Schizophrenia
Schizophrenia – a chronic brain disorder in which
people interpret reality abnormally.
Schizophrenia is characterised by mental and behavioural changes such as hallucinations, delusions, disorganised behaviour or language. It was originally known as Demence précoce (Morel) or dementia precox (Kraepelin). Schizophrenia is the term later chosen by psychiatrist Bleuler to express the split between thoughts, emotions and behaviour in patients with this condition.
The onset of Schizophrenia
Schizophrenia occurs equally in women and men. The difference between the sexes is the age of onset of the disease. Onset in men is earlier than in women. The age of onset for men peaks between 10-25 years, and for women between 25-35 years, and peaks again in middle age (around 45 years).
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Studiile actuale analizează o multitudine de factori posibil implicați: genetici, neuroanatomici/de neurodezvoltare, circuite neuro-funcționale, electrofiziologici, neurochimici și neurofarmacologici, imunologici, endocrinologici, socio-familiali, etc.
În căutarea „genei schizofreniei” au fost vizate câteva zone ale genomului: cromozomii 5, 6, 11, 18 și X, dar absența unor rezultate clare nu infirmă ipoteza, ci demonstrează heterogenitatea genetică pentru schizofrenie.
Factori de neurodezvoltare posibil implicați sunt traumatismele obstetricale, suferinţele fetale, sezonalitatea şi infecţiile virale, agresiunile cerebrale postnatale prin factori traumatici, toxici, infecţioşi sau hipoxici.
Modelul stres-vulnerabilitate se referă la apariția simptomatologiei specifice de schizofrenie pentru o persoană vulnerabilă care este expusă unui stres intens biologic, psihosocial sau de mediu.
Cercetările au arătat că există 4 zone cerebrale intens interconectate care sunt afectate în schizofrenie: sistemul limbic, cortexul frontal, cerebelul și ganglionii bazali.
Schizophrenia – Stages of evolution
At present, the following stages of evolution are recognised:
personality changes (schizotypal or schizoid traits) characterized by: passivity, lack of communication, introversion; cognitive dysfunctions (attention deficit, alterations in working memory), social relational inability.
Significant decline in cognitive abilities and tangential loss of contact with reality. (Social withdrawal and inability to prospect the future; deterioration in professional behaviour or marked eccentric behaviour; marked negligence in dress and personal hygiene).
dominated by the appearance of positive or negative symptoms, associated with other specific symptoms that complete the clinical picture.
with the removal of positive and negative symptoms.
represented by the reappearance of positive symptoms in less than 6 months.
represented by a new psychotic episode at least 6 months after remission.
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Talk to our colleagues about our schizophrenia programs and learn more about having an intervention.
Risk factors for psychotic episode,
relapse and re-fall
Socio-demographic factors
unfavourable social environment, social handicap and social discrimination and low socio-cultural level, marital status (unmarried people have 4 times higher frequency than married people)
(presence of psychotic disorders or schizophrenia in first-degree relatives); obstetric trauma with hypoxia at birth and febrile seizures or toxicosis in the first 12 months of life; consumption of psychoactive substances during pregnancy, severe anemia, blood dyscrasia
Precipitating factors
social psychostress, family with inability to communicate emotionally – schizophrenic mother, or family with very high emotional expression, psychoactive substance use.
Schizophrenia diagnosis and clinical forms
Disorders of thought, perception and affect are "fundamental and characteristic", so that they lead to loss of sense of identity and autonomy, and cognitive deficit progressively sets in.
Thought disorder: usually inferred from abnormalities in written and spoken language, such as: weak associations, continuous digressions in speech, poor speech content and use of idiosyncratic expressions.
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Delirurile: credinţe false, bazate pe inferenţe incorecte despre realitate, în contradicţie cu fondul social şi cultural al pacientului. Se pot observa adeseori idei de referinţă, control, persecuţie, prejudiciu, grandoare, mistice.
Halucinaţiile: percepţii senzoriale în absenţa unor stimuli exteriori. Halucinaţiile auditive (în special vocile care comentează) şi senzaţiile fizice bizare sunt cele mai frecvente.
Afectul anormal: reducere a intensităţii sau variabilităţii emoţionale; răspunsuri afective inadecvate sau incongruente din punctul de vedere al contextului comunicării, emoțiile pot fi instabile sau tocite.
Perturbările comportamentului motor de tip dezorganizat sau catatonic: adoptarea pentru un timp îndelungat a unor poziţii bizare; scheme de mişcări repetate, lipsite de scop; activitate intensă şi dezorganizată sau reducerea mişcărilor spontane, cu o aparentă ignorare a mediului.
Bleuler consideră că la baza scindării mentale a pacienților stau simptome fundamentale specifice, concretizate în 4 procese psihopatologice cunoscute ca cei 4 A:
In schizophrenia, the diagnosis is supported by the presence of the characteristic symptoms described above for a significant period of time (over a month or less, if successfully treated) and which interfere with the individual’s normal social or occupational functioning.
The symptoms appeared at least 6 months ago, in a at least attenuated form, characteristic of the prodromal period and cannot be justified by the use of a substance or a somatic disease/general medical condition.
Depending on the predominance of positive or negative symptoms, of ideo-behavioral disorganization,
schizophrenia can be classified into several forms:
SCHIZOPHRENIA is treatable!
You can improve your quality of life by up to 60%.
Evolution and prognosis for Schizophrenia
It is a chronic disorder, like diabetes or high blood pressure, which improves, and new episodes are prevented with appropriate treatment
In schizophrenia, the evolution over time varies considerably from person to person. Most patients have periods of exacerbation and remission of symptoms. Others maintain a stable level of symptoms and disability, which can range from moderate to severe. Most patients have at least one more psychotic episode after their first episode. However, there are often cases when several episodes occur.
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Evoluţia schizofreniei mai este influenţată şi de orientarea şi motivarea personală, precum şi de sprijinul primit, sub forma asistenţei pentru refacerea capacităţilor şi pentru recuperare.
O mică parte din pacienţi (aprox 10%) rămân sever bolnavi pe perioade îndelungate de timp. Ei sunt acele persoane pe care le vedem în media sau despre care auzim că sunt „nebunie”, ceea ce contribuie la concepția greșită a populației despre schizofrenie.
Între o jumătate şi două treimi din oamenii cu schizofrenie se ameliorează semnificativ sau se recuperează, unii dintre ei aproape complet.
Evoluţia bolii şi recuperarea sunt determinate de un cumul de factori biologici, psihologici şi socio-culturali. Aceşti factori pot fi influenţaţi. Din aceste motive, există şanse considerabile ca pacienţii să ducă o viaţă independentă, să-şi poarte singuri de grijă şi să-şi reia activitatea în familie sau la locul de muncă.
Treatment for schizophrenia
Ever since the introduction of antipsychotics in the treatment of psychiatric illnesses half a century ago, establishing an important step in the management of schizophrenia treatment, this therapeutic area has been characterized by a continuous attempt to optimize therapeutic outcomes in an effort to help patients. In classical terminology, antipsychotics have been called neuroleptics. Many of the antipsychotic drugs discovered in the early days of pharmacopsychiatry are still used today.
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Descoperirea clozapinei a fost o piatră de hotar în tratamentul pentru schizofrenie și al altor tulburări psihotice. Clozapina a fost introdusă în tratamentul schizofreniei la începutul anilor 1970 doar în unele țări din Europa, fiind mai apoi introdusă și în SUA, la începutul anilor 1990. A fost primul antipsihotic care trata simptomele schizofreniei cu un risc minimal în apariția simtomatologiei extrapiramidale (efectul advers cel mai des întâlnit la administrarea de antipsihotice, în special cele tipice, manifestat prin contracturi musculare și posturi bizare).
Currently, two types of antipsychotics are used in the drug therapy of schizophrenia: typical and atypical.
Typical antipsychotics
are the first to appear, from the haloperidol spectrum, with possible unpleasant side effects
Atypical antipsychotics
of the latest generation, are differentiated from classical ones by a low probability of adverse effects
Another category of drugs used as treatment for schizophrenia are thymostabilisers, which are intended to decrease psychomotor agitation and stabilise the patient’s general mood. Sedatives are also used in the therapeutic scheme. In cases of extreme psychomotor agitation, the most commonly used are benzodiazepines.
Because of the risk of post-psychotic episode depression, which can lead to self-harm, antidepressant medication is also administered.
Experience from years of clinical trials has proven that drug therapy is not sufficient in treating this condition, so in recent years, intervention has become interdisciplinary: psychiatrist, psychologist and social worker.
The psychiatrist-patient therapeutic alliance is much more effective following psychological intervention, which brings with it a better perception of the disease, an increase in compliance with treatment and a more effective patient-doctor interaction.
The main goal is
not healing…
The main goal is to regain a high socio-professional functioning, that is why it is important to intervene at the educational level, both at the patients' level and at the level of the family and society in general. A correct understanding of the condition leads the patient to a good relationship with the psychiatrist and openness regarding the whole therapeutic process.
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Familia joacă un rol esențial în gradul de recuperare și reintegrare, în cazul unui pacient bolnav de schizofrenie, indiferent de forma acesteia, de aceea este important să înțeleagă necesitatea tratamentului medicamentos, cu toate posibilele efecte adverse, să înțeleagă și să distingă simptomele, pentru a preveni episoadele psihotice acute și pentru a-l ajuta pe pacient, asigurându-i un mediu în care acesta să se simtă în siguranță, acceptat și susținut.
În tot acest proces, psihiatrul joacă rolul cel mai important, fiind singurul care poate detalia și explica întreaga simptomatologie, riscurile și gradul posibil de recuperare. Scopul principal al procesului terapeutic este acela de a crește perioadele de remisiune și de a scădea intensitatea episoadelor psihotice acute.
Clinică Hope – clinică specializată de psihiatrie și psihoterapie vine în sprijinul dumneavoastră cu cele mai eficiente programe de tratament specifice pentru această afecțiune.
Schizophrenia – frequency and symptoms
- Major psychiatric disorder with a lifetime prevalence of 0.72% (McGrath, 2008), more common in men (ratio 1.4:1), urban, low socioeconomic status, families with a history of schizophrenia;
- Positive symptoms: hallucinations and delusions, disorganized thinking and speech;
- Negative symptoms: unwillingness, emotional flattening, apathy, flattening of speech, isolation and lack of social interest.
The role of psychological interventions in treatment
- Positive symptoms generally respond very well to drug treatment (antipsychotics). But the negative symptoms respond partially, not at all or are worsened by drug treatment.
- Drug treatment, although the main form of intervention in schizophrenia, does not correct many of the patient’s impaired areas of functioning in the social and independent living domains.
- In many cases, the most devastating effects of psychological and mental disorders occur in the social aspects of the lives of those affected.
What are social skills
- Social skills are verbal and non-verbal behaviours that we use to communicate effectively with other people. Social skills are governed by culture, beliefs and attitudes.
- They are constantly changing and developing in the course of our lives.
- Having appropriate nonverbal behaviors in relationships.
- Expressing one’s own opinion to others, assertiveness, negotiation.
- Being able to perceive how the other person feels and being able to show empathy.
- Having appropriate emotional responses.
Social skills training
- Social skills training is a type of psychotherapy that helps people improve their social skills so that they become socially competent. It is a predominantly behavioural therapy.
- It is mainly used for individuals diagnosed with certain psychological or mental disorders whose symptoms involve poor social functioning.
- The main disorders accompanied by social dysfunction are autism, schizophrenia, social anxiety or sociophobia.
- It involves problem identification, objectives, modelling, practice, generalisation.
Connections – Schizophrenia Treatment Programme
A programme coordinating psychiatric consultation, individual psychotherapy and standardized social skills course based on Allan Bellack’s manual.
Psychoeducation course for patients and their families – 1 day.
1-year social skills training programme, weekly group sessions for patients with schizophrenia.
The first specialized programme in Romania aimed at the negative symptoms, psychological and social recovery of these patients, for a fulfilled and independent life.
Development of social skills
Social skills will focus on:
Listening: in order to be able to respond to others, it is important to listen effectively. Training shows how to actively listen to others
Initiate and build relationships of friendship or love
Find and maintain professional activities
Benefits of this treatment
Recent efficacy studies have shown improvements in social functioning in schizophrenia patients treated with SST (Bellack, 2004; Bowie et al., 2012; Granholm et al., 2008, 2009; Horan et al., 2009, 2011; Robert & Penn, 2009; Valencia et al., 2007).
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Aceste studii au observat o reducere mai mare a nivelului de afectare socială și handicap funcțional cu SST, în comparație cu alte tratamente precum Tratament obișnuit (Granholm et al., 2008, 2009; Robert & Penn, 2009; Valencia Rascón, Juárez, & Murow, 2007), numai tratament neuroleptic (Cirici, García, & Obiols, 2001).
Eforturile de a construi programe complete de tratament au adus clinicii în 2018 o neașteptată apreciere internațională, Clinica Hope devenind singura clinică din România care a primit, în Mai 2018, prestigiosul premiu Rose of Paracelsus, decernat de Asociația Medicală Europeană pentru „Bune practici medicale” – Best Medical Practice.
Prin programele noastre, ne dorim să oferim toate șansele de recuperare și beneficiile pentru sănătate pentru toți pacienții noștri și să le oferim înapoi.
Our advantage lies in the fact that we are a clinic exclusively dedicated to mental health, where the psychiatrist and psychotherapist of each patient communicate and collaborate with each other, with your consent, applying specialized programs, so that you receive the best and most effective therapeutic path for you.
Thus, your chances of solving the problems caused by this condition are much higher and the time needed will be much shorter.
Efforts to build comprehensive treatment programmes have brought the clinic in 2018 an unexpected international appreciation, Hope Clinic becoming the only clinic in Romania to receive, in May 2018, the prestigious Rose of Paracelsus Award, awarded by the European Medical Association for “Best Medical Practice”.
We are dedicated to providing the best treatments for your mental and emotional health. How do we know what they are? We apply the knowledge of the latest international treatment guidelines. We aim to offer the full range of interventions that are scientifically proven to be most effective, from medication to types of psychotherapy. We organize everything in TREATMENT PROGRAMMES so that you always know the full range of services you need and what path you need to follow.
We offer an individual approach, where you can choose between all 3 options: psychiatric-medication treatment, psychotherapeutic treatment or mixed treatment.