Schizophrenia: Causes, Symptoms, and Treatment

What is schizophrenia?

Schizophrenia is a significant mental health disorder that affects 1% of people. It affects men and women in early adulthood, between the ages of 18 and 25. It is a psychotic disorder in which the patient’s ability to connect with reality is affected by hallucinations and irrational delusions created by their imagination, preventing them from seeing reality as it truly is. This, in turn, affects the behavior and reactions of a person with schizophrenia toward the reality in which they live and toward the people around them. This necessarily disrupts the course of the person’s life and their ability to perform daily tasks.

What are the symptoms of schizophrenia?

1. Hallucinations: These may include hearing voices that do not exist talking about the person, giving them orders, or threatening them, as well as seeing people who are not there, shapes, or lights. These experiences may be accompanied by olfactory hallucinations, in which the patient smells unpleasant odors that no one else can smell. They may be smells of familiar things, such as soil or musk, or unfamiliar things, such as the smell of death or betrayal. There are also gustatory hallucinations in which food and drink have a strange taste. This taste is often perceived as poison or arsenic, and sometimes as the taste of magic or envy. Auditory hallucinations are the most common. Among the hallucinations that confuse patients and those around them are tactile hallucinations, in which the patient feels that someone is touching their body or organs. This may sometimes extend to feeling that someone is having sexual intercourse with them. The patient may conclude that he is married to a female jinn or that she is married to a male jinn, and a charlatan may tell them this.
2. Delusions: A delusion is a fixed, dominant false belief that cannot be changed through any logical means and is inconsistent with the patient’s cultural, educational, and social background. It may take the form of believing that someone is persecuting, watching, spying on, or intimidating the patient, whether people in their surroundings, official or public organizations, or local and international security agencies. This may be followed by delusions of reference, involving a fixed belief that anyone who laughs, whispers, or talks to someone else intends them harm. It may extend to the internet, newspapers, radio, and television, which the person believes are referring to them, even indirectly. The person often considers this confirmation of their persecutory ideas. This may be followed by delusions of grandeur, even indirectly, arising from the belief that they are subjected to all this persecution: if the whole world is persecuting them, then they must have a mission, be exceptional or a genius, or have been sent by the Lord of the Worlds. There may also be a nihilistic delusion, such as insisting that the digestive system has disappeared, the heart has stopped, or the person is dead. It may be broader, involving a belief that the world has ended. In a delusion of guilt, the person is convinced that they have committed a grave and serious sin that affected humanity, or that they stole or killed despite having no connection to the crime.
3. A person with schizophrenia believes their thoughts are being broadcast to the world:They may believe that everyone knows their thoughts, as though their mind were a radio station, or that other people can read their thoughts, implant thoughts in their brain, control or withdraw their thoughts, and leave their mind empty. These ideas are confusing and lead to many behavioral and social changes.
4. A person with schizophrenia believes that an external force controls them:They believe it controls their thinking, emotions, and actions, and that they have no will of their own in the face of this force. They may identify the force as a particular person or organization, or they may not know who is controlling them.
5. A person with schizophrenia lacks insight and denies their condition:It is notable that most people with schizophrenia lack insight and do not acknowledge their condition, making it difficult for them to accept treatment and follow-up care. They may see the suggestion of treatment as another form of persecution.
6.  Behavioral changes, isolation, neglect of hygiene, and neglect of daily duties:The patient may appear indifferent and emotionally blunted. Others may see them smile or laugh for no apparent reason, talk to themselves, or sometimes mutter. Their speech may become confused and difficult to understand, sounding like disconnected sentences that are difficult to make sense of.
7. The patient’s concentration may be impaired, and they may appear forgetful:This may lead to academic failure or declining performance at work. The patient may sometimes display a tendency toward violence, particularly if they neglect their treatment.

In chronic schizophrenia, these manifestations may not be the main features, but there are also many negative symptoms in addition to those described above, such as indifference, emotional blunting, lack of participation, lack of enthusiasm, and even a lack of interest in what is happening around the person. The patient may spend their time doing nothing except smoking and watching television, and sometimes walking in the street for many hours each day. Their functioning in professional and social life comes to a halt. A mother may become unconcerned about her children, husband, or home, which may lead to divorce.

People with schizophrenia may also drink large amounts of coffee and tea and smoke heavily. They may use other substances when available, such as stimulants and cannabis, making the problem more complicated or causing severe relapses from time to time. These patients’ abilities decline, and they may appear to have a reduced understanding of everyday matters. People with schizophrenia may also sometimes experience mood swings. More than one mental health disorder may occur alongside schizophrenia in the same patient, such as some obsessive-compulsive symptoms or social phobia.

Causes of schizophrenia:

1. Hereditary factors.
2. Life problems, events, and pressures.
3. Chemical changes in the brain..

Treatment of schizophrenia:

The condition may begin suddenly or develop gradually and slowly over several months. In Arab society, treatment is often delayed because the patient refuses it or because people seek help from charlatans of various kinds. These people may beat and torture the patient in an attempt to expel magic or jinn, and the patient may die because of this abuse. Families may then hesitate to take the patient to a psychiatrist.

In most cases, a person with schizophrenia refuses treatment because they believe they are not ill or affected. Their hallucinations may lead them to believe that treatment is a conspiracy by those around them. Even if the person lacks insight and resists treatment, we must recognize that early treatment is important and necessary to bring the condition under control, prevent deterioration, and limit its impact on daily life. This may require admitting the patient to a psychiatric hospital, sometimes involuntarily. If the patient is cooperative and calm, treatment may be provided without hospitalization. After improvement, it is essential to ensure that treatment continues for extended periods and possibly for life. Individual, family, and group psychotherapy follows medication treatment as needed.

The past two decades have seen tremendous advances in psychiatric treatments, particularly antipsychotic medications, leading to better outcomes for this condition. The challenge remains maintaining adherence and follow-up. Long-acting intramuscular injections are therefore available to ensure treatment continues and is not stopped or refused, as commonly happens. People frequently ask what they should do when the patient refuses treatment. They should discuss this with the treating physician even if the patient refuses to attend a clinic.

If someone close to you has schizophrenia, you should know that they need special care and treatment. This care should be based on embracing and supporting them and building emotional bonds and bridges of trust, enabling them to feel safe and turn to you whenever their symptoms intensify. At the same time, this allows you to connect the person with reality and, whenever the opportunity arises, show them that what they feel and think consists only of hallucinations with no basis in reality. Always remember to avoid becoming emotionally agitated with them or harshly urging them to seek treatment and telling them they are ill, because this will make dealing with them and getting them into treatment more complicated.

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