Doctors differentiate between positive and negative symptoms in schizophrenic illnesses.
Positive symptoms include all symptoms in the area of experience and behavior that do not occur in healthy people:
- hallucinations
- delusions
- thought disorders
- ego experience disorders
Negative symptoms, also known as negative symptoms, include complaints that are characterized by a reduction or impoverishment of psychological characteristics compared to healthy people. These include
- a limited capacity for emotional experience
- the inability to feel joy (anhedonia)
- reduced facial expressions and gestures
- slowed thinking with less thought content
- Reduced interest and activity
The World Health Organization (WHO) is responsible for the globally valid diagnostic catalog ICD (International Classification of Diseases). In the current version, the ICD-10-GM-2019, schizophrenic disorders can be found under the code F20.ff. In order not to go beyond the scope of this article, only the main forms are described here.
The code F20.0 stands for paranoid schizophrenia. The primary symptoms are delusions and (usually auditory or visual) hallucinations For example: The patient is firmly convinced that he is being watched by the police. He cannot accept his friends' objections that there is no plausible reason for this. Instead, it is easier for him to believe that his friends are also involved in the police operation (delusion). The affected person hears voices whispering to them that they are being spied on (acoustic hallucination). He may see spies sneaking around in the dimly lit bedroom (visual hallucination).
F20.1 codes hebephrenic schizophrenia. The focus here is on affective disorders. Those affected are listless, their mood is flat and their behavior is often inappropriate. Delusions and hallucinations occur only fleetingly. Hebephrenic schizophrenia is primarily a disease of adolescence and young adulthood. An example: a retail trainee feels increasingly unmotivated and exhausted. She has the impression that customers are watching her in an unpleasant way. Her concentration is disturbed. After work, all she wants to do is go home; she withdraws more and more from her circle of friends and is convinced that her work colleagues are talking about her behind her back and that her boss can read her mind.
Catatonic schizophrenia (F20.2) is mainly characterized by psychomotor disorders. Those affected compulsively adopt a certain posture or move monotonously. Hallucinations can also occur. An example: A 50-year-old man sits with his back absolutely upright in the dining room of an assisted living group. His head is resting on the back of his neck. He stares up at the ceiling and talks to beings that only he can see. During the conversation, he rocks his upper body to the left and right. At times he is unresponsive.
After a schizophrenic episode, many sufferers experience so-called post-schizophrenic depression (F20.4). Residual schizophrenic symptoms are present and the patient suffers from typical symptoms of depression, such as listlessness, recurring negative thoughts and depression. During this phase of the illness, the risk of suicide increases considerably.
Self-assessment checklist
The Early Detection andTherapy Centerfor Psychotic Crises (FETZ) at Munich University Hospital has developed a checklist (see link, page 3), which asks about important warning symptoms. However, this test is in no way a substitute for a medical examination.
Only a specialist, such as a neurologist or psychiatrist, can make a reliable diagnosis.
The doctor will take a medical history and ask the patient in detail about their symptoms. The main symptoms are
- Becoming thoughtless,
- Delusions of control or influence,
- voices that comment or engage in dialog,
- persistent culturally inappropriate delusions and
- possibly negative symptoms.
Depending on the individual case, relatives may also be interviewed.
Further tests are carried out to confirm the diagnosis:
- Physical and neurological examination
- Blood count (inflammation values, liver, kidney and thyroid values)
- Psychological tests, such as memory performance and attention
- Drug screening
- Imaging procedures such as MRI (magnetic resonance imaging)
Research has not yet been able to conclusively explain the underlying causes of this mental illness. However, it appears to be a multifactorial disease process. The bio-psycho-social model is generally used as an explanatory approach. It states that schizophrenia is caused by various factors (genes, environmental influences and personality structures) and their interactions.
A study from 2002 provides clear indications of the role played by genes in the development of the illness: The closer a person is related to a sufferer, the greater their risk of experiencing a schizophrenic phase in the course of their life. The risk of illness is up to ten percent for children with one parent with the disease. For fraternal twins, the risk of illness is 20 percent, for identical twins it even rises to 45 percent.
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Researchers have also been able to show a connection between schizophrenia and brain damage at an early age. This brain damage can already occur at birth. It is also assumed that early childhood infections with herpes viruses, the influenza virus, borrelia or the Toxoplasma gondii parasite favor the onset of schizophrenic psychosis (P. Falkai: Diagnosis, etiology and neuropathophysiology of schizophrenia. In: Neuropsychology of schizophrenia. 1, 2008, S. 36-43.).
Examinations of the brains of schizophrenic patients have also revealed abnormalities in the anatomy. For example, in many patients there are significantly fewer nerve fibers in certain regions of the brain than in healthy people. These include the amygdala, the entorhinal region and the hippocampus. These structures play an important role in memory and the processing of emotions.
The researchers also found a change in brain metabolism. The neurotransmitters (messenger substances) dopamine and glutamate in particular appear to be affected by the disorder.
In addition, mind-altering substances can promote the onset of the mental illness. In particular, the consumption of THC, an active ingredient of the cannabis plant, can trigger schizophrenia in people with a corresponding disposition. The same applies to other psychotropic substances such as cocaine or alcohol.
In addition to neurobiology, genetics and toxic factors, psychosocial factors also influence the development of the disease. According to Zubin and Ciompi's diathesis-stress model, various stressful situations together with other favorable factors can lead to the onset of the disease in people with a genetic susceptibility to schizophrenia.
Experts believe that schizophrenia cannot be completely cured. However, treatment can reduce the symptoms of the mental illness and improve the patient's quality of life.
In the acute phase, drug treatment is often indispensable. Drugs from the group of psychotropic drugs, known as neuroleptics, are primarily used. These act primarily on the positive symptoms. There is no risk of addiction. In the case of negative symptoms, patients are given antidepressants or anxiolytic drugs if necessary.
A non-drug treatment method is electroconvulsive therapy (ECT):during a brief anesthetic, the patient receives electrical impulses lasting a few seconds, which trigger an artificial seizure. These seizures lead to an increased release of neurotransmitters and alleviate the symptoms. The method is widely regarded as outdated or even brutal. The German Medical Association has therefore published a statement explaining the benefits of ECP and the value of the method for patients.
Other therapy components are:
- Occupational therapy,
- regular exercise (sports groups),
- psychotherapy and
- teaching about the illness (psychoeducation).
Treatment usually lasts several weeks and takes place in a psychiatric clinic. It may also make sense for some patients to attend a day clinic.
As soon as the acute phase of the illness subsides, the question of occupational rehabilitation arises. Depending on the patient's state of health, assisted living groups and (temporary) work in a sheltered facility may also be an option.
Self-help as an important pillar of therapy
Schizophrenic disorders place an enormous burden on the person affected and their environment.
Regional self-help groups form a dense network for those affected to exchange ideas and support each other. Contact persons for information on regionally active groups are usually Caritas and Diakonie.
Relatives can find comprehensive information on the website of the Federal Association of Relatives of People with Mental Illness.
The course of treated schizophrenia can be estimated using the rule of thirds:
- In one third of patients, the therapy leads to a significant improvement.
- The second third show little or no alleviation of symptoms.
- One third of patients suffer from treatment-resistant schizophrenia.
The following factors indicate a favorable prognosis:
- acute onset of illness
- short course
- predominantly positive symptoms
- intact social environment
- meaningful employment
However, a complete cure cannot be assumed.
