Schizophrenia – The “psycho” disorder?!

Schizophrenia

What is Schizophrenia?

Schizophrenia is a complex brain disorder, with its pathogenesis in neurodevelopmental anomalies. The 5 domains of schizophrenia include:

  • Positive symptoms (delusions, hallucinations).
  • Negative symptoms.
  • Ubiquitous cognitive deficits
  • Motor symptoms (dyskinesias).
  • Deficits in social cognition, or socio-occupational functioning.
Negative Symptoms: 

Negative symptoms include blunted affect, alogia, avolition, asociality, amotivation, anhedonia, ideational constriction, apathy or inertia, and abulia.

  • Blunted affect: This refers to the decreased intensity and repertoire of emotional expressions.
  • Alogia: This refers to the paucity in the speech content that is evident in patients of schizophrenia.
  • Avolition: This refers to the deficits in initiation and maintenance of goal-directed behaviors.
  • Anhedonia: This is the decreased ability to experience and anticipate pleasure, or pleasurable emotions. Recent studies have pointed out that patients with schizophrenia have the ablility to enjoy the pleasurable experience. However, they display a lack of wanting to experience these pleasurable pursuits or enjoyable experiences. Consummatory hedonia is the ability to experience an emotion. Also, anticipatory hedonia is the want to experience a pleasurable pursuit. Patients with schizophrenia display anticipatory anhedonia. However, negative symptoms have not been unique to schizophrenia alone.
Classification of Negative Symptoms:

Deficits in the brain circuitry concerning reward (nucleus accumbens), motivation and pleasure are the reason for negative symptoms.

Negative symptoms are further classified into:

  • Enduring Primary Negative Symptoms: The enduring primary negative symptoms can consistently present over long periods of time, despite fluctuations in other aspects of the disease. These enduring primary negative symptoms constitute what is called the deficit syndrome in schizophrenia.
  • Transitory Secondary Negative Symptoms: Secondary negative symptoms can occur transitory in nature, fluctuate largely over the course of the illness, and abate with reduction in the other aspects of the disease.
What Causes Secondary Negative Symptoms?
  • These are secondary to positive symptoms. That is, if a patient hears voices commanding him not to venture out of his home, lest he is attacked by his arch nemesis, such an individual is bound to stay at home for the fear of being attacked. Such an individual will also limit his social interaction, and display paucity in his speech content. People mistake this for apathy and alogia. However, in fact it is a reflection of the aftermath of auditory hallucinations, a positive symptom.
  • Secondary negative symptoms are attributable to chronic social deprivation. This is evident in patients who are chronically institutionalized in asylums. Such long bouts of social isolation serve to remove all motivation in these individuals to interact with the outside world, especially at a time when they are overwhelmed by their illness, and are unable to integrate their inner perceptual experiences. Chronic institutionalization comes across as a severely under-stimulating environment. 
  • Lastly secondary negative symptoms may be due to medications themselves. In medical terms, it is called neuroleptic-induced dysphoria. The medications which are used to treat a psychotic breakdown cause a reduction in the levels of the happy hormone serotonin, and this may produce a depression like picture. However, this is not to be confused with the post-psychotic depression that is commonly seen after a psychotic episode. Although the treatment does not differ in both these scenarios, recognition of the individual clinical scenario has important prognostic ramifications. In theory, risk of exacerbation of the psychotic symptoms exists, when the post-psychotic depression is treated with antidepressants.
Deficit Syndrome:
  • Indeed, deficit syndrome or a clustering of these negative symptoms entails a poor quality of life, and impaired socio-occupational functioning.
  • Subsequently, individuals become unproductive, and lead a life of social isolation and deprivation.
  • The motivation to go out and do something beautiful, achieve a target, strive towards betterment of oneself diminishes and stops. Also, work towards a greater good of one’s community, all day to day goals in the lives of a regular individual, cease to exist.
Degree of Future Negative Symptoms:
  • Firstly, Among the strongest predictors of the degree of future negative symptoms is Duration of Untreated Psychosis, or DUP.
  • Thus, DUP refers to the time lag between the appearance of the first psychotic symptoms, and the treatment sought for these symptoms.
  • However, greater the duration of the untreated psychosis, greater is the future occurence of negative symptoms and cognitive deficits.
  • Indeed, an individual with a substantial cognitive reserve offers some protection against the cognitive deficits in schizophrenia, and dementia.
  • Since the nature of these cognitive deficits is ubiquitous, these may be evident as early as the prodromal phase of schizophrenia.
  • Indeed, greater the volume of grey matter loss, greater is the cognitive deficit syndrome. Also, greater the duration of untreated psychosis, greater is the grey matter volume loss.

Treatment:

Factoring in all these points, it becomes imperative to seek comprehensive professional psychiatric help early in the course of the illness. The prodromal phase of schizophrenia presents with memory disturbances, vague anxiety and depressive symptoms, progressive social withdrawal, before the positive symptoms set in. This prodrome can last as long as 5 years before the onset of core psychotic symptoms, like delusions and hallucinations.

Management of Negative Symptoms:
Non-pharmacological Management:
  1. Psychosocial interventions: Indeed, this is as important as psychopharmacological interventions. Thus, forming support groups, and meeting at regular intervals of these groups is important. Nevertheless, these group meetings give voice to individual experiences and problems. So, thereapists give encouragement to client participation. Assessment is done of the progress so far. Therapists also ascertain the goals for the future.
  2. Cognitive Behavioral Therapy (CBT): Therapists aid the clients in recognizing cognitive distortions. Subsequently, they help in unlearning older maladaptive behaviors, and focusing on learning newer adaptive ones. Individualized therapy is suitable. Because, there is no one-size-fits-all treatment. Studies consistently show that individual therapy is better than group therapy in the treatment of negative symptoms.
  3. Cognitive remediation therapy for cognitive deficits: This includes pencil-paper tasks, sudoku, crossword, computer exercises. Therapists tailor some of the exercises to focus on deficits in individual domains like attention, speed of thought processing, verbal working memory, reasoning, and social cognition.
  4. Others: Thus, aerobic exercises help in neurogenesis, synaptogenesis, and modulate neuroplasticity. 
Pharmacological Management:
  1. In fact, Amisulpiride and Fluoxetine treat the negative symptoms. Amisulpride increases levels of the hormone prolactin in the long run. Hyperprolactinaemia can set the precedent for osteoporosis.
  2. However, recent studies have shown that Clozapine has the highest level of evidence in the management of negative symptoms.  With Clozapine, the improvements can be visible even after 6 months of initiation of treatment. 
  3. Moreover, Clozapine trial requires regular monitoring of the White Blood Cell counts, and causes constipation, weight gain, salivation, postural hypotension, and palpitations as common side effects.

Brain Stimulation Techniques:

  1. Transcranial Magnetic Stimulation (TMS). Firstly, TMS of the dorsolateral prefrontal cortex (DLPFC) has proven to be very effective in the treatment of negative symptoms.
  2. Electroconvulsive therapy (ECT). However, it is not as effective for negative symptoms, as it is for depression and positive symptoms.

Novel Treatment Approaches:

  • Emerging molecular targets – These include GABAergic modulation, targeting oxytocin receptors (implicated in the social cognition deficits in schizophrenia, along with mirror neurons). Also, countering neuroinflammation by using cyclo-oxygenase inhibitors like Rofecoxib. Others include – NMDA (N-Methyl-D-Aspartate) antagonists like Memantine, Glycine-reuptake inhibitors like Bitopetrin, and Metabotropic Glutamate Receptor 2/3 agonists like Pomaglumetad. Memantine, Bitopetrin and Pomaglumetad come under the purview of glutamatergic modulation.

There is definitely hope for those afflicted with the deficit syndrome, with researchers identifying a plethora of molecular targets.

Hallucinations Delusions Schizophrenia ?

hallucinations delusions schizophrenia

Weird, Bizarre, Incoherent – Hallucinations Delusions Schizophrenia ?! Serious Mental Illnesses (SMIs) and side effects to varied medicines may cause hallucinations in many individuals. Psychosis and Schizophrenia are the most commonly known causes that may cause this condition. Hallucinations are sensations and feelings that may appear as real to the patient. Thus, convincing him or her of the occurrence of things that are not really happening in reality. Hearing voices, seeing people, and experiencing things that no one else can, are some of the ways in which hallucinations work.

Let us find out the varied signs and symptoms of this condition.

Hearing Voices: One of the most common signs of hallucinations includes hearing voices. You may hear voices from people who cannot be seen or heard by other people around you. In such cases, you may have the distinct feeling of hearing these voices from within. However, this could also be from a source outside your own mind and body. In many cases, you may feel like these voices are trying to talk to you or give you a certain message. Ringing of the ears on a persistent basis may also be experienced in such cases.

Visual Hallucinations: Such hallucinations will make the patient see things. In such cases, the patient may be witness to a scene that cannot be seen by anyone else. Essentially, it is a scene that may not be happening in reality. In visual hallucinations, the patient may also see people that other people in the room or the area cannot see. The patient may also see objects and other creatures. For example, insects crawling across his or her hand. Subsequently, the patient reacts with fear or anxiety, when in reality, no such scene may be happening. These kind of hallucinations also cause occipital seizures where the patient will see spots, shapes and rings of brightly coloured lights. They may be coming towards him or her, or even encircle him or her.

Other kinds of hallucinations

Tactile Hallucinations: In this kind of hallucinations will make the patient feel things that may not really be happening. For example, these hallucinations will make the patient feel hot during winters. They may also feel a blast of air even when there has been none.

Taste Hallucinations: In these hallucinations, the patient may get a salty taste from sweet food, or vice versa. Such hallucinations make the patient imagine that he or she tastes a certain flavor when in reality, this is not true. They are also called gustatory hallucinations.

Olfactory Hallucinations: These hallucinations have to do with odd smells that the patient may get a whiff of. In these hallucinations, the patient imagines certain smells like burning, or other odours. Patients may also feel that their own bodies are letting out certain odours which may not be the actual case.  

Delusion vs. Hallucination

A delusion is a false belief based on incorrect inference about external reality that is firmly sustained despite what almost everybody else believes. This is also despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person’s culture or subculture For example, it is not an article of religious faith.

A hallucination occurs when environmental, emotional, or physical factors such as stress, medication, or extreme fatigue. In a mental illness the mechanism within the brain that helps to distinguish conscious perceptions from internal, memory-based perceptions misfire. As a result, hallucinations occur during periods of consciousness. They can appear in the form of visions, voices or sounds, tactile feelings (known as haptic hallucinations), smells, or tastes.

Delusions are a common symptom of several mood and personality-related mental illnesses. These include schizoaffective disorder, schizophrenia, shared psychotic disorder, major depressive disorder, and bipolar disorder. They are also the major feature of delusional disorder. Individuals with delusional disorder suffer from long-term, complex delusions that fall into one of six categories. They are persecutory, grandiose, jealousy, erotomanic, somatic, or mixed.

So… are all hallucinations delusions schizophrenia ?! If you notice any of the above, it may be time to consult a neuropsychiatrist OR visit your nearest doctor to find out more.

Sexual Problems – How Does It Affect You

Sexual Problems How Does It Affect You

Both men and women can suffer from sexual dysfunction or sexual problems. In common man’s parlance it is a problem that prevents you from experiencing sexual satisfaction. If you are experiencing sexual dysfunction in any part of the sexual response cycle, you are not alone. This traditionally includes excitement, plateau, orgasm, and resolution. Research suggests that 43 percent of women and 31 percent of men report some degree of sexual dysfunction or difficulty.

It also remains a topic that many people are hesitant to discuss and resolve worldwide. Read on to know more on sexual dysfunction. This is so that you can understand it and seek treatment for it. Moreover, this is because treatment options are available and extremely helpful.

Types of sexual dysfunction
Sexual dysfunction is classified into four categories:

  1. Desire disorders: This is a generalized lack of sexual desire or interest in sex
  2. Arousal disorders: Inability to become physically aroused during sexual activity
  3. Orgasm disorders: A delay or absence of orgasm
  4. Pain disorders: Pain during intercourse
Symptoms of sexual dysfunction 

In men:

  1. Erectile dysfunction – An inability to achieve or maintain an erection for penetrative sexual intercourse
  2. Retarded ejaculation – An absent or delayed ejaculation despite sexual stimulation
  3. Early or premature ejaculation – Inability to control ejaculation

In women:

  1. Inadequate vaginal lubrication before or during sex
  2. Inability to relax the vaginal muscles for sexual intercourse to happen
  3. Lack of interest in or desire for sex. An inability to become aroused or pain during intercourse are also classified as sexual dysfunction.
Causes of sexual dysfunction
  1. ​Physical causes – A number of medical conditions can cause problems with sexual function. They include diabetes, heart and neurological problems , hormonal imbalances, kidney or liver failure, and alcoholism and drug abuse. Antidepressant use can also affect sexual function
  2. Psychological causes. – Stress and anxiety, sexual performance anxiety, relationship problems, depression. These are some of the psychological causes responsible for sexual disorders. Feelings of not being good enough and the effects of a past sexual trauma also come into play.
Diagnosis of sexual dysfunction

Subsequently, the doctor will begin with a history. This includes talking about symptoms, followed by a physical exam to rule out medical problems.

However, a major part of diagnosis is psychological. Therefore, the doctor will evaluate your attitude about sex, as well as other contributing factors. Hence, these may include fear, anxiety, past sexual abuse, relationship problems, medications, alcohol or drug abuse, etc. In conclusion, this is to understand the underlying cause of the problem.

Treatment

In fact, most types of sexual dysfunction can be treated by addressing the underlying physical or psychological problems. In addition, other common ways to treat sexual dysfunction are:

  1. By changing a medication which may be causing sexual dysfunction. If you have a sexual dysfunction due to hormone deficiencies, you may benefit from hormone shots, pills, or creams. Men can use Viagra or Cialis for erectile dysfunction by increasing blood flow to the penis.
  2. Mechanical aids – Penile implants or vacuum devices can be used in men to maintain an erection. Vacuum devices are used in women too. In addition, there are dilators to help women who have an extremely narrow vaginal opening.
  3. Sex therapy – Marriage counselors and therapists help couples resolve their relationship issues that may be causing sexual dysfunction.
  4. Behavioral therapy – This helps you to seek insight into your behaviour which may be causing sexual dysfunction and address it.
  5. Psychotherapy. This type of therapy can help you resolve prior sexual trauma. Also, feelings of inadequacy, anxiety, fear, or guilt, and poor body image.

In conclusion, if you have questions and are suffering from any of the above kindly click to read more here. Also, feel free to contact the expert to have your problem/s solved.