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Schizophrenia is a chronic, severe and disabling psychiatric disorder that affects about 1 percent of people all over the world.

This brain disorder is characterized by:

    * impairments in the perception
    * impairments in expression of reality and
    * by significant social or occupational dysfunction


This condition can cause a parson to withdraw from the society and activities in the world around her and to retreat into a world of delusions or separate reality. Contrary to the common misconception, schizophrenia does not mean split or multiple personality. Although, many experts claim that there is not much more to discover about this strange disorder, schizophrenia still remains one of the most disabling and puzzling mental disorders.

Incidence of schizophrenia

This illness affects approximately 1 percent of the population worldwide. In men, schizophrenia typically emerges in the teens or 20s. In women, the onset of schizophrenia is typically in the 20s or early 30s, but it is found almost equally in men and women. The illness represents a significant economic and social burden. It is a mental disorder that, in the US, has a lifetime prevalence of approximately 1%. It has been estimated that approximately 0.025% to 0.05% of the total population is treated for schizophrenia in every year.

Possible causes of schizophrenia

No one really knows for sure what the precise cause of schizophrenia is, although experts have suggested several possible theories. The most common are:

    * Genetic

      Some researchers estimate schizophrenia to be highly heritable.
      There are several researches which tried to prove that there is a 70% chance a person will become schizophrenic if someone close to her has also suffered from this disease. Latest researches have proven that there is a 28% chance for the identical twin developing schizophrenia if the other already has it. Experts even managed to separate seven genes which are most likely involved in the inheritance of schizophrenia or the risk of developing the disease.

    * Environmental

      It is still not clear whether this plays a causal role in the onset of schizophrenia, but, there is some evidence that supports the fact that negative attitudes towards individuals with schizophrenia can have a significant adverse effect.

      Some of the environmental triggers could be living in the environment with emphasized:

          o poverty and discrimination
          o racism in society
          o stress of living in a different culture
          o urban environment

Some researchers have proposed that environmental influences during childhood also may induce the increased risk factors of developing schizophrenia later in life.

    * Neurobiological influences

      Many experts believe that the processes in early neurodevelopment are playing a major role in developing schizophrenia.

The part of these processes which happens during the pregnancy is also extremely important. Some even believe that certain infections in pregnancy can lead to  schizophrenia later in life but there are no significant evidence for this theory.
The fact is that the neurological development of children is considered very sensitive to outer influences such as trauma, violence, lack of warmth in personal relationships and hostility.

Symptoms of schizophrenia

There is a number of possible symptoms that can be associated with the schizophrenia and the most common are:

    * Delusions — These are personal beliefs which are not based in reality, but on some imaginary reasons.
    * Bizarre delusions — For example, some people think that someone else is controlling their thoughts and that thay can't do anything about it
    * Hallucinations — Sensing the things that don't exist. They can be both auditory and visual.
    * Incoherence
    * Lack of emotions
    * Inappropriate display of emotions
    * Social isolation
    * Lack of personal hygiene

In general, all symptoms of schizophrenia can be grouped into three categories: negative, positive and cognitive.

Negative signs and symptoms

These signs are called negative because something is missing from the person’s behavior. They may appear early on and a person may think he or she doesn’t need treatment.  
Such signs may include:

    * Dulled emotions
    * Inappropriate emotions
    * A change in speech which becomes dull and monotone

Positive signs and symptoms

These symptoms are called positive because they indicate that something has been added to the person’s behavior. The characteristic positive signs are hallucinations and illusions.

    * Hallucinations
      
Hallucinations are sensations that occur when someone senses things that don't exist. The most common hallucinations in schizophrenia are auditory hallucinations such as hearing strange voices. They could also be visual, during which, a person sees people or things that do not exist.

    * Delusions

      These are personal beliefs that have no basis in reality. The most common subtype of schizophrenia is paranoid schizophrenia, in which you hold irrational beliefs that others are persecuting you or conspiring against you. 

Cognitive signs and symptoms

These signs and symptoms tend to be more subtle than positive and negative ones. Cognitive signs and symptoms may include:

    * Problems making sense of the incoming information
    * Difficulty paying attention
    * Memory problems

Drug abuse and schizophrenia

Drug abuse is very common in people with schizophrenia. Nicotine is the most common drug abused by people with schizophrenia, but there are also several other drugs such as amphetamines, cocaine and marijuana which are commonly used by schizophrenics and which can make schizophrenia symptoms worse.

Schizophrenia and suicide

One in ten persons suffering from schizophrenia commits suicide which is a devastating fact. Four in ten are known to have attempted suicide. Feelings of being alone, not having a family or other support are considered as the main risk factors. It is proven that only 2% of those with schizophrenia who commit suicide did so in response to their voices. Young men and those with chronic illness are more at risk. A good educational background and high performance expectations are also the risk factors.

Pharmacotherapy of Schizophrenia

Treatment of schizophrenia includes medication and non-medication approach and both of them can be very effective if done properly and in time.
Antipsychotic medications, also known as neuroleptics, are the cornerstone of the treatment. The fact is that in the last couple of years, antipsychotics were generally much more effective in controlling the positive symptoms than the negative symptoms. But now, there are several new generations of antipsychotic medications which provide more effective management of both positive and negative symptoms. These antipsychotics include:

    * clozapine (Clozaril®),
    * risperidone (Risperdal®),
    * olanzapine (Zyprexa®),
    * quetiapine (Seroquel®),
    * ziprasidone (Geodon®) and
    * aripiprazole (Abilify®)

In general, the goal of  the treatment with antipsychotic medications is to effectively control the signs and symptoms with the lowest possible dosage.

New solutions in pharmacotherapy

Science reveals more and more about the underlying pathophysiology of schizophrenia all the time. The progression of anti-psychotic medications is definitely unstoppable.

Dopamine hypothesis

The dopamine hypothesis was the leading theory about the cause of schizophrenia. Therefore the treatment of choice was based on generalized dopamine (D2) receptor antagonists. This theory has since been expanded and modified, leading to the development of antipsychotic drugs that target the different classes of dopamine receptors to differential degrees.

NMDA Hypothesis

NMDA-type receptors are special receptors that use glutamate as a messenger. Some researchers are speculating that targeting NMDA receptors may alleviate positive, negative, and cognitive symptoms of schizophrenia. Normal NMDA receptor activity depends on three key factors:

    * the binding of glutamate to the receptor site,
    * the depolarization (increase in positive charge that indicates neuronal activation) of the neuron membrane in which the receptor is embedded, and
    * the presence of glycine (an amino acid)

The bottom line is that glycine is the focus of many proposed therapies to enhance NMDA activity in the brains of people with schizophrenia. It may be the key of the treatment. Several researches have proven that the use of Glycine has caused improvements of the NMDA receptor dysfunction. This is causing relieving of many symptoms, both, positive and negative.

Non-drug therapies

Although medications are the base of the effective treatment, many people with schizophrenia also benefit from non-drug therapies. These may include:

    * Individual therapy
      Patient is learning the ways of coping with stressful thoughts and situations to reduce the risk of a relapse. Patients may learn to change negative patterns of thoughts and behavior. This should put them in control of their thoughts and feelings.

    * Family therapy
      Both the patient and his family members  may benefit from this type of therapy which provides support and education. Symptoms have a better chance of improving if family members of the patient understand the illness.

    * Rehabilitation
      Training in social and vocational skills necessary to live independently is an important part of recovery. It is based on learning social skills such as good hygiene, cooking and many others.