Is there a cure for schizophrenia?

We analyze the different treatments for this psychotic disorder.

Schizophrenia is the main and most well known psychotic disorder, suffered by about 1% of the world population.

However, despite being relatively well known, there are still a lot of mysteries and aspects to investigate about this disorder. What is it? Why does it occur? And perhaps the most important question... is there a cure for schizophrenia?

What is schizophrenia? Diagnostic Criteria

Schizophrenia is a psychotic disorder characterized by the presence for more than six months of symptoms such as hallucinations (the most prototypical symptom, especially in the form of auditory hallucinations that are attributed to persons or beings outside the self), delusions and speech disorganization, and may also present symptoms such as alogia and abulia, chaotic behavior and catatonia. These symptoms usually appear in the form of psychotic outbreaks, and the disorder may have different courses (with complete or partial remission, with progressive deterioration...), and generate a significant interference in the subject's life in all or almost all areas of life.

These symptoms are usually classified into positive and negative, the former being those that activate the subject or add something to his usual functioning (e.g. hallucinations and delusions) and the latter those that imply a limitation of the latter due to diminished faculties (e.g. alogia and impaired speech and thinking).

Previously, the existence of different subtypes was considered according to the most characteristic symptoms, although in the latest version of the American reference manual, the DSM-5, it has come to be considered as a single diagnostic label.

What are its causes?

The causes of schizophrenia remain largely unknown to this day.. The influence of genetic factors has been observed, which generate a vulnerability that predisposes (but does not necessarily generate) the disorder. Likewise, the environment also has a great influence, being the interaction between both factors what can trigger the disorder. The experience of highly stressful events or the use of some drugs can increase and trigger outbreaks in people with such vulnerability.

People with schizophrenia usually present particularities at the brain level, some of which are directly associated with the symptoms. Among them is the alteration of some dopaminergic pathways, being the mesolimbic pathway and the mesocortical pathway the most related. In the mesolimbic pathway there is an excess of dopamine that is associated with the existence of positive symptoms, while a deficit of this hormone in the mesocortical pathway is responsible for the negative ones. Knowledge of these brain alterations can and is used in their treatment (especially in the medical and pharmacological aspects).

Currently, some authors propose the hypothesis that schizophrenia is the result of a problem in the process of neuronal migration, how neuronal interconnections develophow neuronal interconnections develop throughout development.

Is there a cure?

Schizophrenia is a disorder currently considered to be chronic, and there is currently no curative treatment for this condition. for this condition. However, it is treatable: treatments and therapies are available to control the symptoms and keep the patient stabilized, preventing further psychotic outbreaks and allowing them to lead a normal life.

However, it is necessary that the treatment is carried out continuously throughout the subject's life. This last point is important in order to prevent relapses, which are frequent when subjects, already feeling well, decide to stop treatment and medication. Likewise, continuous monitoring makes it possible to regulate or vary medication intake in those cases in which the prescribed drug is not effective or presents excessive side effects.

However, it is also true that this disorder is not unknown to science, and there is still much room for improvement in its understanding. As with other chronic disorders, both mental and organic, there is still much to be analyzed and discovered, and it is possible that in the future a solution may be found that can be considered a cure as such.

Treatments applied

As we have said, although there is no cure for the moment, schizophrenia is a treatable disorder, and such treatment is carried out in a multidisciplinary manner. The joint use of both psychotherapy and psychotropic drugs is recommended.

Pharmacological and medical treatments

At the pharmacological level, antipsychotics or neuroleptics are mainly used.. The use of atypicals is especially recommended, since they allow to reduce and control to a great extent both positive and negative symptoms and do not have as many side effects as the typical ones. Pharmacological treatment should be maintained throughout the subject's life, since it prevents the appearance of new psychotic outbreaks (although the type of drug in question, the dosage and its level of effectiveness will depend on the individual).

It may also be necessary to apply other types of medication, such as antidepressants, in cases where this is necessary due to the symptomatology presented.

As regards other medical procedures, although it is not a widespread practice, different surgical techniques are being tested, such as the implantation of electrodes in certain brain areas (such as the nucleus accumbens).

2. Psychological treatments

At the psychological level, the treatments to be applied will depend on the problems manifested by the patient.. One of the most fundamental aspects is to make the subject see the need to follow the treatment continuously, since many patients end up abandoning the medication. Another aspect that is fundamental is psychoeducation of both the subject and the close environment, so that everyone understands the subject's situation, what it means for the patient, the need for treatment or aspects such as the symptoms that may be indicating the arrival of a psychotic outbreak. Family and social support is essential both to continue with the treatment and to cope with the disorder (still very stigmatized).

Focusing on the symptomatology itself, in the case of the presence of hallucinations, the technique of focusing on the voices can be used so that the subject gradually learns to attribute them to himself and not to an external entity. Cognitive restructuring is fundamental when trying to combat beliefs and delusions. It should always be kept in mind that these are real mental contents for the patient, and direct confrontation is not generally recommended. Both the form and content of their hallucinations and delusions should be explored. It is important to take into account the meaning and origin that the subject attributes to them, so that these aspects can be worked on. Another therapy that generates positive results is the therapy of acceptance and commitment.

Social skills training or the incorporation of social skills training in multimodal programs is highly recommended, since this is an area that tends to suffer in patients with schizophrenia. Occupational therapy may also be useful, especially in cases of cognitive impairment.

The set of treatments presented above, although they are not a cure for schizophrenia, allow the patient, as we have said, to keep schizophrenia under control, as we have said, they allow the patient to keep the disorder under control and to lead a normal life..

Bibliographical references:

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona

• Vallina, O. and Lemos, S. (2001). Effective psychological treatments for schizophrenia. Psicothema, 13 (3); 345-364.