TREATMENT OF SCHIZOPHRENIA

 

The term schizophrenia sounds like a severe endogenous-procedural mental illness, which is accompanied by acute polymorphic psychotic episodes and an increase in deficient symptoms and social and labor maladaptation between attacks.  The USA Best Doctors provide the best treatment in medical field.

To understand this complex crisis and very multifaceted disease, it is necessary to understand a few concepts that sounded above. First, endogenous is meant the presence in the human psyche and nervous system of some abnormal, painful (pathological) process that leads to the development and progression of the disease. This excludes a possible exogenous (external) cause (use of surfactants, toxic, infectious lesions, etc.) of the psychotic state.

Procedural means, literally, the presence of the process of disease development. In other words, schizophrenia is not an outbreak of inappropriate behaviour that occurs suddenly and passes without a visible trace to the human psyche. Instead, these are periodic polymorphic psychotic states that increase deficient symptoms and maladaptation between attacks.

Deficiency symptoms, also known as "defects," are probably the worst in this disease. The most pronounced, colourful, and violent psychotic episodes are just episodes that are quite successfully stopped at the present stage of the development of medicine (although it may take some time). But each such episode or lack of maintenance treatment in remission leads to increased apathy, lack of initiative, decreased willpower, emotional coldness, and monotony. As a result, a person loses the desire and opportunity to go to work, communicate with people, the range of interests and acquaintances over the year’s narrows, and as a result, a person may become disabled (schizophrenia - one of the diseases for which a disability group from III to I, when a person is not able to take care of themselves).

The only way to survive would be regular care and supervision of relatives or a typical stay in a psychiatric hospital. However, fortunately, everything does not always end so sadly. With timely diagnosis, the beginning of specific treatment, and the continuation of another as a supportive stage of therapy, modern medicine allows you to successfully control the disease and enable a person to return to a normal successful lifestyle. Then you can read about the main symptoms and methods of treatment of this disease.

The main causes of schizophrenia

Unfortunately, the real causes of schizophrenia remain a mystery to modern science. Schizophrenia is considered a multifactorial disease. In other words, there are many known and unknown factors that can affect the occurrence and course of the disease (environmental pollution, psychological trauma and prolonged stress, hereditary predisposition, low social activity, use of surfactants, etc.).

However, to identify among them one or at least a few basic is not possible. The mechanism of symptoms is considered to be an imbalance in the metabolism of the neurotransmitters dopamine and, to a lesser extent, serotonin in the brain (and as a consequence, treatment is aimed at controlling these processes), but this is only an explanation of symptoms, not the immediate cause of the disease.

Schizophrenia is inherited - is it transmitted?

Recent studies show that people whose blood relatives have had a mental illness (including schizophrenia) are statistically more likely to get it. However, this probability is not 100%, but much less (data from different studies differ). Moreover, it is believed that there is no "schizophrenia gene," but there is a set of other genetic factors that can increase the likelihood of the disease. Therefore, it is often impossible and impractical to trace "where it all came from" because it does not affect the nature of the treatment, and the transmission of such genes is possible for up to seven generations.

The main thing that is important to understand is that the diagnosis of "schizophrenia" is not a reason to abandon the prospect of having children. On the other hand, even healthy parents can develop schizophrenia, as the disease does not distinguish between well-being, status, and success.

Medical classification (types and types) of schizophrenia

Schizophrenia is divided into several types depending on the predominant symptoms and various kinds depending on the nature of the course. However, it should be remembered that this division is quite conditional and often has no significant impact on treatment selection. Therefore, in modern classifications of mental illness, it is proposed to abandon the division of schizophrenia into types, as it is not essential.

Before the general classification, it is necessary to allocate such diagnoses as "schizotypal frustration" separately. It used to be called "delayed schizophrenia." Still, then it was abandoned and characterized by schizotypal disorder with a mild course, low susceptibility to psychotic episodes, and often a positive prognosis due to a slight increase in deficient symptoms.

Types of schizophrenia:

Paranoid

characterized by a predominance of "paranoid" or insane symptoms, which may be accompanied by hallucinatory experiences in the form of well-known in society "voices," as well as anxiety, agitation, insomnia, inappropriate expressions, and behaviour.

Catatonic 

characterized by the presence of motor retardation to the point of stupor (a person can be for hours or days in a monotonous, seemingly fantastically uncomfortable or bizarre position, not responding to speech, refusing to eat), with a sudden spontaneous transition to meaningless, unfocused possible aggressive behaviour.

Hebephrenic

 characterized by a predominance of irrational, rude, inadequate, almost childish behaviour. Often accompanied by sexual retardation. Relatively poorly amenable to medical treatment.

Simple

 probably the most insidious kind. Characterized by the absence of psychotic episodes, the disease begins gradually and immediately with deficient symptoms. Insidiousness is when the person and others notice the signs of the disease when the process has gone far enough.

Types of flow

Continuous characterized by frequent psychotic episodes with virtually no periods of remission, a rapid increase in deficient symptoms.

Episodic or recurrent is characterized by serial psychotic states with long periods of remission and often no increase in deficient symptoms.

Paroxysmal -progradient (fur coat (from the word fur coat - a blow in German)) - occupies an intermediate position between the above types of flow.

The main symptoms and signs of schizophrenia

Most often, schizophrenia is characterized by a prodromal or incubation period that can last from several weeks to several years and is not accompanied by symptoms characteristic of schizophrenia. Still, during this period, you can see some features. Next, we will consider these features in detail. Still, it is worth remembering that the presence of one or even several such signs does not indicate the presence of schizophrenia but is only a reason for prophylactic purposes to consult a specialist.

The first signs of the disease may appear a few weeks or years (on average 2-3 years) before the full onset of the disease. These signs include:

• Valuable ideas and hobbies - a person begins to pay much attention to mystical, religious, and philosophical considerations, currents, up to "fanaticism." This is also called metaphysical or philosophical intoxication.
• Decrease in ability to productive activity (work, training) - is shown in the form of a reduction in motivation to action, a search of ephemeral sense in that occurs, the general decrease in inactivity.
• Changes in personality traits - a person's character traits can begin to change for no apparent reason.
• Decreased general activity, the need for communication, the desire for loneliness.
• Oddities in behaviour.

The presence of one or more such signs does not mean the presence of the disease, especially if such symptoms occur in adolescence, which is difficult in all senses of the word, which significantly complicates the diagnosis of the disease.

Directly the symptoms of schizophrenia are divided into positive (productive) and negative (deficient). Consider them in more detail.

Disorders of thinking are singled out. Characteristic of the spectrum of schizophrenic diseases manifested by a loss of purpose, the sequence of the logic of mental activity. Such thinking disorders are called formal, as they relate not to the content of thoughts but to the cognitive process itself. First of all, it concerns the logical connection between ideas. In addition, the imagery of thinking disappears, the tendency to abstraction and symbolism prevails, there are breaks in thoughts, general impoverishment of thinking or its unusualness with the originality of associations, up to meaningless. In the later stages of the disease, the connection between thoughts is lost even within a single phrase. This is manifested in the rupture of language, which turns into a confusing set of passages of words that are completely unrelated.

There is an illogical transition from one thought to another ("slippage"), which the patient himself does not notice. Disorders of thinking are also expressed in the emergence of new bizarre words, understandable only to the patient ("neologisms"), in fruitless reasoning on abstract topics, in sophistication ("reasoning"), and in the disorder of the generalization process, which is based on insignificant features. In addition, there are violations such as an uncontrolled flow or two parallel streams of thoughts.

It should be emphasized that formally the level of intelligence (IQ) in people with schizophrenic spectrum differs only slightly from the IQ of healthy people, i.e., intellectual functioning in this disease remains well preserved for a long time, in contrast to specific impairments of cognitive functions such as attention, ability to plan their actions, etc.

Less often, patients suffer from the possibility of solving problems and problems that require new knowledge. Patients choose words according to their formal features, without caring about the phrase's meaning, skip one question, and answer another. Some thinking disorders appear only in the period of exacerbation (psychosis) and disappear when the condition stabilizes. Others, more stable, persist in remission, creating the so-called. Cognitive deficit.

Positive (productive) range of disorders: pathological signs or symptoms acquired during the disease seem to be added to the patient's mental state before the infection. These include:

Paranoid syndrome (paranoid) - characterized by the presence of insane symptoms (delusional ideas). Delusional thoughts are conventionally divided into several types: the idea of ​​the relationship, persecution (known in society as "mania of persecution"), poisoning, special significance, influence, management. The content of these ideas can be very individual and colourful. For example, some believe that he is being watched by special services, distant relatives, and neighbours.

The very content of these ideas does not affect the nature of the treatment. However, the range of these ideas can affect the danger to the person and others. For example, if a person believes that his food is poisoned, he may completely refuse to eat according to his painful inner logic. At the same time, if a person believes that someone around him is doing these actions, it may seem logical to clarify the relationship with the "offender," which can end in conflict, aggression, and many vague statements to the police. Of course, a person does not always express such feelings aloud, but the presence of such ideas can be assumed by delusional behaviour. For example, abrupt refusal of food, communication with certain relatives, search in the housing of the listening equipment, a search of imaginary pursuers (, a door eye), protective actions (hanging of windows, barricading of doors). Brad can also be hypochondriac (inadequate interpretation of sensations in the body, confidence in the presence of serious and rare diseases, and combinations thereof).

Hallucinatory syndrome (hallucinations) - the presence of pseudo-hallucinations in humans (unlike real hallucinations, a person hears or feels hallucinations in his body and head). Most often represented by single or multiple voices of acquaintances and strangers in the head. Hallucinations can be periodic or permanent. The intensity or strength of hallucinations can also differ from barely audible and have little effect on the patient's condition to noisy. A person may fall into a hallucinatory stupor and not respond to external stimuli.

The content of these "voices," as delusional ideas, can be very individual, but they are generally divided into several types. First, commented - as the name implies, commenting on human actions and thoughts can be positive (joke, praise) and sharply negative (scold, humiliate).

Advised - offer a person to perform certain actions, productive or unproductive.

Imperative - in contrast to the previous type of voice command to take certain actions, resisting them is difficult, sometimes impossible. Acute hallucinations can be both neutral and force a person to harm others and themselves to commit suicide.

Hallucinatory symptoms are not always manifested by "voices," often in the form of bodily sensations, the feeling that external forces control the human body or psyche.

A person's interpretation of hallucinatory experiences can also be varied: some believe that the sensation results from exposure to electromagnetic rays, the influence of intelligence equipment, the influence of God or the Devil. The patient may also be accompanied by a sense of "openness" of their thoughts to others and belief in the ability to hear and influence the opinions of others.

As in the case of delusional ideas, people do not always express their feelings aloud, but their presence can be assumed by unusual behaviour. For example, the patient may not laugh, talk to himself or turn to an imaginary interlocutor, listen to something, look around, close his ears and turn on the music loudly to close off from these experiences.

Before negative (scarce) Circles are due to the painful process of "loss" of the powerful layers of the psyche, which is expressed in the change of character and personality traits due to the weakening of the integrative activity of the central nervous system, patients become lethargic, initiative, passive ("decrease in energy tone"), they lose desire, motivation, desire, growing emotional deficit, appears isolated from others, avoiding any social contacts. Sensitivity, sincerity, delicacy is replaced in these cases by irritability, rudeness, uneasiness, aggression. In addition, in more severe cases, patients have the disorders mentioned above of thinking, which becomes unfocused, amorphous, meaningless. Patients may lose so many former work skills that they have to register a disability group.

Differences in the symptoms of schizophrenia in men and women

There are no significant differences in the symptoms of schizophrenia in men and women. Men are more prone to aggressive tendencies and actions, women are prone to demonstrative behaviour, but given the high individuality in the manifestations of the disease, these features are extremely relative. It is believed that schizophrenia in women is more favourable, but it is not significant compared to the timely diagnosis and provision of qualified medical care.

Stages of schizophrenia

There is a prodromal (incubation stage) (from a few weeks to 2-3 years) when there are no obvious symptoms, but there are behavioural features described above. Most often ends with the emergence of psychosis or the so-called "debut" of the disease when the first appear meaningless and hallucinatory symptoms described above. The best doctors in USA provide more facilities in medical field.

Stage of "exacerbation" or psychotic states. It can begin suddenly and violently within several days and in several weeks or months with a gradual increase in symptoms. Very often, the first alarm signal is a sleep disorder, although it is nonspecific. Psychotic states (psychosis) can last from several days to several months depending on the individual, the severity of the disease, and the presence or absence of medical care. Psychotic states can be reduced (passed) without medical intervention (spontaneous biological remission) but often turn into chronic psychosis, which is difficult to treat and negatively affects the prognosis. At this stage, active treatment methods are used.

Remission is the stage at which the symptoms of schizophrenia are absent or minimal. If you follow the recommendations of experts and the presence of supportive treatment, it is possible to return a person to his usual way of life, social and labor activity. The quality and duration of remission depend directly on exacerbation (psychotic state) treatment and support the treatment phase. Maintenance therapy is not prescribed for several months in advance but should be monitored depending on the patient's condition. There are two important factors:

• Treatment should be sufficient to maintain the person in a normal state;
• Treatment should not interfere with a person's normal life and create excessive discomfort.

Attacks of schizophrenia

An attack of schizophrenia ("exacerbation") is a psychotic state (psychosis), which is accompanied by the appearance or intensification (if in a state of remission to achieve a complete reduction of symptoms is not possible) positive (productive) symptoms. The first psychotic episode in a person's life is also called the onset of the disease.

Manifestations of psychosis are very individual, both between patients and within one process. Psychosis can occur abruptly, literally over several days, and gradually over several weeks and months. It is very important for the patient to monitor his condition, as often, when others notice inadequacy in behaviour, painful symptoms have been present for some time. The sooner a person seeks help with symptoms of deterioration - the faster and more effectively manage to cope with the situation. Most often, one of the first alarming signs of damage is the deterioration of sleep, increased isolation, anxiety. Subsequently, this is joined by meaningless and hallucinatory symptoms. The greater the severity of symptoms, the less a person can control their behaviour and the greater the likelihood that he will cross the conditional "edge,"

In connection with the distortion of perception and mental processes, a person can perform various inadequate and aggressive actions, because according to his inner, painful logic (parallelisms), these actions are rational. Sometimes patients under the influence of the disease can commit crimes, cause property damage, themselves and others. A common mistake of relatives in such situations is to convince the patient of his painful experiences. As mentioned above, one of the characteristics of a ghost idea is the inability to rationally or logically convince a person. Therefore, attempts to demonstrate the falsity of experiences also fails.

For example, the patient claims that bandits who want to kill him hide behind the front door. When demonstrating that there is no one at the door, a person claims that the persecutors obscured around the corner. When no one is around the corner, it turns out that they are already on the roof or waiting at the front door, etc. Such attempts and the very fact of doubt in the reality of the patient's experiences can cause irritation, anger, conflict. In contrast, it is also impossible to "get involved" in painful experiences, confirm them, encourage them, and take an active part. Given the unpredictability and illogicality of inferences, relatives try to help so they can be involved in a crazy structure. As a result, the patient may commit verbal and physical aggression against them (demand and knock out confessions in conspiracy, betrayal, etc.

Treatment of schizophrenia

Thanks to the development of medicine, significant progress has been made in treating schizophrenia and mental disorders in general. The first drug and the first neuroleptic for treatment appeared in the 50s of the twentieth century, and it was chlorpromazine or Aminazine known in our region. For the first time, this drug allowed psychiatry to restrict the patient's freedom in anticipation of spontaneous improvement and affect the course of the disease directly. This drug is morally and obsolete but still occupies its niche in treating mental disorders and other emergencies. Another, perhaps much better-known drug is Haloperidol. There are many horror stories and myths about this drug (not all of them are unfounded), but it is still one of the most effective drugs to treat acute psychotic states.

A huge number of neuroleptics of various properties and characteristics were synthesized. They all occupy a certain niche or, in other words, are the keys to opening the castle of mental disorder.

As a result of the high individuality of people not only in the personal and characterological but also in the biochemical sense, the task of the psychiatrist is a selection of "the same key." Complicating the job is the fact that neuroleptics have a range of specific side effects. However, side effects are not allergic reactions, and to predict the occurrence of side effects, it is impossible to do a skin allergy test (such as with antibiotics).

These side effects include neuroleptic or extrapyramidal syndrome, akathisia, parkinsonism. They manifest in painful muscle spasms, such as the inability to perform normal movements, tremors, anxiety, restlessness, and restless physical sensations in the body and especially in the legs.

Inpatient treatment involves several important components.

The first component: sedation. Involves the use of sedatives as psychotic disorders may be accompanied by severe anxiety, agitation, insomnia. As a result of their actions, a person can calm down, finally sleep, less pronounced behavioural disorders. This component is very important and, in the early stages, plays a leading role. The patient's relatives can often be frightened by this stage as it is connected with the expressed drowsiness, inhibition, passivity. However, this is necessary, and it is important to remember that this phenomenon is temporary and will take place with the abolition of drugs without harm to the psyche and the body as a whole. Sometimes there is the opposite attitude: "it is enough for him / her to sleep so that everything passes." This is not true. After waking up, the symptoms flirt with renewed vigor. For this not to happen, the following component is important.

The second component: the fight against productive symptoms. For this purpose, neuroleptics of incisive action are used. They give a relatively little soothing effect. Their task is to correct the biochemical imbalance, which is the cause of delusions, hallucinations, emotional inadequacy. This effect is not instantaneous, and neuroleptics take several days to work fully. It is not uncommon for a person's condition to improve significantly after the first dose, but it is no less rare for the desired result to have to wait several days or even weeks. This component is associated with the highest probability of side effects and must be under strict control. Drugs actively used in the hospital do not always go to the maintenance treatment stage; very often, a much softer and more comfortable drug is selected for a person.

The third component: tonic therapy and control of vital signs. Mental illness sucks a huge amount of psychological and physical strength from the body. The person is exhausted, cannot sleep properly, and regain strength, appetite decreases. Therefore, it is necessary to fill the lack of vitamins, nutrients, fluids.

The fourth component: involvement of related specialists. Being in a sick state, a person tends to ignore cries for help from his body. As a result, exacerbation of chronic somatic diseases, acquisition of new ones, including injuries, is often observed. Fortunately, in the vast majority of cases, these are not serious complications or life-threatening situations. However, if there are problems and indications, the psychiatrist involves other specialists to provide complete care.

The final stage of inpatient treatment is the selection of maintenance therapy, which will promote the complete recovery of the person from the disease, maintain it in the norm and prevent possible exacerbations. Unlike many other areas of health in psychiatry, except for some conditions, it is not possible to "go to the hospital drip" once or twice a year for prevention. Maintenance therapy is a process that must be inseparable. Otherwise, it can lead to significant deterioration. The nature of maintenance therapy can be divided into two options: taking medication in tablet form and taking depot drugs.