Schizophrenia - Esquizofrenia

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SCHIZOPHRENIA 
Schizo = split; phrenia = mind. 
Even though schizophrenia can be interpreted to mean "splitting of the mind", it doesn't refer to a split 
personality, like some media sources might portray, but rather schizophrenia describes a scattered or fragmented 
patter of thinking. 
Schizophrenia's actually a syndrome meaning there're all sorts of symptoms that might be associated with it and 
different patients might experience different symptoms, although the symptoms can be broadly categorized into 
three major areas: positive symptoms, negative symptoms and cognitive symptoms. 
In schizophrenia, patients have positive symptoms which aren't positive in the sense that they're helpful, but 
positive in the sense that they're some new feature that doesn't have some "normal" or physiologic counterpart. 
These are the psychotic symptoms: delusions, hallucinations, disorganized speech and disorganized or catatonic 
behavior; none of which occur physiologically. 
 Delusions are false beliefs that the patient might feel very strongly about, so much so that they won't 
change their mind, even if you give them evidence against it. There are all sorts of different delusions, 
like, for example, a delusion of control (when somebody thinks that some outside force, or person, or 
thing, is controlling their actions), of reference (where someone might think that insignificant remarks are 
directed at them, like a newscaster is speaking directly to them through the TV). 
 Hallucinations are a second type of positive symptoms, and can be any kind of sensation that's not 
actually there, including visual but also including auditory sensations, like hearing voices or commands. 
 A third type is disorganized speech. An example being something like a "word salad", which seems like 
just a random jumbling of words or phrases, like "pencil dog hat coffee blue". 
 Disorganized behavior on the other hand could be like if they exhibit bizarre or silly behavior that's out of 
context and doesn't seem to have much of a purpose, like for example wearing multiple layers of jackets 
on a hot summer day. 
 Also sometimes the behavior is described as "catatonic", which has to do with their movements, posture 
and responsiveness. So like they might be super resistant to moving, or be in an unresponsive stupor. 
Negative symptoms are like when there's this reduction or removal of normal processes, and this is like a 
decrease in emotions they can express, or a loss of interest in things they once found interesting. 
 One type of a negative symptoms is called flat affect, where they don't respond with an emotion or 
reaction that would seem appropriate, like if they saw something very unexpected like a small monkey 
playing in their living room, they might simply sit and watch idly as if nothing was happening. 
 Another type is alogia, or poverty of speech, which is a lack of content in speech, so like is somebody 
asked them "do you have any children?", they might respond with "yes", instead of "yes, one boy and two 
girls". 
 A third type of negative symptoms is avolition, which is this decrease in motivations to complete certain 
goals, so someone might stay at home for long periods of time, without trying to reach out to friends or 
find work. 
Cognitive symptoms include things like not being able to remember things, learn new things, or understand 
others easily. These symptoms are more subtle though, and more difficult to notice and might only be detected if 
they have really specific test performed. An example might be somebody not being able to keep track of several 
things at once like a phone number and an address. 
People with schizophrenia seem to cycle through three phases, typically in order. During the prodrome phase, 
patients might become withdrawn and spend most of their time alone, and often this seems similar to other 
mental disorders like depression or anxiety disorders. During the active phase, patients experience more severe 
symptoms like delusions, hallucinations, disorganized speech, disorganized behavior, or catatonic behavior. 
Following an active phase, patients often enter into a residual phase, where they might exhibit cognitive 
symptoms like not being able to concentrate or becoming withdrawn again, as with the prodromal phase. 
Diagnosis 
For an official diagnosis of schizophrenia patients need to be diagnosed with two of the following symptoms: 
1. Delusions; 
2. Hallucinations; 
3. Disorganized speech; 
4. Disorganized behavior; 
5. Catatonic behavior; 
6. Negative symptoms. 
And at least one of them has to be either delusions, hallucinations, or disorganized speech. So basically they 
couldn't have just disorganized behavior and negative symptoms. 
Even though some patients have cognitive symptoms as well, they aren't specifically needed for a diagnosis. 
Also though, for a diagnosis, signs of these disturbances must be ongoing for at least 6 months, meaning they're 
likely in one phase or another for 6 months, but there must be at least one month of active-phase symptoms. 
And finally, those symptoms can't be attributable to another condition, like substance abuse. 
Causes 
We don't really know, since it seems like the signs and symptoms of schizophrenia are pretty unique to humans, 
or at least they're hard to imagine or notice in animal models like mice or rats. 
One clue is that the majority of antipsychotic medications that improve schizophrenia symptoms block the 
dopamine receptor D2, which reduces dopamine levels in neurons. This suggests that maybe schizophrenia has 
something to do with increased levels of dopamine. These medications, though, are neither universally nor 
completely effective, and don't work for everyone with schizophrenia, which adds to the confusion and means 
there's probably more to it than just the D2 receptors. 
Interestingly, one of the most effective antipsychotic drugs, clozapine, is a weak D2 antagonist, suggesting that 
other neurotransmitter systems like norepinephrine, serotonin, and GABA are involved. 
Twin studies have shown support for a genetic basis as well, even though there haven't been any specific genes 
conclusively linked to schizophrenia yet. Also, environmental factors, like early or prenatal exposure to infection, 
and certain autoimmune disorders like celiac disease have been linked with schizophrenia. 
Epidemiology 
Schizophrenia seems to happen slightly more in men than woman, with onset in the mid-twenties for men but 
late-twenties for woman; and the clinical signs of schizophrenia are often less severe for woman. Some studies 
suggest this difference might be due to an estrogen regulation of dopamine systems. There doesn't, however, 
seem to be any differences among race. 
Treatment 
Treating schizophrenia can be really tricky, and antipsychotic medications are often used, but it's super important 
to combine the efforts of several clinicians and health professionals, including professionals in therapy or 
counseling, medicine, and psychopharmacology. 
Antipsychotics can be very effective at reducing symptoms, but they often come a lot of additional considerations 
to keep in mind, like cost and the potential for unwanted side effects like tolerance, dependence, and withdrawal. 
https://www.youtube.com/watch?v=PURvJV2SMso&list=WL&index=2&t=0s