Schizophrenia

Schizophrenia is a psychiatric disorder denoting an often chronic, major mental illness primarily affecting thinking, with attendant difficulties in perception of reality, which in turn can affect behavior and emotion. The term schizophrenia comes from the Greek words σχίζω (schizo, split or divide) and φρενός (phrenos, mind) and can be translated as "shattered mind."

Treatment

The first line treatment for schizophrenia is usually the use of antipsychotic medication. The newer atypical antipsychotic medications (such as clozapine, risperidone, olanzapine, quetiapine, ziprasidone and aripiprazole) are preferred over older typical antipsychotic medications (such as chlorpromazine and haloperidol) due to their favorable side-effect profile. Compared to the typical antipsychotics, the atypicals are associated with a lower incident rate of extrapyramidal side-effects (EPS) and tardive dyskinesia (TD). It is still unclear whether newer drugs reduce the chances of developing the rare but potentially life-threatening neuroleptic malignant syndrome (NMS). While the atypical antipsychotics are associated with less EPS and TD than the conventional antipsychotics, some of the agents in this class (especially olanzapine and clozapine) appear to be associated with metabolic side effects such as weight gain, hyperglycemia and hypertriglyceridemia that must be considered when choosing appropriate pharmacotherapy.

Related Topics:
First line treatment - Antipsychotic - Atypical antipsychotic - Clozapine - Risperidone - Olanzapine - Quetiapine - Ziprasidone - Aripiprazole - Typical antipsychotic - Chlorpromazine - Haloperidol - Extrapyramidal side-effects - Tardive dyskinesia - Neuroleptic malignant syndrome - Weight gain - Hyperglycemia - Hypertriglyceridemia

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Atypical antipsychotics and typical antipsychotics are generally thought to be equivalent for the treatment of the positive symptoms of schizophrenia. It has been suggested by some researchers that the atypicals have some beneficial effects on negative symptoms and cognitive deficits associated with schizophrenia, although the clinical significance of these effects has yet to be established. However, recent reviews have suggested that typical antipsychotics, when dosed conservatively may have similar effects to atypicals{{Fn|47}}.

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The atypical antipsychotics are much more costly as they are still within patent, whereas the older drugs are available in inexpensive generic forms. Aripiprazole a drug from a new class of antipsychotic drugs (variously named 'dopamine system stabilizers' or 'partial dopamine agonists') has recently been developed and early research suggests that it may be a safe and effective treatment for schizophrenia{{Fn|16}}.

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Hospitalization may occur with severe episodes. This can be voluntary or (if mental health legislation allows it) involuntary (called civil or involuntary commitment). Mental health legislation may also allow people to be treated against their will. However, in many countries such legislation does not exist, or does not have the power to enforce involuntary hospitalization or treatment.

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Psychotherapy or other forms of talk therapy may be offered, with cognitive behavioral therapy being the most frequently used. This may focus on the direct reduction of the symptoms, or on related aspects, such as issues of self-esteem, social functioning, and insight. There have been some promising results with cognitive behavioral therapy, but the balance of current evidence is inconclusive{{Fn|17}}.

Related Topics:
Psychotherapy - Self-esteem - Cognitive behavioral therapy

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A relatively new approach has been the use of cognitive remediation therapy, a technique aimed at remediating the neurocognitive deficits sometimes present in schizophrenia. Based on techniques of neuropsychological rehabilitation, early evidence has shown it to be cognitively effective, with some improvements related to measurable changes in brain activation as measured by fMRI {{Fn|48}}.

Related Topics:
Neurocognitive deficits - Neuropsychological rehabilitation - FMRI

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Electroconvulsive therapy (also known as ECT or 'electroshock therapy') may be used in countries where it is legal. It is not considered a first line treatment but may be prescribed in cases where other treatments have failed. Psychosurgery is almost non-existent nowadays and is shunned upon by the general community.

Related Topics:
Electroconvulsive therapy - First line treatment - Psychosurgery

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Other support services may also be available such as drop-in centers, visits from members of a 'community mental health team' and patient-led support groups. In recent years the importance of service-user led recovery based movements has grown substantially throughout Europe and America. Groups such as the Hearing Voices Network and more recently, the Paranoia Network, have developed a self-help approach that aims to provide support and assistance outside of the traditional medical model adopted by mainstream psychiatry. By avoiding framing personal experience in terms of criteria for mental illness or mental health, they aim to destigmatise the experience and encourage individual responsibility and a positive self-image.

Related Topics:
Europe - America - Hearing Voices Network - Paranoia Network - Mental illness - Mental health

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In many non-Western societies, schizophrenia may be treated with more informal, community-led methods. A particularly sobering thought for Western psychiatry is that the outcome for people diagnosed with schizophrenia in non-Western countries may actually be much better{{Fn|18}} than for people in the West. The reasons for this recently discovered fact are still far from clear, although cross-cultural studies are being conducted to find out why. One important factor may be that many non-Western societies (including intact Native American cultures) are collectivist societies, in that they emphasize working together for the good of other society members. This is in contrast to many Western societies, which can be highly individualistic. Collectivist societies tend to stress the importance of the connectedness of extended family, providing a useful support mechanism for the stress that mental illness plays on both the ill and others around them.

Related Topics:
Native American - Collectivist societies

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