If someone talks to us about mental disorder, probably one of the first words (possibly along with depression) that comes to mind is the one that gives the title to this article: schizophrenia
And this disorder is one of the best known and probably one of the ones with the greatest amount of literature published, there being vestiges and stories that suggest since ancient times that different people (who were even considered possessed by spirits) manifested visions, strange thoughts, behaviors and expressions that largely coincide 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.
Schizophrenia is one of the most widely known mental disorders, and the main psychotic type disorders We are facing an alteration that represents and generates a significant alteration in the life of those who suffer from it, its diagnosis requiring compliance with a series of criteria.
Thus, the diagnosis of this mental disorder requires that for a minimum of six months at least two of the following symptoms are present most of the time (and each one for at least one month): hallucinations, delusions, alterations and disorganizations of the language, catatonia or negative symptoms such as alogia, emotional flattening and/or avolition.
Perhaps the most common and prototypical symptom is the presence of hallucinations, generally of an auditory nature and in the form of voices in the second person, which can be accompanied by self-referential delusions of persecution and theft, implantation or thought reading
It is important to keep in mind that these hallucinations are not something invented: the subject really feels them as something external. However, these are usually one’s own thoughts that are experienced as coming from outside (it is speculated that they may be due to the disconnection between the prefrontal and speech regions that makes self-awareness of subvocal speech difficult) or anomalous interpretations of outside noises.
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 those alterations that represent a exacerbation or alteration of the patient’s usual abilities and functioning, generally adding something to said operation. An example of this would be hallucinations, delusions and strange behaviors).
Regarding negative symptoms, they will refer to those alterations that represent a loss of existing skills previously. This is the case of alogia or impoverishment of thought, emotional flattening or apathy.
Psychopathology course
Schizophrenia is currently considered a chronic disorder. This disorder It usually occurs in the form of outbreaks, although there are cases in which they do not emerge as such but rather a constant deterioration occurs. Psychotic outbreaks generally arise, in which positive symptoms such as hallucinations and agitation abound, after which there is generally a complete or partial remission.
A single psychotic break with complete remission may occur, although several occur throughout life. As we have indicated, there can be complete remission, but there can also be cases in which said remission is partial and symptoms and cognitive impairment remain This deterioration can remain stable or progress (which is why Kraepelin called this disorder dementia praecox).
Difficulties
Suffering from schizophrenia can have a large number of consequences and generate severe difficulties. And the set of symptoms described above significantly interfere with the subject’s usual functioning on a daily basis, in areas such as interpersonal relationships, work or the academic field.
Social interactions are usually reduced and greatly affected, and work and even academic skills and possibilities can also be greatly altered, especially if there is deterioration. Subjects with schizophrenia usually present attention and information processing problems, especially in those cases that present negative symptoms. Their performance in sustained or selective attention tasks is lower.
Furthermore, we must take into account the effect that the diagnosis itself has on the subject: schizophrenia is a disorder considered chronic and that To this day it is still highly stigmatized, 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 the treatment may appear. This last aspect is especially important, since with treatments 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 that referred to a type of predominant symptomatology or a form of presentation of the specific disease.
Specifically, paranoid schizophrenia could be found (focused on hallucinations and delusions of a persecutory and referential nature, along with aggression and other alterations), disorganized schizophrenia (whose main characteristic is chaotic and incoherent behavior and thinking and emotional flattening and inadequacy) or the catatonic (in which the most prominent problems were psychomotor alterations, with mutism and immobility as well as waxy flexibility and agitation), together with the residual (in which the subject had recovered from an outbreak with the exception of some symptoms that remained , generally of a negative type) or the simple one (with a prevalence of negative symptoms, such as alogia and affective flattening).
However, in the latest version of one of the most used manuals worldwide, the DSM-5, this distinction was no longer made to bring together 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 propose that rather than schizophrenia we should talk about psychotic spectrum disorders, in a similar way 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, they have been developed throughout history different hypotheses about what can trigger schizophrenia
Biological hypotheses
At a biological level, what is known is that people who suffer from schizophrenia present 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 deficiency 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 less blood flow to the frontal areas of the brain differences between both temporal lobes and a smaller volume of some structures such as the hippocampus and amygdala, as well as larger cerebral ventricles.
It has been observed that genetics seems to play a certain role, often seeking the involvement of different genes in the appearance of the disorder. The research carried out shows that there does seem to be a genetic predisposition linked to a greater vulnerability to suffering from it, although the disorder does not have to be triggered. It will be the set of vital circumstances that surround the individual that determine whether or not this predisposition awakens the disorder.
Today, one of the most considered 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 for 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 the flu could cause alterations at the brain level.
In addition to the biological hypotheses, there are others of a much more psychological nature that must be taken into account, although these are not hypotheses that are necessarily mutually exclusive.
The best known and predominant model that is used 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 suffering from this disorder and to presenting 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 (such as a very critical family environment or with excessive expressed emotion to which they must adapt. But depending on the circumstances , it may happen that they fail in said adaptation and cannot adjust, this ends up triggering the disorder.
Some of the oldest theories, of a psychodynamic nature and especially linked to paranoid-type schizophrenia, consider that the causes of the disorder can be found in the presence of deep psychic conflicts from which the subject defends himself through projection (placing one or some of one’s own characteristics in another person) and denial of the conflict, which sometimes end up generating the dissociation of the mind with reality. However, these explanations have no scientific value.
Treatment
Schizophrenia is a chronic disorder that has no recognized cure as such at the moment, although symptoms can be treated in such a way that those who suffer from it can have a normal life and remain stable, preventing the appearance of outbreaks.
To do this, however, Treatment must be continued throughout the subject’s life cycle in order to prevent the appearance of new outbreaks. In general, drugs known as antipsychotics are used for this purpose, which act by treating excess dopamine in the mesolimbic pathway and, in the case of those classified as atypical, also improving the negative symptoms by increasing the levels of said hormone in the mesocortical pathway. .
We also work from the psychological field, 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 reintegration can be of great help to combat the difficulties generated by the disorder. Finally, psychoeducation of the subject and the environment are essential.
