Although this article mainly talks about "Schizophrenia", it will be useful to those seeking information on the "psychosis" in general.
Schizophrenia or schizophrenic disorders are the types of psychotic disorders ("psychosis"), and advice about them (for example in relation to the manner of treatment, medication and origin of disorder) can be of great use to those who suffer from other types of psychotic disorders (" psychosis "). So you should not confuse the term "schizophrenia" that is used here and can be broadly understood as a "psychotic disorder". So if you are interested in "psychosis" - continue reading.
Our wish is that you use this text further acquainted with schizophrenia, explain their reasons and point out the treatment options. This text will encourage you and give you hope for this disease, despite numerous widespread prejudice, can be successfully treated. In addition, it will show you how you can contribute to the patient as significantly improving the quality of life for patients and what you can do as a family member.
Schizophrenic disorders are a set of mental illnesses with similar symptoms and causes that require specific treatment.
In this chapter you will learn:
that schizophrenic disorders associated with brain disorders
Schizophrenic disorders are relatively common
Schizophrenic disorders are hereditary only in so far as may be genetic predisposition (tendency to hypersensitivity)
that the disorder can not be proven laboratory tests or X-ray
that the disorder diagnosed only when symptoms manifest them in sufficient number and severity
to the schizophrenic disorder may very well provide the consequent treatment
What are schizophrenic disorders?
While science still can not answer any questions related to this disease, certainly is: a disease called "schizophrenia" does not exist, and only disease has nothing to do with the splitting of the personality of the patient.
In schizophrenic disorder leads to changes in certain brain functions. Consequently the change opinions, observations and affective, that changes the psyche.
It is not yet completely clear why there is an imbalance of brain function. With confidence still only know that some people are particularly susceptible, and outbreaks can be caused by excessive stress or other mental stresses, use drugs, and hormonal shifts (pregnancy, menopause).
How to recognize a schizophrenic disorder?
The disease can manifest itself in many different ways with completely different signs (symptoms). In some individuals, the symptoms can be very difficult, while the others are not insignificant or expressed.There is only a vague feeling that "something is wrong".
In people suffering from schizophrenic disorder is usually the fear and the feeling that they are required too. In schizophrenic disorder often leads to the loss of their own characteristics, their self and identity.Such a person feels between her and the environment has no borders. The patient also believe that others have taken power over him, because he can not protect (setting limits). In technical terminology this "symptom" disorder called ego.
The document symptoms are often divided into positive and negative symptoms. Some symptoms (positive) during some stage of the disease occur in addition to the normal experience such hallucinations or delusions, and other symptoms (negative) are reflected in the deficit compared to the period before the disease (eg, lack of drive, withdrawal).
The main symptoms are:
lack of sensitivity to disease
Like promenjenosti (like handling of outside / other than)
The biggest positive symptoms
Our brain has a kind of filter for many stimuli in the environment that would otherwise be able to flood the brain. In schizophrenic disorder has disrupted the function of filtering. Possible "defensive strategy" is a complete exclusion of external stimuli (like "putting a curtain") such as in a dream. Our brain, however, it is still in the dream we dream; patients are having any form of "waking sleep" - hallucinations. He hears voices (auditory hallucinations), smell (olfactory hallucinations), or see things that are not there (visual hallucinations) and such observations to be realistic.
Arise from the belief in a real patient reviews. He firmly believes that haunt him (persecution mania), that God (religious mania), or that they all relate to it (delusions), holding fast to their beliefs, some of which can not be deterred by any assurances or evidence that his ideas do not match reality. The cause of this lies in the fact that the patient withdrew into his inner world and that "pulled the curtain", similar to what we saw with hallucinations. In this way, losing their ability to think, his own "reality" compared to the reality of the outside world.
Especially in cases where the patient is emotionally excited or tired of his thought and speech becomes disjointed and hard to understand. The patient will hang up in the middle of a sentence, or will completely lose the thread. Often feels "invasion" of certain thoughts. These symptoms, however, have nothing to do with "maloumnošću".
Intelligence in this disease remains intact!
The most important negative symptoms
In the group of negative symptoms is often very difficult to decide whether a particular patient behavior a sign of illness or an attempt to overcome the disease - by, for example, pulling protected from the onslaught of stimuli.
Lack of will
Patients outbreak lose his customary enthusiasm and interest in all those things that were previously happy to deal with. Therefore, they very hard for the fulfillment of the usual professional and other tasks.
Loss of feeling
The patient can not be happy, not to express their feelings in a way that it used to have.
Patients are often retreat into themselves and distance themselves from their families and other environments. I do not feel good either within a well-known person, and often express fear of them.
In schizophrenic disorders may develop depression, especially if the affected person feel that the disease has greatly changed their lives.
Patients may be so desperate that they do not see any output. About 10% of all patients during the illness and committed suicide!
Depressed behavior and thoughts of suicide should be taken very seriously. In such cases you should contact a doctor immediately!
How can a correct diagnosis of schizophrenia?
Image of schizophrenic disorders can be manifold. Therefore, at the beginning of the disease is very difficult to make a conclusive diagnosis. Family and friends often do not find the explanation for the unusual behavior of a person who suffers from schizophrenic disorder. Neither the patients themselves is not clear that they suffer from a serious illness.
Schizophrenic disorders can not be diagnosed by blood tests or other similar methods.
Diagnosis is based on interviews with leading physician and the patient and his family based on the observed behavior of the patients. When this is particularly important number, scope and duration of symptoms.
Early diagnosis increases the chances that treatment will be successful!
How often schizophrenic disorders?
Schizophrenic disorders occur relatively frequently. Scientific studies have proven that the disease ill about 1% of all people, no matter what country they live in, what race or culture they belong to.
What causes this disease?
Causes of schizophrenic disorders have not been fully elucidated. The facts, however, suggest that some people are more susceptible to external influences and stimuli. Because of these vulnerabilities are particularly strongly about many things, and are therefore less "resistant" to the load, stress and internal conflicts. They are therefore more sensitive than others. Such vulnerability is technical language called vulnerability. If the load and stress becomes too great, for such a person, a kind of "nervous breakdown" and the appearance of symptoms.
Correlation between | in vulnerability and disease outbreaks can be explained on the example of sensitivity to the sun people with fair skin. Skin type is disposition, genetic predisposition, as well as vulnerability. For those sun light skin is just as dangerous as stress is dangerous for particularly vulnerable people. People light skin can be protected with sunscreen, but it should not stay too long in the sun. Protection of vulnerable persons will provide neuroleptics.
What tells dopamine hypothesis?
When the brain processes information, you can still transmit nerve impulses neural pathways. Between individual nerve cells are the points of contact (synapse) where the impulse for the further transfer of the required transmission substances (transmitters). Scientific research has found that the schizophrenic disorder disrupted transmission of stimuli in certain synapses, and the cause is too much unearned substance called dopamine. Neuroleptics to block the reception of the cells (receptors) so that the excess dopamine can not come up too much stimulation of nerve cells.
Are schizophrenic disorders inherited?
And in other diseases (cancer, heart attack) can inherit a tendency for a particular disease. The mere tendency can not, however, sufficient to explain the emergence of disease. Persons in whose families appear schizophrenic disorders, and must not become ill themselves. On the other hand, the disease can occur in cases when no one in the family suffers from schizophrenic disorder.
The risk in the general population is 1%
The risk for close relatives is approximately 10%
When is it a disease?
The disease usually occurs for the first time between | in puberty and the age of thirty, but in individual cases it may start earlier or later. Prior to the actual onset of the disease usually there is a period during which the patient is particularly vulnerable and live in constant tension, torn his thoughts and feelings.This is often respond "beg" - withdrawing into themselves, seeking out the alcohol and drugs or joining a cult. After these attempts to overcome neuspečnih disease symptoms described occur.
Prospects for treatment
The course of schizophrenia can be very different. It may be that the disease occurs only once after which the affected person to be completely healthy again. This happens especially when the disorder occurs in response to certain shocks of fate (reaction psychosis), at the time of hormonal changes (eg, immediately after delivery) or after using the drug. However, such a person because of their particular vulnerability (vulnerability) to be particularly at risk of recurrence.
If the treatment is started early and continued long enough (prophylaxis of recurrences), the psychosis that is, in most cases, can be very convenient to operate. The risk of relapse (worsening) with 85% without treatment, reduced to 15-20% with treatment. It's for these patients means that with high probability be able to live without a relapse (worsening) - provided they are willing to accept the concept of medical treatment and to cooperate with him.
Schizophrenic disorders can be treated just as successfully as other diseases, such as diabetes.
In this chapter you will learn:
which therapeutic options
How long does treatment
The side effects that may occur during treatment
How to treat schizophrenic disorders?
The patient and his family must learn that the patient is particularly sensitive, and should avoid all situations that might trigger the disease, such as excessive stress. In such cases it will be particularly important psychosocial therapy.
During psychosocial therapy patients and their families will learn how to cope with the disease and the problems associated with it. In this way, it can reduce the burden of disease.
Talk to your doctor about which treatment is most appropriate in your particular case (additional psychotherapy, rehabilitation, family therapy etc..). Especially if it occurs for the first time, it is important to participate in psycho educational program. During operation in the patients and their family members will be informed in detail about the disease, its course, and treatment options.
In order to re-establish the disturbed balance transfer stimuli in the brain need medical treatment neuroleptics.
For the treatment of anxiety disorders, depression and sleep disorders doctor will have, in addition to neuroleptics, sometimes prescribe other drugs.
Best results are achieved by a combination of pharmacological and psychosocial treatments neuroleptics therapy.
Why do drugs?
Many people suspect that mental illness can be treated with medication. Drugs were, | however, the only option to treat acute symptoms of a psychosis and successful protection of a resurgence of the disease.Without the use of drugs the patient generally will not be able to accept psychosocial therapy.
There are a number of reasons for taking drugs
Life becomes simpler again, and contacts with family, friends and colleagues a lot easier.
The patient will not start to be interested in different things and to engage in their hobbies.
They will be able to re-focus, and work will become easier. They will be able to look forward to again!
How to find the right remedy?
Given that every body reacts differently to medication, the doctor will have to determine which neuroleptic dose and to what is best for each individual patient. The goal of treatment is successful treatment of symptoms with the least possible side effects. It may be more neuroleptics It is necessary to try before finding the most effective.
Patients starting treatment with often become impatient because the symptoms do not decrease immediately. It can happen that cause certain side effects treatment before the eve of the "good" effects of treatment. Patients feel that just because a drug is not helping. It is necessary, however, a certain amount of time before neuroleptics develop their full effect. Main symptoms (hallucinations, delusions) mostly disappear within a few weeks of treatment.
What will happen if you take medicine?
Without the use of pharmacological treatment occurs more frequently relapse (worsening), accompanied by the frequent and longer stays in the hospital.
The incidence of relapse (worsening)
untar the first 2 years
Without treatment, about 85%
With a long enough treatment about 10%
It is very important bolesinka intensive contact with a physician in order to duly noticed worsening symptoms or side effects that may immediately take appropriate countermeasures.
Why treatment should be continued, even though the acute symptoms have disappeared?
Special susceptibility (vulnerability) patients persists after the disappearance of symptoms. Therefore, the patient still needs the protection that it provides neuroleptics. In this way, it prevents the re-emergence of the disease.
Long-term treatment with low doses of neuroleptics, the reduction of sensitivity and thus preventing relapse (ie, deterioration, density. Pominaće hereinafter only as "relapse"). Such an effect can be achieved only if the patient and after the improvement of acute symptoms is still taking neuroleptics.
Treatment of neuroleptics may decrease the risk of recurrence in 15-20%
How long does treatment neuroleptics?
To prevent recurrence and new outbreaks neuroleptics should take a long time, often several years (prophylaxis of recurrences).
There are international guidelines that regulate the duration of treatment for the prophylaxis of recurrences.
First occurrence: Treatment of neuroleptics after the withdrawal symptoms should continue for at least 1-2 years.
After recurrence: The risk of a new recurrence more than the higher part of the first outbreak of the disease. Treatment should continue for at least 5 years.
In particularly severe relapse should protect neuroleptics carry a lifetime!
The physician should, in each case to determine the duration of treatment should be independently, taking into account the previous course and severity of disease!
The pharmaceutical forms which are given neuroleptics?
Neuroleptics can be used in two ways: orally (by mouth) - in the form of drops, capsules or tablets, and intramuscular (injection into the muscle).
A special form of an intramuscular administration depot injections. A single injection of the patient will receive the amount of active ingredient which is enough for two to four weeks. For intramuscular stored active ingredient is gradually released daily dose, so it is not necessary daily intake, while improving tolerability.
There are short-term deposits with injections of action for 3 days which is primarily used for the treatment of acute illness.
Treatment can be initiated short-depot injections, drops or tablets. When the patient's condition stabilizes, therapy is continued tablets or depot injections.
What are the most common side effects of drugs?
Like all drugs and neuroleptics have a | woman side effects. List of side effects that can be read in the instructions for use, it can sometimes be intimidating. It should, however, keep in mind that the instructions for use of drugs listed all the side effects that are recorded anywhere in the world. Let the "side effects" may actually be symptoms of the disease (for example, fatigue, lack of diligence, concentration disturbance).
Individual susceptibility to adverse effects is very different. Because of this need, if it occurs, always consult a physician. In many cases, these unpleasant side effects can be mitigated or removed by changing the dose, using a different product, or taking additional medication. There are now a new generation neuroleptics (atypical neuroleptics) that cause significantly fewer side effects.
If side effects persist, along with the doctor to assess the benefit of treatment is still greater than the inconvenience caused by these unwanted dejstima.
Neuroleptics are not causing habit or addiction. It is proven with certainty!
Given that the symptoms of the disease and the side effects adversely affect concentration and coordination, consult with your doctor if you must drive or operate machinery.
In patients taking neuroleptics for several years may occur particularly unpleasant side effects ie. late dyskinesia, which are reflected by unconscious movements of the mouth, lips and tongue, and sometimes other muscles. Late dyskinesias are relatively rare - the longtime taking neuroleptics occurs in 15-20% of cases. If there is suspicion of late dyskinesia, you should immediately see a doctor and decide on further treatment.
Muscle cramps (dyskinesia)
Muscle rigidity, tremor, restlessness
Reducing the dose Anticholinergic drugs, neuroleptics changes
The need for constant movement (akathisia)
Decrease in blood pressure
Avoid exaggerated dose increase, slowly getting up, taking a major dose of evening
Dry mouth, constipation, visual disturbances
Dose reduction, appropriate medications (eg detergents) or changes neuroleptics
Diet, changes neuroleptics
Reducing the dose does not operate motor vehicles, major dose taken at night
Sensitivity to sunlight
Avoid the sun, use sunscreen
Dose reduction, change of neuroleptics
Change neuroleptics dose reduction or Anticholinergic drugs
Dose reduction, change of neuroleptics
Unconscious muscle movements
Dose reduction, change of neuroleptics
In rare cases may occur, and other side effects!
What are the atypical neuroleptics?
The new so-called. "Atypical" neuroleptics are drugs that are much more tolerable than the "classical" neuroleptics. When these products are very rare particularly bad set of side effects that include worsening of movement, walking in small steps and discomfort when sitting and standing. In addition it seems that atypical neuroleptics favorable effect on negative symptoms such as lack of political will and social withdrawal.
Why some patients do not want to take drugs?
about the disease, treatment options and mode of action of drugs. Plays a major role and the basic attitude toward the disease and "chemical" treatment of psychiatric disorders.
Tune into a psycho educational group, ask your doctor accurate information and read some guide like this.
Insufficient insight into disease
Affected people believe that the environment has changed and that they themselves are not sick. That is why some of them do not understand that they need therapy.
Again, these measures should be taken.
Fear of everyday reality
Fear of responsibility for their own life forces many patients to escape the "world of psychosis," from which it does not want to come out.
Psycho educational groups will help these individuals to share experiences on how to be a better way to overcome the disease and live normally.
Side effects of drugs
Often the stah of side effects generally cause for rejection drugs, or taking them irregularly.
What can be done against the adverse effects look in the previous section.
Fear of dependence on drugs
Regular intake of neuroleptics, even over a long period of time will not cause addiction!
Fear of change in personality
Patients often fear that they will lose by taking drugs or that their personalities will thus control their thoughts.
The truth is exactly the opposite - if the disease is left untreated, it can lead to confusion of thought and personality disintegration!
Psychosocial therapeutic measures
The patient will often, in order to cope with the disease on the activities of private and professional life, you may need professional help. For that purpose well for the following forms of treatment:
Rehabilitation programs will help the patient to gradually re-fit the normal living and working environment, will give his advice and assistance with housing and vocational services, and will assist him in finding a suitable job or in financial distress.
During family therapy, family conflicts are handled. Therapy can be performed with a single family or multiple family together to form some sort of group therapy.
During behavioral therapy and exercise in patients practicing social field behavior in the workplace and interact with other people, for example in role-play and learning model.
The psycho educational groups, patients and their families will learn how to better understand the disease, its effects and ways of its overcoming.
What are the psycho educational groups?
In such groups in an easily understandable way explain the disease and its treatment methods.Participants will learn how to resolve social conflicts and help each other cope with the disease.
Such therapy group lead psychiatrist, a psychologist, a member of the medical staff or social worker. The program usually takes eight to ten hours at intervals of two to three weeks. After that, the group participants often continue to meet the self-help groups.
Scientific research has proven that patients and their families who participated in the psycho educational groups were better informed and are thus better able to cope with the disease. This is why these patients reported significantly fewer recurrences of disease and hospitalization.
In this chapter, you will learn:
how to identify relapse
what can be done to prevent recurrence
What to do in case of crisis
why patients should avoid alcohol and drugs
Why is it so important to avoid the recurrence?
Recidivism is a heavy burden for all affected. The patient will need at least a year to recover from a relapse and again to be fully able to work. Sometimes it may happen that he never fully return before abilities.
Avoiding relapse is therefore the most important point in the treatment.
How do we recognize threatening relapse? How to avoid it?
Recurrence of the disease much earlier to announce: anxiety, sleep disorders or other signs. It is important to recognize these signs. If they occur, you should immediately see a doctor. The sooner we recognize threatening relapse and as soon as the appropriate measures are taken, then there is a greater chance of preventing the recurrence of the disease!
Any nervousness does not mean that really threatens a relapse. However it is better to consult a doctor sometimes without, but the disease breaks out again.
In the next section you will see a list of symptoms that may signal impending relapse.
Early signs can be different for every patient. Therefore, we should pay attention not only to the typical individual but also to the early warning signs.
And you yourself can make such a list in the table given below.
Typical early warning signs
restlessness, sleep disturbances
lack of appetite
loss of interest
feeling of worthlessness
Like us all laugh and gossip about us
sudden loss of interest in listening to the radio or watching television
increased tendency to consume alcohol or smoke
avoiding new, unusual situations
avoiding large groups of people (cinema)
If these signs persist for several days, be sure to see a doctor!
My early warning signs:
help me: (eg, physical activity, withdrawal, peace, nature)
It hurts me (eg, travel, alcohol, too much television viewing)
How to behave in the event of a crisis?
The probability that the disease persists is not too high when applied satisfactory therapy. There is however some risk (about 15%) and, therefore, must first make a contingency plan.
While the patient was in a stable phase should be together with your doctor and family members should agree on how to proceed in case any given early warning signs, for example, whether to increase the dose, or whether the patient may initially should stay at home or to go for treatment in a psychiatric hospital - if necessary even against his will - to keep it from further damage.
Whether drugs or alcohol increases the risk of recurrence?
THAT! Alcohol and drugs interfere with the metabolism of the nervous system, so it is extremely important that the patient avoids them.
Patients and their families
In this chapter you will learn:
the role it plays in the social environment
why families must be included in the treatment plan
what to look for in daily contact with the patient
What are the needs of family members of patients
What are the prerequisites for successful treatment?
Schizophrenia is not just a "normal" crisis that will disappear by itself, but a serious illness that should be treated. If the patient and his family to accept that fact, the first step to success has already been achieved.
Optimal treatment consists of medication and psychosocial therapy. Good chance that treatment will be successful only exist in those cases where the patients and their families are willing to cooperate with the doctor and to comply with the agreement. Treatment should never be interrupted without consulting a doctor!
How families can help in the treatment?
In everyday life together should adhere to the following rules:
Affected persons have a reduced work capacity and productivity. Always think that this is due to disease and has nothing to do with laziness!
Patients need to withdraw to a solitary place. Because of the disease they often do not distinguish between important and unimportant impressions. Therefore, it is very excitement and stress burden.
Patients should be normal daily schedule and the people on whom they can rely. It is very important to be with sick family members talk plainly and simply, without unnecessary criticism.
The patient must not overload the various activities and duties. Its current capacity is, however, not be lost due to lack of exercise.
Patients and their families in times of stable disease with a doctor must agree on what to do in case the disease reappears (contingency plan).
Do not even try to make sure patients in the inaccuracy of his hallucinations or delusional ideas. For him, they are a reality. Make sure that the patient receives medical attention.
People suffering from schizophrenic disorders rejoice like all people praise and recognition! This is usually accomplished much more than criticism.
Do postaljvati unrealistic goals. Excessive pressure in patients may lead to disease.
Members of the family should try to stay healthy themselves. In addition you have to continue to go about their normal activities and foster social contacts.
Only if you feel well, you will be able to help a sick family member!
Try that as a member of the family consciously live your own life!
The role of family
Support provided by family members or good friends for people suffering from schizophrenic disorder unusually important. Because of the disease that is most often limited by the ability of social contact, and will live quite isolated and lonely for them if no one else does. In crisis situations, but also in solving daily problems, they will need help.
For early detection of disease signs play a very important role just people from the immediate vicinity of patients, as the patient often does not recognize the first signs of illness.
Family members of patients have so good to know all the facts about the disease. The information, support and practical assistance will be given for example in the psychoeducational groups for family members. In such groups to find people with the same problems, but our conversations with others who are in similar situations, will contribute to the successful overcoming problems associated with the disease and tensions. It will help the patient, as taut and nervous family does not present any help. The aim of such psychoeducational groups to establish a constructive partnership between | the patients, families and physicians.
The rights of patients in psychiatric hospitals
Legislation relating to the treatment can be found in several laws. The basic prerequisite for any treatment of the patient's consent.
Patient's consent must be preceded by an interview with a doctor. The doctor will be patients in a simple and easy to understand information about medical treatment, the effects of treatment and the possible negative consequences. In this way, between the patient and the doctor comes to the conclusion of some sort of "agreement on the treatment of" patients who may at any time terminate.
These general rules apply to mental health treatment - for those patients who voluntarily went to the hospital and be judged individually |-operate and make decisions, that is, for those who do not need to restrict freedom of movement.
If, however, patients should be kept and treated against their will, which is permitted under certain circumstances, special rules apply. In such cases, we talk about the "placement in a psychiatric institution" which is governed by special rules.
If a patient should be 'locked up in a psychiatric institution, "it means that she will be admitted to the closed hospital department, or that his movement will be restricted. When placing patients in a psychiatric hospital, the doctor may limit the rights of other patients: contacts with people outside the hospital (visits, phone calls), and access to medical records. Other interventions in the personal rights of patients are not allowed.
For the patient against their will could be placed in a psychiatric hospital must meet the following conditions:
First There is a risk that the patient will harm or endanger themselves were any other ("significant threat to himself or others");
Second two psychiatrists must establish that there really is such a threat, and that the patient is mentally ill;
3rd there is no other treatment options.
The doctor has to prisutpačan way to explain why the patient is placed in a hospital (if he received such information in its current state does not cause more harm than good). He also has to placing the patient in a psychiatric institution inform the court, counsel patients and families.
If the patient because of his mental illness is not (more) I am able to take care of their affairs, he may be assigned a guardian. It will at the request of the patient, his family or other people to do justice.
The patient can be placed in a psychiatric facility at its own request if it has the capacity to act. In this case, the patient must make a statement that agrees to the treatment, and the restriction of freedom of movement.
If you want to know more about the law and the rights of patients and family members regarding the placement of patients in a psychiatric institution, contact a lawyer or social worker.
This text is izrađenen within the PRELAPSE that the company "Lundbeck" launched in many countries.PRELAPSE means "Preventing Relapse in Schizophrenia", ie. Prevention of relapse in schizophrenia. This program is recognized as the World Health Organization (WHO) and the World Psychiatric Association (WPA).
Mental illness is a structured, firmly shaped and relatively permanent disorder of psychic life that usually can not be removed without proper psychotherapy.
Each of mental illness has its own clinical picture, particularly the etiology, dynamics and forecasting.
Freud's all mental illnesses divided into two great classes:
- Neurosis or neurosis transfer
- Psychosis or neurosis narcissistic
Neuroses are: hysteria, phobias and obsessive neurosis and psychosis are schizophrenia, melancholia and paranoia.