented quickly. It is fundamental to intervene from the first psychotic episodes to improve the prognosis. This delay is partly due to a lack of knowledge of the symptoms, both on the side of the patients and in the general population, to a medical organization that is not very effective in identifying them, and to the stigmatization from which these patients suffer.
Are schizophrenics dangerous people?
A widespread misconception is that people with schizophrenia can be dangerous to others during their psychotic episodes. The vast majority of them are only dangerous for themselves. But about half of patients make at least one suicide attempt.
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