Introduction to Schizophrenia

Schizophrenia refers to a mental ailment that modifies people's perceptions of reality. Individuals ill with the disorder abnormally interpret the world, resulting in hallucinations, delusions, unstable behaviour and thought patterns. It impedes basic functioning and hampers one's social life. In the past, schizophrenia was considered a demonic possession, and many had to suffer. Now, schizophrenia treatment options are plenty, and the number of patients returning to normal lives is very high.

What causes schizophrenia?

What exactly triggers schizophrenia remains inconclusive. Nevertheless, researchers point towards an amalgamation of genetic, environmental, physical and psychological elements that increase the likelihood of an individual falling prey to the condition. Certain individuals may be susceptible to schizophrenia leading to a psychotic event sprouting from an emotional or stressful life event. Even so, it remains mysterious as to why certain people are prone to the condition and others are not.

The following factors are said to increase the odds of individual developing schizophrenia:

Genes

While the condition is genetic, it is said to stem from a mix of genes rather than a single one, making individuals more prone to schizophrenia. Nonetheless, carrying these combinations does not guarantee its proneness. A study on various twins proves the genetic nature of the condition. In the case of identical twins (they carry matching genes), if one develops the condition, there is a one in two chance that the other twin would fall prey to it. The odds decrease to one in eight for fraternal twins with different genes. In the common masses, the chances are around one in a hundred. Researchers maintain that genes may not be the only factor determining the condition's likelihood.

Brain development

Research has revealed minute distinctions between the brain structures of those with and without the condition. Although these anomalies do not occur in every schizophrenic patient and maybe there in those without the ailment, it partly suggests that schizophrenia may be a brain disorder. 

Neurotransmitters

Neurotransmitters refer to chemicals responsible for transporting messages betwixt brain cells. Certain medicines ameliorate certain schizophrenia symptoms. Researchers argue that alterations in the magnitude of the neurotransmitters: serotonin and dopamine may lead an individual to develop the condition. While some deduce that schizophrenia stems from a disproportion between serotonin and dopamine, others point toward an alteration in one's body's sensitivity towards them as the condition's root.

Complications whilst pregnancy and birth

Schizophrenic patients are said to have encountered complications whilst and before birth resulting in an impact on the brain. These may include:

1. low birth weight of the newborn

2. early labour

3. asphyxia whilst birth

Triggers

Certain events called triggers may increase the likelihood of schizophrenia in those prone to the condition. They are as follows:

Stress

The primary psychological triggers leading to schizophrenia encompass stress-inducing life events like the following:

1. Loss or deprivation

2. Losing one's home or livelihood

3. Divorce or separation

4. A breakup

5. Physical, mental or sexual abuse

Although these factors do not directly cause schizophrenia, they are likely to increase its probability.

Drugs

Although drug abuse is not a direct cause of schizophrenia, studies reveal that it does increase one's proneness to it or a related condition. Drugs such as cocaine, amphetamines, cannabis and LSD can trigger schizophrenic symptoms in individuals prone to develop it. Cocaine and amphetamines trigger psychotic episodes and lead to an individual's relapse. Researchers have discovered that teens, as well as young adults indulging in marijuana, are susceptible to developing the condition at a later period in life.

How is schizophrenia diagnosed?

Mental health specialists use many tests to assess if a person has schizophrenia. Individuals who believe they might be showing symptoms of the same must see a practitioner immediately, who would check that the symptoms stemmed from the condition and not from other causes. Children suffering from their first schizophrenic episode must get mental health care as soon as possible. An early diagnosis aids in better chances of recovery.

If an individual is diagnosed with schizophrenia, a general practitioner will refer them to their local community mental health team or CMHT. A CMHT comprises professional practitioners that cater to many mental health ailments. A CMHT practitioner (mostly a nurse or a psychiatrist) would turn to a more in-depth examination of their symptoms and inquire about their background and current situation. Most professionals employ a checklist whilst diagnosing an individual.

The criteria for diagnosis are as follows:

1. experiencing one or more of these symptoms for most of a month: incoherent speech, hallucinations, delusions, emotional flattening and hearing voices.

2. comprehending that these symptoms are taking a toll on one's capability to study, work or do chores.

3. ruling out any other potential cause, for instance, bipolar disorder or drug use.

Related psychological conditions

In certain cases, whether the symptoms point towards schizophrenia or a related disorder may seem unclear. The mental health professional may believe the symptoms to be a sign of the following ailments:

Bipolar Disorder: Individuals suffering from bipolar disorder sway from periods of extreme activity, mania, and elevated moods to those of hallucinations, delusion and deep depression.

Schizoaffective Disorder: Practitioners often count this disorder as a type of schizophrenia owing to the similarity of symptoms with the condition. Stress is one factor that may trigger the schizoaffective disorder.

Seeking help elsewhere

Schizophrenic patients hesitate to seek professional help as their delusions take over their ability to think. As a result, they lose rationality, believe they are fine and don't require assistance. In such a case, a friend or family member should convince them to consult a GP, especially if they have suffered from their first acute episode. In addition, in an intensified schizophrenic episode, one might need to visit the emergency department to seek help from a psychiatrist. As a result, if they resist getting help, a relative may intervene and request an assessment. Therefore, Local social services may be helpful if the person has no previous experience. Severe cases may require the patient to be detained for examination and treatment in a hospital under the 2007 Mental Health Act.

Post diagnosis

A recent diagnosis of a relative or friend may seem daunting. One may be anxious about things surrounding the condition, such as the stigma or a lack of knowledge regarding techniques to provide care and support. Nonetheless, it is crucial to understand that being diagnosed is a step towards optimism. A diagnosis opens the door to awareness and treatment. 

Schizophrenia treatment options

 According to the NHS, schizophrenia treatment can be done in a wide variety of ways, depending on the situation and condition of the patient and their family. After assessing an individual, a psychiatrist assigns drugs used for schizophrenia treatment and therapy best suited for them. Community mental health teams (CMHT) are responsible for treating most patients with schizophrenia. They provide care and support and ensure that the patient retains most of their independence. A CMHT comprises pharmacists, social workers, psychiatrists and psychologists, occupational therapists, psychotherapists, counsellors and specialised nurses.

Care programme approach (CPA) as a schizophrenia treatment

CPA is for those who fall prey to complicated mental health illnesses like schizophrenia. It ensures that an individual does not require anything else from the treatment. CPA operates in 4 stages, namely:

1. assessment – one's social and health needs undergo scrutiny

2. care plan – an organised plan to cater to those individual needs

3. appointment of a key worker – a nurse or social worker is a coordinator between the patient and the CMHT

4. reviews – a periodic evaluation of one's treatment 

Acute schizophrenic episodes

In certain cases, a CMHT may not be able to cater to a more rigorous extent of care needed by an individual. People with severe symptoms from an acute schizophrenic episode may require special care coupled with antipsychotic medicine.

Crisis resolution teams (CRT)

Home treatments or CRT may be an option for treating schizophrenia. People with severe or acute mental health illnesses may turn to CRT for help. It's an option for those who want treatment in an environment with the least constraints, unlike a hospital. This is an option for patients as per the schizophrenia treatment guidelines. One may undergo treatment in less restrictive environments such as the patient's house, daycare centres and the like. Crisis resolution teams are also in charge of providing aftercare in an attempt to prevent a potential crisis.

According to the latest research in Schizophrenia treatment, CRT is very effective in a group of schizophrenia patients as it makes them comfortable and stress-free. The feeling of being in a hospital does not positively affect a patient's mind. In that case, CRT is the choice. 

Voluntary and mandatory detention

Detention in a mental asylum is the last choice for a physician during Schizophrenia treatment. Acute schizophrenic episodes that fall under the severe category may require mandatory detention in a hospital or clinic's psychiatric ward. If the psychiatrist concurs with the necessity, one may willingly admit themselves to a hospital. According to the 2007 Mental Health Act, one might need to serve detention on rare occasions. This is allowed if one's mental ailment is beyond severe and their safety and others may be at risk. Mandatory detention entails the detention of patients with schizophrenia.

Their progress determines an individual's period of stay, and they are required to stay at the hospital given that they are in immense need of treatment and arrangement of aftercare. Their progress is under review. This is to assess if the danger level has decreased to facilitate their release.

Advance statements

Suppose an individual is likely to suffer from a future acute schizophrenic episode. In that case, they may want to consult their care coordinator and write advance statements. Advance statements refer to sequences of directions formulated and written for friends and family in case of potential future schizophrenic episodes. These instructions comprise statements about what one would want them to do in that situation. They may also contain the contact details of their care coordinator.

Antipsychotics

Antipsychotics are the drugs used for schizophrenia treatment. Psychiatrists employ antipsychotics as the first step to creating an episode of acute schizophrenia. They suppress the impact of the neurotransmitter called dopamine on a schizophrenic's brain. They work best in alleviating symptoms such as aggression and anxiety in just a few hours of using them. Nevertheless, they require several days to several weeks to minimise delusions and hallucinations. Professional practitioners conduct an in-depth physical assessment of the patient before assigning them antipsychotics to find the right fit.

They are taken either in pill or injection form. Slow-release forms of antipsychotics are injected every two to four weeks. Doctors give antipsychotics until one's acute schizophrenic episode dies down; several people continue taking them for a year or two post their first episode to avert further episodes from occurring. Some take them for longer in case of reoccurrence.

Two primary forms of antipsychotics are:

1. Typical antipsychotics: formulated during the 1950s, typical antipsychotics are first-generation antipsychotics 

2. Atypical antipsychotics: formulated during the 1990s

A psychiatrist and patient jointly discuss the pros and cons of both antipsychotics to determine which one would be the best fit for them. Both cause side effects, the likelihood of which varies depending on the person. Typical antipsychotics may cause trembling, shaking, muscle spasms and muscle cramps. On the other hand, atypical antipsychotics may lead to dry mouth, blurred vision, drowsiness, constipation, weight gain, and absence of sex drive. One may tackle side effects by assigning alternative antipsychotics. If an individual is not satisfied with their current antipsychotics, they may also be assigned an alternative. One must not discontinue their medication without consulting their psychiatrist to prevent relapse. 

Psychological schizophrenia treatment

This treatment can encourage coping with symptoms such as delusions and hallucinations. Psychiatrists assign psychological treatment to help alleviate certain negative symptoms, including apathy and so on, of those ill with schizophrenia. These treatments, coupled with antipsychotic medicine, work best for schizophrenia. Arts therapy, family therapy and cognitive behavioural therapy (CBT) primarily employ psychological treatments to alleviate the condition.

Cognitive Behavioural Therapy (CBT)

CBT attempts to detect the thought patterns that contribute to undesirable behaviour patterns and feelings and encourages the cultivation of practical and realistic thoughts. A patient, for instance, may be coached to acknowledge their delusions and provided with strategies to abstain from acting upon them. Therefore, these one-hour sessions span over several months, depending on the severity of the condition.

Family therapy

Schizophrenic patients may turn to their families for comfort. Although most families provide support and care with pleasure, it may cause a strain to care for an individual with the condition.

Family therapy is there to aid those with the condition and family members who care for them. It attempts to alleviate the strain one may cause to those caring for an individual with schizophrenia. It entails a sequence of casual meetings over about six months.

These sessions involve:

1. Discussions and awareness of the condition 

2. Going over strategies for supporting and caring for someone with the condition

3. Discussing problem-solving techniques for practical problems which may crop up whilst looking after a schizophrenic

Arts therapy

This form of therapy aids in elevating creative expression. In addition, art therapists empower those with schizophrenia to express themselves and convey their experiences with the condition. Further, these are conducted either in small groups or individually. As a result, promoting non-verbal expression through arts may open the door for people with the condition to experience schizophrenia and encourage unique ways of relating to people. Therefore, arts therapies ameliorate certain negative schizophrenic symptoms in people.

How effective is schizophrenia treatment?

 In the past, schizophrenia was a non-curable psychological condition which was not even considered a psychological condition. Many thought that it was demonic possession. Even in the last century, it wasn't favourable for schizophrenic patients. Many had to suffer at the hands of early scientists. We all read the tortures Princess Alice of Battenberg had to endure at the hands of the famous Sigmund Freud. 

Those days are over; we are at a new level in schizophrenia treatment. There are plenty of schizophrenia treatment options available nowadays. As a result, the treatments are highly effective, and a vast majority of schizophrenia patients are living normal life.