What is behind the disease schizophrenia?

15. May 2020

The mental illness schizophrenia is a complex disorder with different manifestations. In some phases, those affected are very listless and introverted, in other phases they suffer from sensory delusions. In severe cases, schizophrenia can be accompanied by a severe reduction in quality of life. Patients need a well-positioned support system to lead independent lives.

Symptoms of schizophrenia – what’s behind it?

As mentioned at the beginning, the disorder pattern of schizophrenia is very complex. A rough distinction is made between positive and negative symptoms. Positive in this case means that there is more or even too much of something. Negative means that there is less or too little of something. But what is too much or too little there? This question is best answered on the basis of people’s normal level of functioning.

Schizophrenia: deviation from normal functioning
People perceive as many sensory impressions as they can process well. The brain blocks out the rest to protect the person from overstimulation. Normally, we also have the right amount of drive to take charge of our lives, but also allow periods of calm. In addition, our mood settles at an intermediate level, meaning it is mostly neutral with only slight and temporary swings up or down. In people suffering from schizophrenia, these normal levels of sensory perception, drive and mood shift.

Positive symptomatology of schizophrenia
In positive symptomatology, the brain of the affected person is overstimulated and produces stimuli that are not perceptible to others. Sensory illusions (hallucinations) and delusional thoughts that revolve around things that do not really exist / occur (Wittchen & Hoyer, 2011). This phase of schizophrenia is also called the psychotic phase. The following phenomena may occur:

Hallucinations:

  • Hearing (auditory hallucinations): Affected individuals perceive voices or sounds that do not objectively exist. The voices can sometimes be very threatening and prompt harmful actions. Auditory hallucinations are the most common type of hallucination.
  • Sight (optical hallucinations): Some patients see things or changes in color or light that are not objectively present.
  • Feeling (kinesthetic hallucinations): There are perceptions on the skin, for example, crawling or burning sensations that are not due to external irritation or other illness.
  • Tasting/smelling (olfactory hallucinations): Smells and tastes are perceived, for example, gas smell in the apartment), even if they are not comprehensible to others.

Delusion:

  • Individual delusions: Delusions are false beliefs associated with a misinterpretation of perceptions or experiences. These ideas can vary widely and affect different areas. However, persecutory ideas or religious content are common. Even when outsiders provide solid evidence that the idea is not true, it is held on to.
  • Incoherent delusional system: When individual delusional ideas relate to each other, sufferers can, in a sense, develop their own world. In the case of a strongly pronounced persecutory delusion, then, for example, entire spy networks are suspected, which have penetrated into all areas of life.
  • Self-reference (ego disorder): All perceptions are related to the own person. Thus, sufferers assume that all their perceptions are hidden messages for them. An example is the recognition of meaningful abbreviations and hidden messages in car license plates. This phenomenon is also known as relationship delusion.
  • Disturbance of thoughts: Affected persons perceive a racing of thoughts, fear that their thoughts can be read by others or assume that strange thoughts have been inserted into them.

Often these perceptual phenomena are accompanied by increased agitation to anxiety or panic. In an acute positive phase of schizophrenia, sufferers have difficulty communicating. Their speech becomes incoherent and disjointed. Outsiders find it difficult to understand what is going on in the affected person because, on the one hand, the sensory delusions can be very abstract and, on the other hand, regular conversation is not possible. Learn more about positive symptomatology and individual psychotic episodes in the blog post.

Negative Symptomatology of Schizophrenia During periods of negative symptomatology, schizophrenia patients appear flattened and slowed. Their drive is inhibited and they move very little. Their facial expressions and gestures freeze and they have limited ability to communicate with outsiders. Speech utterances decrease, and some patients even fall silent altogether. The mood can be severely depressed, so that the affected person appears severely depressed.

Symptom-free phases of schizophrenia
In addition to phases of positive or negative symptomatology, there are also symptom-free intervals in which those affected can live symptom-free. Often, however, problems have already accumulated in previous phases of the disease, which also strongly affect these phases. Thus, schizophrenia can have serious consequences, such as job loss, financial problems and family difficulties.

Excursus: The risk of developing schizophrenia is about 1% in the general population. If both parents have schizophrenia, the risk increases to 30%. This speaks for the hereditary component in the development of schizophrenia.

Wrong use of the term “schizophrenic”

Unfortunately, the term “schizophrenic” is used colloquially to describe people or conditions that are ambiguous or irrational. Mistakenly, it refers to people who each behave completely differently in the same situation, as if they had two personalities. The application of the term schizophrenic in this context is wrong! Sufferers of schizophrenia, do not suffer from multiple personalities, but from sensory delusions and hallucinations.

Excursus: Patients who give the appearance of having multiple personalities, suffer from the so-called dissociative identity disorder. Here it comes, simplified, to a splitting off of personality parts, which can come to the fore depending on the situation and determine the behavior of the person.

Causes of schizophrenia

Like all other mental illnesses, schizophrenia cannot be attributed to single causes. It is known that families may have a higher hereditary susceptibility to developing schizophrenia. However, a hereditary risk does not necessarily mean that schizophrenia will develop. External factors must also be present, such as psychological stress, adverse attachment behaviors, or substance abuse, for schizophrenia to develop (Ziegler & Lincoln, 2012).

Biological background of schizophrenia
The biological explanation of the development of schizophrenia is based on what is known as the dopamine hypothesis. Dopamine is one of the most important messenger substances in our brain and ensures, among other things, that our brain is receptive to sensory impressions. The positive symptoms of schizophrenia result from the fact that too much dopamine is present and the brain is, in a sense, overexcited. Medications that regulate the amount of dopamine in the brain therefore help to reduce positive symptomatology.

Treatment of schizophrenia

Classically, the positive symptoms of schizophrenia are treated with so-called neuroleptics. These reduce the concentration of dopamine in the brain. In the past, these drugs had severe side effects. Dopamine is also responsible for smooth movements, and the first neuroleptics reduced the dopamine concentration so much that movement restrictions or involuntary muscle movements occurred. Nowadays, more modern drugs are used with fewer side effects. Treating negative symptomatology is more difficult because not all patients respond to common antidepressants (Aleman et al., 2017).

Psychotherapeutic Interventions
Of course, schizophrenia patients also need to learn how to cope well with their illness. Psychotherapeutic support is necessary for this. Here, for example, patients learn methods of stress reduction to prevent the recurrence of schizophrenic episodes. Furthermore, distorted or delusional thought content is addressed and checked for validity. In addition, there are holistic approaches, such as the Soteria concept, in which affected persons live in residential groups specifically designed for schizophrenia patients and learn to build interpersonal relationships and to organize their lives independently (Nischk, 2014).

Progression of the illness
The myriad combinations of symptoms and the phasic course of schizophrenia mean that the course of schizophrenia can vary greatly from patient to patient. In some sufferers it remains with single episodes, in others the illness returns again and again. According to a study by Bailer (2000), the course of the disease is milder in female patients and in patients who are embedded in a functioning social environment. This study result emphasizes the importance of relatives in the treatment concept of schizophrenia. Thus, it makes sense to view patients holistically and embedded in their environment.

LIMES Castle Clinics’ holistic treatment concept for schizophrenia

Patients suffering from schizophrenic episodes are in good hands at LIMES Schlosskliniken. Our team of experts is experienced in dealing with psychotic episodes and their after-effects. At our clinic, patients are gently stabilized and receive long-term training in dealing with their illness. Holistic and individual treatment is designed so that the circumstances of the individual patient’s life can be included in the therapy.

References

(1) Aleman, A., Lincoln, T. M., Bruggeman, R., Melle, I., Arends, J., Arango, C., & Knegtering, H. (2017). Treatment of negative symptoms: where do we stand, and where do we go? Schizophrenia research, 186, 55-62

(2) Bailer, J. (2000). Prognosis and course of schizophrenic psychosis: results of a five-year prospective follow-up study. Lang

(3) Nischk, D., Merz, P., & Rusch, J. (2014). Update from Soteria-The promotion of practical life and social skills of people with schizophrenia from a phenomenological perspective. Psychiatric Practice, 41(01), 45-49

(4) Wittchen, H. U., & Hoyer, J. (2011). Clinical psychology & psychotherapy (Vol. 1131). Heidelberg: Springer.

Categories: Psychosis

Friederike Reuver
Autor:in Friederike Reuver
"Die LIMES Schlosskliniken haben sich auf die Behandlung von psychischen und psychosomatischen Erkrankungen spezialisiert. Mit Hilfe des Blogs möchten wir als Klinikgruppe die verschiedenen psychischen Erkrankungen näher beleuchten und verschiedene Therapien sowie aktuelle Themen vorstellen."

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