Schizophrenia
The term schizophrenia with a set of psychiatric disorders with a common core but very different in their presentation and evolution, and comes from "schizophrenia" from the Greek "σχίζειν (schizein) fractionation and meaning" φρήν (phren) designating mind. It uses the plural to designate them. The schizophrenia are psychiatric disorders chronic, usually beginning in adolescence or early adulthood. These are not "split personality" as we sometimes think. They result in changes in the perception of reality (delusions), cognitive and social dysfunction and behavioral more or less important. The term is often used figuratively, especially in the press, to discuss attitudes about or simply contradictory.
History
Symptoms. The literature of Greek and Roman civilizations alluded without indicating how they were treated.
Historically, the psychiatrist Emil Kraepelin was the first to distinguish between early dementia described fifty years before him by Benedict Augustin Morel, and other forms of madness. It was then renamed schizophrenia by the psychiatrist Eugen Bleuler when it became clear that the designation of Kraepelin is not an adequate description of the disease.
In 1898 Emile Kraepelin, speaking of early dementia, are three variations:
1. the hebephrenie (Hebe = adolescence phren = mind): describes an intense disintegration of the personality;
2. the catatonia: the most severe form;
3. paranoid form: the least serious form, based on hallucinations.
In 1911 Eugen Bleuler used the term schizophrenia, and highlights five symptoms:
1. disorder of the association of ideas;
2. disorder affectivity;
3. loss of contact with reality;
4. autism (in the sense of autistic withdrawal);
5. dissociative syndrome.
In 1956, Gregory Bateson, Donald D. Jackson, Jay Haley and John Weakland publish joint article Towards a theory of schizophrenia, which introduces the concept of "double bind." The authors consider mental illness as an evasion adaptive structure disease (neurosis pregnant) family relations. This theory, proposed by the research team from the School of Palo Alto, causes a disruption of traditional psychiatric approaches and contributes to the emergence of family therapy, whose initial goal is obviously to protect the child.
The role of context in the emergence of schizophrenia is not opposed to other possible causes, and it is clarified a little later in these terms:
"Where the predominant double bind as a model of communication, if the diagnosis focuses attention on the individual patient more openly, we find that the behavior of this individual meets the criteria for schizophrenia. In this sense we can only give the double bind value causative."
Epidemiology
Schizophrenia affects 1% of the world, without changes in a country, a culture or period to another.
Heredity is a factor that increases the risk as the genetic background increases. Thus, the child is born increase the risk of:
* 5% if a second-degree relative (uncle, aunt, cousin, cousin) who suffers from schizophrenia;
* 10% if a first degree relative (father, mother, brother, sister);
* 10% if a different sister who suffers from schizophrenia;
* 40% if both parents of children with schizophrenia;
* 50% if it has an identical twin with schizophrenia.
Some studies suggested that the risk increases in major cities [ref. necessary]. More than 200 studies had also previously suggested that the risk of schizophrenia increased from 5 to 8% among children born in winter or spring. An explanation could come from a study which concluded that the increased risk of schizophrenia in adults whose mothers had been infected by an influenza virus during her pregnancy (the same for the risk of obsessive-compulsive disorder, autism and other diseases of the brain).
In 2004, Alan S. Brown (psychiatrist at Columbia University) had studied frozen blood, sampled from 1959 to 1966 among 189 pregnant women, 64 of which then gave birth to children who become schizophrenic. These women have given their blood several times during their pregnancy, which made it possible to compare retrospectively if and when they were exposed to the flu. The study showed that when they had contracted the flu in the middle part of pregnancy, the risk of schizophrenia was increased 3 and 7 if the exposure was made in the first 3 months. Up to one fifth of all cases of schizophrenia could be caused by prenatal infection.
According to Christopher L. Coe, a psychologist at the University of Wisconsin-Madison, several studies suggest that this is not the virus itself that affects the brain development of fetuses, but rather the immune response to viruses. Cytokines expressed by the immune system may be involved because they play a role in brain development, at least in vitro (on cell cultures) where, at high rates, as during an influenza infection, they prevent the normal development of neurons. Under normal circumstances, the placenta does filter or hormones or nutrients pass from mother to fetus. When the mother suffers a flu infection, the placenta would behave differently, sometimes invite the fetus to produce its own cytokines even if not in contact with the virus. Studies have shown that interleukin 8 increased significantly in the blood of mothers giving birth to children with schizophrenia.
Two genes that appear associated with the risk of schizophrenia, are also involved in the production of cytokines.
Experience was injected to pregnant mice, not a virus but a molecule based on viral RNA, not dangerous, but is recognized as foreign by the body, to get an immune response without infection. The mice born from these mothers behaved as the offspring of mothers infected with the flu (and much more unusually fearful than normal mice, less inclined to explore and interact with other mice), suggesting that it is the immune response and not the virus (or a gene predisposing activated by viral infection) that affect the formation of the brain (the autopsy showed that the neurons of these mice were abnormally distributed). This suggests that schizophrenia may have some environmental causes (such as certain autoimmune diseases) and pre-natal origin of infections during pregnancy.
Paradoxically, these results also raise the question of the recommendation of the CDC to vaccinate pregnant women (because the vaccine causes an immune reaction, which could sometimes become permanently act upon the brain of the fetus) and the precautions to take in case of pandemic influenza .
Infection in early childhood or adult could sometimes be a cause of mental illness, not directly but via an auto-immune response, but this remains to be confirmed.
Ina Weiner studied whether antipsychotics might prevent schizophrenia caused by environmental factors of this type. Mice selected from a batch of in utero exposure to a toxic chemical that has led many of them to develop symptoms and brain abnormalities referring to schizophrenia in humans (with the first signs of cognitive decline at puberty, before development of symptoms of schizophrenia relatives) were treated with antipsychotics at the first symptoms. This treatment has protected the symptoms of schizophrenia and related brain changes (decrease of the weight of the hippocampus, that accompany schizophrenia).
There seems to be a common genetic cause with bipolar disorder, which poses the question by some of the real distinction between the two syndromes.
These diseases, which occur most often in people aged 15 to 35 years, are a major public health problem.
Some Ideas
The term schizophrenia, initially introduced by Bleuler, literally means "spirit cut. Combined with the frequent representation in the Anglo-Saxon cinema of characters with multiple personalities, this etymology promotes widespread confusion among the general public between schizophrenia and dissociative disorder with multiple personalities.
On the other hand, part of the general press has taken the habit of association between schizophrenia and unsafe or heteroagressifs. In fact, although it actually happens that patients with schizophrenia are dangerous conduits, this remains relatively rare. The rate of violence is not higher in the schizophrenic population than in the total population. Finally, the condition is a source of vulnerability in itself and thus exposes schizophrenics to social violence: statistics show that they have a life expectancy lower than the total population.
Diagnosis
The diagnosis of schizophrenia based on the finding by the psychiatrist and / or indirect signs psychologist primarily related to severance, and thus putting them into perspective with psychic experiences reported by the patient. This diagnosis may be supplemented by neuropsychological tests. There is no biological test or medical imaging can make a positive diagnosis of schizophrenia. Achieving balance sheets including somatic complement is essential, especially at the beginning of the pathology to the diagnosis, but also during the course of the disease.
Schizophrenia, a disease?
Georges Lanteri Laura in his texts on the psychiatric symptoms explained that initially the disease is a procedure and not something that the medical history record is as follows: in the seventeenth century, Thomas Sydenham empowers a disease when the symptoms change so typical and predictable in all patients (gout, chorea, for example). Then, with Jean-Baptiste Morgagni and Rudolf Virchow, the concept of disease is formulated as follows: groups of physical signs related to impaired macroscopic and microscopic specific. The work of Pasteur decentre the concept of disease observed at the injury causation. Then the Experimental Medicine, Claude Bernard, include in the definition of the disease's pathophysiology. With regard to schizophrenia, we must acknowledge that it is in a "pre-sydenhamienne" We do not currently have tests with a reliable diagnostic value.
Diagnostic category
The diagnostic criteria used may be those of the international classifications: DSM and International Classification of Diseases ICD-10. In this case the diagnosis is based on collecting a list of clinical symptoms that must be met for a person to be "qualified" for schizophrenic: it depends on both the presence and duration of certain signs or symptoms. Y are also subjective elements in a relational context given the bizarre "interpreted" in a relational context where the subjective feelings of the clinician involved.
The estimation of the symptoms of schizophrenia as other mental disorders is always put in perspective with the social, familial and cultural issue. Indeed some oddities, or speech, for example, may experience a social variability.
Thus, it is commonplace for clinicians that references to phenomena that might seem delusional in France can testify from depression for a subject included in the heavily North African culture (for example because of the use of Arabic dialectal depleted on the semantic compared to the classical Arabic language in terms of descriptions of states of mind, as well as the influence of which can move Mektoub guilt outside the individual sphere).
In the DSM-IV, these criteria are:
* A) symptoms:
These symptoms may be present in isolation or associated with, and a change of more than six months of symptoms to suggest a diagnosis that requires further eliminate organicity.
The cognitive disorders are often the first symptoms that occur in the schizophrenic. Also known as symptoms. These are the disorders that cause the problems of socialization in a person.
* Disorders of attention, concentration, lack of tolerance to the effort: the schizophrenic takes time to answer questions, to respond to situations requiring a rapid response, it is no longer able to follow its course, to focus on a film.
* Disorders of memory: the schizophrenic forgets to do the tasks of daily living (doing homework, go to appointments), has trouble telling what they read, to remember what others say or to follow a conversation. Her autobiographical memory is affected: he forgets several moments of his personal history. Its working memory operates more difficult: it is unable to perform several tasks at the same time remembering where it is in each.
* Disorders of executive functions: executive functions are essential to all behavior directed, autonomous and adapted to prepare a meal. The schizophrenic has difficulty in conceptualizing the actions needed to accomplish a task, to anticipate consequences, and lack of planning, organizing sequences of actions to achieve a goal and also lack flexibility, discernment, verification of self-criticism.
While they come in first, these symptoms persist longer than acute symptoms.
The acute symptoms (positive) is usually in early adulthood, between 17 and 23 years for men and between 21 and 27 years for females. They are called "positive" because they are events in addition to normal mental function. It is their presence that is abnormal.
* Hallucinations: these are disturbances of perception most often hearing (the schizophrenic hears a voice that made comments or uttering insults, threats), but sometimes visual, olfactory or tactile.
* Fun: they are logical misjudgements. The schizophrenic imagines that the person who looks on the bus or the crosses on the street is there to spy, it feels watched, persecuted or in danger believes that television sends messages, it is believed to have the power to influence world events, it is controlled by a force or you can read his thoughts, and so on.
* Language incoherent: the schizophrenic may say no action phrases and invent or incomprehensible words.
* Acting funny: for example close the blinds of the house for fear of being spied on, collecting empty water bottles and so on.
Deficit symptoms (negative) observed by a lack or absence of spontaneous behavior, expected.
* Isolation, social withdrawal: the schizophrenic loses enjoy leisure activities. He abandons his friends, retired to his room, becoming irritable if one tries to approach. He gradually cut from reality.
* Alog or difficulty of conversation: The schizophrenic no longer his words, gives brief and evasive answers and no longer able to communicate ideas or emotions.
* Apathy, loss of energy: the schizophrenic spends his days watching TV without really being able to follow what happens, he neglects his health or his personal appearance and lack of persistence or interest to start or complete routine tasks (studies, work, household). This gives an impression of carelessness, negligence, lack of willpower and laziness.
* Decrease in the expression of emotions: the face of schizophrenic becomes inexpressive, his vocal inflections decline (he always speaks in the same tone), its movements are less spontaneous, its gestures, less demonstrative.
* B) social dysfunction or occupation:
If during a significant period since the beginning of the unrest, one of the areas related to social relationships such as work, relationships or health, were significantly reduced compared to the previous situation.
* C) Duration:
Continuous signs of the disorder persisting for at least six months: This period must include at least one month of symptoms (or less in case of successful treatment) corresponding to the criteria of type A.
We can begin to count, for example, five subtypes of schizophrenia:
* Catatonic type (with few movement or adjustment);
* Type hebephrenique-catatonic or hebephreno (where the decline autistic predominates);
* Paranoid type (where delusions and / or delirium more or less badly structured predominate);
* Type dysthymic (with major disorders of mood);
* Type heboidophrenique (pseudo psychopathic).
Clinical presentation
The schizophrenia is characterized clinically by mental dissociation and the presence, in varying proportions of symptoms known as "positive" and "negative". This classification was introduced by Andreassen in the 1980s. Positive symptoms, so called because in addition to the experience of reality and usually include the semiological elements common to acute psychosis: delusions and hallucinations, and cognitive disorders grouped under the term disruption or disorder course of thought. Negative symptoms are so called because they reflect the decline of normal functions, resulting in impaired cognitive function complex integration functions impaired memory, difficulty concentrating, poverty of spontaneous language, behavior engine: Aboulie, amim, apragmatisme, but also social and emotional functioning: impairment of the life of relation, an abrasive affect and motivation (athymhormie). Because of the large number of different possible combinations of these symptoms, leading to different clinical forms, some consider schizophrenia as a syndrome, clinical pathology of multiple and not a single disease.
The psychiatrist Kurt Schneider tried to list the specific types of psychotic symptoms that could produce psychosis. They are called first rank symptoms and include the feeling of being controlled by an external force, no longer be master of his thought, the flight of thought, and echo the comments of thought, the impression that thought is transmitted to other people, the perception of voices commenting on the thoughts or actions of the subject, or having conversations with other voices hallucinées in short what is the automation of mental Clerambault GG.
Medication
The typical and atypical neuroleptics, called recently for mainly commercial reasons antipsychotics are the main drugs used to treat schizophrenia or related disorders. They do not cure the disease, they help heal, and alleviating some symptoms. They have side effects, some of which are corrected by treatment of so-called "correction." They may be combined with other psychotropic drugs (anxiolytics, hypnotics, antidepressants). Drug treatments are generally needed one aspect but never sufficient in complex care. The treatment is a long and difficult process.
A second generation of antipsychotics has been developed, it is antagonistic to dopamine and serotonin (SDA) with a more focused (fewer side effects). At meso-limbic, they block D2 receptors (dopamine, there is a decrease in positive syndromes. At the meso-cortical, they block the production of serotonin, which triggers the production of dopamine (deficient at this level) the negative symptoms disappear. This second-generation neuroleptics are in the form of tablets or injections to be performed at specified intervals. Careful injection provides a much greater psychological stability to the patient. Indeed, the product is released gradually and patient no longer has to worry about the daily (tablets), ... and the risk of total cessation of medical care-even for a period expected to temporarily disappears (the cessation of treatment is often not compatible with monitoring, in real danger of the coming, ultimately, a crisis of madness). It is important for efficiency of care, the patient (to make a choice) wishes (r) 'sa' plug - in-charge ... and also in the acceptance of (type of) medication and / or method of administration, monitoring scizophrenique disorder associated with psychosis is over time, and requires to avoid Refractive coming ... for all these reasons, in no case the injection can not be imposed 'ambulatory', knowing that happy negationism can take-in-charge, son-in-apparent complexity, is absolutely contrary to the laws of ethics.
Read also Autism
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