Schizophrenia is a chronic, severe, and disabling brain disorder that has affected people throughout history.
People with the disorder may hear voices other people don’t hear. They may believe other people are reading their minds, controlling their thoughts, or plotting to harm them. This can terrify people with the illness and make them withdrawn or extremely agitated.

People with schizophrenia may not make sense when they talk. They may sit for hours without moving or talking. Sometimes people with schizophrenia seem perfectly fine until they talk about what they are really thinking.

 

Symptoms of schizophrenia

The symptoms of schizophrenia fall into three broad categories: positive symptoms, negative symptoms, and cognitive symptoms.

Positive Symptoms

Positive symptoms are psychotic behaviors not seen in healthy people. People with positive symptoms often “lose touch” with reality. These symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether the individual is receiving treatment. They include the following:

Hallucinations are things a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel. “Voices” are the most common type of hallucination in schizophrenia. Many people with the disorder hear voices. The voices may talk to the person about his or her behavior, order the person to do things, or warn the person of danger. Sometimes the voices talk to each other. People with schizophrenia may hear voices for a long time before family and friends notice the problem.

Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects, and feeling things like invisible fingers touching their bodies when no one is near.

Delusions are false beliefs that are not part of the person’s culture and do not change. The person believes delusions even after other people prove that the beliefs are not true or logical. People with schizophrenia can have delusions that seem bizarre, such as believing that neighbors can control their behavior with magnetic waves. They may also believe that people on television are directing special messages to them, or that radio stations are broadcasting their thoughts aloud to others.

Thought disorders are unusual or dysfunctional ways of thinking. One form of thought disorder is called “disorganized thinking.” This is when a person has trouble organizing his or her thoughts or connecting them logically. They may talk in a garbled way that is hard to understand. Another form is called “thought blocking.” This is when a person stops speaking abruptly in the middle of a thought. When asked why he or she stopped talking, the person may say that it felt as if the thought had been taken out of his or her head. Finally, a person with a thought disorder might make up meaningless words, or “neologisms.”

Movement disorders may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other extreme, a person may become catatonic. Catatonia is a state in which a person does not move and does not respond to others. Catatonia is rare today, but it was more common when treatment for schizophrenia was not available.

 

Negative Symptoms

“Flat affect” (a person’s face does not move or he or she talks in a dull or monotonous voice)

• Lack of pleasure in everyday life • Lack of ability to begin and sustain planned activities • Speaking little, even when forced to interact.

People with negative symptoms need help with everyday tasks. They often neglect basic personal hygiene. This may make them seem lazy or unwilling to help themselves, but the problems are symptoms caused by the schizophrenia.

Cognitive symptoms

Cognitive symptoms are subtle. Like negative symptoms, cognitive symptoms may be difficult to recognize as part of the disorder. Often, they are detected only when other tests are performed.Cognitive symptoms include the following:

• Poor “executive functioning” (the ability to understand information and use it to make decisions) • Trouble focusing or paying attention • Problems with “working memory” (the ability to use information immediately after learning it). Cognitive symptoms often make it hard to lead a normal life and earn a living. They can cause great emotional distress.

TreatmentAntipsychotic medications

• Chlorpromazine • Haloperidol • Perphenazine • Fluphenazine • clozapine • Risperidone • Olanzapine • Quetiapine • Ziprasidone • Aripiprazole • Paliperidone

Side effects of many antipsychotics include:

• Drowsiness • Dizziness when changing positions • Blurred vision • Rapid heartbeat • Sensitivity to the sun • Skin rashes • Menstrual problems for women. Typical antipsychotic medications can cause side effects related to physical movement, such as: • Rigidity • Persistent muscle spasms • Tremors • Restlessness.

Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements a person can’t control.

Psychosocial treatments

Psychosocial treatments can help people with schizophrenia who are already stabilized on antipsychotic medication. Psychosocial treatments help these patients deal with the everyday challenges of the illness, such as difficulty with communication, self-care, work, and forming and keeping relationships. Learning and using coping mechanisms to address these problems allow people with schizophrenia to socialize and attend school and work.

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Rehabilitation – Rehabilitation emphasizes social and vocational training to help people with schizophrenia function better in their communities. Because schizophrenia usually develops in people during the critical career-forming years of life (ages 18 to 35), and because the disease makes normal thinking and functioning difficult, most patients do not receive training in the skills needed for a job.

Rehabilitation programs can include job counseling and training, money management counseling, help in learning to use public transportation, and opportunities to practice communication skills. Rehabilitation programs work well when they include both job training and specific therapy designed to improve cognitive or thinking skills. Programs like this help patients hold jobs, remember important details, and improve their functioning.

Family education – People with schizophrenia are often discharged from the hospital into the care of their families. So it is important that family members know as much as possible about the disease. With the help of a therapist, family members can learn coping strategies and problem-solving skills. In this way the family can help make sure their loved one sticks with treatment and stays on his or her medication. Families should learn where to find outpatient and family services.

Self-help groups – Self-help groups for people with schizophrenia and their families are becoming more common. Professional therapists usually are not involved, but group members support and comfort each other. People in self-help groups know that others are facing the same problems, which can help everyone feel less isolated. The networking that takes place in self-help groups can also prompt families to work together to advocate for research and more hospital and community treatment programs. Also, groups may be able to draw public attention to the discrimination many people with mental illnesses face.

It consists of bringing patients face to face with reality of the disease. The goal of intervention is also confrontation that is to break through feeling of denial and help the patient recognize the adverse consequences likely to occur if the disease is not treated. This step involves convincing the patient that they are responsible for their own action, while reminding them of how alcohol/drug has created significant life impairments. It also maximizes the motivation for treatment and continuous abstinence.

Detoxification
It is the control withdrawal, wash out of the substance from the system. The withdrawal occurs because the brain has physically adapted to presence of the particular drug and cannot act adequately in its absence.

Replacements are used.

Counselling
It focuses on day to day life issues to help patient maintain a high level of motivation for abstinence and to enhance their functioning. Counselling deals with how to build a lifestyle free of alcohol/drugs.

Counselling is done in two ways:
Individual
Group

Counselling helps to develop modes of coping to be used when craving for alcohol/drug increases and when any event of emotional state makes a return to addiction.

Recovery is a process of trial and error, patient uses slips that occur to identify high risk situations and develop more appropriate coping techniques.

Most treatment efforts recognize that the affect of alcohol/drug has a significant effect on relationships and important aspect of recovery involves helping family members and close friends understand the disease and realize that rehabilitation is an ongoing process that last 6-12 months.