Schizophrenia: Psychiatric Significance Of Its Clinical Presentations And Treatment
Schizophrenia is a disease of protean manifestations. The symptoms of the illness include disturbances in thinking, mood, perception and motor behaviours. These symptoms occur in a clear and conscious setting of the mind.
Disturbance in thinking: A characteristic disturbance is splitting and loosening of associations. Here the ideas get disinterred and disorganized and the talk becomes irrelevant, incoherent and illogical. Loosening of association is a fundamental symptom of schizophrenia. Thought block is another disturbance seen in these patients. They do think, thoughts are being inserted (thought inertion) or thoughts are withdrawn or stolen (thought-withdrawal) from their minds. They may coin new words for their own purposes (neogisms). They may fail to catch the wider meaning of proverbs which may be interpreted in the literal sense. This is due to the loss of abstract thinking.
Delusions: Many kinds of delusions are found in schizophrenia. Persecutory and grandiose delusions are the common ones. Delusions may occur all of a sudden. These are known as primary delusions, which are pathognomonic of schizophrenia. Secondary delusions also may develop either from the primary delusions or from affective disturbances.
Disturbances of affect: All kinds of affective changes may be seen in schizophrenia. In the early stages, a loss of emotional feeling may be noted. But many patients show an incongruous affect. In some cases liability, depression, elation, anxiety or exaltation may be the affective change.
Disturbance of perception: The most common abdnormality is auditory hallucination which occur in a clear, conscious setting. Hallucinatory voices may comment or give orders or pass simple statements to the patient. Tactile hallucinations in the form of waves, electricity or vibrations are experienced by many. Visual hallucinations are uncommon and other kinds of hallucinations are rare.
Motor disturbances: Many varieties of motor disturbances may develop. The patients lack energy and initiative. In some, the motor activity may be completely blocked up (stupor). In some cases, there is mutism (absence of voice production). The patient may show automatic obedience like waxy flexibility and negativism. Negativism is manifested as retention of saliva and urine or doing just the opposite of what is expected normally. Other motor disturbances include repetition of activities such as stereotypy, mannerism or preservation. At times, they exhibit spells of senseless excitement or states of complete withdrawal from the surroundings (autism).
Other clinical features: Mental functions such as consciousness orientation, memory and intelligence are fully preserved, but the reasoning, judgement and insight are impaired.
Electroconvulsive therapy (ECT)
The principal methods of treatment of schizophrenia include pharmacotherapy, ECT and psychosocial therapy.
Pharmacotherapy: Neuroleptic drugs are used such as:
- Chloropromazine hydrochloride (50 to 300 mg thrice daily given orally or injection, 50 to 100 mg intramuscularly).
- Thioridazine hydrochloride (50 to 300 mg thrice daily, given orally).
- Trifluoperazine (5 to 15 mg thrice daily, given orally)
- Flufenazine decanoate (Injection, 12.5 to 25 mg given intramuscularly once in two to four weeks).
- Butyrophenone derivatives such as Haloperidol (5 to 15 mg thrice daily, given orally or injection: 5 to 10 mg given intramuscularly); Tripedol (5 to 15 mg thrice daily, given orally) and pemozide (2 to 4 mg given once daily orally).
Electroconvulsive therapy (ECT): ECt is beneficial in catatonic schizophrenia, acute schizophrenic episodes, and in schizophrenic excitement.
Psychological treatment: Schizophrenic patients are helpless. They require psychosocial support. They should be listened to and their problems should be understood. Close social contact should be established. Useful physical activities are to be encouraged through occupational therapy and other kinds of group activities. The family members should be educated about the nature of the illness and their role in the care of the patient. All these measures will help in the re-socialization of the patient, who can return to society as a useful member after completion of therapy.
© 2014 Funom Theophilus Makama