Schizophrenia

Schizophrenia: Signs often months in advance

Schizophrenia is a mental illness that is one of the psychoses and manifests itself through a wide variety of symptoms. Many sufferers show the first warning signs months or years before the onset of psychosis . But these are often so unspecific that they do not immediately suggest schizophrenia as a clinical picture. Neither the person affected nor those around them associate the symptoms with such a serious mental disorder.

There are a few early warning sign that can be used to identify schizophrenia:

• Listlessness, drive and motivation disorders, disinterest, declining commitment, e.g. B. at school or at work
• Trouble sleeping
• depressed mood, depression
• Tension, nervousness, restlessness, restlessness
• Irritability, moodiness
• Attention, memory and concentration disorders - thoughts often get mixed up
• Increased sensitivity to light and noise
• Increased willingness to conflict - those affected clash with others more often
• Mistrust of others and deceptions - they relate everything to yourself
• Withdrawal from society, isolation
• Neglect of outward appearance, unkempt appearance

Some studies even suggest that schizophrenia may show up in the eyes because their movements change. In addition, the retina of the eyes appears to be thinner in those affected than in healthy people, as a study by the Ulm University Hospital showed.

There are several forms of schizophrenia; the symptoms differ in type and severity. Each form focuses on different symptoms.

Paranoid schizophrenia symptoms

Patients with paranoid schizophrenia have all kinds of delusions and imagine things that have nothing to do with reality. You feel followed, monitored and controlled. Others harbor conspiracy theories, believe that they are seriously ill or called for higher tasks.

Most also experience hallucinations in schizophrenia, mainly acoustic ones . This allows a person with schizophrenia to hear voices when in reality no one is talking to them. The voices in their heads sometimes describe all the actions they are taking or give them instructions and orders. Some have conversations with themselves and mumble something incomprehensible to themselves. By the way, there is a crucial difference between the delusion and a hallucination in schizophrenia: In the case of delusions, thinking is disturbed; in the case of a hallucination, perception does not work properly.

In addition, people with schizophrenia experience themselves and their environment as alien - the boundaries between the self and the environment are blurred. “I disorder” is what specialists say. So many can no longer distinguish between "own" and "foreign". Many are also convinced that others can read their thoughts, influence them or take them away from them. They feel manipulated, remote-controlled or hypnotized from the outside.

In contrast to other forms of schizophrenia, paranoid schizophrenia has hardly any effect on mood, feelings, language, movements or drive.

Hebephrenic Schizophrenia - Signs

Hebephrenic schizophrenia primarily affects affect - emotional expression -, drive, and formal thinking. These symptoms are typical:

• Striking emotional life : The mood is rigid, hardly changeable and the feelings are flattened. Then those affected laugh and giggle again in situations that are actually serious.
• Formally disturbed thinking : Patients are mentally fidgety, do not stick to the matter and jump from one topic to the next.
• Inappropriate behavior that does not fit the situation: People with schizophrenia sometimes make movements that appear bizarre, ornate and incomprehensible to others. Some articulate themselves exaggerated, choose strange, inappropriate, incomprehensible words or express themselves stilted.
• The possibility for self-criticism and self-reflection is reduced.
• The social skills are lost, which in turn is reflected in a lack of friendships. Affected people are unable to establish close social contacts.

Most of the time they lack the insight that they are actually sick.

Catatonic schizophrenia - symptoms

This form of schizophrenia particularly affects motor skills and movements. It occurs less often. This is how catatonic schizophrenia can be recognized:

• Noticeable movements : Those affected have a high level of arousal and an enormous urge to move. They often run back and forth aimlessly or perform the same stereotypical movements over and over again. Sometimes they also make faces.
• Freeze (stupor): Then they freeze again and persist in sometimes strange postures, often for many hours. In this state, they are often not accessible to other people by speaking to them. However, it can change very quickly and suddenly turn into violent excitement and aggressiveness.

What is schizophrenia?

By definition, schizophrenia belongs to the psychoses, more precisely to the endogenous psychoses. This means that the mental illness arises “from within” without any particular negative experiences or physical causes. People with psychosis lose touch with reality, have delusions and experience disorders of perception, thinking, language and feelings.

The meaning of schizophrenia can also be derived from these symptoms: The word schizophrenia means something like “split mind” (Greek schizein = “split, split, splinter” and phrēn = “spirit, soul, mind”). The Swiss psychiatrist Eugen Bleuler coined the term in 1911.

However, it is important that the intelligence and intellectual abilities of those affected are usually not impaired, at least not initially. Contrary to what many believe, schizophrenia has nothing to do with being "crazy", mental disorders or a split personality.

Schizophrenia: how many get sick and at what age?

Doctors estimate that approximately 4.6 in 1,000 people will develop schizophrenia at some point in their life. Every year around 15 per 100,000 inhabitants are newly diagnosed with schizophrenia. The disease affects men and women almost equally often, but men get it three to four years earlier. The mental illness usually shows itself for the first time between the ages of 15 and 35. The majority - namely 65 percent - are younger than 30 years of age when diagnosed. The disease is found more frequently in people with low educational attainment, low socio-economic status and in single people. The question of whether social disadvantage is a contributory cause or a consequence of schizophrenia has not yet been clarified.

Types of Schizophrenia: Three different forms

Schizophrenia has many faces. There are several types of mental illness, each of which has different symptoms in the foreground. What they all have in common is that schizophrenia is a very drastic disease that can have serious consequences if doctors do not diagnose and treat it in good time. Psychiatrists mainly distinguish three forms of schizophrenia:

• Paranoid schizophrenia : It is the most common, accounting for around 65 percent of cases. It usually begins between the ages of 25 and 35. Delusions and hallucinations are typical of paranoid schizophrenia.

• Hebephrenic schizophrenia : This form usually begins between the ages of 15 and 25 years. Above all, the mind and the world of emotions are impaired.
• Catatonic schizophrenia : It also usually begins between the ages of 15 and 25. It manifests itself in disorders of motor skills and movements.

In addition to these three main forms, there are other, rarer forms of the disease.

Schizophrenia: causes are largely unknown

The causes of schizophrenia are still not clear. However, experts suspect that several neurobiological, psychological, and social factors must work together for the disease to actually break out. The so-called “ vulnerability- stress- coping model ” offers an explanation : Schizophrenia patients are more sensitive (vulnerability), have less resistance (resilience) and are less able to withstand stressful life events. The cause of this susceptibility also lies in the genes (genetic disposition). At the same times, they are less able to deal with internal or external stress factors and have no effective coping strategies.

The following factors can play a role in the development of schizophrenia and promote it:

• Genes : It is known that schizophrenia is genetic, but only partially. Affected people have “receptivity genes”, so-called susceptibility genes . Scientists have identified more than 100 such risk genes so far. However, the individual contribution of these genes is very small. So to a certain extent, schizophrenia is hereditary. Relatives of those affected have an increased risk of this psychosis. How high it is depends on how close the relationship is. With identical twins, the risk of disease is up to 50 percent. If one of the parents or siblings falls ill, it is around twelve percent.
• Changes in the brain : Researchers know that some messenger substances in the brain are excessively active, such as dopamine, serotonin and glutamate . When their balance gets out of balance, communication between different brain areas no longer runs smoothly. The structure and organization of brain functions are disrupted.
• Developmental disorders in the womb or in childhood
• Complications of pregnancy and childbirth, e.g. B. Viral infection of the mother
• sleep disorders
• Drug use, e.g. B. cannabis, amphetamines
• Malnutrition

• Radical changes in life: separation, divorce, relocation, new job
• Sometimes the causes of schizophrenia lie in childhood: emotional trauma in early childhood, growing up in an urban environment, or a family atmosphere with strong criticism and tutelage

There is no such thing as “one” risk factor for schizophrenia, but rather several must come together. Exactly what it is is very different from person to person.

Treating schizophrenia - combining multiple therapies

Schizophrenia therapy should always start as soon as possible. Otherwise the disease can have serious consequences for health, everyday life and social life. However, it is known from a survey that in Germany only about 40 percent of people with a psychosis (not just schizophrenia) are under any (not only specialist) therapy. Schizophrenia can be treated by doctors in a clinic or on an outpatient basis in an established specialist practice.

Doctors and various therapists who work closely together are involved in the treatment of schizophrenia. Together they work out an individual treatment plan. Which therapies are suitable for schizophrenia depends on the disease phase (acute, stabilization and remission phase), but also the wishes and needs of the sick person. Doctors combine several therapies with each other, so the treatment is always based on several building blocks. For example, drugs, cognitive behavioral therapy and sociotherapy are used against schizophrenia .

First of all, the acute psychotic and other symptoms must subside as quickly as possible. In this way, those affect should be able to lead an independent, self-determined and responsible life again. They are then able to assert their interests themselves, to organize themselves and to determine their living conditions individually. It is also important to include relatives, life partners and close confidants in the treatment.

Schizophrenia drugs: Antipsychotics attack the messenger substances in the brain

Antipsychotics (neuroleptics) effectively reduce acute symptoms, such as delusions and hallucinations. They aim at the balance of the messenger substances in the brain and bring them back into line. Points of attack are, for example, dopamine and serotonin. Doctors usually combine several schizophrenia drugs. Today there are modern second-generation neuroleptics ( atypical neuroleptics ) that work well and have fewer side effects than older drugs from this class of substances.

Patients have to continue taking the medication - in a lower dose than at the beginning - for another one to two years. Otherwise there is a risk of relapse and schizophrenia will return. One problem is that some patients stop taking their medication on their own because they lack insight into the disease and feel perfectly healthy again. Sometimes your doctor doesn't know about it either.

It is therefore an important pillar for the success of therapy that patients trust their doctor, speak to him in case of problems, accept the drug-based schizophrenia therapy for themselves and stand behind it. And: Doctors never administer the antipsychotics alone, but also select other, non-drug measures.

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