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Complications of schizophrenia


Schizophrenia - Symptoms and causes

Overview

Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning, and can be disabling.

People with schizophrenia require lifelong treatment. Early treatment may help get symptoms under control before serious complications develop and may help improve the long-term outlook.

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Symptoms

Schizophrenia involves a range of problems with thinking (cognition), behavior and emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized speech, and reflect an impaired ability to function. Symptoms may include:

  • Delusions. These are false beliefs that are not based in reality. For example, you think that you're being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you; or a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.
  • Hallucinations. These usually involve seeing or hearing things that don't exist. Yet for the person with schizophrenia, they have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.
  • Disorganized thinking (speech). Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad.
  • Extremely disorganized or abnormal motor behavior. This may show in a number of ways, from childlike silliness to unpredictable agitation. Behavior isn't focused on a goal, so it's hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
  • Negative symptoms. This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (doesn't make eye contact, doesn't change facial expressions or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience pleasure.

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present.

In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It's uncommon for children to be diagnosed with schizophrenia and rare for those older than age 45.

Symptoms in teenagers

Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be more difficult to recognize. This may be in part because some of the early symptoms of schizophrenia in teenagers are common for typical development during teen years, such as:

  • Withdrawal from friends and family
  • A drop in performance at school
  • Trouble sleeping
  • Irritability or depressed mood
  • Lack of motivation

Also, recreational substance use, such as marijuana, methamphetamines or LSD, can sometimes cause similar signs and symptoms.

Compared with schizophrenia symptoms in adults, teens may be:

  • Less likely to have delusions
  • More likely to have visual hallucinations

When to see a doctor

People with schizophrenia often lack awareness that their difficulties stem from a mental disorder that requires medical attention. So it often falls to family or friends to get them help.

Helping someone who may have schizophrenia

If you think someone you know may have symptoms of schizophrenia, talk to him or her about your concerns. Although you can't force someone to seek professional help, you can offer encouragement and support and help your loved one find a qualified doctor or mental health professional.

If your loved one poses a danger to self or others or can't provide his or her own food, clothing, or shelter, you may need to call 911 or other emergency responders for help so that your loved one can be evaluated by a mental health professional.

In some cases, emergency hospitalization may be needed. Laws on involuntary commitment for mental health treatment vary by state. You can contact community mental health agencies or police departments in your area for details.

Suicidal thoughts and behavior

Suicidal thoughts and behavior are common among people with schizophrenia. If you have a loved one who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

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Causes

It's not known what causes schizophrenia, but researchers believe that a combination of genetics, brain chemistry and environment contributes to development of the disorder.

Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren't certain about the significance of these changes, they indicate that schizophrenia is a brain disease.

Risk factors

Although the precise cause of schizophrenia isn't known, certain factors seem to increase the risk of developing or triggering schizophrenia, including:

  • Having a family history of schizophrenia
  • Some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development
  • Taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood

Complications

Left untreated, schizophrenia can result in severe problems that affect every area of life. Complications that schizophrenia may cause or be associated with include:

  • Suicide, suicide attempts and thoughts of suicide
  • Anxiety disorders and obsessive-compulsive disorder (OCD)
  • Depression
  • Abuse of alcohol or other drugs, including nicotine
  • Inability to work or attend school
  • Financial problems and homelessness
  • Social isolation
  • Health and medical problems
  • Being victimized
  • Aggressive behavior, although it's uncommon

Prevention

There's no sure way to prevent schizophrenia, but sticking with the treatment plan can help prevent relapses or worsening of symptoms. In addition, researchers hope that learning more about risk factors for schizophrenia may lead to earlier diagnosis and treatment.

By Mayo Clinic Staff

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Schizophrenia: What Are the Complications?

Written by Stephanie Watson

In this Article

  • Alcohol and Drug Abuse
  • Trouble Keeping a Job
  • Financial Problems
  • Thoughts of Suicide
  • Stress on Relationships

Schizophrenia can affect your life in many ways. It can impact your job, your relationships, and your finances. The large number of complications that come with schizophrenia make treatment so important.

Getting the right mix of medicine, therapy, and support early on will give you or your loved one the best chance to manage your illness and lead a more fulfilling life.

Alcohol and Drug Abuse

Substance use is a common problem in people with schizophrenia. One reason people use drugs and alcohol is to self-medicate. They think these things will relieve symptoms like depression and anxiety.

Though you might feel better for a short time while using drugs or alcohol, you'll feel much worse in the long run. Some drugs, like marijuana, can trigger psychotic symptoms and make you more likely to relapse after treatment.

If you've used substances to manage a mental illness, see your doctor. Treatments can safely relieve your schizophrenia symptoms and lower your desire to use drugs and alcohol.

Trouble Keeping a Job

Symptoms like hallucinations, delusions, and scattered thinking can make it hard to hold a job. People with schizophrenia are six to seven times more likely to be unemployed than those without this condition.

Working is important for many reasons. Not only does having a job let you support yourself, it also gives you a feeling of self-worth.

You'll be more likely to find and keep a job if you can get on a treatment to manage your symptoms. If you already work, you may qualify for job accommodations -- things that make it easier to do your work -- under the Americans with Disabilities Act (ADA).

Helpful accommodations for schizophrenia include:

  • A flexible schedule
  • Extra breaks during the day
  • Headphones to mask the noises around you
  • Memory apps
  • Counseling

Financial Problems

Without a steady job, it's hard to afford a place to live. Even though only 1% of Americans have schizophrenia, up to 20% of homeless people have this condition.

Just because you have schizophrenia doesn't mean you'll end up homeless. Getting on the right treatment will make you more likely to keep your job and stay financially independent.

Thoughts of Suicide

Suicide is a real risk among people with schizophrenia. Many who have this condition think about ending their life. Between 20% and 40% attempt suicide.

You're most likely to have suicidal thoughts during your first year of living with the disease, when everything still seems new and unknown. If you feel sad, hopeless, or worthless, or you've lost interest in life, see your doctor. Treatments can stop these upsetting thoughts and prevent you from hurting yourself.

Stress on Relationships

It isn't easy to meet new people when your moods are unstable, your behavior is impulsive, you feel anxious, and you have the urge to withdraw from the world. Even when you do meet someone you like, the stigma of your disease can make the person shy away from you.

Schizophrenia can lead to a much smaller social circle, especially if your symptoms aren't well controlled. Research shows that people who have more negative symptoms have fewer friends.

Loneliness is twice as common in people with schizophrenia than in those without it. Feeling lonely can have a wide range of effects on your health, including depression, heart disease, and Alzheimer's disease.

The challenges don't end if you're already dating someone or married. Mental illness can put a strain on relationships. And if you're in a bad relationship, it could make your schizophrenia worse.

Sex can be another issue. The antipsychotic drugs you take to manage schizophrenia could dull your interest in sex. If you're having problems with your relationship or sex life, talk to your doctor or a therapist.

Schizophrenia

Schizophrenia is a serious mental disorder in which the patient suffers from hallucinations (most often auditory), his interpretation of reality is distorted, delirium begins (false fixed beliefs), impaired thinking, behavior. The social activity of a person depends on the severity of the disease. Approximately 10% of patients commit suicide, about 80% experience depression at least once in their lives.

The average age of onset of the disease in men is 18 years, in women - 25. Over the years, the severity of the disease may decrease, the most difficult period is the first 5-10 years.

Contrary to popular belief, schizophrenia is not a split personality disorder.

This is a life-long chronic disease that requires constant treatment: medication and psychotherapy.

Synonyms Russian

Bleuler's disease, discordant psychosis, schizophrenic psychosis, latent schizophrenia, paranoid schizophrenia, dementia praecox.

English synonyms

Schizophrenia, Schizophrenic disorder, Schizophrenic psychosis, Dementia praecox.

Symptoms

12-24 months before the onset of the disease, in some cases, there may be slight distortions in perception, cognitive function, decreased ability to experience pleasure, difficulty in solving problems, irritability, suspicion, social isolation. In men, the first symptoms of schizophrenia most often appear at the age of 16-20, in women - at about 25. In childhood and after 45 years, schizophrenia begins extremely rarely.

Symptoms of the disease are divided into groups.

1. Positive symptoms.

  • Delirium - false beliefs. The patient may feel threatened, followed, followed. It may seem to him that excerpts from books, newspapers, films are addressed directly to him. The schizophrenic may believe that others are able to read his thoughts, that thoughts and actions are put into him by external forces.
  • Hallucinations are images that appear in the mind. They can be auditory, visual, olfactory, gustatory, tactile. The most common in schizophrenia are auditory: the patient can hear voices commenting on his actions, talking to each other, making critical or offensive remarks. Hallucinations can be extremely unpleasant for the patient and even lead to threatening consequences, for example, if voices order him to do something that could harm others.
  • Thinking disorders - disorganized thinking with incoherent speech, with constant transitions from one topic to another.
  • Inadequate behavior can be manifested by childish naivety, stupidity, excitement, inappropriate appearance and actions, unreasonable joy or sadness.

2. Negative symptoms.

  • Loss of interest in daily activities, neglect of personal hygiene.
  • Absence of emotions.
  • Violation of the ability to plan one's actions.
  • Social isolation, lack of facial expressions, expressionlessness of the face, lack of eye contact when communicating.
  • Poverty of speech: monosyllabic answers, laconicism.
  • Problems with comprehending information, abstract thinking, understanding social connections. The ability to solve problems, understand other people's points of view, and analyze one's own experience is lost.
  • Disorders of attention, memory.

Symptoms of schizophrenia often lead to a violation of the socialization of the patient: he may lose his job, family, friends, stop taking care of himself.

It is noteworthy that people with schizophrenia are often unaware of their illness and consider themselves healthy, refusing treatment.

General information about the disease

Schizophrenia is a serious mental disorder in which the patient has hallucinations, the interpretation of reality is distorted, there is delirium, thinking, behavior, and social adaptation are disturbed.

Although the causes of the disease have not yet been established, it is known that schizophrenia has a biological basis - damage to the brain structure: an increase in the ventricles of the brain, a decrease in some of its areas, a violation of the activity of biologically active substances (dopamine and glutamate).

It is believed that schizophrenia can be caused by genetic factors and factors affecting the fetus during pregnancy and childbirth:

  • genetic predisposition - if both parents have schizophrenia, the risk of developing schizophrenia in a child is 40%;
  • complications during pregnancy, childbirth or the first years of life, such as maternal malnutrition during pregnancy, flu in the 2nd trimester of pregnancy, Rh incompatibility of the child with the mother, low birth weight, hypoxia (oxygen deprivation), and others

Schizophrenia is a chronic disease that must be treated throughout a person's life. Approximately 1-2 years before the onset of the disease, distortions of perception and thinking of the patient may appear, difficulties in solving problems, irritability, suspicion, and social isolation are observed. The onset of the disease (delusions, hallucinations) can be sudden (over weeks or months) or slow (over several years). The severity of the disease can vary from mild to severe.

Types of schizophrenia course: a) episodic - with exacerbations and remissions, b) continuous. The most difficult period of the disease is the first 5-10 years from the onset of schizophrenia, after which approximately 10 years of stability occurs. Then the severity of the disease may decrease.

The following forms of schizophrenia are distinguished:

  • paranoid - characterized by delusions and auditory hallucinations, while thinking and emotional sphere do not suffer;
  • disorganized - characterized by disorganization of speech, behavior, inadequacy;
  • catatonic - impaired activity - either immobility or excessive activity and the adoption of frilly postures;
  • undifferentiated - a combination of various symptoms of the disease;
  • residual - when schizophrenia with pronounced symptoms is followed by a long period of moderately severe negative symptoms.

If left untreated, schizophrenia can lead to serious mental and behavioral problems:

  • suicide, harm to one's own health, about 10% of patients commit suicide;
  • depression - 80% of schizophrenics have it at least once in their lives;
  • abuse of alcohol, drugs;
  • homelessness, asociality;
  • aggressiveness - with delusional ideas of persecution; hallucinations calling for violence and non-compliance with the prescribed treatment.

Who is at risk?

  • Having relatives with schizophrenia.
  • Exposure to viruses, toxins, malnutrition (especially in the first and second trimesters) during the mother's pregnancy.
  • Persons who have undergone severe stressful situations, shocks.
  • Persons whose father's age at the time of conception was over 60 years.
  • Substance users.

Diagnosis

The diagnosis of "schizophrenia" is made by a psychiatrist on the basis of a long-term comprehensive study of the history of the disease, the mental state of a person, his behavior, the symptoms of the disease. There are no changes in the analyzes characteristic of schizophrenia.

Additional testing, including a neurological consultation, may be done to rule out other medical conditions or substance abuse.

Laboratory tests

  • Complete blood count
  • Thyroid-stimulating hormone (TSH), which characterizes the function of the thyroid gland.

In some situations, determination may be indicated:

  • Blood and urine levels of drugs and heavy metals
  • The level of cortisol, a hormone produced by the adrenal glands. With its excess or deficiency in the body, the mental status of a person can change.

Other research methods

  • Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain. These studies are performed in order to exclude volumetric formations of the brain, hemorrhages.
  • Electroencephalography (EEG). In some cases, an EEG is required, a research method that evaluates the electrical potentials of the brain.

In all cases, the extent of the examination is determined by the attending physician.

Treatment

Schizophrenia is a chronic disease that requires lifelong treatment, even if symptoms are rare and less severe. Treatment involves taking medications (neuroleptics), psychotherapy and rehabilitation of a schizophrenic.

The patient may need to be hospitalized in a neuropsychiatric dispensary, especially during exacerbations and attacks of schizophrenia.

Side effects of antipsychotics include weight gain, diabetes, and high blood cholesterol levels.

Rehabilitation of the patient is aimed at the socialization of the patient, instilling in him social skills, professional rehabilitation, training.

Prevention

There is no way to prevent schizophrenia.

People at increased risk of developing schizophrenia should stop using alcohol, drugs, psychotropic substances; avoid exposure to mental and emotional stress, overwork, lack of sleep. At the first signs of the disease, it is necessary to consult a specialist and begin treatment.

To prevent severe attacks and complications of schizophrenia, the treatment plan prescribed by the doctor must be strictly followed, lifelong therapy and periodic stay in a medical institution are possible to avoid attacks and exacerbations of the disease.

Recommended tests

  • CBC
  • Thyroid Stimulating Hormone (TSH)
  • Cortisol
  • Screening for the presence of narcotic, psychotropic and potent substances

Literature

  • Dan L. Longo, Dennis L. Kasper, J. Larry Jameson, Anthony S. Fauci, Harrison's principles of internal medicine (18th ed.). New York: McGraw-Hill Medical Publishing Division, 2011.

causes, forms, symptoms, signs, stages, diagnosis, treatment

Causes

Classification

Symptoms

Complications

Diagnosis

Treatment

Prevention

Schizophrenia is a chronic mental disorder characterized by a disturbance in the process of thinking, emotional reactions, and a distorted perception of the outside world.

Without treatment, the disease progresses, the patient's social maladjustment increases, followed by disability.

In order to relieve symptoms and establish a long-term remission, drugs are used, psychotherapeutic and physiotherapeutic methods are used.

Causes

Most scientists adhere to the version that schizophrenia is caused by a whole range of factors, including hereditary burden, adverse social and environmental living conditions.

Predispose to the development of the disease:

  • the presence of mental disorders in close relatives;
  • complicated childbirth in the mother;
  • past infection or poor nutrition during pregnancy;
  • psychological trauma experienced in childhood;
  • violation of the laying of a number of brain structures even before birth;
  • age from 18 to 30 years.

Schizophrenia in men appears earlier than in women. It is also worth noting that it is more common among urban residents than rural ones.

The neurotransmitter theory of the onset of the disease states that, in essence, schizophrenia is a consequence of impaired activity of neurotransmitters in the dopaminergic and glutamatergic synapses of the brain. The debut of the disease is often preceded by a long pathological process in the central nervous system, which lasts for several months or years.

The first psychosis can be provoked by the use of narcotic substances, psycho-emotional shock, prolonged experiences and nervous overload. In women, schizophrenia often manifests during pregnancy or after childbirth.

Classification

According to the international classification of diseases, there are seven forms of schizophrenia with different manifestations and prognosis.

The hebephrenic variant of the disease often debuts in adolescence or youth, is characterized by foolishness, pretentious, mannered behavior, disorganized thinking and speech disorders.

Paranoid schizophrenia is the most common. Positive symptoms come to the fore with its exacerbation. In most cases, paranoid delusions and auditory hallucinations predominate.

The catatonic form is distinguished by the predominance of movement disorders. Among the latter there may be stupor, lack of speech, episodes of freezing, sometimes with complete submission and the possibility of giving the sick person any posture (wax flexibility), periodically interrupted by short-term psychomotor agitation.

Simple schizophrenia proceeds slowly, without acute psychosis, with progressive negative symptoms. Apathy, emotional coldness, loss of initiative, drives and interests are growing. The patient becomes passive, uncommunicative, "withdraws into himself."

In cases where the scarcity or, conversely, the abundance of symptoms does not allow attributing schizophrenia to one of the known forms, it is diagnosed as undifferentiated.

Residual schizophrenia can be observed in patients who previously had episodes of acute psychosis with hallucinations and delusions, followed by a chronic mental disorder with the progression of negative symptoms. Post-schizophrenic depression appears immediately after psychosis and is characterized by a persistent decrease in mood along with mild residual manifestations of the disease.

Forms of childhood schizophrenia depend on the time of manifestation of the disease. At preschool age, negative symptoms predominate, autism increases, lack of interest in gaming activities, communication. Schizophrenia in children of primary school age is also manifested by isolation and emotional coldness, alienation from others. Patients can immerse themselves in their fantasies, live in a fantasy world. As they grow older, productive symptoms may appear, such as delusions, hallucinations, obsessions. Adolescents often have a hebephrenic variant, not only behavior changes dramatically, but also the social circle.

Conditions corresponding to various types of indolent schizophrenia (neurosis-like, psychopathic, "poor symptoms") are considered in the ICD-10 under the heading "Schizotypal disorder". They have manifestations similar to classical schizophrenia, but are more favorable in terms of prognosis, and are not accompanied by such profound personality changes.

Symptoms

Schizophrenia proceeds in several stages. Before the manifestation of the disease, the patient may have a prodromal period for months or years. At this time, the patient gradually loses interest in work, social life, and his own appearance. There may be non-specific disturbances in memory, thinking, speech, absent-mindedness, unexplained anxiety, mild depression. Characterized by introversion, perhaps a passion for philosophy, religion, the appearance of addiction to alcohol or drugs.

Symptoms of an exacerbation of schizophrenia or its manifestation depend on the form of the disease. During psychosis the following phenomena may be present:

  • delusional thoughts and obsessions, more often delusions of persecution;
  • hallucinations, mostly auditory, often with a complete separation from reality;
  • disorganization of speech and thinking;
  • the appearance of suicidal tendencies;
  • unreasonable fear, increased anxiety;
  • behavior inappropriate to the situation;
  • psychomotor agitation or limitation of mobility.

The residual stage in the interictal period is characterized by complete or partial remission of the disease. In the first case, there are no obvious signs of schizophrenia, the patient's critical attitude towards the psychosis he has suffered is usually restored, and personality changes are minimally pronounced. With incomplete relief, less obvious symptoms of a mental disorder persist. The patient is able to maintain orderly, socially acceptable behavior.
the moment of falling asleep.

Complications

The disease can progress with aggravation of negative symptoms, a growing personality defect. People with this course of schizophrenia are emotionally empty, not interested in the feelings of others, absorbed in their own experiences, being in a bad mood most of the time.

At the same time, the social isolation of such patients increases, they stop going to work or study, prefer a solitary pastime.

Ultimately, there may be loss of self-care skills and ability to function. During acute psychosis, a person can be dangerous to himself and others, commit suicide or murder.

Diagnosis

A psychotherapist or psychiatrist is engaged in the identification and treatment of the disease. Diagnosis of schizophrenia includes a conversation with the patient, and, if possible, his relatives and close associates. The patient's behavior, hereditary anamnesis, social status, existing complaints are analyzed. Symptoms of a mental disorder must be present for a month or longer.

Specially designed questionnaires, tests, scales are used to correctly assess the emotional and psychological status, determine suicidal tendencies, depressive disorders and clarify other parameters. For the purpose of differential diagnosis of schizophrenia with other diseases and the exclusion of an organic cause of psychotic disorders, a consultation with a neurologist can be prescribed, laboratory and instrumental studies have been carried out.

Treatment

When a diagnosis of schizophrenia is established, drug therapy is recommended to relieve acute psychotic symptoms and achieve long-term remission. Antipsychotics are the first choice drugs. Additionally, tranquilizers and mood stabilizers can be used.

Physiotherapeutic methods are used when medicines are ineffective. They involve the effect of an electric current or magnetic field on the brain.

Psychotherapy sessions are carried out outside the exacerbation of the disease. An important place in the treatment of schizophrenia is occupied by the social rehabilitation of such patients, education, psychological support by the patient's relatives and friends.

It is necessary to exclude factors that can cause a relapse of the disease and aggravate negative symptoms:

  • alcohol and drug use;
  • lack of family and social support;
  • condemnation from others;
  • stress;
  • insufficient sleep;
  • nicotine addiction.

Prophylaxis

Since the cause of schizophrenia has not been established, specific prevention measures have not been developed. Patients should be informed about the increased risk of developing mental disorders in their children. Early detection and treatment of the disease increases the patient's chances of establishing a long-term remission.

The author of the article:

Novikov Vladimir Sergeevich

psychotherapist, clinical psychologist, kmn, member of the Professional Psychotherapeutic League

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