Schizophrenia is the main and best-known psychotic disorder, suffered by around 1% of the world’s population.
However, despite being relatively known, there are still a large number of mysteries and aspects to investigate regarding this disorder. What is it? Why does it occur? And what is perhaps the most important question… is schizophrenia curable?
Schizophrenia is a psychotic-type 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 people or beings other than one’s own self), delusions and disorganization of speech, and may also present symptoms such as alogia and abulia, chaotic behavior and catatonia. These symptoms generally appear in the form of psychotic outbreaks, and the disorder can have different courses (with complete or partial remission, with progressive deterioration…), and generate significant interference in the subject’s life in all or almost all vital areas.
These symptoms are usually classified as positive and negative, the first being those that activate the subject or add something to their usual functioning (for example hallucinations and delusions) and the second those that represent a limitation due to the decrease in faculties. (case of alogia and poverty of speech and thought).
Previously, the existence of different subtypes was considered based on 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 your causes?
The causes of schizophrenia remain largely unknown today The influence of genetic factors has been observed, which generate a vulnerability that predisposes (but does not necessarily have to generate) the disorder. Likewise, the environment also has a great influence, with the interaction between both factors being what can trigger the disorder. The experience of highly stressful events or the consumption of some drugs can increase and trigger outbreaks in people with this 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, the mesolimbic pathway and the mesocortical pathway being the most related. In the mesolimbic pathway there is an excess of dopamine that is associated with the existence of positive symptoms, while a deficiency of this hormone in the mesocortical pathway is responsible for the negative ones. Knowledge of these brain alterations can and in fact is used in their treatment (especially with regard to medical and pharmacological matters).
Currently, some authors propose the hypothesis that Schizophrenia is the result of a problem in the neuronal migration process how neuronal interconnections develop throughout development.
Is there a cure?
Schizophrenia is a disorder currently considered chronic, and there is currently no curative treatment for this condition. However, it is treatable: treatments and therapies are available that control the symptoms and keep the patient stabilized, preventing more psychotic outbreaks from reappearing and allowing them to lead a normal life.
However, it is necessary that the treatment be carried out continuously throughout the subject’s entire life. This last point is important in order to prevent relapses, which are usually frequent when subjects, already feeling well, decide to stop treatment and medication. Likewise, continuous monitoring makes it possible to regulate or vary the intake of medication, in those cases in which the prescribed drug is not effective or has excessive side effects.
However, it is also true that this disorder is not unknown to science, there is still a large room for improvement regarding its understanding. As with other chronic disorders, both mental and organic, there is still much to analyze and discover, and it is possible that in the future a solution will be found that can be considered a cure as such.
As we have said, although without a cure at the moment, schizophrenia is a treatable disorder, with said treatment being carried out in a multidisciplinary manner. The joint use of both psychotherapy and psychotropic drugs is recommended.
1. Pharmacological and medical treatments
At a pharmacological level, antipsychotics or neuroleptics are mainly used The use of atypical ones is especially recommended, since they allow both positive and negative symptoms to be greatly reduced and controlled and do not have as many side effects as the typical ones. Pharmacological treatment must be maintained throughout the subject’s life, since it prevents the appearance of new psychotic outbreaks (although the type of drug in question, the dose and its level of effectiveness will depend on the person).
It may also be necessary to apply other types of medications, such as antidepressants, in cases where it is necessary due to the symptoms presented.
Regarding other medical procedures, although it is not a general 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
On a psychological level, the treatments to be applied will depend on the problems expressed by the patient One of the most fundamental aspects is to make the subject see the need to continue the treatment continuously, given that many affected people end up abandoning the medication. Another aspect that is fundamental is psychoeducation of both the subject and the close environment, so that the subject’s situation is understandable to everyone, 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 break. Family and social support is essential both to continue with treatment and to face the disorder (still highly 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 little by little the subject learns to attribute them to themselves and not to an external entity. Cognitive restructuring is essential when trying to combat beliefs and delusions. It should always be taken into account that these are real mental contents for the patient, and it is generally not advisable to use direct confrontation. Both the form and content of his 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. Likewise, another therapy that generates positive results is acceptance and commitment therapy.
Training in social skills or incorporating it into multimodal programs is highly recommended, given that it is an area that tends to suffer in patients with schizophrenia. Occupational therapy may also be useful, especially in cases where there is cognitive impairment.
The set of treatments presented above, although they do not represent a cure for schizophrenia, As we have said, they allow the patient to keep the disorder under control and lead a normal life
