Schizophrenia - Better Understand and Treat

 

Schizophrenia is the classic delusional disease, almost one percent of people get it. With the appropriate therapy, the symptoms can now be treated well.

Delusions, hallucinations, and thought difficulties: Schizophrenia affects around 800,000 people. There are risk factors for schizophrenia that make it more likely:

·         Pregnancy and childbirth complications

·         Malnutrition

·         Rather low intelligence

Traumatic experiences also increase the risk, probably why refugees have schizophrenia more than twice as often as others.

But even those who are not affected by any of these factors can develop schizophrenia because over 60 percent of the risk is inherited. But that does not mean that there is the schizophrenia gene, says Professor Peter Falkai, head of the university psychiatry at the Ludwig Maximilians University in Munich.

The illness often begins with mental abnormalities that are only recognized as harbingers in retrospect. It usually breaks out in young adults. Only one in five people with schizophrenia make it into regular employment. Even stable partnerships often remain an unfulfilled wish.

In a study with Mannheim patients, only about a quarter of the people with schizophrenia were married, in a healthy comparison group, it was two thirds. In addition, people with schizophrenia often suffer from physical illnesses: the respiratory tract, the digestive system, and the cardiovascular system.

Social relationships are often a big problem for schizophrenics

Those affected die on average a dozen years earlier than others. The drugs against schizophrenia, so-called neuroleptics, also have serious physical side effects.

Social relationships, in particular, are often a major problem for schizophrenics. Even as adolescents, when the first signs of the disease appear, they usually have few close relationships.

Psychotherapists such as the Hamburg psychology professor Tania Lincoln try to promote those affected' social skills because patients have often had experiences that explain to a certain extent why they feel persecuted.

Where does a mental illness begin?

In any case, the boundaries to normal are blurred, as Tania Lincoln found out in a survey of 350 people without mental illness. A quarter was convinced that they had to fulfill a special mission in life. Ten percent believed that sometimes their thoughts were loud enough for others to hear. But such symptoms can become so massive that there is no getting around a diagnosis of a psychotic disorder.

Hallucinations are also a common symptom of schizophrenia. Many patients hear voices. For example, they comment on what they are doing and often make disparaging remarks. Or they give orders on what the patient should or should not do. Then it can be dangerous for the environment because the voices can even order murders.

Could psychologists or psychiatrists intervene early?

You can at least see a risk, says Andreas Bechdolf, a psychiatry professor and chief physician at Vivantes Klinikum Am Urban in Berlin. He knows that 75 percent of patients have symptoms five to six years beforehand, such as changes in thinking and perception and a lack of concentration.

However, clear signs such as delusion or hallucinations do not occur. Should doctors still prescribe neuroleptics as a precaution for the often young sufferers? Many experts advise great caution. It is unclear how reliably these agents can prevent schizophrenia.

In any case, they do not offer any protection. But there is a risk of serious side effects such as movement disorders and obesity. Most importantly, most young people with the same symptoms will never develop schizophrenia without treatment.

Psychotherapy is just as effective as medication

Several experts, therefore, demanded in the summer of 2019 in the journal Psychological Medicine that the help facilities for people with these symptoms no longer be called "early detection centers".

The current state of the literature is such that psychotherapy is just as effective as pharmacotherapy with an antipsychotic. And the guideline recommendations are currently that one should rather go for psychotherapy because it has fewer side effects. And it also helps people who don't get psychosis in the end.

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