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Schizophrenia is an illness that attacks the brain, and is characterized by a collapse of thought processes and poor emotional responses. It usually has lots of consequences for individuals suffering from it, their families, and the entire society. It is among the most serious psychiatric disorders.
The history of schizophrenia is the history of psychiatry itself. The first documentation of the disease was in 1809; doctors who were working in “madhouses” and “asylums” began writing books about the lunatics. They collected observations on the lunatics and they tried to classify the collected information and speculate the causes of their suffering. In ignorance of the disease, they performed crude autopsies on the bodies looking for the source of this madness.
Being curious to understand and treat diseases of the mind, psychiatrists did all they could to help patients, especially those with tragic and chronic mental illness and those institutionalized. Therefore, these disorders have always been the sole purpose of the profession and are responsible for the existence of this field. In the 21st century, schizophrenia is seen as a genetic disease, similar to diabetes, which was discovered due to advances in the area of genetics. Many question the presence of the disease in ancient times.
“Insanity” exists in every society; it is known from history books, which provide us with descriptions of hallucinations, delusions and peculiar behavior being the primary signs. In 1985 by D.V. Jeste and his colleagues published articles about the existence and description of mental illnesses in the communities of Babylon and ancient India. The descriptions from other communities describe the disease with the symptoms given earlier. However, the genetic basis of the disease is argued, since there are cases when the symptom exists in people with head shock, brain infection, injury due to birth problems etc.
It was not until the 1700s that doctors, known then as mad-doctors, began to list down the symptoms of the diseases in terms of syndromes. The British authorities were the first and most famous ones in their written examination on madness. In the 1800s France and German joined the research efforts and dominated in the field. This was the creation of the medical specialty known as psychiatry and the French were first to include lectures on mental illness in their medical schools. The 20th century saw the mental illness given the name schizophrenia by Eugene Bleuler, a Swiss psychiatrist, challenging the previous name of the illness, which in the 19th century was named Dementia Praecox. This signaled a significant contribution to study of the disease, with Bleuler publishing his now popular monograph Dementia praecox oder die Gruppe der Schizophrenia. These developments have continued throughout the years until now when genes are being seen as key in the cause and development of the disease. Advances in brain imaging technology, neurochemistry, and neuropathology have led to a more sophisticated and comprehensive view of the disease.
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No one symptom can characterize schizophrenia. In fact, the proper diagnosis of the disease involves the observance of several symptoms that may last for months.
In order to have a clear mental picture of schizophrenia, its symptoms are divided into two categories: positive and negative symptoms. The positive symptoms are viewed as behaviors not seen in the normal repertoire of human activities, on the other hand, the negative symptoms refer to relevant behavior that are eliminated from the behavioral repertoire.
The positive symptoms dominate during the active period of the disease, when an affected individual is most disturbed and troublesome. This normally leads to hospitalization or referral for care, because they will be acting and saying things that will bother the people around them. The negative phases are predominant during the prodromal or residual phases of the illness. In addition, those are seen by the blunting of drive and emotion, for example, social withdrawal, lack of energy, poverty of words etc.
The positive symptoms were first described by Schneider (1959) who regarded these symptoms as pathognomonic of schizophrenia. He felt that these symptoms were primary and could not be derived from other symptoms. These existing symptoms are viewed as positive, as opposed their absence. They are additional to the patient. They intensify or distort hearing, speaking, and thinking.
The positive syndromes include delusions, hallucinations and strange ideas, dreams, or perceptions. Delusions are strong formed viewpoints in things that are of immense importance to the patient but are not real. They cannot be explained because someone in his or her right mind would view the beliefs as untrue. Even after getting a strong proof that the belief is obviously untrue the patient will go on believing in it. There are nine documented types of delusions and the examples include among others: grandeur, thought control, passivity, reference, poverty of speech, jealously.
Hallucination is the next symptom; it refers to visions in the form of dreams that a patient experiences while he/she is awake. These are apparent perceptions that originate inside a person’s brain. The person experiencing it can sense the visions with all his/her senses. Hallucinations linked to schizophrenia are auditory and involve the hearing of nonexistent voices. The next most general observation is that of seeing things or people that are not present. Non-auditory hallucinations are rare in schizophrenic cases. The voices the patients hear are real to them, as if they are experiencing the conversations in real life. The voices may perform a commentary on the patient’s actions or give commands. They anguish the victim, telling him/her to do unpleasant things and sometimes even threatening the person. This makes the patient unreachable, disturbed, anxious, or agitated.
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Disorganized thought is common among schizophrenic patients, and it makes them to think not logically. They may not be able to deduce the valuable information from a conversation or social situations. The disordered thinking leads to extremely short attention periods, drifting thoughts and a lack of focus.
An illogical train of reasoning and observation accompanying formal thought disorder makes patients hard to understand. Persons who are not familiar with these symptoms are perplexed and frightened by these patients. These symptoms can appear in many forms, for example, a quick change of topics. This is usually known as derailment as the patient cannot put his or her thoughts on a straight, continuous track.
The negative symptoms are the “removals” from normal brain functions representing missing traits. Most people consider the positive symptoms as the only signs of this disorder, but the negative symptoms are also part of the disease. They include alogia, affective flattening, avolition and anhedonia. Simply referred to as the 4 A’s. Alogia refers to the difficulty in communicating their thought and expressions. Patients with alogia do not speak a lot.
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Affective flattening, also known as blunted affect, is the display of lack of affection or emotional expression from patients suffering from schizophrenia. Avolition, also known as apathy, is a term used to describe the lack of planning and self-motivation. While the inability to find interest in pleasurable activities is called anhedonia. Patient’s facial expressions appear uninterested with the events around them. Social isolation is also observed and has little or nothing to say.
In the early 16th century, physician Paracelsus suggested that convulsions may influence the course of mental sickness. In the beginning of the 20th century, it was believed that a negative correlation existed between epilepsy and schizophrenia. He believed an antagonistic relationship could exist between the diseases.. This was evidenced through the results that showed that when the two illnesses did co-exist, the occurrence of convulsions weakened the severity of the psychosis. Also, the two disorders show contrasting neuropath logical features. Ladilas Von Meduna, a Hungarian psychiatrist, speculated that artificially induced convulsions could be therapeutic to patients suffering from schizophrenia. In January 1934, he administered an injection of camphor in oil to patient and a convulsion resulted. After several such treatments, the patient recovered and was fit to leave the hospital. The intramuscular camphor in oil had one disadvantage: it was difficult to predict when the convulsions would occur. The patients were filled with anxiety waiting for the fits, which was also stressful to the physician and nurses. Afterwards, he replaced the camphor in oil with intravenous pentylenetetrazol. In 1935, the results of the patients were promising, and this was the first time that schizophrenia conditions showed hope of being cured. The pentylenetetrazol acted much faster than the camphor, inducing fits in minutes, but it also had some disadvantages. For example, the severities of the convulsions were uncontrollable and in some cases the patients experienced repeated seizures.
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An Italian neuropsychiatric suggested the replacement of a conversant drug with electrically induced convulsions in humans. The first test was performed in 1938 on a male patient whose prognosis had been deemed poor. The first few tests on the patient were not successful and an increase of voltage and stimulus duration was suggested. The changes brought about instant results with the patient experiencing full convulsions compared to twitching, observed earlier. The patient continued to have the E.C.Ts and was released after considerable improvement. The use of this therapy spread fast to all continents, and by 1940, the treatment was in wide use. After the introduction of neurotic medication, the popularity of ECT faded because the patient lapsed back after weeks and even months. However, the ECT is again gaining popularity due to some patients not responding to drugs and partly because of advances in the ECT methodology.
ECT is effective when affective symptoms predominate and also when the illness is acute and in the presence of positive symptoms. Efficacy of ECT is less than that of drugs, the combination of the two (E.C.T neurotic) is superior to either method alone.
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The use of antipsychotic medication has shown beneficial evidence on the positive symptoms and on reducing relapse. The drugs were introduced in 1950 and they include chlorpromazine and haloperidol. These drugs have changed life of many peoples' who suffered from the disease. The drugs usually have a sedative effect on agitation and also have effects on brain receptors and, thus, on psychotic symptoms. Some people do not respond to medication, especially those suffering from the negative symptoms are the only problem. Moreover, side effects of the drugs complicate treatment as they include sedation, postural hypotension (a drop in blood pressure while standing), extra pyramidal side effects (tremor, slowness, and rigidity) etc.
The drugs are effective to some extent in reducing relapses and time spent in hospitals, but they do not change the course of the disorder. Clozapine has been known to have added effects over the others, as it leads to complete remission of symptoms in some cases and improvement in many cases. Newer antipsychotics have been developed with the combination of Clozapine and have been known not to exacerbate cognitive effects but to improve them. They may cause sedation and weight gain and the latter may worsen the negative symptoms by increasing depression and lowering self-esteem. If medications are taken regularly, cognitive functioning will improve and they could also have a synergistic effect on psychological treatment.
The two remedies are both efficient in their own way; they both specialize in the positive symptoms of the disease and deal little with the negative symptoms. The ECT is more preferable, as it does not aggravate the negative symptoms of schizophrenia. After several E.C.Ts are performed on a patient, remarkable improvements are noted, and if complemented with the psychotics, the complete remission of the symptoms is guaranteed. Relapse of disease is reduced by the psychotics.
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