How does the disease manifest itself?
Symptoms are divided into three groups. Positive ones are what appear additionally: delusions, hallucinations, often auditory, a feeling of external influence, broken speech. Negative - what is lost: emotional expressiveness, motivation, interest in life, the ability to have fun and communicate. The third group is cognitive impairment: attention, memory, and planning suffer. It is the negative and cognitive manifestations that have the greatest impact on daily life, although others usually notice delusions and hallucinations first.
- Delusions: persecution, influence, special purpose
- Auditory hallucinations, voices commenting or commanding
- Feeling like someone else's thoughts are being read
- Broken, inconsistent speech
- Emotional flattening and loss of motivation
- Social isolation
- Difficulty with attention, memory and planning
First signs and beginning
Full-blown psychosis is often preceded by a prodromal period, which can last for months. At this time, a person gradually moves away from friends, loses interest in studies and hobbies, becomes suspicious, thinks strangely, changes his sleep pattern, and stops taking care of himself. Such changes can easily be attributed to adolescence, laziness or depression. The sooner the onset is recognized and treatment is started, the better the long-term outcome, therefore, if there is a noticeable and sustainable change in the behavior of a young person, it is better to consult a specialist without waiting for full-blown psychosis.
- Increasing isolation and loss of friends
- A sharp decline in academic performance or performance
- Suspicion and strange beliefs
- Changing your sleep pattern
- Loss of interest in hygiene and appearance
- Unusual experiences: a feeling of a changed world
- Anxiety and tension for no clear reason
Causes and risk factors
There is no single cause for schizophrenia. It is based on the interaction of hereditary predisposition with external factors influencing brain development. The risk is increased by complications of pregnancy and childbirth, severe infections and stress at an early age, as well as cannabis use during adolescence, when the brain is especially vulnerable. It is important to emphasize: the disease does not arise due to poor upbringing or weak character, and it is not the family’s fault. There is also a common misconception about the danger of patients: more often they themselves become victims, rather than a source of aggression.
- Hereditary predisposition
- Complications of pregnancy and childbirth
- Use of cannabis and other psychoactive substances in adolescence
- Severe chronic stress and traumatic experiences
- Urban environment and social exclusion
- Neurodevelopmental disorders
Diagnostics
There is no specific analysis or image confirming schizophrenia: the diagnosis is made by a psychiatrist based on the clinical picture, its duration and impact on a person’s life. A mandatory step is to exclude other causes of psychosis: brain tumors and injuries, epilepsy, infections, autoimmune encephalitis, thyroid diseases, poisoning and psychoactive substance use. For this purpose, an examination is prescribed, including neuroimaging and laboratory tests. The diagnosis during the first episode is often clarified over time, observing the development of the condition.
- Clinical interview and observation by a psychiatrist
- Assessing the duration and nature of symptoms
- Information from loved ones with the patient’s consent
- MRI of the brain to exclude organic causes
- Blood tests, thyroid hormones
- Substance screening
- Pathopsychological examination by a clinical psychologist
Treatment and rehabilitation
The basis of treatment is antipsychotic drugs, which reduce delusions and hallucinations and prevent new exacerbations. They are selected individually, assessing the effect and tolerability, and are taken for a long time: spontaneous withdrawal upon improvement is the most common cause of recurrent psychosis. Long-acting forms help with poor adherence. The psychosocial part is no less important: skills training, support in study and work, psychoeducation for the family, cognitive behavioral therapy. This integrated approach allows many people to maintain independence and social connections.
- Antipsychotic medications prescribed by your doctor
- Long-term use and prevention of exacerbations
- Long-acting injectable forms if necessary
- Psychoeducation of the patient and family
- Cognitive behavioral therapy
- Social and everyday skills training
- Employment and study support
- Quitting alcohol and psychoactive substances