If anyone tells us about a mental disorder, one of the first words (maybe next to depression) that comes to mind is probably the one that gives this article the title: schizophrenia.
And is this disorder one of the best known and probably the most published publications, and there are relics and stories that make you think from ancient times that different people (who were even considered possessed by spirits) manifested strange visions, thoughts, behaviors and expressions that largely coincide with the symptomatology inherent in this disorder. Throughout this article we will be talking about what schizophrenia is, how it affects those who have it, and how it is treated.
What is schizophrenia?
Schizophrenia is one of the most well-known mental disorders in general, and the main one of psychotic type disorders. We are faced with an alteration that causes and generates a significant alteration in the life of those who suffer, requiring a diagnosis of compliance with a number of criteria.
Thus, the diagnosis of this mental disorder requires that for at least six months at least two of the following symptoms appear (and at least for one month each): hallucinations, delusions, alterations and disorganizations of language, catatonia or negative symptoms such as allergy, emotional flattening and / or abulia.
Perhaps the most common and typical symptom is the presence of hallucinations, usually auditory in nature and in the form of second-person voices, which may be accompanied by self-referential delusions, persecution, and theft. implantation or reading of the thought.
It is important to keep in mind that these hallucinations are not something made up: the subject really feels them as something external. However, these are usually thoughts that are felt to be coming from the outside (it is speculated that they may be the cause of the disconnection between the prefrontal and the regions of speech which hinders the self-awareness of the subvocal speech) or abnormal interpretations of external noise. .
Positive and negative symptoms
The predominant psychotic-type symptoms in schizophrenia they 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 alterations that involve a exacerbation or impairment of the patient’s ability and normal functioning, In general, add something to this operation. An example of this would be hallucinations, delusions and strange behavior).
As for the negative symptoms, they will refer to the alterations that involve a loss of existing skills previously. This is the case of allergy or impoverishment of thought, emotional flattening or abulia.
Schizophrenia is currently considered a chronic disorder. this disorder usually in the form of shoots, Although there are cases when they do not arise as such, but constant deterioration occurs. Psychotic flare-ups usually occur, in which positive symptoms such as hallucinations and agitation abound, after which there is usually complete or partial remission.
It is possible that a single psychotic flare with complete remission could occur, although several usually occur throughout life. As we have indicated, there may be complete remission, but there may also be cases in which this remission is partial and where symptoms and cognitive impairment persist. This deterioration may remain stable or progress (which is why Kraepelin called this disorder dementia premature).
Suffering from schizophrenia can have a number of consequences and lead to serious difficulties. And it is that the set of symptoms described above significantly interferes with the normal functioning of the subject in daily life, in areas such as interpersonal relationships, work or academia.
Social interactions are often reduced and greatly affected, and professional and even academic abilities and opportunities can also be significantly altered, especially with disabilities. People with schizophrenia often have problems with attention and information processing, especially with negative symptoms. Their performance in prolonged or selective care tasks is poorer.
In addition, one must take into account the effect that the diagnosis itself has on the subject: schizophrenia is a disorder considered to be chronic and that to this day, he remains very stigmatized, Even by the very people who suffer from it. The diagnosis is a very harsh and traumatic period for the subject, and it is possible that depressive symptoms and / or a period of mourning, denial of diagnosis and opposition to treatment may appear. This last aspect is particularly important, because with the treatments, psychotic epidemics are considerably reduced or avoided.
Are there any types of schizophrenia?
Until relatively few years ago, in schizophrenia, we could find a series of typologies which referred to a predominant type of symptomatology or form of presentation of the particular disease.
Specifically, one might find paranoid schizophrenia (focused on persecuting and referential hallucinations and delusions, as well as aggression and other disorders), disorganized (the main characteristic is chaotic and incoherent behavior and thinking, and a flattening and affective insufficiency) or catatonic (in which the most prominent problems were psychomotor disturbances, with mutism and immobility as well as flexibility and restlessness of cereals), next to the residue (in which the subject had recovered from an epidemic with the exception of some remaining symptoms, usually negative) or simple (with prevalence of negative symptoms, such as allergy and emotional flattening).
However, in the latest version of one of the world’s most widely used manuals, the DSM-5, this distinction is no longer made for agglutinate all subtypes into a single diagnostic entity. Despite this, it is a decision that is not shared by many professionals, who criticize this measure. In fact, some people suggest that more than schizophrenia, we should be talking about psychotic spectrum disorders, like what happened with autism.
Hypothesis on its causes
The causes of this disorder, like those of many others, are still largely unknown today. Despite this, they have been developed throughout history different assumptions about what can trigger schizophrenia.
Biologically, people with schizophrenia are known to have alterations in dopamine levels in certain brain pathways. Specifically, subjects who present positive-type alterations such as hallucinations or delusions have an excess or hyperfunction of dopamine synthesis in the mesolimbic pathway, while negative symptoms have been linked to a deficiency of this hormone in the mesolimbic pathway. dopaminergic route. However, the reason for this phenomenon is still unknown.
On the cerebral level, it has been observed that there are differences such as decreased blood flow to the frontal areas of the brain, Differences between the two temporal lobes and a smaller volume of certain structures such as the hippocampus and amygdala, as well as larger cerebral ventricles.
It has been observed that genetics seem to play a role, often seeking to involve different genes from the onset of the disorder. Research shows that there appears to be a genetic predisposition linked to a greater vulnerability to sufferWhile the trouble doesn’t have to trigger it. It will be the set of vital circumstances surrounding the individual that will determine whether or not this predisposition awakens the disorder.
Today, one of the most studied hypotheses is that we are faced with a problem of neuronal migration throughout development that generates alterations that eventually stabilize and would only generate manifestations in the presence of stressful agents. or changes in hormonal products such as those produced by passage into adulthood.
Another hypothesis links it to the existence of viral infections during pregnancy, based on the fact that many people with this disorder are usually born in winter and that different conditions such as the flu could cause brain damage.
In addition to biological hypotheses, there are others of a much more psychological nature that must be taken into account, even if they are not necessarily mutually exclusive hypotheses.
The best known and most widely used model in the psychological explanation of schizophrenia is the diathesis model (Or vulnerability) -stress. 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 be confronted on a daily basis with different types of stressors, such as vital events or other more permanent circumstances (such as a very critical family environment or an environment with excessive expressed emotion to which they have to adapt. that they fail in this adaptation and cannot adjust, it ends up generating the onset of the disorder.
Some of the oldest theories, of a psychodynamic nature 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 projection (locate one or more of his characteristic in another person) and the denial of conflict, which sometimes ends up generating the dissociation of the spirit from reality. However, these explanations have no scientific value.
Schizophrenia is a chronic disorder for which no cure is currently recognized, although symptoms can be treated so that those who suffer from it can lead a normal life and remain stable, thus avoiding the appearance of epidemics.
For this, however, treatment should be continued throughout the subject’s life cycle in order to avoid the appearance of new shoots. Medicines called antipsychotics are generally used to treat excess dopamine in the mesolimbic pathway and, in the case of those classified as atypical, also to improve negative symptoms by increasing levels of this hormone in the mesocortical pathway.
We also work from the psychological field, with therapies such as focusing on auditory hallucinations or cognitive restructuring to change cognitions and beliefs (delusional and / or on the disorder itself). too much social skills training and sometimes counseling and professional reintegration can be of great help in combating the difficulties caused by the disorder. Finally, the psychoeducation of the subject and the environment is fundamental.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
- Sants, JL; Garcia, LI; Calderon, MA; Sanz, LJ; of rivers, P .; Left, S .; Román, P .; Hernangómez, L .; Navas, E .; Lladre, A and Álvarez-Cienfuegos, L. (2012). Clinical Psychology. CEDE PIR preparation manual, 02. CEDE. Madrid.
- Vallina, O. and Lemos, S. (2001). Effective psychological treatments for schizophrenia. Psicothema, 13 (3); 345-364.