Schizophrenia is one of the major syndromes in psychiatry.
The stance the schizophrenic takes, his thoughts and feelings contradict the rules of reality. Either a multitude of unconnected thoughts spring to the patient’s mind which do not lead to a conclusion, or he is intellectually completely impoverished. He has certain perceptions, mostly auditory, and they are called hallucinations. He has certain thoughts and ideas that cannot possibly be true. These are called delusions. The content of the delusions can be very varied, like being followed, harmed, someone reading the patient’s mind, thoughts being transmitted via the TV and radio and similar. In reality delusions are related to the person’s subjective state, in other words the social environment he lives in, the geography, or his past psychological experiences can play a part in the delusions. Whilst I was in Malatya for a meeting, my colleagues mentioned that they frequently come across delusions related to the University Hospital in that town, as this hospital is very different from the general architecture in the rest of the town, and has very advanced equipment. We could give many other examples like this. To express it in more general terms, the patient is unable to tell apart whether the stimulus comes from within him or from the outside world. Is what is happening a dream? Or is it reality? He does not know. He is confused for a while. This confusion which we see in the initial stages of the illness, is accompanied by serious distress.
Schizophrenia generally emerges in people of a young age, but this is not a general rule. The illness can start in childhood as well as in people of advanced age. It’s probability during a person’s lifetime is around 1%. This percentage is the same for women and men, and does not vary according to social background. Some researchers claim that schizophrenia is more common in lower socio-economic classes, but it is predominantly believed that this is not the cause but the result of the illness.
The cause of the disease is unfortunately not fully understood. There are many theories. The theory I support is that “it is a brain disease, where a multitude of factors and more than one gene play a role in its onset”. As a result a sensitivity against a chemical transmitter called dopamine develops, which can explain the delusions and hallucinations which we call positive symptoms. The biological basis for the negative symptoms is still under investigation. Social withdrawal, poor thought content and similar symptoms are referred to as negative symptoms.
Drugs play an important role in the treatment of the disease. Dopamine antagonists are used to prevent positive symptoms. In catatonic schizophrenia (in which the patient is in a state of physical immobility, as if he were frozen) and in patients with a risk of suicide, the use of electroshock therapy is an option.
We must not forget that each psychotic attack leads to the loss of millions of nerve cells. Therefore it is of vital importance that treatment is started at an early stage and continued consistently.