Schizophrenia – Medical ExpertsPsychoses are mental illnesses that are associated with Loss of reality, delusions and affective disorders accompany. The following sections provide comprehensive information about the different types of schizophrenia, their causes and treatment options. According to the Federal Chamber of Psychotherapists, schizophrenic psychoses are not rare diseases. They occur as frequently as, for example, chronic rheumatism. Every year, 0.5 to 1 percent of Europeans develop schizophrenia – Men are just as likely to be affected as women, but at a younger age.
Schizophrenia cases in Germany
122.134 cases in 2019
125.037 cases in 2022 ( prognosis )
Symptoms of schizophrenia
Doctors distinguish between positive and negative symptoms in schizophrenic illnesses.
To the positive symptomatology counts all symptoms from the area of experience and behavior, which do not occur in healthy people:
– Hallucinations – Delusions – Thought disorders – Ego-experience disorders
The Negative symptomatology, also called minus symptomatology, Includes symptoms characterized by a diminution or impoverishment of mental characteristics compared with healthy people. These include:
– A limited ability to experience emotions – the inability to feel pleasure (anhedonia) – reduced facial expressions and gestures – slowed thinking with less thought content – decreased interest and reduced activity
Diagnosis I: Forms of schizophrenic disorders
The World Health Organization (WHO) is responsible for the globally valid diagnostic catalog ICD (International Classification of Diseases). In the current version, the ICD-10-GM-2019, schizophrenic disorders are found under the code F20.ff. In order not to go beyond the scope of this article, only the main forms are described here.
The number F20.0 stands for paranoid schizophrenia. The primary symptoms are delusions and (usually auditory or visual) hallucinations An example: the patient is firmly convinced that he is being observed by the police. He cannot accept the objections of his friends that there is no plausible reason for this. Instead, he finds it easier to believe that his friends are also involved in the police action (delusion). The affected person hears voices whispering to him that he is being spied on (acoustic hallucination). Possibly sees spies sneaking around in the dim bedroom (visual hallucination).
F20.1 codes the hebephrenic schizophrenia. Here affective disorders are in the foreground. The affected persons are listless, their mood is flattened, the behavior is often inappropriate. Delusions and hallucinations occur only fleetingly. Hebephrenic schizophrenia is primarily a disease of adolescence and young adulthood. An example: A retail trainee feels increasingly unmotivated and exhausted. She has the impression that customers are watching her in an unpleasant way. Their concentration is disturbed. After work, she just wants to go home; she withdraws more and more from her circle of friends.In addition, she is convinced her work colleagues are talking about her behind her back and her boss can read her mind.
The catatonic schizophrenia (F20.2) is characterized mainly by psychomotor disturbances. Affected person compulsively adopts a certain posture or moves monotonously. Hallucinations can also occur. An example: A 50-year-old man sits in the dining room of an assisted living group with his back absolutely erect. The head is in his neck. He stares fixedly at the ceiling and talks to beings only he can see. During the conversation, he rocks his upper body left and right. At times he is unresponsive.
After a schizophrenic episode, many sufferers experience what is called a post-schizophrenic depression (F20.4). Residual schizophrenic symptoms are present and the patient suffers from typical features of depression, such as listlessness, recurrent negative thoughts, and dejection. During this phase of the illness, the risk of suicide increases significantly.
The FagileErcognition and TherapyZentrum for Psychotic Crises (FETZ) at Munich University Hospital has a Checklist (cf. Link, page 3) is developed, which asks for important warning symptoms. However, this test is in no way a substitute for a medical examination.
Diagnosis II: The medical examination
Only a specialist, such as a neurologist or psychiatrist, can make a reliable diagnosis. The physician takes the patient's medical history. Interviews the affected person in detail about his or her symptoms. The leading symptoms are:
– thought aloudness, – delusions of control or influence, – voices commenting or dialoguing, – persistent culturally inappropriate delusions, and – evtl. Negative symptomatology.
Depending on the individual case, relatives are also interviewed.
To confirm the diagnosis, further tests are performed:
– physical and neurological examination – blood count (inflammatory values, liver, kidney and thyroid values) – test psychological examination, such as memory and attention – drug screening – imaging procedures such as MRI (Magnetic Resonance Imaging)
schizophrenia – the causes
Research has not yet been able to conclusively explain the underlying causes of the mental illness. However, it seems to be a multifactorial disease process to act. As a rule, the bio-psycho-social model is used as an explanatory approach. It states that schizophrenia is caused by various factors (genes, environmental influences and personality structures) and their interactions.
A study from 2002 provides clear indications of the role played by the Genes Playing a role in the development of the illness: The closer a person is related to a sufferer, the greater their risk of experiencing a schizophrenic episode during their lifetime. In children with a parent with the disease, the risk of the disease is up to ten percent. In fraternal twins, the risk of developing the disease is 20 percent; in identical twins, the risk rises to 45 percent.
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Researchers have also been able to establish a connection between schizophrenia and brain damage in early life. These brain damages can already occur at birth. It is also believed that early childhood infections with herpes viruses, influenza virus, Borrelia, or the parasite Toxoplasma gondii may favor the onset of schizophrenic psychosis (P. Falkai: Diagnosis, etiology, and neuropathophysiology of schizophrenia. In: Neuropsychology of Schizophrenia. 1, 2008, S. 36-43.).
Studies of the brains of schizophrenic patients also showed that abnormalities in the anatomy. For example, many sufferers have significantly fewer nerve fibers in certain brain regions than healthy people. These include the amygdala, the entorhinal region and the hippocampus. These structures play an important role in memory. In the processing of emotions .
In addition, the researchers found a change in brain metabolism. Above all, the neurotransmitters (messenger substances) dopamine. Glutamate seem to be affected by the disorder.
In addition mind-altering substances promote the onset of the mental illness. In particular, the use of THC, an active ingredient in the cannabis plant, can trigger schizophrenia in people with a predisposition to it. The same applies to other psychotropic substances such as cocaine or alcohol.
In addition to neurobiology, genetics, and toxic factors, neuroleptics also influence psychosocial factors the development of the disease. According to Zubin and Ciompi's diathesis-stress model, various stressful situations together with other favoring factors can lead to the onset of schizophrenia in people with a genetic susceptibility to the disorder.
Schizophrenia – therapy options
Experts ame that schizophrenia is caused by cannot be completely cured. However, treatment can reduce the symptoms of mental illness. Improve the patient's quality of life.
In the acute phase drug treatment often indispensable. The drugs used are primarily from the group of psychotropic drugs, the so-called psychotropic drugs Neuroleptics, to use. These act mainly on the positive symptoms. Dependence is not to be feared. In the case of negative symptoms, the patients often receive Antidepressants or antianxiety drugs.
A non-drug treatment method is the Electroconvulsive therapy (ECT).During a short anesthesia, the patient receives electric impulses lasting a few seconds, which trigger an artificial seizure. These seizures lead to an increased release of neurotransmitters and alleviate the symptoms. The method is widely considered outdated or even brutal. Therefore, the German Medical Association published a statement explaining the benefits of EKP and the value of the method for patients.
Other therapy components include:
– occupational therapy, – regular exercise (sports groups), – psychotherapy and – imparting knowledge about the disease(psychoeducation). The treatment usually lasts several weeks. Takes place in a psychiatric hospital. Also the connection to a day clinic can be useful for some patients.
Once the acute phase of the illness subsides, the question of vocational rehabilitation arises. Depending on the state of health, assisted living groups are also available. A (temporary) job in a sheltered facility may be considered.
Self-help as an important pillar of therapy
Illnesses from the schizophrenic form circle mean an enormous load for the concerning and its surrounding field.
Regional self-help groups form a dense network for those affected to exchange information and support each other. Contact persons for information on regionally active groups are usually Caritas and Diakonie.
Relatives can find comprehensive information on the website of the Federal Association of Relatives of Mentally Ill People.
The Prognosis of Schizophrenia
The course of a treated schizophrenia can be compared with the Rule of thirds assess:
– In one third of the patients, the therapy leads to a clear improvement. – The second third shows no or only slight relief of symptoms. – One third of patients suffer from therapy-resistant schizophrenia.
The following factors indicate a favorable prognosis:
– acute onset of illness – short course – predominantly positive symptoms – intact social environment – a meaningful occupation
However, a complete cure cannot be amed.
– Falkai, P. (ed.) (2016): Praxishandbuch Schizophrenie: Diagnostik – Therapie – Versorgungsstrukturen (Practical Manual Schizophrenia: Diagnosis – Therapy – Care Structures). Elsevier Publishing. – Bauml, J. (2008): Psychoses from the schizophrenic form circle: Guide for patients and relatives, Guide for professional helpers, Introduction for interested laymen. Springer-Verlag. – Bailer, H. Aschauer, S. Kasper: Genetics of schizophrenia. In: Journal of Neurology, Neurosurgery and Psychiatry. 3, 2002, S. 25-31.