What experience caused your mental illness
- What is schizophrenia? severe mental disorders. The main forms are paranoid schizophrenia, hebephrenic schizophrenia, catatonic schizophrenia.
- Symptoms: Delusions (e.g. paranoia), hallucinations (e.g. hearing voices), disorders of emotional impulses (e.g. fluctuations between extreme moods), thinking and language disorders, psychomotor abnormalities (bizarre postures, immobility, etc.)
- Causes: unexplained, but we know various influencing factors (triggers) such as genetic predisposition, high sensitivity, stressful situations, stress, disturbed messenger metabolism in the brain (possibly drugs as a trigger)
- Therapy: Medicines (neuroleptics, antidepressants, sedatives), cognitive behavioral therapy
- Schizophrenia in children: rarely, is often overlooked
- Forecast: very variable, depending on the form and severity of the disease
What is schizophrenia?
Schizophrenia is one severe mental disorder. Those affected suffer from massive changes in their thoughts, feelings and perceptions at times. Their behavior also changes dramatically and often appears bizarre or frightening to outsiders.
Experts include schizophrenia endogenous psychoses: Psychoses are mental illnesses in which patients perceive or process reality in a changed manner. "Endogenous" means that the disease in question arises "from within" due to various factors, that is, without a recognizable physical cause and without a recognizable connection with certain experiences.
Have people with schizophrenia no split personalityas is widely believed. So you don't have multiple personalities that come out alternately, as is the case with dissociative identity disorder.
Schizophrenia: "Stand by the patient"
Three questions toProf. Dr. med Eckart Rüther,
Specialist in psychiatry and psychotherapy
When should I, as a relative, pay attention?Prof. Dr. med Eckart Rüther
You should be alerted if the patient behaves, talks, or does something completely different that he has not done before. Some of them show extreme behavioral problems: For example, those affected hear voices that are not there or feel persecuted. They are also not accessible to logic or are very erratic, so to speak “illogical” in their thoughts or actions.
How dangerous are people with schizophrenia?Prof. Dr. Eckart Rüther, MD
Usually completely harmless! When delusional and excited - especially when the person concerned is afraid - assaults against others can occur. Do not show any aggression here or object. If you understand the disease better, it will be easier for you to adjust to the patient and be by his side!
What is the best way to deal with a patient with schizophrenia?Prof. Dr. Eckart Rüther, MD
Patience, understanding and mindfulness are paramount. If a patient wants to talk to you in a delusional phase, listen to them. But don't encourage him to keep telling the story. Don't talk him out of his delusion. Instead, try to distract him, for example by directing the conversation towards hobbies or harmless topics.
- Prof. Dr. med Eckart Rüther,
Specialist in psychiatry and psychotherapy
Until 2006 director of the Clinic for Psychiatry and Psychotherapy at the University Medical Center Göttingen (UMG). His research focuses on psychopharmacology, therapy for schizophrenia, dementia, and sleep medicine.
Schizophrenia symptoms are extremely diverse. Each patient develops their own clinical picture. To outsiders, the patients can appear unpredictable and very frightening - especially if someone knows little about the disorder.
Certain symptoms occur in the run-up to schizophrenia. These include insomnia, severe irritability and tension. Those affected are often particularly sensitive to light and noise. They often become suspicious of others and withdraw. Some neglect their appearance and are increasingly less interested in school or work. Sometimes the first false perceptions appear. These signs can last a few months or years before the schizophrenia moves into its acute phase.
Acute and chronic phase of illness
Schizophrenia usually comes on in flares. The symptoms that appear in the Acute phase occur is referred to as "Positive schizophrenia symptoms" (positive symptoms): Symptoms predominate here that healthy people do not show. Hallucinations, for example, often occur, such as hearing voices that are not there. Many sufferers also have delusions such as paranoia. Overall, the patients tend to be active or overactive in the acute phase of the disease.
The chronic phase, on the other hand, is through a Negative or minus symptoms marked, that is, restrictions of certain psychological functions and emotionality are now in the foreground. So the patients lapse into external and internal lethargy: they will unpowered and work exhausted. Every activity is difficult for them. you neglect their social contacts and withdraw. Some even neglect their personal hygiene. This behavior does not only affect their private life. Those affected are often no longer able to practice their profession. In this phase, many people find it difficult to get out of bed at all, let alone get through a whole working day. In addition, schizophrenic patients often act in the chronic phase of the disease emotionless. They show no more joy. Her voice is monotonous and her facial expressions expressionless. Your interest in hobbies, jobs and social contacts is waning. Your language is impoverished.
Three subtypes of schizophrenia
Depending on the predominant symptoms in the acute phase, there are three subtypes of schizophrenia: paranoid schizophrenia, hebephrenic schizophrenia and catatonic schizophrenia.
In practice, however, it has been shown that there are no rigid boxes for schizophrenia: Typical symptoms of one form also occur in patients who have typical symptoms of another form. A clear classification of the patients in one of the three subtypes is therefore often not possible.
Paranoid schizophrenia is the most common form of the disorder. The most prominent symptoms in the acute phase are here Delusions and hallucinations.
A common delusion is about Paranoia. Here those affected are convinced that they are being persecuted by a person, an organization or even by aliens. They fear being constantly monitored and wiretapped. Also Relationship mania Often seen in paranoid schizophrenia: People believe that some person's actions or statements are directed at them. Other varieties of delusion are around Megalomania and delusional messages (e.g. a death message through a normal black coat).
Hallucinations include paranoid schizophrenia acoustic hallucinations very common: for example, patients hear voices that do not exist in reality. Sometimes the voices seem friendly, but often also threatening, because they give the patient orders or abuse him. Are also possible physical hallucinations: For example, some patients are convinced that individual parts of the body are dissolving or are not in the right place. They are less common in paranoid schizophrenia visual and touch hallucinations.
You can read more about this special form of schizophrenia in our article Paranoid Schizophrenia.
In this form of schizophrenia, thinking, emotions and drive are particularly severely impaired. In many patients this appears Think incoherently and illogically. This is reflected in the language. Some patients talk a lot and without context. Some only speak in Scraps of words or neglect the sentence structure. What has been said is then no longer understandable for outsiders. Conversely, in acute phases it also happens that those affected no longer speak at all.
The emotional disturbances in Hebephrenic schizophrenia lead to one aloof and often inappropriate behavior. For example, people laugh while saying that they are very unhappy. Or fooling around at a funeral. In this way, those affected often irritate and snub their surroundings.
In an acute phase, the mood of the patient can both euphoric (manic) and depressed (depressed) be. This switch can be mistaken for symptoms of bipolar disorder.
Learn more about this form of schizophrenia in the Hebephrenic Schizophrenia article.
For catatonic schizophrenia are above all psychomotor disorders typical. Perform the patient strange movements, for example with their hands, arms or legs. They bend their bodies or walk around aimlessly. In these moments the patients are very aroused. They repeat often stereotypewhat someone else is saying.
In other moments they fall into one Rigid state (stupor). They then often remain in an unusual position for hours. Although patients are awake, they no longer react or speak in this state (Mutism).
Catatonic schizophrenia is rare these days - possibly because modern drugs work better than drugs that were previously used.
Schizophrenia: causes and risk factors
It is not yet known exactly what triggers schizophrenia. However, several factors certainly come together, including genetic, biological and psychosocial ones.
Schizophrenia - between delusion and reality
Delusion or reality?Schizophrenia is a mental illness that has many misconceptions about it. And it scares many. In fact, people with schizophrenia can be extremely disturbing in their psychotic phases. But the world they live in can be not only frightening, but also fascinating and wondrous. Here you can read what the mental disorder is really all about.
The fairy tale of the split personalityMany believe schizophrenics have a split personality, much like Dr. Jekyll and Mister Hyde. In fact, the name of the disease comes from the ancient Greek “schízein”, which means “to split”. But there is no split in personality. Rather, patients develop hallucinations and delusional thoughts. The illness also changes drive and feelings. So, in a way, they're split off from the real world.
Voices in the headMany people with schizophrenia hear voices that only exist in their head. They are often threatening or offensive or give orders. But you can also be kind, like a wise advisor or a funny companion. Some schizophrenic patients with such auditory hallucinations are convinced that God is speaking to them.
Tracked and spied onDelusional thoughts are also common in schizophrenia. Those affected are convinced that they are being persecuted by aliens, the FBI or an alien organization. They fear being constantly spied on or are even convinced that a surveillance device has been implemented for them. Others believe that they themselves are God, the Messiah or Satan.
Delusional rush of loveA delusional relationship can also arise in schizophrenia: Patients believe that the actions or statements of a certain person contain messages for them. Often these are celebrities. In the delusions of love, patients believe that this person is madly in love with them. They write her countless letters, wait for her visit or a marriage proposal.
Magical worldWith schizophrenia, the world can become a magical place full of wonders and signs. The weather report or a song on the radio contains a message, a black dog announces an accident, a red car becomes a promise that something wonderful will happen.
Confusion of feelingsPatients with so-called hebephrenic schizophrenia hardly have such delusions, but irritate their environment in other ways. Your feelings and expressions do not match the situation: you make faces at a funeral or suddenly start crying for no reason. Their thoughts are often confused, their language chaotic. Later, those affected withdraw further and further, they no longer have any interests and neglect their appearance.
Nobel Prize for an ingenious patientThe schizophrenic symptoms can be treated with medication. However, they dull the mind, dampen imagination and creativity. The mathematician John Nash believed he worked for the Secret Service, his best friend was just a phantom. Nash received treatment, but stopped taking the pills because they robbed him of his genius. He lived with his hallucinations, kept them at bay with logic and discipline - and won the Nobel Prize.
"You schizo!"“You schizo!” Is still a common swear word. People with schizophrenia can be quite extraordinary. The "Schizos" supposedly included the expressionist Edvard Munch, the poet Friedrich Hölderlin, the dancer Vaslav Nijinsky, the philosopher Friedrich Nietzsche, the naturalist Isaac Newton and Ludwig II of Bavaria.
One in a hundredSchizophrenia is not that rare: one in a hundred people gets sick. With a third the ghost is over after a delusional phase, another third experiences relapses again and again, with the others the schizophrenia is chronic. It is not yet known exactly why some get sick. Experts suspect a disturbed messenger metabolism in the brain. Genetic factors obviously play a role in combination with stressful experiences
Genetic causes of schizophrenia
A genetic predisposition definitely plays a role in the development of schizophrenia. For example, if one identical twin has schizophrenia, about 45 percent of the time the other twin will also develop the disease. The risk of illness is just as high if both parents are schizophrenic. If only one parent is affected, the risk for children is still 12 percent. For comparison: in the average population, only about one percent develop schizophrenia.
Stress and negative experiences
People with schizophrenia are likely to be particularly sensitive to stress. Even before the disease breaks out, they can often handle stressful situations poorly. At some point the burden becomes too great. Then the stress becomes the trigger that triggers the disease.
Many schizophrenic patients report critical life events before the onset of the disease. This can be, for example, the loss of a loved one or a problematic professional situation. But positive situations can also cause stress - for example a wedding or the birth of a child.
Changes in the brain
It is likely that messenger substances in the brain (neurotransmitters) play an important role in the onset of schizophrenia. Dopamine, for example, is important for motivation and inner drive, but also for controlling motor skills. All of this is disturbed in schizophrenia. When schizophrenic patients take amphetamines, their bodies release more dopamine. At the same time, the symptoms of schizophrenia worsen.
Glutamate and serotonin also seem to play a role. The latter has a mood-enhancing effect and influences the perception of pain and memory performance.
In addition, certain brain structures are changed in people with schizophrenia. The limbic system, which is responsible for regulating emotions, is particularly affected.
Drugs and schizophrenia
It is unclear whether drugs can cause schizophrenia. Some experts suspect a connection between schizophrenia and the use of drugs such as cocaine, LSD, amphetamines or cannabis.
What is certain is that some drugs can induce delusions, hallucinations, and other conditions similar to symptoms of schizophrenia. However, the effect wears off after a while.
Some studies show that drug use significantly worsens the course of the disease in schizophrenia. It has not yet been clarified that a genetic predisposition in combination with certain substances can trigger schizophrenia.
Schizophrenia: examinations and diagnosis
If you suspect that you or a relative may have schizophrenia, you should contact a specialist clinic for schizophrenia or a specialist in psychiatry.There are now some early detection and therapy centers that specialize in the disease.
To be able to diagnose schizophrenia is a detailed conversation necessary with the person concerned. The psychological symptoms that occur are discussed in detail. There are established criteria and special clinical ones for this Questionnaires. The key symptoms that are asked about are specified in the ICD-10 for schizophrenia:
- Thought sounding, inspiration, withdrawal, spreading
- Control or influence mania; Feeling of what has been done regarding body movements, thoughts, activities or sensations; Delusions
- Commentary or dialogical voices
- Persistent, culturally inappropriate, or completely unrealistic delusion (bizarre delusion)
- Persistent hallucinations of any sensory modality
- Tearing off or inserting thoughts into the flow of thoughts
- Catatonic symptoms such as arousal, postural stereotypes, negativism or stupor
- Negative symptoms such as noticeable apathy, impoverishment of speech, flattened or inadequate affect
For the diagnosis of "schizophrenia" at least one clear symptom (or two or more symptoms, if less clear) in groups 1 - 4 or at least two symptoms in groups 5 - 8 must appear, almost continuously for a month or longer.
Exclusion of other diseases
Schizophrenia-like symptoms can also occur, for example, in brain diseases (such as epilepsy, brain tumor), various psychological disorders (such as depression, bipolar disorder, anxiety disorders) and in a state of intoxication (e.g. due to cocaine, LSD or alcohol). These must be ruled out before the doctor can clearly diagnose schizophrenia. Various examinations are necessary for this.
For example, you can use Blood and urine tests Detect drugs and medication in the body that may be responsible for the symptoms. Blood tests also help rule out a metabolic disorder or inflammation, for example.
A imaging study of the brain with a computed tomography or magnetic resonance imaging scan shows whether abnormalities in the brain could be causing the schizophrenia symptoms. If an encephalitis is suspected during the examinations, the nerve fluid (liquor) must also be examined (CSF diagnostics).
The doctor can also help special tests Check the various brain functions, for example organizational thinking, memory performance and the ability to concentrate.
Schizophrenia often occurs together with other mental illnesses (such as anxiety disorders, bipolar disorder, etc.). This can make diagnosis difficult.
Read more about the examinations
Find out here which examinations can be useful for this disease:
Having schizophrenia Medication and one psychotherapy treated. The problem is that patients lack insight into the disease in acute schizophrenic phases. If there is a risk that the patient will endanger himself or others, a forced admission to a clinic may be necessary.
When an acute phase breaks out, the patient is first treated in a clinic to stabilize him. Afterwards, he can usually organize his life at home on his own again.
Drug treatment of schizophrenia
Different groups of drugs can be used to treat schizophrenia, depending on the form and severity of the symptoms:
- Neuroleptics (antipsychotics): They were the first effective drugs to treat psychosis. By intervening in the metabolism of neurotransmitters, they reduce states of tension and anxiety, delusions and hallucinations. Neuroleptics have strong side effects such as muscle stiffness, tremors, muscle twitching, subdued emotions, tiredness, listlessness and reduced reaction speed.
- Atypical neuroleptics: These further developments of the "classic" neuroleptics work better and have fewer side effects. Well-known representatives are risperidone and clozapine.
- Antidepressants: In addition to antipsychotic drugs (classic or atypical neuroleptics), the doctor sometimes prescribes antidepressants. This is useful for schizophrenia patients who are also depressed. Antidepressants have a positive effect on mood, drive and performance.
- Sedatives: During an acute psychotic phase, many patients experience severe anxiety. Then tranquilizers can help. However, since they are addictive, they are only used for a short time if possible.
In contrast to sedatives, neuroleptics cannot make you addicted - neither physically nor mentally.
Psychotherapy for schizophrenia
Psychotherapy is becoming more and more important in the treatment of schizophrenia. It can have a long-term positive effect on the course of the disease. Cognitive behavioral therapy is usually chosen. Important elements of psychotherapeutic treatment are:
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