What is schizophrenia?

One of the most misused psychiatric terms is the word "schizophrenia". This disease is often incorrectly used to describe a person with strange ideas and/or behaviour or someone with a "split personality". 

Emil Kraepelin (1856 - 1936) first described this disease at the beginning of this century and the name "schizophrenia" was used in 1911 by Eugene Bleuler (1857 - 1939).

What is schizophrenia?
Schizophrenia is a chronic disease which has a cyclic course in which there may be several episodes of acute psychosis. The psychotic episodes, when the person loses contact with reality, are characterised by several symptoms including hallucinations, delusions and unusual thought content.

Hallucinations are abnormalities in perception where one may, for example, hear voices speaking inside one's head, or one may see things which do not exist.

Delusions are beliefs that a person firmly believes in and cannot be convinced differently, despite logical arguments or proof to the contrary.

These thoughts may are often be based on reality, but with incorrect interpretation of the situation. A person may believe that he is the president (presuming of course that he is not!!), that everybody is against him or that the television is broadcasting his thoughts to all the people in his neighbourhood.

A person suffering from schizophrenia often lacks social interaction with people in his family and his friends. These patients become socially isolated and the withdrawal may be to the extent that he refuses to get out of bed or eat a meal.

These patients have poor self-care and are therefore often untidy on themselves.

What causes schizophrenia?
It is estimated that 1% of a population may suffer from schizophrenia, but the disorder is more prevalent in families where schizophrenia has previously been diagnosed.

The disease is caused by abnormalities in the chemicals in the brain (the neurotransmitter, dopamine) and is mostly a treatable condition.

There are several ways to optimalise the treatment and the role of family members and other loved ones must not be underestimated in improving the patients' quality of life and the outcome of the treatment.

Medication, stress management, education and information are integral in improving the treatment of schizophrenia.

The treatment with medication consists of antipsychotic drugs. The antipsychotics initially bring the acute psychosis under control and thereafter, often at a reduced dose, maintain the apsychotic state.

These drugs, as all medication, have side effects and these can be minimised by using the correct dose and by taking the medication regularly. The side effects can also be treated with medication if they interfere with the patient's functioning.

In recent years the "new generation" antipsychotics have been developed. These drugs seem to be more effective in reducing social isolation and withdrawal of patients and have been proven to cause significantly fewer side effects than their predecessors.

As soon as the patient has responded to medication and the abnormal thoughts are under control, psychoeducation should be started.

The goal of psychoeducation is to fully inform the patient and the relatives about the disease and all other aspects of treatment. Topics that should be addressed during the psychoeducation are the early recognition of schizophrenia symptoms, the prevention of recurrence of the psychotic episodes, the role of medication and side effects.

This information is essential for the patient to understand why he needs the medication and that it will be administered for many years until the disease is later fully under control.

If the patient is not informed adequately about potential side effects he may stop using the medication without consulting the psychiatrist for advice.

To improve compliance to treatment the relatives need to be given as much information about the disorder as possible. In this way they will understand the patient better and therefore be able, and willing, to help in the long-term encouragement and treatment of the patient.

Although this disease has received much negative media attention, it often has a favourable outcome. There have recently been major advances in the treatment of the disorder with the development of the new generation antipsychotics.

This gives even more hope for a successful outcome in the treatment of schizophrenia.

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