Understanding and Prevention of Schizophrenia

Schizophrenia is a severe mental disorder that can affect behavior, emotions, and communication. People with schizophrenia can experience hallucinations, delusions, chaotic thinking, and behavioral changes. Based on data from WHO, there are more than 20 million people worldwide suffering from schizophrenia. Meanwhile, according to research by the Indonesian Ministry of Health in 2019, it is estimated that there are 450,000 people with severe mental disorders in Indonesia, including schizophrenia.

It is important to note that people with schizophrenia are at 2–3 times higher risk of dying at a young age. This is because schizophrenia is usually accompanied by other diseases, such as heart disease, diabetes, or infections. In addition, people with schizophrenia are also prone to suicide attempts.

It is not known exactly what causes schizophrenia. However, schizophrenia is thought to be linked to a number of factors:

• Genetic Factors
  A person from a family with schizophrenia has a 10% higher risk of developing the condition. The risk increases by 40% if both parents have schizophrenia. In people who have an identical twin with schizophrenia, the risk increases to 50%.

• Brain Chemical Imbalance
  Research shows that an imbalance in dopamine and serotonin levels is at risk of causing schizophrenia. Dopamine and serotonin themselves are part of neurotransmitters, which are chemicals that function to send signals between brain cells.
  Research also shows that people with schizophrenia have several differences in the structure and function of their brains, including:
  • Fewer connections between brain cells.
  • Smaller size of the temporal lobe (the part of the brain associated with memory).
  • Larger size of the brain ventricles (the fluid-filled parts of the brain).

• Pregnancy and Childbirth Complications
  Conditions during pregnancy are thought to be at risk of causing schizophrenia in the fetus. These conditions include malnutrition, exposure to toxins or viruses, preeclampsia, diabetes, and bleeding during pregnancy. Complications during childbirth also pose a risk of causing schizophrenia in children, such as lack of oxygen during birth (asphyxia), low birth weight, or premature birth.

• Environmental Factors
  The environment can also influence the development of schizophrenia in some sufferers, namely:
  • Stress, for example due to divorce, disharmony in the family, losing a job, or being abandoned by a loved one.
  • Traumatic experiences, such as bullying, sexual abuse, and physical or emotional violence.
  • Drug abuse, such as cocaine, marijuana, and amphetamines.Research shows that marijuana addicts are four times more likely to develop schizophrenia.

Early symptoms of schizophrenia usually appear in young adulthood. In men, early symptoms appear in their early 20s. Meanwhile, symptoms in women usually begin to appear in their 20s or early 30s.

Some of the early symptoms experienced by schizophrenia sufferers are:

• Tendency to isolate oneself from others.
• Difficulty concentrating and lack of motivation.
• Changes in sleep patterns.
• Difficulty with schoolwork.
• Depression and irritability.

Based on the type, schizophrenia symptoms are divided into two types, namely:

Positive Symptoms

Positive symptoms include changes in thinking patterns and behavior, for example:

• Hallucinations
  Hallucinations are feelings of experiencing something that is not real, such as hearing certain whispers. Auditory hallucinations are the most common form of hallucinations in people with schizophrenia.
• Delusions
  Delusions are beliefs that are contrary to reality, such as feeling watched, followed, or even hurt. These beliefs can affect the behavior of people with schizophrenia.
• Confusion in thinking
  Difficulty concentrating can make it difficult for people with schizophrenia to focus, even on simple activities, such as reading or watching. This can make it difficult for people with schizophrenia to remember and communicate. Abnormal behavior can include catatonia, which can occur in catatonic schizophrenia.
• Behavioral chaos
  This chaos is characterized by irregular motor behavior and abnormal or unpredictable body movements. Unexpectedly, people with schizophrenia can even scream suddenly and get angry for no reason.

Negative Symptoms

Negative symptoms refer to loss of interest, motivation, and facial expressions. These symptoms can last for years before the sufferer experiences the initial symptoms. Negative symptoms generally appear gradually and worsen over time.
Some of these symptoms are:

• Odd emotional responses, such as facial expressions and tone of voice that are inappropriate for the situation.
• Difficulty feeling happy or satisfied.
• Reluctance to socialize and prefer to stay at home.
• Loss of interest and motivation in various activities.
• Changes in sleep patterns.
• Neglect of appearance and personal hygiene.

People with schizophrenia are often unaware of their condition. Therefore, if you see or suspect that someone close to you is experiencing symptoms of schizophrenia, take them for treatment. If there is a person with schizophrenia who is neglected around you, immediately take them to a health service or doctor. People with schizophrenia must be treated immediately so that their symptoms do not worsen or relapse.

Immediately contact an ambulance or the hospital emergency room if a person with schizophrenia shows behavior of hurting themselves or others, not eating or drinking, or even trying to commit suicide.

To diagnose schizophrenia, the doctor will carry out several stages of examination, namely questions and answers, physical examination, psychiatric examination, and supporting examinations. In the question and answer session, the doctor will find out about the following things:

• Physical and mental health history of the patient and his/her family.
• History of the patient’s pregnancy and childhood.
• History of traumatic events experienced by the patient.
• History of medication and substance abuse.

Based on DSM–5 (The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), a person can be said to be suffering from schizophrenia if they have the following criteria:

• Patients experience at least two of the following symptoms:
• • Delusions.
  • Hallucinations.
  • Disorganized speech.
  • Disorganized behavior.
  • Negative symptoms.
    At least one of the two minimal symptoms that must be present is delusions, hallucinations, or disorganized speech.
• Symptoms interfere with the patient’s daily activities, school, work, or social life.
• The above symptoms must be experienced by the patient for at least 6 months.
• The above symptoms are not caused by other mental disorders, such as bipolar disorder or drug abuse.

The doctor will also perform several supporting examinations to rule out the possibility that the patient’s symptoms are caused by other diseases. Some examinations that can be performed are:

• Complete blood count.
• Liver, thyroid, and kidney function tests.
• Tests for electrolytes, blood sugar, vitamin B12, vitamin D, folate, and calcium levels.
• Pregnancy test, if the patient is a woman of childbearing age.
• Urine sample test to detect drug abuse.
• MRI or CT scan of the brain, to detect brain disorders such as subdural hematoma, vasculitis, abscess, or brain tumor, which may underlie the onset of schizophrenia.

To date, there is no cure for schizophrenia. Existing treatments are limited to controlling and relieving symptoms. It should be noted that during treatment, patients must have regular check-ups so that doctors can assess the effectiveness of the medicine, adjust the correct dosage, and anticipate side effects of the medicine.

Following are some treatment methods for schizophrenia:

• Mediciness
  To treat hallucinations and delusions, doctors will prescribe antipsychotic medicines in the form of drinks or injections. This medicine can reduce symptoms such as delusions, hallucinations, difficulty concentrating, and feelings of anxiety and guilt. That way, the patient’s quality of life and ability to interact can improve. Please note, antipsychotic medicines must be taken for life even though symptoms have improved.Some types of antipsychotic medicines prescribed by doctors are:

• • Chlorpromazine.
  • Haloperidol.
  • Fluphenazine.
  • Aripiprazole.
  • Clozapine.
  • Paliperidone.
  • Olanzapine.
  • Risperidone.
• Psychotherapy
  Psychotherapy aims to enable patients to control their symptoms. This therapy will be combined with medication.
  Some of the psychotherapy methods used are:

• • Individual therapy
    Individual therapy aims to teach the patient’s family and friends how to interact with the patient. One way is to understand the patient’s thought patterns and behaviors.
  • Cognitive behavioral therapy
    Cognitive behavioral therapy aims to change the patient’s behavior and thought patterns, help the patient understand the triggers for hallucinations and delusions, and teach the patient how to cope with them. This therapy can be combined with medication.
  • Cognitive remediation therapy
    Cognitive remediation therapy aims to teach patients how to understand the environment. This therapy also improves the patient’s ability to pay attention or remember things, and control their thought patterns.
• Electroconvulsive therapy
  Electroconvulsive therapy is the administration of small electrical currents to the brain to trigger brief, controlled seizures. This therapy is used when medications are ineffective in relieving symptoms. In this therapy, the doctor will first give a general anesthetic. After that, the doctor will attach electrodes to the patient’s head. Next, a low electric current will be passed through the electrodes to trigger a brief seizure.
• Transcranial magnetic stimulation (TMS)
  Transcranial magnetic stimulation (TMS) is a therapy that transmits electromagnetic waves to the brain. This therapy is done by attaching a special device that transmits the waves to the patient’s head without surgery. Based on research, this therapy can reduce hallucinations and negative symptoms of schizophrenia.

Untreated schizophrenia can trigger serious complications, such as:

• Suicide attempts.
• Depression.
• Obsessive-compulsive disorder (OCD).
• Self-injurious behavior.
• Alcohol addiction.
• Drug abuse.
• Aggressive or agitated behavior.

People with schizophrenia can also have problems in relationships with family and the surrounding environment. In addition, people with schizophrenia are also prone to being viewed negatively by people around them. In addition, the symptoms experienced by sufferers can also make it difficult for them to work so that it can have a bad impact on their financial condition.

Until now, it is not known for sure how to prevent schizophrenia. However, early diagnosis and treatment can help prevent schizophrenia sufferers from experiencing worsening symptoms and relapses. In addition, families and relatives of sufferers are also expected to be able to learn how to detect symptoms of schizophrenia early on, such as the emergence of delusions or megalomania, recognize risk factors, and how to live with sufferers. That way, communication and interaction between family and sufferers can be better.