Is schizophrenia curable?

Schizophrenia is the main and best known psychotic disorder, suffered by around 1% of the world's population.

However, despite being relatively well known there are still a lot of mysteries and aspects to be investigated regarding this disorder. What is it? Why is it produced? And perhaps the most important question… does schizophrenia have a cure?

What is schizophrenia? Diagnostic criteria

Schizophrenia is a psychotic-type disorder characterized by the presence for more than six months of symptoms such as hallucinations (the most prototypical symptom, especially in the form of auditory hallucinations that are attributed to people or beings other than one's own self), delusions and disorganization of speech, which may also present symptoms as the praise and the abulia, chaotic behavior and catatonia. These symptoms generally appear in the form of psychotic outbreaks, and the disorder may have different courses (with complete remission or partial, with progressive deterioration ...), and generate significant interference in the life of the subject in all or almost all areas vital.

These symptoms are usually classified as positive and negative, with the former being those that activate the subject or add something to their normal functioning (for example, hallucinations Y delusions) and the second those that suppose a limitation of this one due to the diminution of faculties (case of the alogia and the poverty of the speech and of the thought).

Previously, the existence of different subtypes was considered based on the most characteristic symptoms, although in the latest version of the American reference manual, the DSM-5, has come to be regarded as a single diagnostic label.

What are your causes?

The causes of schizophrenia remain largely unknown to this day.. The influence of genetic factors has been observed, which generate a vulnerability that predisposes (but does not necessarily have to generate) to the disorder. Likewise, the environment also has a great influence, being the interaction between both factors what can trigger the disorder. The experience of highly stressful events or the consumption of some drugs can increase and trigger outbreaks in people with such vulnerability.

People with schizophrenia usually have peculiarities at the brain level, some of which are directly associated with the symptoms. Among them is the alteration of some dopaminergic pathways, the mesolimbic pathway and the mesocortical pathway being the most related. In the mesolimbic pathway there is an excess of dopamine which is associated with the existence of positive symptoms, while a deficit of this hormone in the mesocortical pathway is responsible for the negative ones. The knowledge of these cerebral alterations can and in fact is used in their treatment (especially with regard to the medical and pharmacological).

Currently some authors propose the hypothesis that schizophrenia is the result of a problem in the neuronal migration process, of how neural interconnections develop throughout development.

Is there a cure?

Schizophrenia is a disorder currently considered to be chronic, and there is currently no curative treatment for this condition. However, it is treatable: treatments and therapies are available to control symptoms and maintain stabilized the patient, preventing further psychotic breakouts from reappearing and allowing them to lead a life normal.

However, it is necessary that the treatment be carried out continuously throughout the life of the subject. This last point is important in order to prevent relapses, which are usually frequent when subjects, already feeling well, decide to stop treating and taking medication. Likewise, continuous monitoring allows to regulate or vary the taking of medication, in those cases in which the prescribed drug is not effective or has excessive side effects.

However, it is also true that this disorder is not unknown to science, there is still a wide room for improvement regarding its understanding. As with other chronic mental and organic disorders, there is still much to analyze and discover, being possible that a future will find a solution that can be considered a cure as such.

Treatments applied

As we have said, although there is no cure for the moment, schizophrenia is a treatable disorder, and said treatment is carried out in a multidisciplinary way. The joint use of both psychotherapy and psychotropic drugs is recommended.

1. Pharmacological and medical treatments

At the pharmacological level, antipsychotics or neuroleptics are mainly used.. The use of atypicals is especially recommended, since they allow to greatly reduce and control measure both positive and negative symptoms and do not have as many side effects as the typical. Pharmacological treatment must be maintained throughout the life of the subject, since it prevents the appearance of new psychotic outbreaks (although the type of drug in question, the dose and its level of effectiveness will depend on the person).

It may also be necessary to apply other types of medications, such as antidepressants, in cases where it is necessary due to the symptoms presented.

Regarding other medical procedures, although it is not a generalized practice, they are being tested different surgical techniques, such as the implantation of electrodes in certain areas of the brain (such as the nucleus accumbens).

2. Psychological treatments

At a psychological level, the treatments to be applied will depend on the problems manifested by the patient. One of the most fundamental aspects is to make the subject see the need to continue the treatment continuously, since many affected end up abandoning the medication. Another aspect that is fundamental is psychoeducation both to the subject and to the immediate environment, so that the situation is understandable for everyone of the subject, what it implies for the patient, the need for treatment or aspects such as symptoms that may be indicating the arrival of an outbreak psychotic. Family and social support is essential both to continue treatment and to face the disorder (still highly stigmatized).

Focusing on the symptomatology itself, in the case of hallucinations, the technique of focusing on voices so that little by little the subject learns to attribute them to himself and not to an entity external. The cognitive restructuring it is essential when trying to combat beliefs and delusions. It should always be kept in mind that it is about real mental content for the patient, and it is generally not advisable to use a direct confrontation. Both the form and the content of your hallucinations and delusions should be explored. It is important to take into account the meaning and origin that the subject attributes to them, so that these aspects can be worked on. Also, another therapy that generates positive results is acceptance and commitment therapy.

Social skills training or the incorporation of this in multimodal programs are highly recommended, since it is an area that tends to suffer in patients with schizophrenia. Occupational therapy may also be helpful, especially in cases of cognitive impairment.

The set of treatments presented above, although they do not represent a cure for schizophrenia, As we have said, they allow the patient to keep the disorder under control and lead a normal life.

Bibliographic references:

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona

• Vallina, O. and Lemos, S. (2001). Effective psychological treatments for schizophrenia. Psicothema, 13 (3); 345-364.