Schizophrenia is undoubtedly the most notorious of all psychiatric illnesses. It’s the
prototype psychiatric illness showcased in popular media like movies, television and also the
most dramatic of all psychiatric illnesses.
Schizophrenia is a subtype of psychosis. This illness is characterised by a break from reality
and an absence of insight. Patients are not aware that they are suffering from any illness
and fail to believe it even when abundant evidence is provided to them for the same.
Schizophrenic disorders are characterised by fundamental and characteristic distortions of
thinking and perception. Clear consciousness and intellectual capacity are usually
maintained. Family members are often puzzled that the patients “understand” everything
and yet behave in a bizarre manner. The illness often starts with a perplexity. Patients feel
confused and are unable to understand what exactly they are going through. Gradually, well
formed thought disturbances and symptoms emerge which grow strong over time. Patients
might become irritable or garrulous due to such thought processes.
Let’s look at the symptoms of schizophrenia.
– Disturbance of thinking in the form of delusions i.e., fixed, firm unshakeable belief in
a fact despite evidence proving it false. Patients can have different types of
delusions; feeling like others want to harm them (persecutory), others are keeping
and eye on them/ discussing about them (referential), their loved ones have been
replaced by imposters, a chip has been put in their brain, someone is controlling
them, being able to control the weather etc (bizarre); delusion of infidelity, love,
grandiosity to name a few.
– Disturbances of thought- someone is broadcasting their thoughts to others,
someone is inserting thoughts in their mind or withdrawing thoughts from their
mind.
– Hallucinations i.e., a perception of having heard, seen, touched, smelled or tasted
something that isn’t actually there. Most common hallucinations are those of
hearing.
– Breaks in train of thought; irrelevant or incoherent speech, making up new words or
neologism.
– “Negative” symptoms- marked apathy, reduced speech, dulling of expressions, social
withdrawal, poor social performance (interpersonal, academic, work etc.)
– Disorganised behaviour e.g., fire setting, disrobing, wandering etc
– Catatonic behaviour.
The diagnosis of schizophrenia is mainly by clinical assessment. Occasionally psychometric
tests can be used when in doubt.
What are the treatment modalities available to treat schizophrenia?
– This disorder occurs due to imbalance of brain chemical known as dopamine. Hence,
it needs to be treated by methods which will restore that balance. Most commonly
used treatment modality is medication in the form of tablets, syrup or injections.
This class of medicines is known as antipsychotics and should only be administered
following a psychiatrist’s advice. For patients who refuse medication, injections can
be used. Or when patients are on long term treatment, long acting injections can
replace tablets.
– In severe forms of illness, electroconvulsive therapy (ECT) is quite effective. It leads
to faster symptom resolution and is safe.
– It is imperative to complete the course of medications to prevent a relapse of illness.
Medication shouldn’t be stopped without doctors’ advice. In some cases, long term
medications become necessary.
