schizophrenia

and Christiane Fux, medical editor

Julia Dobmeier is currently completing her master's degree in clinical psychology. Since the beginning of her studies, she has been particularly interested in the treatment and research of mental illnesses. In doing so, they are particularly motivated by the idea of enabling those affected to enjoy a higher quality of life by conveying knowledge in a way that is easy to understand.

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Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Schizophrenia is one of the psychoses - that is, one of the mental illnesses in which those affected perceive or process reality in a changed manner. In the case of schizophrenia, patients sometimes live in a different world. They suffer from paranoia, hallucinations and motor disorders. Read here what exactly schizophrenia is, how to recognize it and how it can be treated.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F21F20

Brief overview

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), disturbances 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: drugs (neuroleptics, antidepressants, sedatives), cognitive behavioral therapy
Schizophrenia in children: rare, often overlooked
Prognosis: very variable, depending on the form and severity of the disease

What is schizophrenia?

Schizophrenia is a serious 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 consider schizophrenia to be one of the 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.

People with schizophrenia do not have a split personality, as is widely believed. So you don't have multiple personalities that come out in turns, as is the case with dissociative identity disorder.

Schizophrenia: "Stand by the patient"

Three questions for

Prof. Dr. med. Eckart Rüther,
Specialist in psychiatry and psychotherapy
1
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.
2
How dangerous are people with schizophrenia?

Prof. Dr. med. Eckart Rüther
Usually completely harmless! In the case of delusion and excitement - especially if the person concerned is afraid - assaults towards others can occur. Don't 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!
3
What is the best way to deal with a patient with schizophrenia?

Prof. Dr. med. Eckart Rüther
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 tell others. 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

Schizophrenia symptoms are extremely diverse. Every 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 occur in the acute phase are called "positive schizophrenia symptoms" (positive symptoms): Symptoms predominate here that healthy people do not show. Hallucinations, for example, often occur, for example the patients hear voices that are not there Those affected also have delusions such as paranoia, and overall, the patients tend to be active or overactive in the acute phase of the disease.

The chronic phase, on the other hand, is characterized by negative or negative symptoms, which means that limitations of certain psychological functions and emotionality are now in the foreground. The patients lapse into external and internal lethargy: they become listless and appear exhausted. Every activity is difficult for them. They 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 appear emotionless in the chronic phase of the disease. 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, schizophrenia can be divided into three subtypes: 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

Paranoid schizophrenia is the most common form of the disorder. The most striking symptoms in the acute phase are delusions and hallucinations.

A common delusion is 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. Delusional relationships are also often seen in paranoid schizophrenia: those affected believe that the actions or statements of a certain person are directed at them. Other variants of delusion are megalomania and delusional messages (such as a death message through a normal black coat).

Acoustic hallucinations are very common among hallucinations in paranoid schizophrenia: for example, patients hear voices that do not exist in reality. Sometimes the voices seem friendly, but often threatening because they give the patient orders or abuse him. Physical hallucinations are also possible: For example, some patients are convinced that individual parts of the body are dissolving or are not in the right place. Visual and touch hallucinations are less common in paranoid schizophrenia.

You can read more about this special form of schizophrenia in our article Paranoid Schizophrenia.

Hebephrenic schizophrenia

In this form of schizophrenia, thinking, emotions and drive are particularly severely impaired. For many patients, thinking appears incoherent and illogical. This is reflected in the language. Some patients talk a lot and without context. Some only speak in fragments 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 a distant 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 patient's mood can be both euphoric (manic) and depressed (depressed). This switch can be mistaken for symptoms of bipolar disorder.

Learn more about this form of schizophrenia in the Hebephrenic Schizophrenia article.

Catatonic schizophrenia

Psychomotor disorders are particularly typical of catatonic schizophrenia. The patients make 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 often repeat stereotypically what someone else is saying.

In other moments they lapse into a state of rigidity (stupor). They then often remain in an unusual position for hours. Although the patients are awake, they no longer react or speak in this state (mutism).

Catatonic schizophrenia occurs only rarely today - possibly because modern drugs work better than previously used preparations.

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.

Genetic causes of schizophrenia

A genetic predisposition definitely plays a role in the development of schizophrenia. For example, if an 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 loved one has 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.

In order to be able to make the diagnosis of schizophrenia, a detailed discussion with the person affected is necessary. The psychological symptoms that occur are discussed in detail. There are defined criteria and special clinical questionnaires for this. 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 (such as cocaine, LSD or alcohol). These must be ruled out before the doctor can clearly diagnose schizophrenia. Various examinations are necessary for this.

For example, blood and urine tests can be used to 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.

An imaging test of the brain with a computed tomography or magnetic resonance imaging scan shows whether abnormalities in the brain could be causing the symptoms of schizophrenia. If an encephalitis is suspected during the examinations, the nerve fluid (liquor) must also be examined (liquor diagnostics).

In addition, the doctor can use special tests to check the various brain functions, such as organizational thinking, memory 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.

Schizophrenia: treatment

Schizophrenia is treated with medication and psychotherapy. 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, compulsory 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 the 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:

Reduction of fears through information: First of all, it is important to take away the patient's fear of the disease by providing detailed information on schizophrenia. The relatives also benefit from more knowledge, for example by developing more understanding for the patient and thus being able to support him better. Communication training, which makes it easier to deal with the patient, also helps.

Dealing with stress and stressful situations: In therapy, the patient learns, among other things, to better cope with stressful situations that can worsen his symptoms. The central aspect is dealing with stress.

Processing frightening experiences: With the help of psychological schizophrenia therapy, the patient can also better process the frightening experiences that he went through during the acute phases of the illness. That stabilizes him overall.

Recognizing early warning signs: In addition, patients learn to recognize the early warning signs of a schizophrenic phase. These can be very different. Often times, for example, insomnia or severe irritability herald a new outbreak. It is then important to reduce the sources of stress and possibly, in consultation with the doctor, to increase the dose of medication for a short time.

Support after the hospital stay

After an inpatient stay, the patient usually needs support at home. Social pedagogues take on this task. They help those affected to find their way back in everyday life.

Many patients face particular difficulties that their ability to concentrate, their working memory and the ability to plan ahead have suffered as a result of the disease. Then cognitive rehabilitation helps. She works with behavioral therapy measures as well as special training on the computer. This increases the likelihood of returning to work. In addition, insight into the disease and adherence to therapy are strengthened.

Schizophrenia in children

In most cases, schizophrenia does not appear until after puberty in young adulthood. However, an estimated two percent of patients fall ill in childhood and adolescence. Before the age of ten, however, schizophrenic diseases are extremely rare. "Early onset schizophrenia" (EOS) is what doctors call an initial manifestation of schizophrenia between the ages of 13 and 18. It is particularly observed in male adolescents.

Because the disease is so rare in children, children and adolescents, it is often discovered late. This is also due to the fact that the symptoms of schizophrenia in children and adolescents differ from those in adult patients.

In addition, the personality of children and adolescents is naturally constantly evolving. Mood swings are normal to some extent during puberty. However, if children and adolescents fall into longer periods of depression, or if there are severe language and writing difficulties or delusional ideas, a doctor or psychiatrist should be consulted urgently.

Schizophrenia: disease course and prognosis

The risk of developing schizophrenia is generally around one percent. This means that an estimated 800,000 people in Germany live with the disease.

She meets men and women equally often. However, the disease breaks out earlier in men than in women. They fall ill on average between 20 and 25 years of age, whereas women between 25 and 30 years of age. We do not know why this is so.

Since the course of schizophrenia varies greatly from person to person, there is no generally valid prognosis. Some patients only experience a single acute phase of the disease, in others the course is severe and leads to chronic schizophrenia. Others again have schizophrenic phases, which thanks to the treatment also subside. Most of the time, the acute symptoms diminish over time. However, schizophrenia often requires lifelong treatment.

Hebephrenic schizophrenia has a less favorable prognosis than the other forms of the disease. It begins insidiously, but often becomes chronic and then proceeds without any symptom-free phases. The personality of the patient is changing increasingly.

Risk of suicide

The fears that schizophrenia causes are often very stressful for the patient. After a few relapses, those affected often lapse into deep hopelessness. This can even lead to suicide - the suicide rate among schizophrenia patients is around ten percent. Young men are particularly at risk. A good connection to therapists, family or friends is therefore particularly important.

Increased risk of other diseases

Statistically, patients with schizophrenia have a significantly increased risk of various other diseases. These include metabolic and cardiovascular diseases, cancer and lung diseases. Attending physicians should pay particular attention to signs of this in schizophrenia patients.

Every fourth to fifth person is healed

Since schizophrenia patients have been treated with a combination of neuroleptics and psychotherapy, the prognosis for the disease has improved significantly. Approximately 20 to 25 percent of patients recover completely with this treatment. But even if the patients are not completely cured, outpatient care is often sufficient to lead a largely normal life despite the schizophrenia. The social environment has a major influence on this: If patients receive a lot of understanding and support from friends and family, this can have a positive effect on the course of the disease.

Schizophrenia: Information for Relatives

If a person suffers from schizophrenia, it is extremely stressful for the relatives. In the acute phases the patient lives in his delusional world and can hardly be reached. Perhaps his madness also extends to the relatives, whom he believes have sinister intentions and whom he treats with suspicion.

At the same time, however, the relatives are important supports for the patient. Their understanding and support are critical to the course of the disease.

As a relative of a schizophrenic patient, you should therefore accept offers of help that provide you with detailed information about the illness and how to deal with those affected. For example, it is important that you encourage the patient to be as independent as possible. He must neither be under nor overburdened. Special communication training can also be useful for you.

You should also talk to the treating doctors and therapists and get advice if you are overwhelmed and don't know what to do next. Groups of relatives can also be of great help. You can find out where you can find one in your area from the National Contact and Information Center (NAKOS) (www.nakos.de).