What is schizophrenia? Symptoms and Treatments

If someone talks to us about mental disorder, probably one of the first words (possibly along with depression) that comes to mind is the one that gives this article its title: schizophrenia.

And it is that this disorder is one of the best known and probably the one that has published the greatest amount of literature, existing vestiges and stories that suggest since ancient times that different people (who were even considered possessed by spirits) manifested strange visions, thoughts, behaviors and expressions that largely coincide with the symptoms of this disorder. Throughout this document we are going to talk about what schizophrenia is, how it affects those who suffer from it and how it is treated.

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What is schizophrenia?

Schizophrenia is one of the best known mental disorders at a general level, and the main one of the psychotic type disorders. We are facing an alteration that supposes and generates an important alteration in the life of those who suffer from it, requiring a series of criteria to diagnose the compliance.

Thus, the diagnosis of this mental disorder requires that at least two of the following symptoms (and each for at least a month): hallucinations, delusions, language alterations and disorganizations, catatonia or negative symptoms such as allergy, affective flattening and / or abulia.

Perhaps the most common and prototypical symptom is the presence of hallucinations, generally of an auditory nature and in form of second-person voices, which may be accompanied by self-referential delusions, persecution, and theft, implantation or thought reading.

It is important to keep in mind that these hallucinations are not something invented: the subject really feels them as something external. However, it is usually their own thoughts that are experienced as coming from outside (it is speculated that they may be due to the disconnection between prefrontal and speech regions that hinders self-awareness of subvocal speech) or abnormal noise interpretations exteriors.

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Positive and negative symptoms

The predominant psychotic-like symptoms in schizophrenia they have generally been grouped into two broad categories, positive and negative symptoms, which have different characteristics and effects on the patient.

The positive symptoms would refer to those alterations that suppose a exacerbation or alteration of the capacities and habitual functioning of the patient, generally adding something to said performance. An example of this would be hallucinations, delusions and strange behaviors).

With regard to negative symptoms, they will refer to those alterations that suppose a loss of existing skills previously. This is the case of alogy or impoverishment of thought, affective flattening or apathy.

Course of psychopathology

Schizophrenia is currently considered a chronic disorder. This disorder usually takes the form of shoots, although there are cases in which they do not arise as such but that there is a constant deterioration. Psychotic outbreaks generally appear, in which positive symptoms such as hallucinations and agitation abound, after which there is generally a complete or partial remission.

A single psychotic outbreak with complete remission may occur, although several usually occur throughout life. As we have indicated, there may be complete remission, but there may also be cases in which said remission is partial and symptoms and cognitive impairment remain. This deterioration can remain stable or be in progress (which is why Kraepelin called this disorder dementia precocious).

Difficulties

The suffering of schizophrenia can have a great number of consequences and generate severe difficulties. And it is that the set of symptoms described above significantly interfere with the functioning habitual of the subject in the day-to-day, in areas such as interpersonal relationships, work or the academic.

Social interactions are often reduced and greatly affected, and skill and employment and even academic possibilities can also be greatly altered, especially if there is a deterioration. Subjects with schizophrenia tend to present attention and information processing problems, especially in those cases with negative symptoms. Their performance in tasks of sustained or selective attention is lower.

In addition, it is necessary to take into account the effect that the diagnosis itself has on the subject: schizophrenia is a disorder considered chronic and that to this day it is still highly stigmatized, even by the very people who suffer from it. The diagnosis is a very hard and traumatic moment for the subject, and it is possible that depressive symptoms and / or a period of mourning, denial of diagnosis and opposition to treatment may appear. This last aspect is especially important, since psychotic outbreaks are greatly reduced or prevented with treatments.

Are there types of schizophrenia?

Until relatively few years ago, within schizophrenia we could find a series of typologies that referred to a predominant type of symptomatology or a specific disease presentation form.

Specifically, paranoid schizophrenia (focused on hallucinations and delusions of a persecutory and referential nature, along with aggressiveness and other alterations), disorganized (whose main characteristic is chaotic and incoherent behavior and thinking and flattening and affective inadequacy) or catatonic (in that the most prominent problems were psychomotor alterations, with mutism and immobility as well as waxy flexibility and agitation), together with the residual (in which the subject had recovered from an outbreak with the exception of some symptoms that remained, generally of a negative type) or the simple one (with a prevalence of negative symptoms, such as allergy and affective flattening).

However, in the latest version of one of the most widely used manuals worldwide, the DSM-5, this distinction was no longer made in order to agglutinate all subtypes into a single diagnostic entity. Despite this, it is a decision that is not shared by many professionals, who criticize this measure. In fact, some people propose that more than schizophrenia we should talk about psychotic spectrum disorders, in a similar way to what has happened with autism.

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Hypothesis regarding its causes

The causes of this disorder, like those of many others, are still largely unknown to this day. Despite this, they have been elaborated throughout history different hypotheses about what may trigger schizophrenia.

Biological hypotheses

On a biological level, what is known is that people with schizophrenia present alterations in the levels of dopamine in certain brain pathways. Specifically, those subjects who present positive alterations such as hallucinations or delusions present an excess or hyperfunction of the synthesis of dopamine in the mesolimbic pathway, while negative symptoms have been related to a deficiency of this hormone in the mesocortical dopaminergic pathway. However, the reason for this phenomenon is still unknown.

Cerebrally, it has been observed that there are differences such as a decreased blood flow to the front areas of the brain, differences between the two temporal lobes and a smaller volume of some structures such as the hippocampus and the amygdala, as well as larger brain ventricles.

It has been observed that genetics seem to play a role, often seeking the involvement of different genes in the onset of the disorder. Research shows that there does appear to be a genetic predisposition linked to a greater vulnerability to suffer it, although the disorder does not have to be triggered. It will be the set of vital circumstances that surround the individual that determine whether or not said predisposition awakens the disorder.

To date, one of the most widely considered hypotheses is that we are facing a problem in neural migration throughout development that generates alterations that end up stabilizing and that would only come to generate manifestations in the presence of stressors or hormonal changes such as those produced by the passage to adulthood.

Another hypothesis links it to the existence of viral infections during pregnancy, based on the fact that many subjects with this disorder are usually born in winter and that different conditions such as the flu could cause alterations at the level cerebral.

Psychological hypotheses

In addition to the biological hypotheses, there are others of a much more psychological nature that must be taken into account, although these are not hypotheses that are necessarily mutually exclusive.

The best known and most prevalent model that is employed in the psychological explanation of schizophrenia is the diathesis model (or vulnerability) -stress. This hypothesis establishes the existence of a stable and permanent vulnerability, partly biological and partly acquired, to suffer from this disorder and present information processing problems or problems of social competence and management of the stress. These subjects will face different types of stressors on a day-to-day basis, such as life events or other circumstances. more permanent (such as a very critical family environment or with excessive expressed emotion to which they should adapt. But depending on the circumstances, it may happen that they fail in this adaptation and cannot adjust, this ends up generating the triggering of the disorder.

Some of the oldest theories, of character psychodynamic and especially linked to paranoid-type schizophrenia, consider that the causes of the disorder can be found in the presence of deep psychic conflicts from which the subject defends himself through projection (placing one or some of the own characteristics in another person) and denial of the conflict, which sometimes end up generating the dissociation of the mind with reality. However, these explanations have no scientific value.

Treatment

Schizophrenia is a chronic disorder that has no recognized cure as such at the moment, although symptoms can be treated in such a way that those who suffer from it can have a normal life and remain stable, preventing the appearance of outbreaks.

To do this, however, the treatment must be continued throughout the life cycle of the subject in order to prevent the appearance of new shoots. In general, drugs known as antipsychotics are used for this, which act by treating excess dopamine in the via mesolimbic and, in the case of those classified as atypical, also improving the negative symptoms by increasing the levels of said hormone in the mesocortical pathway.

We also work from the psychological field, with therapies such as targeting to work on the auditory hallucinations or cognitive restructuring to change cognitions and beliefs (delusional and / or on the own disorder). Also social skills training and sometimes counseling and job reintegration can be of great help to combat the difficulties generated by the disorder. Finally, the psychoeducation of the subject and the environment are fundamental.

Bibliographic references:

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
• Santos, J.L.; García, L.I.; Calderón, M.A.; Sanz, L.J.; de los Ríos, P.; Izquierdo, S.; Roman, P.; Hernangómez, L.; Navas, E.; Ladrón, A and Álvarez-Cienfuegos, L. (2012). Clinical psychology. CEDE PIR Preparation Manual, 02. CEDE. Madrid.
• Vallina, O. and Lemos, S. (2001). Effective psychological treatments for schizophrenia. Psicothema, 13 (3); 345-364.