People who have a mental illness have affected their affective tone, their behavior and the way they communicate with other people.
We are more prepared to accept and understand the case of physical diseases. Other elements that tend to be confused are that these disorders do not have a known or easy-to-recognized cause or causes, vary from one person to another and their treatment is also confusing.
Mental health and mental illness depends on our lifestyle, the quality of the affective relationships we have, of our ability to love and accept others, to give confidence and support, and receive them, from our tolerance .
This set of values, attitudes and skills can admit a variety of definitions, there are no absolute parameters and each culture and each human group and each family and individual elaborates their own.
You could consider psychically normal anyone who behaves and act like most people in your environment, if someone does not behave like most people are said to be sick. From the medical perspective a mental disorder would be that unhappy behavior that does not sore any concrete results, which moves away from reality. From the social point of view, a mentally illness would not fit your environment.
The term of schizophrenia was introduced by the Bleuler Swiss psychiatrist in 1911. But this disorder was already identified by the German kraepelin psychiatrist in 1896 under the name of "precocious dementia", wanting to mean that the affected people, necessarily suffer serious deterioration Cognitive and behavioral, similar is to the dementias experienced by some elderly people, but in this case it would be given at a youthful age.
However Bleuler noted that it was not like that in all cases and considered it more appropriate to give the name of schizophrenia as a split in the association of ideas or as a withdrawal of reality and social life. The term of schizophrenia itself means "game mind".
The age of appearance is between 15 and 45 years, although they usually begin at the end of adolescence, there are also cases of onset in childhood, which usually mask with school problems or bad behavior.
Whoever suffers from schizophrenia Experience a distortion of thoughts and feelings. What characterizes schizophrenia is that it affects the person in a total way, so whoever suffers it begins to feel, think and speak differently than as before. This person can start to be strange more isolated, can avoid going out with friends, sleeps little or too much, speak only or laugh at no apparent reason (although these symptoms do not have to appear in all patients.)
It is very important not to forget that the person who has a schizophrenia can not explain what is happening to him, he is afraid to do or believe he is sick and therefore he will not ask for help or complain in most cases of what happens to him. For all this most of them and above all at the beginning of the disease do not accept to take medication or go to the specialist.
Symptoms are called to those manifestations of the subject who announce an anomaly or illness. Symptoms would be the pains, inflammations, changes in biological rhythms. The problem of schizophrenia is that most symptoms are subjective, depend on what the patient refuses. There are two types of symptoms in schizophrenia:
- Positive symptoms: are those manifestations that the patient does or experience and that healthy people do not usually present.
Negative symptoms: They are those things that the patient stops doing and that healthy individuals can perform daily, such as thinking fluently and with logic, experiencing feelings towards other people, having will to get up every day.
- Positive symptoms:
The scheme of positive symptoms is as follows: they can be in other disorders.
- Mental positive symptoms: (Psychotic)
- hallucinations: They are deceptions of the senses, interior perceptions that occur without an external stimulus. It is not in a position to recognize that the perceived arises only from its indoor experiences and is not presenting in the external world. , They can be auditory, tactile, visual, taste and olfactory.
- Delirio: It is an erroneous conviction of pathological origin that manifests itself despite contrary and sensible reasons. The scope with reality is restricted. The patient sees delirium as the only valid reality. Although the thoughts themselves are contrary to the laws of logic, the patient is inaccessible to this objection. When it is noticed of this state, sometimes you do not have to think about the beginning of a treatment or hospitalization, since the despair that can occur in the patient makes there suicide attempts. Types: Persecution, guilt, greatness, religious, somatic, reference ...
- Disorders of thought: The way of speaking usually gives us significant indications about upset thought. They often relate that they have lost control over their thoughts, which have been subtracted, taxes or who are directed by strange powers or forces related to language we have: derailment, tangentiality, ilogicality, speech pressure, distalability ...
In psychotic crises, these previous symptoms described can be accompanied by:
Positive symptoms in the field of feelings: anguish, excitability
Positive vegetative symptoms: insomnia, palpitations, sweats, dizziness, gastrointestinal disorders, respiratory disorders
Positive symptoms of motor skills: Behavior, aggressive and / or agitated, body concern, strange and absurd movements, repetitive behavior.
Negative symptoms: In the Schizophrenia there is also another series of symptoms, less alarming but that are usually confused as signs of laziness or Evil behavior, are the so-called negative symptoms such as apathy, lack of energy, lack of pleasure, unociability, etc., which should be treated to the same extent as active or positive symptoms.
All these symptoms affect all areas: social, work, family. In some aspects the schizophrenic patient has less action capacity than a healthy person. These deficiencies call them negative symptoms.
These symptoms can be seen before the hallucinations and delusions appear, but in their clearer form they manifest only after the disappearance of positive symptoms. We would talk about the residual phase of the disease.
You have to emphasize that not all people suffering from schizophrenia have these impediments or symptoms. Around a third of the patients do not have it at all or so little accentuated that they barely bother him in everyday life.
Negative symptoms
Affective poverty : it manifests itself as an impoverishment of the expression of emotions and feelings, decreases emotional capacity; It is manifested in aspects of behavior as: Immutable facial expression: the face seems frozen, from wood, mechanical., Decreased spontaneous movements and shortage of expressive ademans: Does not use the hands to express yourself, stay motionless and sit down ..., Little Visual Contact : You can shuffle to look at others, stay with a lost look, affective incongruity: the affection expressed is inappropriate. Smile when you talk about serious topics. Silly laughter, absence of vocal inflections: Speech has a monotonous quality and important words are not emphasized by means of speech tone changes or volume.
AlloGia: refers to the impoverishment of thought and cognition. It is manifested through: poverty of language: restriction of the amount of spontaneous language, the answers are brief and there is rarely additional information, poverty of the content of the language: although the answers are long, the content is poor. Language is repetitive and stereotyped vague, blocking: language interruption before a thought or idea has been completed. After a period of silence that can last a few seconds can not remember what was saying or what I wanted to say, increasing response latency: the patient takes longer than normal in answering the question.
Abulia-Saphy: Abulia manifests itself as a lack of energy, impulse. Apathy is lack of interest. Unlike the lack of energy of depression, in schizophrenia is relatively chronic and normally it is not accompanied by a sad affectivity. It is manifested in: problems with toilet and hygiene, lack of persistence at work, school or any other task, feeling of fatigue, slowness, propensity to physical and mental exhaustion.
anhedonia - unociability: Anhedonia is the difficulty of experiencing interest or pleasure for the things that before he liked to do or by activities normally considered pleasant: he has few or no hobbies, they tend to show a Decrement of activity and sexual interest based on what it would have to be normal according to the age and state of it, it may show inability to create appropriate upcoming and intimate relationships for your age, sex and family state, relationships with restricted friends and similar. They make little or no effort to develop such relationships.
Attention cognitive problems: problems in concentration and attention, she is able to focus only sporadically distracted in the middle of an activity or conversation is manifested in social situations; is going away, it does not follow the plot of a conversation, little interested in topics; Ends abruptly apparent discussion or task.
Types of Schizophrenia:
We have pointed out the individual character of the picture of the disease, so subordination to one of the various types of pathology often means a simplification. In addition frequently mixed tables are presented, which can be difficult to classify. It is also observed many times that the picture of the disease varies over time.
Paranoid schizophrenia: is characterized by the predominance of delusions and hallucinations, especially auditory. Delusions and hallucinations sometimes constitute a unit. It is the most common, usually begins between 20 and 30 years and is the best evolves despite the ostentation of the picture.
Catatonic schizophrenia: is predominant movement disorder or motor movements. Experts speak of "catatonic stupor." Despite having the waking consciousness, the patient does not respond to attempts to contact him. The face he remains motionless and expressionless, no inner movement and even strong pain stimuli is perceived can not cause any reaction. In severe cases can not speak or eat, or drink for periods long enough to endanger her life. However inside the patient may have true feelings storms, which often only manifest themselves in an acceleration of the pulse. constant repetition also occur at the same movement (automatic) and faces. Pictures of extreme gravity, in which the patient is kept for example on one leg for a few weeks, only rarely observed by the current possibilities of treatment. Only happen when no one takes care of the sick or when treatment is not effective. The prognosis for this type of schizophrenia usually be bad.
Schizophrenia Disorganized or Hebephrenic: predominates absurd affection, inappropriate (they tend to laugh when given bad news, behaviors are often children, the mood is absurd, there disinhibition in feelings. they often have strange behaviors such as laughing for no apparent reason and make funny faces. they often show lack of interest and participation. There are cases in which hallucinations and delusions are manifested, although this is not a condition even-handed in this type of schizophrenia most cases outbreaks are not clearly definable. it usually starts at an early age as puberty, so are called juvenile schizophrenics and there are even cases where the disease comes from childhood (childhood psychosis). developments hebéfrenicos slow and unnoticed by presenting few symptoms are classified as simple schizophrenia. in the absence of symptoms is difficult to recognize, (the evidence suel to be self-neglect, solitary behavior ...). The prognosis is usually unfavorable compared to other schizophrenics, because of the immature personality of the patient.
Undifferentiated Schizophrenia: is a type of schizophrenia in which prevails not a specific symptom for diagnosis, is like the mixture of the other above.
residual schizophrenia: in these cases should have been, at least one episode of schizophrenia before, but at present no significant psychotic symptoms. It is the phase in which the negative symptoms are more obvious. It is not seen in all patients.
course of the disease: When symptoms of schizophrenia are presented for the first time in the life of a person and disappear after full shortly, talking and a schizophrenic or psychotic episode, usually after these episodes are no negative symptoms.
You can talk about a schizophrenia when already on the first occasion presented by the manifestations of the disease are maintained for a more or less long time, when the symptoms reappear after some time and when the disease flows into negative symptoms, You can distinguish three phases:
1st prodromal phase: is the phase in the life of the person that occurs before the unleashing of the disease. It can be seen that in some people suffering from the disease they had already been different in childhood and youth, solitary, silent, low performance. But it does not necessarily have to be like that, there are cases in which no anomaly is detected in the person suffering from schizophrenia. It is called a prodromal phase to the phase that occurs before a crisis, therefore there are a series of symptoms that can help us in some cases it has detecting them: tension and nervousness, loss of appetite or disorganization in meals, difficulty concentrating, Difficulty in sleeping, enjoys less than things, does not remember accurately, depression and sadness, worried about one or two things, he sees less to his friendships, thinks that they laugh or speak ill of him, loss of interest in things, Feel bad without a clear reason, it feels very agitated or excited, it feels useless, other changes ...
2nd Active Phase: is the phase where the disease is triggered, are the so-called outbreaks or crisis, the symptoms that occur are the positive, hallucinations, delusions, thought disorders ... is In the phase in which the family will be alarmed and tends to ask for medical help. These crises can sprout suddenly and develop the entire picture in a few days. In other cases the beginning of the disease can be produced very slowly and unnobly. The duration of the buds varies according to the person and can spread from a few weeks to a year. The same patient usually has outbreaks of similar durations. The same happens with the intervals between buds, according to the characteristics of the person can oscillate between months and several years and are generally of the same duration in the same person.
3rd residual phase: Do not suffer from all the patients, in this phase Negative symptoms reach their culmination and personal, social and labor deterioration is serious.
Theory of three thirds: 1/3 is recovered, 1/3 continues to have certain limitations after an outbreak. , 1/3 serious course of the disease and can not live autonomously.
Causes of schizophreni A:
It is logical that it has been intensely investigated on such a serious and striking disease as schizophrenia. Research has obtained important partial results, which are located in very diverse fields. That is why we can say with enough security that there is no cause for some people to suffer this disease, but there is attributing responsibility to a whole set of causes.
These causes are defined in various conceptual models:
1: Model Vulnerability-Stress
It is assumed that there is a special psychic vulnerability so that a schizophrenia may occur. The first responsibility is due to certain hereditary conditions. It is known that in some families, schizophrenias are frequent, while in others not. Due to this predisposition a person can be vulnerable to suffer the disease but this is not a equanimous condition to develop it. As a trigger of the disease, a special emotional load (stress) must be added. The pathological symptoms of schizophrenia should be understood as an attempt to escape this excessive load in some way.
What are these charges? They can be stressful life events, normally unpredictable, as the death of a close person, military service, the loss of a job ... Also a happy event, like the birth of a child, a wedding, that is, Situations that suppose a change in life. Especially a permanent emotional burden can mean an excessive requirement for a vulnerable person: overly concerned attitude of the family or couple cohibies the person and decreases their autonomy, there are cases in which the person suffering from schizophrenia is by itself, more retracted, Because of this they cause others to want to help you. Another attitude would be when family members have an attitude of undercover rejection, that is, there is no talk of the problem but manifests itself in expressions and attitudes, the affected is criticized and devalued. Excessive emotional charges triggers the first buds, but also subsequent shoots are caused by stress situations even if they are mild load.
It is necessary to mention the existence of other medical models such as: the genetic, neurochemical model, brain alterations, functional, electrophysilogical and neuropsychological alterations, complications in childbirth, virus infections.
At the moment, none of these possible causes has been demonstrated as definitive and investigations continue to confirm them.
Treatment: The treatment of schizophrenia is fundamentally based on antipsychotic drugs, which control the active symptoms, but it is necessary and at the same time complementary that the patient receives a psychosocial (psychological, occupational and social) treatment, it is essential that the person leave of hallucinar, of deliring, but it is also that it recovers its habits of life, that this throughout the busy day, that has its group of friends, that is, integration into society, standardization.
Antipsychotic medication: The pharmacological treatment of schizophrenia is carried out by means of drugs called neuroleptic (NL) for its cataleptic effects and more modernly there is a certain consensus on calling them antipsychotics (AP).
Since the introduction of antipsychotic chlorpromazine in 1954, psychotropic medications have become the pillar of treatment for schizophrenia and other psychiatric diseases. Numerous studies have documented the effectiveness of antipsychotics in the treatment of schizophrenia and lithium and antidepressants in the treatment of affective disorders. Antipsychotics or neuroleptics have shown their effectiveness both in the acute treatment of psychotic symptoms and at relapse level.
Antipsychotics also receive the name of neuroleptics. They were discovered at the beginning of the 50s. They are especially useful for the symptoms characteristic of schizophrenia. They come from five chemical families but all offer the same therapeutic effects. There is no difference in efficiency between a type of antipsychotic against another. Only thanks to pharmacological treatments, the possibilities of rehabilitation and a quick turn to the social environment have been opened.
Schizophrenia is accompanied by an alteration of cerebral metabolism, it is an excessive performance of dopamine. Antipsychotics block the excessive effect of dopamine and restore the balance in cerebral metabolism. However neuroleptics also modify other brain metabolistic areas, in addition to the desired effects, unfortunately also lateral effects or undesirable secondary effects.
The effect of the AP is described as a reassuring for cases of motor restlessness, aggressive behaviors and internal tensions. Hallucinations, delusions and schizophrenic disorders of perception virtually disappear with drugs. When the outbreaks of the disease are repeated, permanent treatment with neuroleptics offers important and relatively safe protection against relapses to acute crises.
Two large groups of AP are distinguished: Classical or typical calls that are characterized by blocking dopaminergic receptors D2 are very effective in positive symptoms, but cause enough side effects and atypical effects that act on serotonergic receptors, producing fewer side effects and Being more effective in negative symptoms.
An important innovation is deposit or injectable neuroleptics, which are injected into gluteus and act over many days. Its advantage is in the fact of guaranteeing the release of the substance, the possibility of reducing the dose to be administered, a drug level in predictable and constant plasma and patients who have absorption difficulties with oral medication can be treated.
In the same way that those affected can react in each case in a very different way to situations of life, the reactions to neuroleptics also vary greatly. The patients respond in very diverse ways to treatment and sometimes more milder or strongest side effects can occur.
We distinguish between the side effects that appear in the first phase of treatment with neuroleptics and the side effects of these in cases of long-term medication. Most side effects appear in the first weeks of treatment. We must mention especially fatigue, dry mouth, dizziness and stunning, circulatory and view disorders, constipation and difficulties to urinate.
Some other side effects can be maintained for a longer time or even starting later. All side effects are described in the instructional papers included in the drug boxes. Often, these descriptions cause a deep insecurity to those affected and their families, so it is very important to give them precise information.
Other side effects that may appear are: muscle spasms, Parkinson syndrome produced by medication, Avish, late dyskinesias, neuroleptics increase sensitivity to sunlight, weight gain, sexual scope: it belongs to the loss of Normal excitability. But some medications can also cause otherwise, that is, a constant excitement. For women, it is especially taking into account that the taking of neuroleptics leads to irregularities in menstruation or even amenorreas.
It is necessary to mention that there are counterattors to file the side effects, as well as pharmacological therapy, for the treatment of schizophrenia is not based solely on antipsychotics, these are usually accompanied by antidepressants, anxiolitics, humor stabilizers.
Psychosocial rehabilitation: Psychopharmacological treatment is essential in the treatment of schizophrenia and other psychoses, but a good therapeutic support is necessary for the good evolution of the disease, this support is psychosocial rehabilitation. By putting an example, I comment that it is useful for the patient to take his treatment if his only activity is to be all day in bed, or having prescribed a medication and lack of sickness and control awareness is not taken, These are some examples of the many that we see what we work in rehabilitation of these patients who have a diagnosis and do not know what happens to them and because their lives can not be the same as before.
Having a psychotic disorder can not be the obstacle that prevents the development of valuable social roles, such as work or at least one occupation, housing, interpester and affective relationships, social consideration and use of community resources. Rehabilitation is understood today as the proportion of the help required by the person for psychosocial performance.
Psychosocial rehabilitation centers are framed within the Community model, work with the patient in its family context and not an institution.
It will try to decrease or eliminate the deficit or deterioration in the different areas that prevent a normal integration of the patient in their environment, training the skills that allow greater autonomy and social integration, improving the quality of life of the patient and his Social and family surroundings.
For each patient an individualized plan of different rehabilitation is carried out depending on his illness, state, deterioration, problems and social and labor situation.
The following areas are worked on:
Psychoeducation of the patient and the family: Provide an updated and understandable information about mental illness, teaching to discriminate the symptoms, prodrut, importance of antipsychotic medication, become awareness of illness, accepting it and learning to live with it.
Social skills: Work through group activities Gratifying and educational techniques of social treatment. Your progressive stepping is from the configuration of small groups to play or perform cooperative tasks until specific social skills training, such as asking for favors, accepting criticism, conversational skills ...
Health education: Encourage health as a good that can be obtained actively. It is worked through modules, which are: sexuality, food, sleep, prevention of anxiety, self-esteem and autoimagen, cognitive abilities.
Guidance and tutoring: Orient and advise on any doubt problem that the user presents and can not be treated from the programs developed in the group, evaluate the achievement of the objectives previously marked for user.
Activities of daily life: The intervention refers to provoking the acquisition and maintenance of a wide range of skills necessary for daily life, this is done through programs such as personal care, domestic activities and cultural orientation
Personal development: Development of the patient in its community environment: Make paperwork of daily life, promote the orientation of it to social, cultural, sports, political, teaching resources to seek employment.
Sports activities: physically stimulate the user through sports techniques at the same time that coordination techniques, group work, toilet and hygiene are worked.
Other areas: socioeconomic and sanitary benefits, labor training, residential alternatives, use of free time, education of the person affected, occupation and support.
As I mentioned at the beginning, all the points exhibited here would need more words and time to develop them in full, but I think that with the here we can make a general scheme of this disease that unfortunately and despite all the scientific advances made, brand and Change the lives of many people who suffer from it, because they suffer it or because their son, his wife, his father or mother began a day to listen to voices.
