Schizophrenia: Symptoms, Causes, Risk Factors, Classifications, Diagnosis, Treatment, Prognosis

Schizophrenia is a severe mental illness where patients have abnormal perceptions of reality. Hallucinations, delusions, and disordered thoughts and behavior are all possible symptoms of schizophrenia, which can make it difficult to carry out daily tasks and be disabling.

Schizophrenia patients need ongoing medical care. Early intervention could help control symptoms before serious issues arise and might assist the long-term prognosis.

Read this blog further for a quick overview of this important topic Schizophrenia: Symptoms, Causes, Risk Factors, Classifications, Diagnosis, Treatment, Prognosis for PSYCHIATRY to ace your NEET PG exam preparation.

Symptoms of Schizophrenia   

Following are explained some of the symptoms of schizophrenia:                                 

Positive Symptoms (psychotic symptoms) 

• Delusions
• Hallucinations which are false perceptions without any real object. The most common  hallucinations which are suffered by patients are auditory hallucinations. 
• Patients with these symptoms respond well to medications and have a good prognosis.

 Negative Symptoms  

• Anhedonia - Loss of interest 
• Avolition - Loss of will/drive (loss of motivation).
• Affective blunting - Inability to express emotions.
• Asociality - Decrease in the drive to socialize.
• Alogia - Decrease in verbal communication. 
• Attention deficits - Not able to pay any attention.
• Apathy - Lack of concern. 

These symptoms are known as negative symptoms because every ability is getting reduced and these patients don't respond well to medications and thus have a bad prognosis.

Disorganized Symptoms

• Disorganized speech and/or thoughts is a formal thought disorder.
• Disorganized behavior 
• Inappropriate affect with respect to setting or social behavior. 

For a better understanding of this topic go watch this video regarding the case scenario of schizophrenia.

Catatonic Symptoms

Basically these are motor symptoms. Karl Kahlbaum coined the term catatonia.

• Symptoms
  • Stupor: Extreme hypoactivity or immobility.
  • Excitement: Extreme hyperactivity towards non-goal-directed activities. 
  • Mutism - no or little verbal communication. 
  • Catalepsy: maintaining an odd posture for a longer time. It is a Passive phenomenon. 
  • Posturing: Same as catalepsy, but it is an active phenomenon. In this, the patient gets into the posture and maintains it for a longer time.
  • Waxy flexibility- Feeling of resistance while making passive movement on the patient which appears as like bending a wax candle.
  • Negativism: Patient opposes or gives no response to instructions. 
  • Automatic obedience: Patient becomes excessively cooperative.
  • Mannerism: Repetitive odd movements which are purposeful movements.
  • Stereotypy: Repetitive odd movements which are non purposeful movements. 
  • Echolalia: Mimicking examiner's speech.
  • Echopraxia: Mimicking examiner's actions.
  • Grimacing: Maintenance of odd facial expressions.
  • Ambitendency: Inability to decide motor movements. 

If a patient has 3 or more symptoms among these they are called catatonic symptoms.

Symptoms related to suicide, violence, and homicide                                 

Suicide

It is the most common cause of premature death in patients with schizophrenia.Rate of suicide is 5 to 6%.

• Risk factors for suicide are:
  • Presence of major depressive disorder.
  • Young males- Decline in a higher level of functioning and are Hopeless of the future. 
  • Increased symptoms like Delusions of persecution and Command hallucinations 
  • Comorbid substance use.

Clozapine decreases suicidal ideation. Antidepressants can be administered for comorbid depression.

Violence- It may be seen in patients with untreated Schizophrenia. Homicide- The rate of homicide is similar to the general population. 

Causes Of Schizophrenia

Though its specific cause is unknown, doctors believe that genetics, brain chemistry, and environment all contribute to how schizophrenia manifests.

Problems with certain naturally occurring brain chemicals, such as the neurotransmitters dopamine and glutamate, may make schizophrenia worse.

 Neuroimaging research has shown that the brain and central nervous system of people with schizophrenia are distinct. The implications of these alterations are unclear to experts, although they do imply that schizophrenia is a brain condition.

Risk Factors Of Schizophrenia

Several factors, including the following, seem to increase the likelihood of schizophrenia development or onset, despite the fact that the precise origin of schizophrenia is unknown.

Some of these risk factors are:

• Schizophrenia running in families.
• Some problems with pregnancy and delivery include malnutrition or exposure to substances or viruses that could affect the development of the brain
• Use of psychotropic drugs in the teen years.

Classification of Schizophrenia                          

i. According to ICD 11 and DSM 5

Schizophrenia is classified based on the course of illness.

• Schizophrenia with the first episode- In this condition the patient is currently symptomatic and there is Partial remission.
• Schizophrenia with multiple episodes- in this condition   The patient previously had 1 episode and then  Develops another episode again. Remission is present between the 2 episodes.
• Schizophrenia with continuous course- in this condition the Symptoms are continuously present. To diagnose this type the symptoms should be present for up to 1 year.

ii. Subtypes of Schizophrenia

Earlier ICD 10 and DSM 4 classified schizophrenia based on the symptoms. These subtypes are now removed from the newer classification. The subtypes are:

• Paranoid schizophrenia -  In this condition, the patient has Delusions and hallucinations. This condition has a Late onset and a Good prognosis. In this, the Personality of the patient is preserved.
• Hebephrenic or disorganized- in this condition the patient Has disorganized symptoms like giggling, mirror gazing, etc. This condition generally has an Early-onset with Poor diagnosis. It causes Severe personality deterioration.
• Catatonic schizophrenia- Mostly catatonic symptoms are present along with other symptoms. Treatment can be done with the help of  Lorazepam (IV) and ElectroConvulsive Therapy. It has the Best prognosis.
• Residual schizophrenia -  At an early stage, the patient has delusions and hallucinations in this condition which Later on become minimal and mostly show negative symptoms. 
• Undifferentiated Schizophrenia - There are features of more than  1 subtype in this condition. So it is difficult to differentiate or put it into one subtype, due to which the Patient has a mixture of symptoms. 
• Simple Schizophrenia- in this condition the Patient has predominantly negative symptoms and this condition has the Worst prognosis. According to ICD10 if these negative symptoms are present for more than 1 year then can be called simple schizophrenia. 
• Post Schizophrenic Depression- Schizophrenic symptoms in the past 1 year but Now it has improved and Later develops depressive symptoms. There is a High risk of suicide in this condition.

iii. Other Classifications    

• TJ Crow classified schizophrenia into 2 syndromes:
  • Type 1
  • Type 2

Feature	Type 1	Type 2
Symptoms	Positive symptoms	Negative symptoms
Response to treatment	Good	Poor
Ventricles	Normal	Dilated
Prognosis	Good	Poor

• Van Gogh Syndrome: Dramatic self-mutilation in schizophrenic patients. 
• PfRopf Schizophrenia: Schizophrenia occurs in patients with mental retardation.
• Substances causing schizophrenia-like symptoms: 
  • Hallucinogens - Phencyclidine, amphetamine, cocaine, cannabis.

iv. ICD 11                      

Separated catatonia into a separate diagnostic category. Which Includes

• Catatonia associated with another mental disorder- it includes Mood disorders, Schizophrenia, and Autism spectrum disorder
• Catatonia induced by psychoactive substances- Also includes medications.
• Catatonia unspecified

Diagnosis of Schizophrenia

Diagnosis can be made on the basis of the following symptoms:

• Delusions
• Hallucinations 
• Disorganized speech
• Grossly disorganized or catatonic behavior.
• Negative symptoms.

According to DSM-5, the patient should have 2 or more symptoms. At least 1 symptom should be  present from the 3 that is Delusions, Hallucinations, Disorganized speech and it Should be present for 1 month. The total duration of disturbances should be around 6 months.

According to ICD 11, the duration should be 1 month.

DSM 4: Gives special significance to:

• Bizarre Delusions
• SFRS hallucinations 

No other symptoms are required to diagnose the patient with schizophrenia.

Prognostic Factors of Schizophrenia          

Factor	Good	Bad
Onset	Acute (within 2 weeks)/ abrupt (within 2 days)	Insidious (symptoms started gradually/ slow)
Age	Late (30s and 40s)	Early (10s and 20s)
Subtypes	Catatonic/ Paranoid	Simple (Worst) / Hebephrenic
Gender	Female (better compared to male and has late age onset)	Male (poor)
Prominent Symptoms	+ve	-ve
Mood symptoms	Present (change in emotions)	Absent (no emotions change)
Family history	Mood disorder (like bipolar, mood disorders)	Schizophrenia
Marital status	Married (has good support from partner)	Unmarried/ divorced ()
Social Support	Good (has good support from family)	Poor (lacks support from family)
Premorbid functioning	Good (has better connections and relations)	Poor (doesn’t have proper connections and relations)
Employment	Employed	Unemployed
Precipitating factors	Present (patient may have financial or relationship issues)	Absent (patient may not have any financial or relationship issues)

Treatment of Schizophrenia 

 Typically, medication, counseling, and self-management approaches are used in the treatment of schizophrenia. These incorporate:

• Antipsychotics. These drugs prevent the brain from using specific molecules to communicate between cells.
• Other Pharmaceuticals. Additionally, other medications may be suggested by your doctor to treat symptoms that develop concurrently with or as a result of your schizophrenic symptoms. Additionally, they may recommend drugs to aid with antipsychotic medication side effects like tremors.
• Psychotherapy. You can manage your disease and cope with it by using talk therapy techniques like cognitive behavioral therapy (CBT). 
• ECT stands for electroconvulsive treatment. Your healthcare professional might suggest ECT if other therapies don't work.

Complications Of Schizophrenia

Complications associated with schizophrenia are:

• Suicide, suicide attempts, and suicidal thoughts
• Obsessive-compulsive disorder (OCD), anxiety disorders
• Depression
• Abuse of nicotine, alcohol, or other drugs
• Being unable to work or go to school
• Homelessness and money issues
• Social isolation Medical and health issues
• Becoming a victim
• Despite being rare, aggressive behavior

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