Indian Psychiatry schizophrenia

Definition: Schizophrenia is a psychotic illness which is manifested in its acute/active phase by delusions, hallucinations and disturbance of other mental processes. The residual psychiatric symptoms in cases which run a chronic course comprise of what are known as negative symptoms. These are: impaired/restricted social functioning, loss of drive or motivation, reduced display or experience of emotion, and neglect of self care.

• Prevalence worldwide is 2-4 cases per thousand population • 10-20 new cases per 1,00,000 population per year • One in 100 people will develop schizophrenia in their lifetime • Average age of onset is 25 years, it is found to occur early in males as compared to females • Sex ratio is same • More common in those who are single or divorced • More common in social classes IV and V

• Family history (although no major genes have been identified), the lifetime risk of developing schizophrenia by relatives of those who already have schizophrenia is roughly as follows: Parent -------------------------------------- 6% Siblings (brothers or sisters)--------------10% Child (one parent with schizophrenia)---14% Child (both parents with schizophrenia)-46%

Clinical features: It is not possible to identify schizophrenia definitively based on one or two symptoms alone. All of the symptoms of this illness can also be found in other brain disorders. For example psychotic symptoms may be caused by the use of drugs, or may be characteristics of a manic episode in bipolar disorder. However, when a doctor sees the symptoms of schizophrenia and carefully asses the course of the illness over six months, he or she can almost always make a correct diagnosis. So it is not at all advisable to resort to diagnosing schizophrenia based on a few symptoms as one sees it. The importance of consulting your doctor as early as possible cannot be emphasised in any stronger manner. The onset of schizophrenia may be sudden or gradual. If it is sudden, then we are more likely to encounter "psychotic" symptoms, or positive symptoms including delusions and hallucinations and other abnormalities of thought, because the patient has lost touch with reality in certain important ways. "Positive" as used here does not mean "good." Rather, it refers to having overt symptoms that should not be there. Common delusions are those of persecution and control in which patients believe others are spying on them, spreading false rumours about them, planning to harm them, poison their food, in order to take away their property or possessions after the patients die, or trying to control their thoughts or actions, or even reading their minds. They think even they can read other people’s minds. Some people with schizophrenia show various thought abnormalities. They think that their own thoughts are being tampered or interfered with, people or external agents/agencies are inserting new thoughts in their minds, taking away their thoughts or that their thoughts are so loud in the head that the person sitting next to them can hear them. Hallucinations cause people to hear or see things that are not there. Auditory hallucinations (hearing voices) are more commonly observed, when patients talk about hearing one to many voices, talking to, or about them in derogatory terms, calling them names, or commenting on their actions or even ordering them to follow their commands. Disorganized symptoms include confused thinking and speech, and behaviour that does not make sense (bizarre). For example, people with schizophrenia sometimes have trouble communicating in coherent sentences or carrying on conversations with others; sometimes inventing new words, or even an entire language. At times they repeat what the other person says (echolalia) or repeat their actions (echopraxia). They tend to show motor abnormalities in that they tend to move more slowly, repeat rhythmic gestures or make movements such as walking in circles or pacing. Some people develop the habit of storing or hoarding unusual items, or covering themselves in several layers of redundant clothing. If however, the onset is slow, what is seen is a gradual deterioration in the patients’ previous abilities – like worsening of school/university record or poor work record. A previously diligent student looses interest in completing home work or other projects and is not interested in anything academic. Negative Symptoms include emotional flatness or lack of expression, an inability to start and follow through with activities, speech that is brief and lacks content, and a lack of pleasure or interest in life. "Negative" does not, therefore, refer to a person's attitude, but to a lack of certain characteristics that should be there. Physical problems associated with schizophrenia: Some of the following problems may lead to various disorders of physical health in people with schizophrenia: Heavy smoking Unusual eating habits Excess fluid consumption Poor hygiene General self neglect

How is schizophrenia treated?
While there is no 100% cure for schizophrenia, it is a highly treatable and manageable illness. The mainstay of treatment is pharmacological (or drug treatment),
in the form of antipsychotic medication. Drug treatment is effective in about 90% of acute cases. Positive symptoms respond better than negative symptoms
to drug treatment.
• Hospitalization: Despite research in UK, USA etc showing that patients with both acute and chronic schizophrenia can be cared for satisfactorily outside
hospitals (in community settings) , people who experience acute symptoms of schizophrenia may require intensive treatment including hospitalization.
Hospitalization is necessary to treat severe delusions or hallucinations, serious suicidal thoughts, an inability to care for oneself, or severe problems with
drugs or alcohol.
• Medication: The primary medications for schizophrenia are called antipsychotics. Antipsychotics help relieve the positive symptoms of schizophrenia by helping
to correct an imbalance in the chemicals that enable brain cells to communicate with each other. It is important to note that it takes usually 3-4 weeks before
satisfactory results are observed with antipsychotics. As with drug treatments for other physical illnesses, many patients with severe mental illnesses need to
try several different antipsychotic medications before they find the one, or the combination of medications, that works best for them.
There are several antipsychotics now available in the market. The older ones are sometimes known as traditional or conventional antipsychotics. Some of them
are Chlorpromazine (largactil), Trifluperazine, Thioridazine, Haloperidol and depot injections that need to be given once in 2-3 weeks.

New medications have been introduced which are generally called atypical antipsychotics or new generation antipsychotics. While all of them may have more
or less the same efficacy in treating symptoms of schizophrenia, some claim to lead to less side effects than others.

• Psychosocial Rehabilitation: Rehabilitation aims to allow the patient to lead as near normal a life as possible, and includes efforts to reduce relapse
prevention (recurring of the acute symptoms) and also improve adherence to medication. Research shows that people with schizophrenia who attend structured
psychosocial rehabilitation programs and continue with their medical treatment manage their illness best. Rehabilitation requires a formal assessment of both
individual skills in activities of daily living (ADL) – like cooking, cleaning, washing, money budgeting, parenting skills etc – by trained occupational therapists,
where such services are available, or by the psychiatrists themselves where there are no such resources.
RemedyFind is a free and unbiased site that lets individuals rate the effectiveness of the treatments they have tried. Visit this site to find treatments that are most
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