Schizophrenia belongs to the endogenous psychoses and is a severe mental illness. Worldwide, about 45 million people suffer from the disease. Different forms of schizophrenia exist:
- The most common is the paranoid-hallucinatory form with the delusional experience, hallucinations and ego disorders.
- This is followed by the catatonic schizophrenia with agitation, rigid posture or postural and speech stereotypies.
- Likewise, hebephrenic schizophrenia with onset in adolescence, a flat, incongruous, cheerfully limp affect, thought disorders (disordered thinking, indeterminate or bizarre speech) and drive disorders (apathetic or disengaged behavior).
- Undifferentiated schizophrenia, in which no clear assignment to the above forms is possible, is another form.
- In addition, there is the schizophrenic residual, in which still a schizophrenic symptomatology remains after at least one schizophrenic phase.
Negative and positive symptoms of schizophrenia.
The different forms of schizophrenia show different symptoms, which facilitate the classification. These are called negative and positive symptoms of schizophrenia. They can exist simultaneously-but positive symptoms often predominate during the acute phase of the illness, and negative symptoms predominate between episodes.
- Negative symptoms include impoverishment of speech, facial expressions, and gestures; an apathetic attitude; loss of the ability to feel pleasure; attention deficit disorder; and social withdrawal.
- Positive symptoms include hallucinations, a delusion, ego disorders such as thought aloudness and bizarre behavior.
Often, even before the first phase of the disease, there is a negative symptomatology, in which unusual behavior with social withdrawal occurs, for example, books on unusual topics are suddenly read, in adolescents, this phase is often accompanied by a performance kink.
Course and prognosis
Schizophrenias can progress in different ways: schizophrenic psychoses can occur acutely and dramatically or insidiously and hardly noticeable to outsiders. They can remain a one-off episode or determine further life at shorter or longer intervals. Most often, recovery occurs after a period of illness, but a wavelike, chronic course of the disease and a progressive event are also possible (rarest). Married patients in whom stress or acute, severe life events have led to an onset of illness have a good prognosis, as do patients with rare and short phases of illness who show an acute onset of illness and in whom early drug treatment of psychotic symptoms is successful. In contrast, divorced or separated male patients in social isolation with long and frequent phases of illness and insidious onset have a poor prognosis. Negative symptomatology, auditory hallucinations, and delusions that remain pharmacologically untreated for long periods also worsen the prognosis.
Importance of neuroleptics in schizophrenia.
Adequately prolonged and properly used drug therapy with neuroleptics, also known as antipsychotics, is particularly important. Sixty to 80 percent of those with the disease relapse within 2 years of their first hospitalization. However, if neuroleptics are given long enough, this relapse rate can be reduced by at least 50 percent, meaning that neuroleptics should be given for at least a year, even if the schizophrenia symptomatology has completely disappeared. A viable patient-doctor relationship helps patients understand their illness – both its origins, symptomatology and treatment methods, and the individual options they have to prevent relapse.
Other treatment for schizophrenia
Furthermore, drug therapy includes the use of atypical antipsychotics. Compared with typical neuroleptics, these often have a more favorable effect on subjective well-being, neurophysiologic performance, communication quality, and thus prevention of relapse due to their altered action profile. Modern treatment concepts also combine drug therapy with psychotherapy, trauma therapy and family therapy for patients, relatives and close caregivers. Psychoeducation also plays a major role.The knowledge imparted in the process makes it easier to deal with the disease and contributes to relaxation in the families. In addition, the patients’ readiness for therapy can be significantly increased and an approaching relapse can be treated in time.
Crisis Plan
A crisis plan that includes the patient’s individual early symptoms such as restlessness, nervousness and tension, sleep disturbances, difficulties at work, feelings of being overwhelmed, concentration or memory problems, and social withdrawal should be emphasized. The plan specifies what the patient can do, together with relatives or friends, when such symptoms occur, for example, increase the dose of medication, see the doctor. With these measures, which also include occupational and work therapy, vocational rehabilitation and assisted living, up to 60 percent of patients can still be permanently reintegrated (40 percent in their old job, 20 percent below their former level), and only 10 percent of patients become permanently unable to work.
