schizophrenia

Quick Overview

• What is schizophrenia? severe mental disorders. The main forms are paranoid schizophrenia, hebephrenic schizophrenia, catatonic schizophrenia.
• symptoms: Delusions (e.g., paranoia), hallucinations (e.g., hearing voices), emotional disturbances (e.g., swaying between extreme moods), thought and speech disorders, psychomotor abnormalities (bizarre postures, immobility, etc.)
• Causes: unexplained, but one knows various influencing factors (triggers) such as genetic predisposition, high sensitivity, stressful situations, stress, disturbed messenger metabolism in the brain (possibly drugs as a trigger)
• Therapy: Medicines (neuroleptics, antidepressants, sedatives), cognitive behavioral therapy
• Schizophrenia in children: rare, is often overlooked
• Forecast: very variable, depending on the form and severity of the disease

What is schizophrenia?

Schizophrenia is one severe mental disorder, The sufferers suffer at times from massive changes in their thoughts, feelings and perceptions. Their behavior also changes dramatically and is often bizarre or frightening to outsiders.

Experts rank schizophrenia among the endogenous psychoses: Psychoses are mental illnesses in which patients perceive or process the reality of reality. “Endogenous” means that the disease in question is caused by various factors “from the inside out”, that is, with no apparent physical cause and no apparent connection with certain experiences.

People with schizophrenia have no split personalityas is often assumed. So they do not carry several personalities in themselves, which appear alternately, as is the case with a Dissociative Identity Disorder.

Schizophrenia: symptoms

Schizophrenia symptoms are extremely diverse, Every patient develops a very unique clinical picture. For outsiders, patients can be unpredictable and very frightening – especially if someone knows little about the disorder.

Certain symptoms occur in the run-up to schizophrenia. These include sleep disorders, severe irritability and tension. Frequently, those affected are particularly sensitive to light and noise. They often become suspicious of their fellow human beings and withdraw. Some neglect their appearance and are increasingly less interested in school or work. Occasionally, first illusions occur. These symptoms can persist for several months, as well as years, before schizophrenia passes into its acute phase.

Acute and chronic disease phase

Schizophrenia usually runs in spurts. The symptoms in the acute phase occur, is called as “Positive schizophrenia symptoms” (positive symptoms): Here, symptoms that healthy people do not show are predominant. Often hallucinations occur, for example, patients hear voices that are not there. Many sufferers also have delusions such as paranoia. Overall, patients are more active or overactive in the acute disease phase.

The chronic phase is by a Negative or negative symptoms This means that restrictions of certain psychological functions and emotionality are now in the foreground. The patients thus fall into external and internal lethargy: they will unmotivated and work exhausted, Every activity is difficult for them. she neglect their social contacts and retire. Some even neglect their personal hygiene, This behavior does not only affect your private life. The affected are often no longer able to practice their profession. Many people find it difficult to get out of bed at this stage, let alone endure a full day’s work. In addition, schizophrenic patients often act in the chronic disease phase emotionless, They show no joy. Her voice is monotone and her facial expressions are expressionless. Her interest in hobbies, job and social contacts is dwindling. Your language is impoverished.

Three subtypes of schizophrenia

Depending on the predominant symptoms in the acute phase, schizophrenia is divided into three subtypes: paranoid schizophrenia, hebephrenic schizophrenia, and catatonic schizophrenia.

In practice, however, there are no rigid drawers for schizophrenia: typical symptoms of one form also occur in patients who have typical symptoms of a different form. A clear classification of patients in one of the three subtypes is therefore often not possible.

Paranoid schizophrenia

Paranoid schizophrenia is the most common form of the disorder. The most striking symptoms in the acute phase are here Delusions and hallucinations.

A common delusion is about paranoia, Here, those affected are convinced to be persecuted by a person, an organization, or even aliens. They fear being constantly monitored and intercepted. Also delusions often shows in paranoid schizophrenia: those affected believe that actions or expressions of a particular person are addressed to them. Other variants of delusion are about Megalomania and delusional messages (about a death message through a normal black coat).

Among the hallucinations are in paranoid schizophrenia acoustic hallucinations very common: patients hear, for example, voices that do not exist in reality. Sometimes the voices are friendly, but often threatening, because they give orders or insult the patient. Also possible physical hallucinationsFor example, some patients are convinced that individual parts of the body dissolve or are not in the right place. Rarely are in paranoid schizophrenia visual and touch hallucinations.

Read more about this particular schizophrenia form in our article Paranoid Schizophrenia.

Hebephrenic schizophrenia

In this form of schizophrenia, especially the thinking, the emotions and the drive are severely impaired. This appears in many patients Thinking incoherent and illogical, This is reflected in the language. Some patients talk a lot and without context, Some only speak in scraps or neglect the sentence structure. For outsiders, what is said is then no longer understandable. Conversely, in acute phases, it also happens that those affected do not talk anymore.

The emotional disturbances of schepephrenic schizophrenia lead to a dispassionate and often inappropriate behavior, The victims laugh, for example, while they say that they are very unhappy. Or they are silly at a funeral. Thus, those affected often irritate and snub the environment.

In an acute phase, the mood of the patient both euphoric (manic) and depressed (depressive) be. This change can be confused with the symptoms of bipolar disorder.

Learn more about this form of schizophrenia in the article Hebephrenic Schizophrenia.

Catatonic schizophrenia

For a catatonic schizophrenia are especially psychomotor disorders typical. Perform the patients strange-looking movements, for example with her hands, arms or legs. They bend their bodies or walk around aimlessly. In these moments, the patients are very excited. They repeat often stereotypedWhat someone else says.

At other moments they fall into one Rigid state (stupor), They often stay in an unusual position for hours. Although the patients are awake, they do not react and speak in this condition (mutism).

Catatonic schizophrenia rarely occurs today – possibly because modern drugs work better than previously used drugs.

Schizophrenia: causes and risk factors

What triggers a schizophrenia ultimately, you do not know exactly. But there are certainly several factors, including genetic, biological and psychosocial.

Genetic causes of schizophrenia

A genetic bias plays a role in the genesis of schizophrenia in any case. For example, if a monozygotic twin suffers from schizophrenia, the other twin suffers in about 45 percent of cases as well. The risk of disease is just as high if both parents are schizophrenic. If only one parent is affected, the risk for children is still 12 percent. For comparison, in the average population, only about one percent of schizophrenia.

Stress and negative experiences

People who develop schizophrenia are likely to be particularly sensitive to stress. Even before the disease breaks out, they can often deal badly with stressful situations. At some point, the burden becomes too great. Then the stress becomes the trigger that triggers the disease.

Many schizophrenic patients report critical life events before onset of the disease. This can be, for example, the loss of a close person or a problematic job situation. But positive situations can also cause stress – for example, a wedding or the birth of a child.

Changes in the brain

Probably neurotransmitters in the brain play an important role in the onset of schizophrenia. Dopamine, for example, is important for motivation and inner drive, but also for the control of motor skills. All this is disturbed in schizophrenia. If schizophrenia patients take amphetamines, their body releases more dopamine. At the same time, the schizophrenia symptoms worsen.

Glutamate and serotonin also seem to play a role. The latter has a mood-enhancing effect and influences sensation of pain and memory.

In addition, certain brain structures are altered in people with schizophrenia. Affected above all is the limbic system, which is responsible for the regulation of emotions.

Drugs and schizophrenia

It is unclear whether drugs can cause schizophrenia. Some experts suspect a link between schizophrenia and the use of drugs such as cocaine, LSD, amphetamines or cannabis.

It is clear that some drugs can cause delusions, hallucinations and other conditions that are similar to the symptoms of schizophrenia. However, the effect diminishes after some time.

Some studies show that the use of drugs significantly worsens the course of schizophrenia. The fact that a genetic system in combination with certain substances can trigger a schizophrenia, is still unclear.

Schizophrenia: examinations and diagnosis

If you suspect that you or a relative is suffering from schizophrenia, you should consult a specialist schizophrenic clinic or a psychiatrist. There are now also some early detection and treatment centers that specialize in the disease.

To diagnose schizophrenia, one is detailed conversation necessary with the person concerned. In the process, the psychological symptoms that occur are discussed in detail. There are set criteria and special clinical ones questionnaires, The key symptoms that are asked for are specified in the ICD-10 for schizophrenia:

1. Speech, input, withdrawal, propagation
2. Control or influencing delusions; Feeling of the made with regard to body movements, thoughts, activities or sensations; delusional perception
3. Commenting or dialogic voices
4. Persistent, culturally inappropriate or completely unrealistic delusion (bizarre delusion)
5. Persistent hallucinations of every sensory modality
6. Thoughts tearing or shifts into the flow of thought
7. Catatonic symptoms like arousal, postural stereotypes, negativism or stupor
8. Negative symptoms such as conspicuous apathy, speech deprivation, flattened or inadequate affect

The diagnosis of “schizophrenia” must include at least one distinct symptom (or two or more symptoms, if less clear) of groups 1-4 or at least two symptoms of groups 5-8, almost throughout one month or more.

Exclusion of other diseases

For example, schizophrenia-like symptoms may also be present in brain disorders (such as epilepsy, brain tumors), various mental disorders (such as depression, bipolar disorder, anxiety disorders) and intoxication (such as cocaine, LSD or alcohol). These must be excluded before the doctor can clearly diagnose schizophrenia. For this purpose, various investigations are necessary.

For example, by using Blood and urine tests Detect drugs and medications in the body that may be responsible for the condition. Blood tests also help to rule out a metabolic disorder or inflammation.

A Imaging examination of the brain Computer tomography or magnetic resonance imaging shows whether abnormalities in the brain could cause the symptoms of schizophrenia. If there is a suspicion of encephalitis during the examinations, then additionally the nerve water (cerebrospinal fluid) has to be examined (CSF).

In addition, the doctor can help with special tests Check the various brain functions, such as organizational thinking, memory and concentration.

Schizophrenia often occurs together with other mental illnesses (such as anxiety disorders, bipolar disorder, etc.). This can make the diagnosis more difficult.

Schizophrenia: treatment

Schizophrenia comes with drugs and one psychotherapy treated. The problem is that patients in acute schizophrenic phases lack insight into the disease. If there is a risk of the patient endangering himself or others, forced hospitalization may be necessary.

When an acute phase develops, the patient is first treated in a clinic to stabilize him. Afterwards, he can usually resume his own life at home.

Drug treatment of schizophrenia

Depending on the form and severity of the symptoms, different groups of drugs may be used to treat schizophrenia:

• Neuroleptics (antipsychotics): They were the first effective drugs to treat psychosis. By intervening in the metabolism of the neurotransmitters, they reduce tension and anxiety, delusions and hallucinations. However, neuroleptics have strong side effects such as muscle stiffness, tremors, muscle twitching, subdued emotions, fatigue, listlessness and reduced reaction speed.
• Atypical antipsychotics: These developments of the “classic” neuroleptics work better and have fewer side effects. Known representatives are risperidone and clozapine.
• antidepressants: In addition to the antipsychotic drugs (classic or atypical antipsychotics), the doctor sometimes prescribes antidepressants. This is useful in schizophrenia patients who are simultaneously depressed. Antidepressants have a positive effect on mood, drive and performance.
• sedative: During an acute psychotic phase, many patients suffer from severe anxiety. Then sedatives can help. However, since they are dependent, they are only used at short notice if possible.

Neuroleptics, in contrast to tranquilizers, can not make you addicted – neither physically nor psychologically.

Psychotherapy for schizophrenia

Psychotherapy is becoming increasingly important in the treatment of schizophrenia. It can have long-term positive effects on the course of the disease. Mostly a cognitive behavioral therapy is chosen. Important elements of psychotherapeutic treatment are:

Reduction of fears through information: First, it is important to the patient by detailed information on schizophrenia to take the fear of the disease. The relatives also benefit from more knowledge, for example by developing more understanding for the patient and thus better supporting him. It also helps a communication training, which facilitates the handling of the patient.

Dealing with stress and stressful situations: In therapy, the patient learns, among other things, better to cope with stressful situations that aggravate his symptoms. The central aspect is dealing with stress.

Processing frightening experiences: Using psychological schizophrenia therapy, the patient can also better handle the frightening experiences he has experienced during the acute stages of the disease. That stabilizes him overall.

Recognize early warning signs: In addition, patients learn to recognize the early warning signs of a schizophrenic phase. These can be very different. For example, sleep disorders or severe irritability often signal a new outbreak. It is then important to reduce the sources of stress and possibly in consultation with the doctor to increase the drug dose for a short time.

Support after the hospital stay

After a stay in hospital, the patient usually needs support at home. Take on this task social workers, They help the person affected to find their way in everyday life.

Many patients find that their ability to concentrate, their working memory, and the ability to plan ahead have suffered from the disease. Then one helps cognitive rehabilitation, She works with behavioral therapy as well as a special training on the computer. This increases the likelihood of re-entering the profession. In addition, disease insight and adherence to therapy are strengthened.

Schizophrenia in children

In most cases, schizophrenia only occurs after adolescence in adulthood. However, an estimated two percent of patients fall ill already in childhood and adolescence. However, schizophrenic disorders are extremely rare before the age of ten. As “early onset schizophrenia” (EOS) refer to physicians a first manifestation of schizophrenia between the 13th and 18 years of age. It is especially observed in male adolescents.

Because the disease is so rare in children children and adolescents, it is often discovered late. The fact that the symptoms of schizophrenia in children and adolescents differ from those of adult patients also contributes to this.

In addition, the personality of children or adolescents naturally continues to evolve. Mood swings are normal to a certain extent during puberty. However, if children and adolescents fall into prolonged depressive phases or if they have severe language and writing difficulties as well as delusions, a doctor or psychiatrist should urgently be consulted.

Schizophrenia: disease course and prognosis

The risk of developing schizophrenia is generally about one percent, Thus, an estimated 800,000 people in Germany live with the disease.

she meets Men and women alike, However, the disease breaks out earlier in men than in women. On average, they fall ill between the ages of 20 and 25, whereas women are between 25 and 30 years old. Why this is so, you do not know.

Since the course of schizophrenia varies greatly from person to person, there is no general prognosis, Some patients experience only a single acute phase of the disease, while others have a severe course leading to chronic schizophrenia. Again and again others have schizophrenic phases, which, however, abate thanks to the treatment. Most of the time, the acute symptoms get weaker over time. Nevertheless, schizophrenia must be often treated for a lifetime become.

The hebephrenic schizophrenia has a less favorable prognosis than the other forms of disease. It begins insidiously, but often becomes chronic and then proceeds without symptom-free phases. At the same time, the personality of patients is increasingly changing.

suicide risk

The fears that cause schizophrenia are often distressing for the patients. After a few relapses, those affected often go into deep hopelessness. This can even lead to suicide – the suicide rate among schizophrenia patients is about ten percent. Particularly at risk are young men. A good connection to therapists, family or friends is therefore particularly important.

Increased risk of other diseases

Statistically, patients with schizophrenia have a significantly increased risk of various other disorders. These include metabolic and cardiovascular diseases, cancer and lung diseases. Doctors should pay special attention to appropriate signs in schizophrenia patients.

Every fourth to fifth is healed

Since schizophrenia patients are treated with a combination of neuroleptics and psychotherapy, the prognosis of the disease has improved significantly. About 20 to 25 percent of patients will be well again with this treatment. But even if the patients are not completely cured, an outpatient care is often sufficient to lead a largely normal life despite the schizophrenia. The social environment has a great influence on this: If patients receive a lot of understanding and support from friends and family, this can positively influence the course of the disease.

Schizophrenia: information for relatives

If a person suffers from schizophrenia, it is extremely stressful for their relatives. In the acute stages, the patient lives in his delusional world and is barely reachable. Perhaps his delusion extends to the relatives, whom he subordinates to sinister intentions and encounters with mistrust.

At the same time, the relatives are important pillars for the patient. Their understanding and support are crucial to the disease process.

As a member of a schizophrenia patient, you should therefore accept offers of help that provide you with detailed information about the disease and how to deal with it. For example, it is important that you encourage the patient to be as independent as possible. In doing so, he must not be under- or over-challenged. Also a special communication training can be useful for you.

In addition, look for the conversation with the attending physicians and therapists and get advice if you are overwhelmed and do not know what to do next. Relatives can also be an important help. You can find out where you can find one in your area through the National Contact and Information Center (NAKOS) (www.nakos.de).

book recommendations

Arnhild Lauveng: Tomorrow I’m a Lion – How I Defeated Schizophrenia, btb, 2010