Schizophrenia is a psychiatric illness that affects people in their youth, with a limited prevalence and incidence, but with major chronic consequences for sufferers if not treated properly

It is a disabling mental disorder that requires ongoing treatment.

How schizophrenia manifests itself: symptoms

Schizophrenia leads sufferers to a loss in their ability to function on a daily basis, due to the main characterising elements and symptoms, variously combined from subject to subject, which are

• cognitive impairment (deficits in important functions such as attention, certain components of memory, the ability to plan, schedule and adapt usefully to ‘feedback’ from the environment);
• delusions (persistent beliefs or ideas that do not correspond to reality and are not ‘criticised’ by the sufferer, i.e. they are indistinguishable from actual inferences)
• disorganisation of thought and behaviour;
• hallucinations (false sensory perceptions, usually auditory, in the absence of an external stimulus, so-called ‘voices’ that do not exist but are perceived as real ones, but also noises heard by the patient in the absence of a stimulus)
• apathy (lack of interest in anything);
• anhedonia (loss of pleasure and interest in usually gratifying activities);
• avolition, which corresponds to the lack of motivation or ability to finalise common activities in everyday life.

Loss of daily functioning

The loss of daily functioning can be such that this disease, although infrequent, is among the top 20 human diseases that cause the most ‘years lived in disability’, according to the World Health Organisation.

When we talk about loss of daily functioning, we are talking about the habitual abilities performed on a daily basis consistent with the person’s age and life context.

We can therefore observe a reduction or loss of the ability to study or work, and in the most severe cases also a difficulty in taking care of oneself in simple daily actions such as caring for one’s person, one’s home, and having adequate and purposeful rhythms and lifestyles.

Also in the same area, we have deterioration or complete loss of social relationships, due to progressive isolation, loss of friendships and relationships in general.

Severity of schizophrenia symptoms

The severity of symptoms is variable and much depends on the timeliness of treatment, which must integrate

• drug therapy to improve and prevent the flare-up of the so-called ‘positive’ symptoms, which are more evident such as delusions, hallucinations, disorganisation;
• rehabilitation therapy to act on the restoration of daily functioning through behavioural programmes by improving neuro-cognitive functions (such as short-term memory, attention, planning and abstraction abilities) and socio-cognitive functions (i.e. the ability to be fully competent in complex human social interaction).

These functions are deteriorated by the disease in a more subtle way, especially in the first years after onset, and are correlated with a loss of daily functioning in a more significant way, but also with a reduced response to behavioural rehabilitation programmes, which is why they must be addressed in the design of the intervention.

The causes of schizophrenia

Experts agree on the complexity of causes.

The interaction of several factors combined in different ways and with different relative weights influences the risk at the individual level: these include genetics and biological and environmental risk factors that have an ‘epigenetic’ effect, such as certain perinatal problems or later substance use during adolescence (particularly cannabis), and the presence of stressful life events and situations such as migration, belonging to a minority social group, urbanisation and others.

These latter factors are called ‘epigenetic’ because they modulate the expression of genetic risk and together with it determine the dysfunctions underlying psychopathological phenomena and cognitive impairment.

It is important to specify that familiarity for the disorder explains only a relative share of the risk and many cases are defined as ‘sporadic’ i.e. without any affected member in the family of origin, cases in which epigenetic components act on genetic risk configurations that are probably widely distributed in the general population.

When to consult the specialist?

None of the above symptoms is diagnostic of this disease per se, but the simultaneous presence of several of them in youth (usually late adolescence) over a sufficiently long period is suggestive of a possibility and therefore of the need for specialist investigation for early intervention, which is key to improving the prognosis.

Treatment

The management of the disease has improved considerably in recent years, and consequently so has the patient’s quality of life.

Today, it is possible to treat the acute psychopathological conditions of the disease pharmacologically and which sometimes require hospitalisation, while at the same time reducing the tendency towards chronicity and the aggravation of the most striking symptoms of the acute conditions, the ‘positive symptoms’, provided that constant therapy is provided.

Drug therapy

Drug therapy alone is usually not sufficient to achieve optimal functional results.

Early and integrated intervention is essential to slow down the evolution of the disease and contain the symptoms.

Today, high levels of ‘recovery’ can be achieved and a good outcome is estimated in 40% of cases, unlike in the past.

Provided that simultaneously integrated and personalised treatments are carried out at an early stage.

Pharmacological treatments are necessary and today we can count on numerous molecules that also significantly improve the symptomatology and stabilise the situation, particularly that of the ‘positive symptoms’, as delusions, hallucinations, disorganisation of thought and behaviour are defined.

Individualised rehabilitation interventions

Even the best pharmacological treatments are not, however, able to modify in a clinically relevant way the so-called ‘negative’ symptoms (i.e. apathy, anhedonia, avolition, social withdrawal), nor the decay of cognitive functions, both psychopathological dimensions strongly correlated with daily malfunctioning.

For this reason, drug therapy must be supplemented with customised ‘state of the art’ rehabilitation interventions, which not only act ‘downstream’ on behaviour, simply reshaping it in a way that is useful in everyday life, but also go to work at the basis of dysfunction, improving the cognitive performance necessary for good functioning in the world.

Today, the international scientific community provides clear indications for neurocognitive and sociocognitive rehabilitation interventions, combined with cognitive-behavioural and psychosocial rehabilitation, which can lead to good results in the majority of sufferers, in association with pharmacological treatments.

Schizophrenia, the advice

It is important not to underestimate the first signs of mental distress by contacting one’s GP, who can recommend a specialised centre where, if the diagnosis is confirmed, the patient can be followed by a team of expert psychiatrists, psychologists and rehabilitation technicians dedicated to treating psychotic disorders and schizophrenia.

The sooner action is taken, the less damage the pathology can cause to the individual.

Unfortunately, there are still strong prejudices in society towards mental illness and this causes sufferers to be and feel stigmatised and consequently delay access to treatment.

With the knowledge we have today and the intense and constant research activity in this field, the scientific community unanimously agrees that the earlier action is taken, and with the most advanced programmes, the greater and better the chances of cure and return to pre-morbid functioning.

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Source:

GSD