A. Although this sounds a bit like a school project, I'm going to answer it so I can try to relay to you the complexity and the fascinating details of this unfortunate mental illness. I might just add that the first time I encountered a schizophrenic in a floridly psychotic state in the emergency room when I was a medical student was an experience I will never forget. What became strikingly obvious to me as I tried to talk with this woman was that she was clearly thinking and perceiving things in a way which was not only foreign to me, but that I could not understand. Her thought process was completely different than mine. Yet, this process and these perceptions (she was seeing fire swirling around the room) were undeniably and exceptionally real to her.
Schizophrenia is a disease which affects about 1% of people in the industrialized world. Its onset is most often seen in men and women in their teens, 20's or 30's. It is usually first noticed by family or friends who note a persons withdrawal from normal activity, social interests, and the people around them.
History
Descriptions of an illness consistent with todays understanding of schizophrenia date back to 1400 BC. In 1896 a German psychiatrist named Emil Kraeplin first used the term dementia praecox to describe a psychotic disease characterized by a severe disturbance in functioning. It began in adolescense and worsened throughout adulthood. He also noted a variety of forms of this disease. In 1911 a Swiss psychiatrist, Eugen Bleuler first used the term schizophrenia- a splitting of the mind- to describe these patients. He was referring to a splitting of the normally integrated psychological processes which had been postulated by Freud and Jung. Soon, the illness of syphillus became better understood. Interestingly, when people began to recognize tertiary syphilis (3rd stage disease) for what it was, it accounted for up to one third of patients considered severly mentally ill! So yet again definitions were refined.
Definition
As docs, we have a very strict set of criteria which must be met in order
to diagnose someone as schizophrenic. For this I refer you to the DSM-IV
(Diagnostic and Statistical Manual of Mental Disorders). What you find in
schizophrenia are disturbances of the following:
Causes
Many theories have been put forward over the years and many possible factors have been studied. Of the things we know for sure, a genetic predisposition to schizophrenia DOES exist. While the incidence in the general population is 1%, it rises to 8% if you have a sibling with schizophrenia, 12% if one parent is schizophrenic and 39% if both parents are schizophrenic.
With the discovery of the usefulness of neuroleptic drugs in the treatment of schizophrenics came a lot of research into the biochemistry of the disease. What we have found is that these drugs, which are proven effective, work by blocking dopamine receptors in the brain (dopamine is a chemical found in the brain, amongst other places). This has lead us to believe that an imbalance, an excess in dopamine production or function is somehow related to the symptoms of schizophrenia.
Other factors such as socioeconomic class, family development and dynamics, even month of birth have been implicated to play a role in the development of schizophrenia. But the evidence remains strongest for the genetic factor and the biochemical imbalances as two of the strongest causes of schizophrenia.
Treatment
Historically, people were treated with everything from induced coma (ie they put them in a coma for long periods of time), brain surgery, and electroconvulsive therapy ( ECT, commonly referred to as shock treatments). Although all of these have shown some degree of success, todays mainstay of treatment is family education, good social support, a good alliance with a therapist and medication. All of these together aim at avoiding acute episodes of psychosis, learning which stresses are too much for the patient and how to recognize the onset of troubling symptoms. The medications, primarily the neuroleptics, have helped reduce both the number of hospital admissions and the length of stay in hospital for these people.
Schizophrenia is a mental illness which strikes individuals often in their younger and primest of years. Its course is invariably chronic, and often progressive. Todays treatments, however, allow most schizophrenics to lead fulfilling, fairly individual lives. Understanding of the disease continues to evolve and understanding of the people with the disease will help contribute to their overall wellbeing.
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