What is schizophrenia? Symptoms and treatments

This psychopathology is one of the mental disorders with the most severe symptoms.

If someone talks to us about mental disorder, probably one of the first words (possibly together with depression) that comes to mind is the one that gives title to this article: schizophrenia.

This is because this disorder is one of the best known and probably the one that has been published in the most literature, with vestiges and stories that make us think since ancient times that different people (who were even considered possessed by spirits) manifested visions, thoughts, behaviors and strange expressions that coincide to a large extent with the symptoms of this disorder. Throughout this document we are going to talk about what schizophrenia is, how it affects those who suffer from it and how it is treated.

What is schizophrenia?

Schizophrenia is one of the most widely known mental disorders, and the main of the psychotic-type disorders. the leading psychotic-type disorder.. This is an alteration that involves and generates an important alteration in the life of the person who suffers from it, requiring its diagnosis of the fulfillment of a series of criteria.

Thus, the diagnosis of this mental disorder requires that during a minimum of six months at least two of the following symptoms are present for most of the time (and each one for at least one month): hallucinations, delusions, language alterations and disorganizations, catatonia or negative symptoms such as alogia, affective flattening and/or abulia.

Perhaps the most common and prototypical symptom is the presence of hallucinations, generally of an auditory nature and in the form of voices in second person, which may be accompanied by self-referential delusions of persecution and theft, implantation or thought reading.

It is important to note that these hallucinations are not something invented: the subject really feels them as something external. However, they are usually thoughts that are experienced as coming from the outside (it is speculated that they may be due to the disconnection between prefrontal and speech regions that hinders self-awareness of subvocal speech) or anomalous interpretations of external noises.

Positive and negative symptoms

The predominant psychotic type symptoms in schizophrenia have generally been grouped into two broad categories, positive and negative symptoms, which have different characteristics and effects on the patient.

Positive symptoms would refer to those alterations that represent a exacerbation or alteration of the patient's usual abilities and functioning, usually by adding something to that functioning.usually adding something to such functioning. An example of this would be hallucinations, delusions and strange behaviors).

Negative symptoms refer to those alterations that involve a loss of existing abilities. loss of previously existing abilities. previously. This is the case of alogia or impoverishment of thought, affective flattening or abulia.

Course of psychopathology

Schizophrenia is currently considered a chronic disorder. This disorder usually presents in the form of outbreaksalthough there are cases in which they do not arise as such but a constant deterioration takes place. Generally psychotic outbreaks arise, in which positive symptoms such as hallucinations and agitation abound, after which there is usually a complete or partial remission.

It is possible that a single psychotic break with complete remission may occur, although usually there are several over the course of a lifetime. As we have indicated, there may be complete remission, but there may also be cases in which remission is cases in which such remission is partial and symptoms and cognitive impairment remain.. Such deterioration may remain stable or progress (which is why Kraepelin called this disorder dementia praecox).

Difficulties

The suffering from schizophrenia can have a great number of consequences and generate severe difficulties. The set of symptoms described above significantly interfere with the normal functioning of the subject in daily life, in areas such as interpersonal relationships, work or academics.

Social interactions are often greatly reduced and affected, and occupational and even academic ability and possibilities may also be greatly impaired, especially if there is impairment. Subjects with schizophrenia often present attentional and information processing problems, especially in those cases with negative symptomatology. Their performance in sustained or selective attention tasks is lower.

In addition, the effect of the diagnosis itself on the subject must be taken into account: schizophrenia is a disorder considered to be chronic and which is still highly stigmatized today. is still highly stigmatized, even by the people who suffer from it.even by the people who suffer from it. The diagnosis is a very hard and traumatic moment for the subject, and it is possible that depressive symptoms and/or a period of mourning, denial of the diagnosis and opposition to treatment may appear. This last aspect is especially important, because with treatment, psychotic outbreaks are greatly reduced or prevented.

Are there types of schizophrenia?

Until relatively few years ago, within schizophrenia we could find a series of typologies which referred to a predominant type of symptomatology or a specific form of presentation of the disease.

Specifically, one could find paranoid schizophrenia (centered on hallucinations and delusions of persecutory and referential character, together with aggressiveness and other disturbances), disorganized schizophrenia (whose main characteristic is chaotic and incoherent behavior and thinking and affective flattening and inadequacy) or catatonic schizophrenia (in which the most prominent problems were psychomotor disturbances, with mutism and immobility as well as waxy flexibility and agitation), together with residual (in which the subject had recovered from an outbreak with the exception of some symptoms that remained, generally of a negative type) or simple (with prevalence of negative symptoms, such as alogia and affective flattening).

However, in the latest version of one of the most widely used manuals worldwide, the DSM-5, this distinction is no longer made to all subtypes into a single diagnostic entity.. However, this is a decision that is not shared by many professionals, who criticize this measure. In fact, some people propose that rather than schizophrenia we should speak of psychotic spectrum disorders, similar to what has happened with autism.

Hypotheses regarding its causes

The causes of this disorder, like those of many others, are still largely unknown. Despite this, different hypotheses have been developed throughout history different hypotheses as to what can trigger schizophrenia.

Biological hypotheses

On a biological level, what is known is that people suffering from schizophrenia have alterations in dopamine levels in certain brain pathways. Specifically, those subjects who present positive alterations such as hallucinations or delusions present an excess or hyperfunction of dopamine synthesis in the mesolimbic pathway, while negative symptoms have been related to a deficit of this hormone in the mesocortical dopaminergic pathway. However, the reason for this phenomenon is still unknown.

Cerebrally, it has been observed that there are differences such as a lower Blood flow to the frontal areas of the brain. less blood flow to the frontal areas of the brain, differences between both temporal lobes of the brainIt has been observed that there are differences between both temporal lobes and a smaller volume of some structures such as the hippocampus and the amygdala, as well as larger cerebral ventricles.

It has been observed that genetics seems to play a role, often looking for the involvement of different genes in the onset of the disorder. Research has shown that there does appear to be a genetic predisposition linked to a greater vulnerability to suffer from it, although the disorder does not have to be triggered.although the disorder does not have to be triggered. It will be the set of vital circumstances surrounding the individual that will determine whether or not this predisposition triggers the disorder.

At present, one of the most widely held hypotheses is that we are facing a problem in neural migration throughout development that generates alterations that end up stabilizing and that would only generate manifestations in the presence of stressors or hormonal changes such as those produced by the transition to adulthood.

Another hypothesis links it to the existence of viral infections during pregnancy, based on the fact that many subjects with this disorder are usually born in winter and that different conditions such as influenza could cause alterations at the cerebral level.

Psychological hypotheses

In addition to the biological hypotheses, there are others of a much more psychological nature that must be taken into account, although they are not necessarily mutually exclusive hypotheses.

The best known and most predominant model that is used in the psychological explanation of schizophrenia is the the diathesis (or vulnerability)-stress model (or vulnerability)-stress model. This hypothesis establishes the existence of a stable and permanent vulnerability, partly biological and partly acquired, to suffer from this disorder and to present information processing problems or problems of social competence and stress management. These subjects will face different types of stressors on a daily basis, such as life events or other more permanent circumstances (e.g. a very critical family environment or with excessive expressed emotion) to which they will have to adapt. But depending on the circumstances, it may happen that they fail in this adaptation and are unable to adjust, which eventually leads to the onset of the disorder.

Some of the oldest theories, of psychodynamic character and especially linked to paranoid schizophrenia, consider that the causes of the disorder can be found in the presence of deep psychic conflicts from which the subject defends himself by means of projection (placing one or some of his own characteristics in another person) and denial of the conflict, which sometimes end up generating the dissociation of the mind from reality. However, these explanations have no scientific value.

Treatment

Schizophrenia is a disorder of chronic character that has no recognized cure as such for the moment, although the symptoms can be treated. the symptoms can be treated The disease can be treated in such a way that sufferers can lead a normal life and remain stable, preventing the onset of outbreaks.

For this, however, treatment must be continued throughout the subject's life cycle in order to prevent new outbreaks. to prevent the appearance of new outbreaks. In general, drugs known as antipsychotics are used for this purpose, which act by treating the excess of dopamine in the mesolimbic pathway and, in the case of those classified as atypical, also improving the negative symptomatology by increasing the levels of this hormone in the mesocortical pathway.

Psychological work is also carried out, with therapies such as focusing to work on auditory hallucinations or cognitive restructuring to change cognitions and beliefs (delusional and/or about the disorder itself). Also social skills training and sometimes counseling and job reinsertion can be of great help in combating the difficulties generated by the disorder. Finally, psychoeducation of the subject and the environment are fundamental.

Bibliographical references:

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.
• Santos, J.L. ; García, L.I. ; Calderón, M.A. ; Sanz, L.J. ; de los Ríos, P. ; Izquierdo, S. ; Román, P. ; Hernangómez, L. ; Navas, E. ; Ladrón, A and Álvarez-Cienfuegos, L. (2012). Psicología Clínica. Manual CEDE de Preparación PIR, 02. CEDE. Madrid.
• Vallina, O. and Lemos, S. (2001). Effective psychological treatments for schizophrenia. Psicothema, 13 (3); 345-364.