Schizophrenia: diagnosis and treatment

Schizophrenia usually occurs in episodes: so-called attacks alternate with relatively calm periods. Treatment consists of both the use of drugs and psychosocial measures, such as psychotherapy and sociotherapy in particular.

Early warning signs

The disease itself is often preceded by the so-called prodromal phase – a stage lasting several years when it is already possible to perceive changes. Early warning signs that may indicate schizophrenia include:

• low performance,
• depressed mood,
• nervousness to the so-called overexcitability (the original English term overexcitability can be freely translated into Czech as “overexcitability”)
• Sleep Disorders ,
• concentration and memory disorders,
• apathy ,
• social download ,
• perception of voices that other people cannot hear – so-called auditory hallucinations ,
• unusual and incomprehensible thought processes,
• a person has a persistent feeling that he is being watched or cheated in some way,
• confusion .

Note: The above symptoms are very non-specific and may have other causes. They are less pronounced and less regular than in the case of manifest (apparent, obvious) disease. Therefore, it is important to consult them with a psychiatrist .

In addition, disabled people feel that they are no longer “who they have always been”. The changes in personality are also noticed by those around them. Other symptoms include non-auditory forms of hallucinations (disability e.g. sees things or people that are not there, or smells smells that no one else can smell) or delusions (feeling of persecution, feeling that a person is being controlled by other forces, for example extraterrestrial , and these control his thoughts, feelings and actions).

Dealing with feelings is usually difficult for sufferers. It is also difficult for them to understand the emotions of others. A large proportion of sufferers are ashamed of their symptoms and fear being considered “crazy”. Thinking disorders can have an overwhelming impact on everyday life. People affected by schizophrenia have a limited ability to plan tasks or activities; they often don’t even have enough motivation to make them happen.

Diagnosis of schizophrenia

The classification criteria on which the diagnosis of schizophrenia is based are defined in the International Classification of Diseases ( ICD-10 ). For a definite diagnosis of schizophrenia, it is necessary to exclude other disorders that resemble this disease (e.g. schizotypal personality disorder , acute and transient psychotic disorders, or some organic diseases, for example of the brain ). Diagnostics begins with an anamnestic interview, during which the psychiatrist finds out the so-called anamnesis (history of previous illnesses) and examines the psychological state of the affected person.

This is followed by a physical and neurological examination, possibly also an examination by a psychologist . In addition, blood tests and brain scans using computed tomography ( CT ) or magnetic resonance imaging ( MRI ) are performed. If the doctor suspects an infectious disease that can manifest itself similarly to schizophrenia, he can also use other examination methods, such as e.g. a special laboratory examination , electroencephalography ( EEG ), etc.

Treatment options

Schizophrenia is mainly treated with drugs , psychotherapy and sociotherapy. The sooner treatment is started, the better. The drugs of first choice are so-called antipsychotics ( neuroleptics ). In addition, the doctor may prescribe benzodiazepines (to calm down, only for a short time) and antidepressants as accompanying treatment . The doctor will educate the patient about the side effects of all prescribed medications. During drug treatment, it is necessary to go for regular check-ups, during which the doctor checks the patient’s weight, motor skills , blood pressure and the results of laboratory tests. Part of psychotherapy is also psychoeducation , during which the patient learns to better understand his illness and live with it. Ideally, the patient’s family and immediate surroundings are also involved in this process.

By sociotherapy we mean the (re)acquisition of social skills , provision of basic social needs (such as material security, living conditions, etc.) and rehabilitation , including in the work environment. Other therapeutic methods are sometimes used, such as occupational therapy or physiotherapy .

If treatment is necessary in a hospital (either during hospitalization , on an outpatient basis or in the form of day care), it is provided by multidisciplinary teams (doctors, psychologists, psychiatric nursing care , etc.). In cases of severe agitation or danger to oneself or others (e.g. aggressiveness ), doctors have no choice but to implement emergency measures, or even to force court-ordered hospitalization.

Psychosocial facilities (e.g. psychosocial services), which also play an important role in the care provided to patients with schizophrenia, help the disabled and their families to manage their daily lives.

Treatment of schizophrenia requires extensive expertise and experience. It is often a thorny path that begins with the difficult diagnosis and continues with the search for optimal treatment options that are individual for each patient. The motivation of the patient and his relatives to cooperate in the treatment is also important.

Prognosis   

With timely and correctly selected treatment, 70-80% of all patients in whom the disease appeared for the first time will recover within 3-6 months of diagnosis. 60-80% of patients do not relapse if they take antipsychotics as part of long-term treatment. If the patient suffers from other mental illnesses (e.g. addiction , depression ), the treatment is more complicated and the prognosis can worsen. Approximately one third of those affected respond poorly or little to treatment and need lifelong support from doctors and their immediate surroundings.

What can I do as a relative in a crisis?

If a psychiatric crisis occurs (complete loss of contact with reality, extensive movement disorders , severe irritability, signs of endangering oneself or others) or strong side effects of the medication appear, contact the attending physician immediately. If it is not available, call the emergency medical service (emergency number 155). The attending physician or pharmacist will inform you about the side effects of the medicines .

Who can I contact?

If you suspect that you suffer from schizophrenia, or if you would like to help someone close to you, the best advice is a psychiatrist. You can also first consult the situation with a general practitioner , who will then take further steps. Child psychiatrists specialize in psychiatric care for children and adolescents (under 18).