Schizophrenia is a mental disorder, which is characterized by abnormalities in the perception of reality. Its onset usually coincides with the onset of adulthood, but there are cases of early schizophrenia, including childhood. Diagnosis is based on the analysis of the patient's complaints and his behavior. Currently, there are no clinically approved laboratory tests for schizophrenia.
This disease is polyetiological, often genetically determined (possible generic binding disease). However, an important role in the disease manifestation (symptomatic manifestation) play environmental factors. Currently, the most common is biopsychosocial model of schizophrenia, which takes into account biological (heredity, organic changes of CNS structures), psychological (stress factors, injuries, etc.) and social factors (Searles, 2012).
The main biological factors of schizophrenia are primarily genetic predisposition and disorders of prenatal development. Heredity of schizophrenia is complex, with the possible interaction of several genes that increase the risk to a critical value or cause several pathological processes, folding into a single diagnosis. Studies indicate nonspecific detectable risk genes for schizophrenia: they can increase the likelihood of developing other psychotic disorders, such as bipolar disorder. In the literature there is also mentioning of the transfer of schizophrenia primarily through the male line.
Prenatal factors are most important during formation of fetal nervous system (first trimester). Interesting is the discovered dependence of the risk of schizophrenia and the season of birth: the disease is more common in those born in winter and spring (at least in the northern hemisphere). There is also provided evidence that prenatal (antenatal) infections increase the risk, which is yet another confirmation of a connection between disease and impaired fetal development.
As for the social factors, there is observed a strong correlation of schizophrenia risk with the degree of area’s urbanization. Another risk factor is the low social status, including poverty and migration in relation to social tensions, racial discrimination, family disadvantage, unemployment and poor living conditions. Experienced abuse and traumatic experiences in childhood also appear as an incentive to the future development of schizophrenia. It is believed that the risk is not affected by parenting, but its contribution can be made by a broken relationship, which is characterized by a lack of support.
Important socio factors provoking schizophrenia are also alcoholism and drug addiction. In some people, certain drugs can cause illness or provoke another attack. However, it is possible that patients use psychoactive substances in an attempt to overcome the negative feelings associated with the action of drug therapy, as well as with the disease itself, key features of which are considered negative emotions, paranoia and anhedonia, as it is well known that depression and stress levels of dopamine decrease. Amphetamines stimulate the release of dopamine and excessive dopaminergic activity, which at least partly causes psychotic symptoms in schizophrenia.
As possible reasons for the development and maintenance of schizophrenia, there may be a variety of different psychological mechanisms (GWAS, 2011). Cognitive distortions were found in patients and those at risk, especially under stress or in confusing situations, include excessive attention to possible threats, jumping to conclusions, the propensity to external attribution, distorted perception of the social environment and mental states, difficulty in distinguishing between internal and external speech, and the problems with low level of visual information processing and concentration. Some of these cognitive features may reflect the overall neurocognitive disorders of memory, attention, problem solving, executive function and social cognition, while others may be associated with specific problems and experiences. Despite the apparent flatness of affect, many patients react very emotionally to stressful and negative incentives, such sensitivity may account for susceptibility to the manifestation of symptoms of schizophrenia and the development of the disease. Content of delusions and psychotic experiences can reflect emotional causes of disease. Perhaps the development of safe habits in the behavior to avoid imagined threats contributes to maintaining chronic delusions.
Overview of the prognosis of schizophrenia has changed significantly since the beginning of the century after discovery of early dementia diagnosis. This attitudinal change is due to the revaluation of dementia concepts in schizophrenia and dementia as a diagnostic criterion for the disease. As for dementia as nosological feature, the its obligation suffered serious doubts with the inception of new systematics. Since there were pointed out cases of convalescence even in hebephrenia, it becomes clear that under rough dementia there was understood disorder of mental activity due to chronically flowing psychosis (e.g., catatonic, delusional dementia), not an irreversible degradation of the organic intellectual type (for example, with a progressive paralysis). This view was confirmed by its subsequent period of active treatment, especially psychopharmacology and different ways of social rehabilitation.
Thus, clinical and social prognosis must consider the likelihood of long or short periods of exacerbation of psychosis, the severity and the rapid development of the defect, as well as opportunities for social adaptation (family, work). One of the important prognosis criteria is to determine the actual form of the disease. So, certainly better prognosis is observed in episodic course and worst – in continuous. However, the last criterion is relative and applies to active, psychotic form (as opposed to flaccid).
Prognosis of the disease leaves a fairly wide range of possible outcomes, including social adaptation. It is this feature of the disease that opens up opportunities for secondary prevention and social and occupational rehabilitation. Known value for the prognosis have genetic data. Thus, the presence in relatives (especially close) of paroxysmal, especially affective psychosis, almost eliminates the development of continuous malignant forms, in which in the family environment there are most frequent anomalies of schizoid personality type, rather than deployed psychosis.
Currently, the main methods of treating schizophrenia are psychotropic drugs with antipsychotic, antidepressive, tranquilizing and stimulating effects. Shock treatments widely used in the past are now used on narrower grounds. All biological treatment methods are combined with psychotherapy and measures for employment and social adaptation. Rehabilitation measures – the desire to preserve personal activity with the maximum use of intact bonds and emotions – are binding principles at all stages of treatment, both in hospital and community. Socio-readaptation and rehabilitation approach significantly increases the efficiency of biological treatments.
Variety of clinical manifestations of schizophrenia excludes any one-two standard methods of treatment. The most important determinants of therapeutic tactics are the shape and type of flow, stage of disease, structure of the syndrome, which determines the patient's condition. Treatment of schizophrenia, given its tendency to chronicity and frequent recurrence, is long and includes both direct-therapeutic and supporting preventive effect (Brown & Derkits, 2010). Finally, we have to reckon with the peculiarities of individual patients responding to the drugs, and it requires individualization of treatment.
Rehabilitation complex activities are carried out at all stages of treatment in patients with schizophrenia. This complex includes the maximum possible limit of restraints for patients. For example, their stay in the enclosed compartment or observation ward, as well as active, along with the relief of acute symptoms of the disease, including occupational therapy, group therapy, and others. It is necessary to widely use medical leave with the ability to spend the end of the week at home or transfer patients to day hospital regime.
Of great importance is the unit labor patients with the necessary reorientation of goals and attitudes, especially when reducing disability. Employment should be adequate as patients. During the chronic disease and with residual psychopathology and personality defect, it is necessary to try labor and social adaptation of patients in special circumstances, where daily psychiatric observation is provided.
References
Brown, A. S., & Derkits, E. J. (2010). Prenatal infection and schizophrenia: a review of epidemiologic and translational studies. American Journal of Psychiatry, 167(3), 261-280.
Schizophrenia Psychiatric Genome-Wide Association Study (GWAS) Consortium. (2011). Genome-wide association study identifies five new schizophrenia loci. Nature genetics, 43(10), 969-976.
Searles, H. F. (2012). Collected papers on schizophrenia and related subjects. Karnac Books.
