Schizophrenia: hallucinations as an important symptomSchizophrenia is a mental illness that can manifest itself in many different ways. It affects both sexes with equal frequency worldwide. Occurs preferentially in young adulthood.
Schizophrenia is a group of various diseases of the mind. They all have in common the separation of essential areas of the psyche that normally work together (Greek. s'chizein: "to split off" and greek. phrēn: "mind, spirit"). The result is disturbances in certain areas of the psyche:
– Perception (sensory) – thinking – boundaries between the self and the environment (ego-environment boundaries) – emotional world (affect) – movement (psychomotor)
What is schizophrenia?
Schizophrenics often suffer from
strongly distorted perception and evaluation of reality. In severe cases, the diseased person is no longer able to distinguish between an internal reality and the external one. Nevertheless, it does not increase the risk of violent behavior. Instead, sufferers are much more likely to self-harm. Accordingly, the suicide rate in schizophrenia is significantly higher than in the rest of the population.
Schizophrenias occur worldwide. The frequency is comparable across all countries and cultures and is about one percent. There is also no difference in frequency between men and women. Almost all schizophrenias occur for the first time in young adulthood, the majority before the age of 30. Year of life.
If the disease is clustered in the family, the risk of the disease also increases. The risk increases with the degree of relationship and is highest when siblings or parents are affected by schizophrenia.
Common symptom of schizophrenia: hallucinations
Schizophrenia offers a colorful picture of a wide variety of symptoms. However, this is not a characteristic that is exclusive to schizophrenia. Therefore, in the history of this disease, several people have worked to compile a clear overview of the most common symptoms. The result is a few typical disorders that can be found in most sufferers:
Hallucinations belong to the group of perceptual disorders. In schizophrenia, they usually appear as hearing voices (auditory hallucinations). There are different types of voices that comment on the actions of the sufferer, have a conversation with him or give orders. Apart from hearing, all other senses can be affected. Thinking processes. The language. thoughts are disordered and often have no recognizable coherence (disjointedness). In conversation, for example, sentences are suddenly broken off (blocking) or words are invented that do not exist (neologism).
Delusions is a generic term for certain content-related thought disorders. The delusion is characterized by the fact that the affected person is absolutely convinced of something that seems impossible and cannot be diaded from it. Typical examples are delusions of persecution, delusions of poisoning and delusions of jealousy. In contrast to other disorders, delusions in schizophrenia are often even more bizarre and cannot be replicated. The delusion can go so far that the whole world is explained with delusional thoughts (delusional system).
Ego disorders include symptoms in which the boundaries between the self and the environment become blurred. For example, one's own body (depersonalization) or the environment (derealization) are perceived as alien. In some cases, the affected person feels like a marionette whose movements (external influence) and thoughts (thought inspiration) are made from the outside. In some cases, the ego disorders can go so far that there is a complete isolation from reality (autism).
Affective disorders are changes in the emotional world. It is the most common disorder in schizophrenia. Emotional contact with other people is usually diminished. The affected person shows inappropriate (parathymia) or few emotions (lack of affect).
Catatonic symptoms belong to the group of movement disorders that are triggered by the psyche (psychomotor). They can manifest themselves both as extreme agitation or as rigid immobility (stupor). In addition, there may be peculiar movements or postures. These symptoms are particularly frequent in the so-called catatonic schizophrenia.
The different forms of schizophrenia
Depending on which disorders are in the foreground, different subtypes of schizophrenia can be distinguished:
Paranoid schizophreniaThis form is the most common of all schizophrenias. It is characterized by disorders of perception. Above all, delusions and auditory hallucinations play a major role here. The preferred age of onset is between 30 and 40 years of age.
Hebephrenic schizophreniaIn the foreground are disturbances of the emotional world, primarily lame and indifferent behavior. This subtype is most commonly found in adolescence.
Catatonic schizophreniaIn this type there are predominantly disturbances of the movement. Most of those affected fall ill between the ages of 15 and 25. A life-threatening complication is the combination of rigidity with fever (pernicious catatonia).
Undifferentiated schizophrenia: Here none of the disorders is in the foreground. No classification can be made among the three most common forms.
In practice, doctors roughly divide the disorders into positive symptoms and negative symptoms. The positive symptoms are mainly hallucinations, thought disorders, delusions, ego disorders and movement disorders. They all have in common that in comparison to the normal state something is added. The emotional disturbances and social withdrawal are among the negative symptoms, because something is lost compared to the normal state. The negative symptoms in schizophrenia respond much worse to therapy than the positive ones.
Possible causes and triggers of schizophrenia
No physical causes can be demonstrated in schizophrenia. The fact that the disease occurs more frequently in some families suggests a genetic predisposition (polygenic inheritance). In addition, the childhood of those affected was often marked by problems in the family, such as abuse or neglect. In this way, the psyche is pre-damaged at an early age.
Major life events are often triggers for schizophrenia
However, the actual triggers are often drastic life events. This includes both stressful and relieving moments:
– Deaths – Separations/losses – Sexual encounters – Illness – Exams – Completion of education
Psychological vulnerability is a risk factor for schizophrenia
The entire development of schizophrenia is nowadays summarized in the so-called vulnerability-stress-coping model. According to this model, a mental susceptibility (vulnerability) already exists before the onset of the disease. Responsible for this is the interaction from the hereditary disposition. The development during childhood.
Throughout a person's life, there are constant changes in one's own body or in the environment (stress). As a rule, the psyche knows how to help itself with suitable coping strategies and fends off the stress (coping). In some cases, however, coping fails. The stress hits the psyche directly. The more susceptible the psyche is, the higher the risk that a mental illness will break out at such moments.
What tests are there for schizophrenia?
There is no single test for the diagnosis of schizophrenia. Instead, the doctor assesses whether, and if so, how many typical disorders are present. The more disorders are present, the more likely is the diagnosis.
In the case of schizophrenia, the diagnosis may only be made if other illnesses can be ruled out as the cause. All diseases that can impair the brain's function (organic psychoses) come into question:
Illnesses that can trigger signs similar to those of schizophrenia
– Fall or blow – Inflammations – Infections – Bleeding – Circulatory disorders – Poisoning – Withdrawal – Metabolic diseases – Tumors
Differentiating schizophrenia from depression
Differentiation from other mental illnesses, such as depression, is usually successful because the typical schizophrenic symptoms are absent. After other causes have been successfully ruled out, the diagnosis is based on the following criteria if they persist for at least one month:
– Ego disorders – Delusions – Persistent, culturally inappropriate or bizarre delusions – Auditory hallucinations – Persistent hallucination of other senses – Formal thought disorders – Catatonia – Negative symptoms, especially lack of emotion
The diagnosis can be made definitively if one of the first four or two of the last four criteria are present.
Treatment of schizophrenia depending on the severity of symptoms
The treatment of schizophrenia primarily involves the use of medication (pharmacotherapy). Here the typical. Focus on atypical antipsychotics. Both compensate for imbalances of neurotransmitters in the brain, as is present in schizophrenia. Their difference lies in the side effect profile. While typical antipsychotics are more likely to cause movement disorders, atypical antipsychotics are more likely to cause metabolic and cardiac arrhythmias. However, when the medication is discontinued at the end of the treatment, the side effects disappear again.
When the symptoms of schizophrenia have subsided, drug treatment is continued for several more months (maintenance therapy). This can reduce the risk of recurrence. In persistent cases, therapy must be continued for several years for this purpose.
The Catatonic schizophrenia Represents a special case of therapy. If the medication does not work sufficiently, it is recommended to consider electroconvulsive therapy as early as possible. This technique is performed under general anesthesia. Involves temporary memory impairment. However, there is no permanent damage.
Sociotherapy follows the therapy of schizophrenia
Psychotherapy is used to support. Its main purpose is to inform the patient about the disease and to give him courage and hope. Without the understanding of the disease, the willingness to cooperate is often very low. The most important goal of sociotherapy is to enable the sufferer to live as independently and self-determined a life as possible. It is primarily concerned with reintegration into the private environment, one's own home and job. For this purpose, the social skills of the sufferer can be trained. However, the majority of sufferers do not require sociotherapy after discharge from the hospital.
Prognosis for schizophrenia has improved
In about half of the cases, schizophrenia announces itself months to years before the illness with symptoms of other mental illnesses, such as anxiety, depression, mania, concentration or (prodromal stage).
The first episode of schizophrenia develops in two out of three patients within a short period of time. An episode usually lasts several weeks to months. Thereafter, symptoms regress completely or partially for a period of months to years. However, depression or fatigue may occur during this phase.
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Drug treatment has greatly improved the prognosis of schizophrenia. In most cases, it does not remain with a single episode, but in four out of ten people, the disease is cured after several episodes and never returns. When schizophrenia reaches a permanent state, symptoms increase initially but then do not get worse. As the person ages, the disorder usually becomes weaker and milder. In very few cases, the schizophrenic symptoms persist throughout life.
Schizophrenia is almost impossible to prevent
The causes of schizophrenia are not yet clearly understood. Therefore, specific prevention is not possible. However, an intact social environment plays a major role.
Schizophrenia predominantly affects people who are already prone to mental illness. This is partly due to a genetic predisposition, but also to the experience of dealing with other people. However, the prospects of recovery improve greatly for patients who receive a lot of support from friends and family during the illness. This is why doctors believe that you can prevent schizophrenia and other mental illnesses if you have established a functioning social network.