Schizophrenia: Meaning and definition

Schizophrenia affects approximately 1 percent of all adults, globally. Experts say schizophrenia is probably many illnesses masquerading as one.

Some research suggests that schizophrenia may be the result of faulty neuronal development in the brain of the fetus, which later in life emerges as a full-blown illness.

Individuals with schizophrenia may hear voices that are not there. Some may be convinced that others are reading their minds, controlling how they think, or plotting against them. This can distress patients severely and persistently, making them withdrawn and, at times, frantic.

Symptoms of schizophrenia

A sizable proportion of people with schizophrenia have to rely on others because they are unable to hold a job or care for themselves. Many may also resist treatment, arguing that there is nothing wrong with them.

Some patients may present clear symptoms, but on other occasions, they may seem fine until they start explaining what they are truly thinking. The effects of schizophrenia reach far beyond the patient – families, friends, and society are affected too.

Symptoms and signs of schizophrenia will vary, depending on the individual.

The symptoms are classified into four categories:

• Positive symptoms – also known as psychotic symptoms. For example, delusions and hallucinations.
• Negative symptoms – these refer to elements that are taken away from the individual. For example, absence of facial expressions or lack of motivation.
• Cognitive symptoms – these affect the person’s thought processes. They may be positive or negative symptoms, for example, poor concentration is a negative symptom.
• Emotional symptoms – these are usually negative symptoms, such as blunted emotions.

Below is a list of the major symptoms:

• Delusions – the patient displays false beliefs, which can take many forms, such as delusions of persecution, or delusions of grandeur. They may feel others are attempting to control them remotely. Or, they may think they have extraordinary powers and abilities.
• Hallucinations – hearing voices is much more common than seeing, feeling, tasting, or smelling things which are not there, however, people with schizophrenia may experience a wide range of hallucinations.
• Thought disorder – the person may jump from one subject to another for no logical reason. The speaker may be hard to follow or erratic.

Other symptoms may include:

• Lack of motivation (avolition) – the patient loses their drive. Everyday actions, such as washing and cooking, are neglected.
• Poor expression of emotions – responses to happy or sad occasions may be lacking, or inappropriate.
• Social withdrawal – when a patient with schizophrenia withdraws socially, it is often because they believe somebody is going to harm them.
• Unawareness of illness – as the hallucinations and delusions seem so real for patients, many of them may not believe they are ill. They may refuse to take medication for fear of side effects, or for fear that the medication may be poison, for example.
• Cognitive difficulties – the patient’s ability to concentrate, recall things, plan ahead, and to organize their life are affected. Communication becomes more difficult.

What are the causes schizophrenia?

Experts believe several factors are generally involved in contributing to the onset of schizophrenia.

Evidence suggests that genetic and environmental factors act together to bring about schizophrenia. The condition has an inherited element, but environmental triggers also significantly influence it.

Below is a list of the factors that are thought to contribute towards the onset of schizophrenia:

Genetic inheritance

If there is no history of schizophrenia in a family, the chances of developing it are less than 1 percent. However, that risk rises to 10 percent if a parent was diagnosed.

Chemical imbalance in the brain

Experts believe that an imbalance of dopamine, a neurotransmitter, is involved in the onset of schizophrenia. Other neurotransmitters, such as serotonin, may also be involved.

Family relationships

There is no evidence to prove or even indicate that family relationships might cause schizophrenia, however, some patients with the illness believe family tension triggers relapses.

Environmental factors

Although there is no definite proof, many suspect trauma before birth and viral infections may contribute to the development of the disease.

Stressful experiences often precede the emergence of schizophrenia. Before any acute symptoms are apparent, people with schizophrenia habitually become bad-tempered, anxious, and unfocused. This can trigger relationship problems, divorce, and unemployment.

These factors are often blamed for the onset of the disease, when really it was the other way round – the disease caused the crisis. Therefore, it is extremely difficult to know whether schizophrenia caused certain stresses or occurred as a result of them.

Drug induced schizophrenia

Marijuana and LSD are known to cause schizophrenia relapses. Additionally, for people with a predisposition to a psychotic illness such as schizophrenia, usage of cannabis may trigger the first episode.

Some researchers believe that certain prescription drugs, such as steroids and stimulants, can cause psychosis.

Schizophrenia diagnosis and tests

A schizophrenia diagnosis is reached by observing the actions of the patient. If the doctor suspects possible schizophrenia, they will need to know about the patient’s medical and psychiatric history.

Certain tests will be ordered to rule out other illnesses and conditions that may trigger schizophrenia-like symptoms, such as:

• Blood tests – in cases where drug use may be a factor a blood test may be ordered. Blood tests are also done to exclude physical causes of illness.
• Imaging studies – to rule out tumors and problems in the structure of the brain.
• Psychological evaluation – a specialist will assess the patient’s mental state by asking about thoughts, moods, hallucinations, suicidal traits, violent tendencies, or potential for violence, as well as observing their demeanor and appearance.

Schizophrenia diagnosis criteria

Patients must meet the criteria outlined in the DSM (Diagnostic and Statistical Manual of Mental Disorders). This is an American Psychiatric Association manual used by healthcare professionals to diagnose mental illnesses and conditions.

The doctor needs to exclude other possible mental health disorders, such as bipolar disorder or schizoaffective disorder.

It is also important to establish that the signs and symptoms have not been caused by, for example, a prescribed medication or substance abuse.

The patient must:

• Have at least two of the following typical symptoms:
  • delusions
  • disorganized or catatonic behavior
  • disorganized speech
  • hallucinations
  • negative symptoms that are present for much of the time during the last 4 weeks
• Experience considerable impairment in the ability to attend school, carry out their work duties, or carry out everyday tasks.
• Have symptoms that persist for 6 months or more.

Treatments :

With proper treatment, patients can lead productive lives. Treatment can help relieve many of the symptoms of schizophrenia. However, the majority of patients with the disorder have to cope with the symptoms for life.

Psychiatrists say the most effective treatment for schizophrenia patients is usually a combination of:

• medication
• psychological counseling
• self-help resources

Anti-psychosis drugs have transformed schizophrenia treatment. Thanks to them, the majority of patients are able to live in the community, rather than stay in a hospital.

The most common schizophrenia medications are:

• Risperidone (Risperdal) – less sedating than other atypical antipsychotics. Weight gain and diabetes are possible side effects, but are less likely to happen, compared with Clozapine or Olanzapine.
• Olanzapine (Zyprexa) – may also improve negative symptoms. However, the risks of serious weight gain and the development of diabetes are significant.
• Quetiapine (Seroquel) – risk of weight gain and diabetes, however, the risk is lower than Clozapine or Olanzapine.
• Ziprasidone (Geodon) – the risk of weight gain and diabetes is lower than other atypical antipsychotics. However, it might contribute to cardiac arrhythmia.
• Clozapine (Clozaril) – effective for patients who have been resistant to treatment. It is known to lower suicidal behaviors in patients with schizophrenia. The risk of weight gain and diabetes is significant.
• Haloperidol – an antipsychotic used to treat schizophrenia. It has a long-lasting effect (weeks).

The primary schizophrenia treatment is medication. Sadly, compliance (following the medication regimen) is a major problem. People with schizophrenia often come off their medication for long periods during their lives, at huge personal costs to themselves and often to those around them.

The patient must continue taking medication even when symptoms are gone. Otherwise they will come back.

The first time a person experiences schizophrenia symptoms, it can be very unpleasant. They may take a long time to recover, and that recovery can be a lonely experience. It is crucial that a person living with schizophrenia receives the full support of their family, friends, and community services when onset appears for the first time.

What Is Carcinoid Syndrome?

Carcinoid syndrome is a group of symptoms you might get if you already have a type of cancer called carcinoid tumors. It starts when the tumors release chemicals into your bloodstream. The symptoms can be similar to other illnesses, like asthma, irritable bowel syndrome, and menopause. You may have episodes when your skin suddenly gets red and warm, you have trouble breathing, or you have a rapid heartbeat, for example.

Carcinoid tumors usually grow in your stomach and intestines, but you can also get them in your lungs, pancreas, or rarely, testicles or ovaries. If you have carcinoid syndrome, it usually means that your cancer has spread to another area, most often your lungs or liver.

Although there’s no cure for carcinoid tumors, treatments can help you live longer and better. You can also take steps to relieve the symptoms of carcinoid syndrome and feel more comfortable.

What Is Intracerebral Hemorrhage?

Intracerebral hemorrhage (ICH) is when blood suddenly bursts into brain tissue, causing damage to the brain.

Symptoms usually appear suddenly during ICH. They include headache, weakness, confusion, and paralysis, particularly on one side of the body. The buildup of blood puts pressure on the brain and interferes with its oxygen supply. This can quickly cause brain and nerve damage.

This is a medical emergency requiring immediate treatment. ICH is not as common as ischemic stroke (when a blood vessel is blocked by a clot), but it’s more serious.

Treatment generally involves surgery to relieve the pressure from the accumulation of blood and to repair damaged blood vessels. Long-term treatment depends on the hemorrhage location and the amount of damage. Treatment may include physical, speech, and occupational therapy. Most people have some level of permanent disability

What Are the Causes of Intracerebral Hemorrhage?

High blood pressure is the most common cause of intracerebral hemorrhage. In younger people, another common cause is abnormally formed blood vessels in the brain. Other causes include:

• head injury or trauma
• ruptured cerebral aneurysm (weak spot in a blood vessel that bursts)
• arteriovenous malformation (a grouping of malformed blood vessels in the brain that disrupts normal blood flow)
• use of blood thinners
• bleeding tumors
• cocaine use (can cause severe hypertension and lead to hemorrhage)
• bleeding disorders (e.g., hemophilia, sickle cell anemia)

Anyone can have an intracerebral hemorrhage, but your risk increases with age.

What Are the Symptoms of Intracerebral Hemorrhage?

Symptoms of ICH include:

• sudden weakness, tingling, or paralysis in the face, arm, or leg, especially if it occurs on only one side of the body
• sudden onset of severe headache
• trouble swallowing
• trouble with vision in one or both eyes
• loss of balance and coordination, dizziness
• trouble with language skills (reading, writing, speaking, understanding)
• nausea, vomiting
• apathy, sleepiness, lethargy, loss of consciousness
• confusion, delirium

What Are the Complications of Intracerebral Hemorrhage?

Depending on the location of the hemorrhage and how long your brain was without oxygen, complications may include:

• impaired language skills
• fatigue
• problems with swallowing
• vision loss
• difficulty with sensations or movements on one side of the body
• pneumonia
• cognitive dysfunction (memory loss, difficulty reasoning), confusion
• swelling on the brain
• seizures
• depression, emotional problems
• fever

How Is Intracerebral Hemorrhage Treated?

Treatment within the first three hours of the onset of symptoms generally results in a better outcome.

Surgery can relieve pressure on the brain and repair torn arteries. Certain medications can help manage symptoms, such as painkillers to ease severe headaches. Antianxiety drugs may be necessary to control blood pressure. If your doctor determines that you’re at risk for seizures, antiepileptic drugs may be necessary.

Long-term treatment will be needed to overcome symptoms caused by damage to the brain. Depending on your symptoms, treatment may include physical and speech therapy to help restore muscle function or improve communication. Occupational therapy may help a person regain certain skills and independence by practicing and modifying everyday activities.

How Can I Prevent Intracerebral Hemorrhage?

You can decrease your chances of ICH by:

• not smoking
• treating heart disease
• treating high blood pressure
• keeping diabetes under control
• maintaining a healthy lifestyle

What is Vestibular Hypofunction

What are varicose veins?

Higher than normal hemoglobin levels can be seen in people living at high altitudes and in people who smoke. Dehydration produces a falsely high hemoglobin measurement that disappears when proper fluid balance is restored.

Some other infrequent causes are high hemoglobin levels are:

• advanced lung disease (for example, emphysema);
• certain tumors;
• a disorder of the bone marrow known as polycythemia rubra vera, and;
• abuse of the drug erythropoietin (Epogen) by athletes for blood doping purposes (increasing the amount of oxygen available to the body by chemically raising the production of red blood cells).

Sickle cell disease is a genetic condition in which the quality of hemoglobin is defective. This condition can cause abnormal hemoglobin that can result in abnormally-shaped (sickled) red blood cells (see illustration). These abnormal red blood cells cannot easily pass through small blood vessels leading to inadequate oxygen for the tissues of the body.

Sickle cells also have a shorter life span than normal red blood cells (10 to 20 days compared to 120 days). This rapid turnover may result in inadequate time to replace the red blood cells and may result in anemia.

In sickle cell anemia, one defective hemoglobin gene is inherited from each parent. If only one gene is inherited from one parent, then the condition is milder and referred to as sickle cell trait.

Symptoms of sickle cell anemia vary depending on its severity. Patients with sickle cell trait may experience mild, if any, symptoms at all. In sickle cell disease, symptoms are more significant, especially in episodes of acute crisis. These symptoms can include:

• generalized body aches and pain,
• chest pain,
• bone pain,
• shortness of breath,
• ulceration of skin,
• fatigue,
• strokes,
• blindness, and
• delayed growth and puberty.

Thalassemia is a group of hereditary conditions with quantitative hemoglobin deficiency. The body’s failure to make globulin molecules will lead to a compensatory mechanism to make other less compatible globulin molecules. The different types of thalassemia are defined based on what type of globulin molecule is deficient. The severity of these conditions depends on the type of deficient globulin chain, the number of deficient globulins, and the severity of the underproduction. Mild disease may only present as mild anemia whereas severe deficiency may not be compatible with life.

There are a number of ways to increase hemoglobin levels. In general, low hemoglobin levels that need to be increased are caused by three circumstances: decreased red blood cell production (for example, altered bone marrow hemoglobin production, iron deficiency), increased red blood cell destruction (for example, liver disease), and by blood loss (for example, trauma from a gunshot or knife wound). Addressing these underlying causes of low hemoglobin levels initially determines what method to use to increase hemoglobin levels.

Methods to increase hemoglobin levels are varied and their use depends on the underlying problems. Some of the ways to increase hemoglobin include:

• transfusing red blood cells
• receiving erythropoietin (a hormone used to stimulate red blood cell production in individuals with decreased red blood cell production or increased red cell destruction)
• taking iron supplements
• increasing the intake of iron-rich foods (eggs, spinach, artichokes, beans, lean meats, and seafood) and foods rich in cofactors (such as vitamin B6, folic acid, vitamin B12, and vitamin C) important for maintaining normal hemoglobin levels. Such foods include fish, vegetables, nuts, cereals, peas, and citrus fruits.

Individuals should not take iron supplements or other treatments for low hemoglobin levels without first discussing such treatments with their physician as side effects from these treatments and/or excess iron intake may cause additional problems. Also, iron supplements should be kept away from children as iron poisoning in young children can be fatal

Loss of vision is considered sudden if it develops within a few minutes to a couple of days. It may affect one or both eyes and all or part of a field of vision. Loss of only a small part of the field of vision (for example, as a result of a small retinal detachment) may seem like blurred vision. Other symptoms, for example eye pain, may occur depending on the cause of vision loss.

Causes:

Sudden loss of vision has three general causes:

• Clouding of normally transparent eye structures

• Abnormalities of the retina (the light-sensing structure at the back of the eye)

• Abnormalities of the nerves that carry visual signals from the eye to the brain (the optic nerve and the visual pathways)

Light must travel through several transparent structures before it can be sensed by the retina. First, light passes through the cornea (the clear layer in front of the iris and pupil), then the lens, and then the vitreous humor (the jellylike substance that fills the eyeball). Anything that blocks light from passing through these structures, for example, a corneal ulcer or bleeding into the vitreous humor, can cause loss of vision.

Most of the disorders that cause total loss of vision when they affect the entire eye may cause only partial vision loss when they affect only part of the eye.

An Inside Look at the Eye

When the Visual Pathways Are Damaged

Nerve signals travel along the optic nerve from each eye. The two optic nerves meet at the optic chiasm. There, the optic nerve from each eye divides, and half of the nerve fibers from each side cross to the other side. Because of this arrangement, the brain receives information via both optic nerves for the left visual field and for the right visual field. Damage to an eye or the visual pathway causes different types of vision loss depending on where the damage occurs.

HOW AND WHY BLINDNESS DEVELOPS

Anything that blocks the passage of light from the environment to the back of the eye or disrupts the transmission of nerve impulses from the back of the eye to the brain will interfere with vision. Legal blindness is defined as a visual acuity of 20/200 or worse in the better eye, even after correction with eyeglasses or contact lenses, or a visual field restricted to less than 20° in the better eye. Many people who are considered legally blind can distinguish shapes and shadows but not normal detail. Blindness can occur under the following circumstances: Light cannot reach the retina. Damage to the cornea caused by infections such as herpes keratoconjunctivitis or an infection that follows contact lens overwearing, which results in an opaque corneal scar Damage to the cornea caused by vitamin A deficiency (keratomalacia), which causes dry eyes and results in an opaque corneal scar (rare in developed nations) Damage to the cornea caused by a severe injury that results in an opaque corneal scar A cataract, which causes loss of clarity of the lens Light rays do not focus on the retina clearly. Imperfect focusing of light rays on the retina (refraction errors) that cannot be fully corrected with eyeglasses or contact lenses (such as from certain types of cataracts) The retina cannot sense light rays normally. Detached retina Diabetes mellitus Macular degeneration Retinitis pigmentosa Inadequate blood supply to the retina, usually due to a blockage of the retinal artery or vein, which may be caused by inflammation of the blood vessel wall (such as that caused by giant cell arteritis), or due to a blood clot that travels to the eye from somewhere else (such as from the carotid artery in the neck) Infection of the retina (such as from Toxoplasma,parasites, or fungi) in people who have AIDS Nerve impulses from the retina are not transmitted to the brain normally. Disorders affecting the optic nerve or its pathways inside the brain, such as brain tumors, strokes, infections, and multiple sclerosis Glaucoma Inflammation of the optic nerve (optic neuritis) The brain cannot interpret information sent by the eye. Disorders that affect the areas of the brain that interpret visual impulses (visual cortex), such as strokes and tumors

Common causes

The most common causes of sudden loss of vision are

• Blockage of a major artery of the retina (central retinal artery occlusion)

• Blockage of an artery to the optic nerve (ischemic optic neuropathy)

• Blockage of a major vein in the retina (central retinal vein occlusion)

• Blood in the jellylike vitreous humor near the back of the eye (vitreous hemorrhage)

• Eye injury

Sudden retinal artery blockage can result from a blood clot or small piece of atherosclerotic material that breaks off and travels into the artery. The artery to the optic nerve can be blocked in the same ways and can also be blocked by inflammation (such as may occur with giant cell [temporal] arteritis). A blood clot can form in the retinal vein and block it, particularly in older people with high blood pressure or diabetes. People with diabetes are also at risk of bleeding into the vitreous humor.

Sometimes what seems like a sudden start of symptoms may instead be sudden recognition. For example, a person with long-standing reduced vision in one eye (possibly caused by a dense cataract) may suddenly become aware of the reduced vision in the affected eye after covering the unaffected eye.

Less common causes:

Less common causes of sudden loss of vision (see Table: Some Causes and Features of Sudden Loss of Vision) include stroke or transient ischemic attack (TIA), acute glaucoma, retinal detachment, inflammation of the structures in the front of the eye between the cornea and the lens (anterior uveitis, sometimes called iritis), certain infections of the retina, and bleeding within the retina as a complication of age-related macular degeneration.

Treatment

• Treatment of the cause

The disorder causing the loss of vision is treated as rapidly as possible, although treatment may not be able to save or restore vision. However, prompt treatment may decrease the risk of the same process occurring in the other eye.

Key Points

• Sudden loss of vision is an emergency, so people should go directly to a hospital.

• The presence or absence of pain helps indicate which causes are most likely.

• If vision returns quickly on its own, transient ischemic attack and ocular migraine are among the likely causes.

Cleft lip and cleft palate are facial and oral malformations that occur very early in pregnancy, while the baby is developing inside the mother. Clefting results when there is not enough tissue in the mouth or lip area, and the tissue that is available does not join together properly.

A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip. This separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.

A cleft palate is a split or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front portion of the roof of the mouth), and/or the soft palate (the soft back portion of the roof of the mouth).

Cleft lip and cleft palate can occur on one or both sides of the mouth. Because the lip and the palate develop separately, it is possible to have a cleft lip without a cleft palate, a cleft palate without a cleft lip, or both together.

What Causes a Cleft Lip and Cleft Palate?

In most cases, the cause of cleft lip and cleft palate is unknown. These conditions cannot be prevented. Most scientists believe clefts are due to a combination of genetic and environmental factors. There appears to be a greater chance of clefting in a newborn if a sibling, parent, or relative has had the problem.

Another potential cause may be related to a medication a mother may have taken during her pregnancy. Some drugs may cause cleft lip and cleft palate. Among them: anti-seizure/anticonvulsant drugs, acne drugs containing Accutane, and methotrexate, a drug commonly used for treating cancer, arthritis, and psoriasis.