As for the predisposition in men and women, there is more tendency to be seen in men.
Dr. Ileana Fumero, psychiatrist and clinical researcher at the BDH Research Center. Photo: Provided by the doctor to Medicine and Public Health.
The Dr. Ileana Fumero, psychiatrist and clinical researcher at the Centro de Investigación BDH Research, clarifies that schizophrenia “is a mental illness in which the individual’s ability to think, feel and act is affected”, so “their general functioning is going to have a negative impact. Those who suffer from schizophrenia, and for their families, it is a disease that impacts their behavior and functioning”.
Fumero adds that: “there are different types of schizophrenia”, but it is necessary to clarify that “psychosis, which is a syndrome that can occur with hallucinations and delusions, will not only occur in schizophrenia, since it can occur in other psychiatric conditions, such as major depression, bipolar disorder, delirium in people with hormonal or chemical imbalances”, that is, “schizophrenia presents with psychosis, or positive symptoms, but it is also characterized by presenting negative symptoms and cognitive symptoms. Positive symptoms refer to people who have hallucinations, hear voices or see things that are not there, have delusions or ideas that may be false, but are rooted in the person’s thinking, they may believe that someone is following them, that someone spy or who poison them through food, among others”.
“The negative symptoms refer when they present difficulty in motivation or in having relationships, that is why they are often isolated, they do not participate, the facial expression may seem inexpressive or as without feelings.”
“Cognitive symptoms refer to the difficulty experienced by these people to properly understand the information given to them, or they process it in a different way and it is difficult for them to acquire information or use it properly. They may also have difficulty paying attention or concentrating. Therefore, they may have problems studying or following instructions or working”, so the person with schizophrenia will not only have psychotic symptoms, but this other range of symptoms. Sometimes they will also have “disorganized thought or behavior.” They say words that don’t make sense, are incoherent or illogical, that don’t have an explanation.”
The person must have a few months presenting these symptoms to be able to establish the diagnosis. Later it is seen that they develop the different types of schizophrenia “some are more paranoid, they believe that they are persecuted or hurt or speak ill of them; other patients have a more disorganized schizophrenia, they don’t understand what they say and they find it difficult to follow instructions”.
For this reason, the most important thing is to find out if the psychotic episode is due to other causes, such as substance use, or if the person has a schizophrenic disorder. “Usually it will present at younger ages, from 13 to 35 years old, it presents at a late age, 15-18 years old; many may begin with a change in behavior, more withdrawn, less participative, difficulty engaging in usual adolescent activities, many do not have or no longer have friends, have more bizarre thoughts or ideas, may lose care of their hygiene, among others”, a change will be seen or behaviors that were previously presenting will be exacerbated.
Contributing physiological factors must be ruled out in diagnosis. Laboratory tests may be necessary. Toxicology tests should be done, since “substance use can increase the probability of suffering psychotic episodes or schizophrenia”, while a person continues to use substances, it can delay or lengthen the response to treatment.
“If it doesn’t stop, the brain deteriorates, because it is a neurodegenerative condition,” emphasizes Fumero, it is required that the affected person reaches the psychiatrist as soon as possible to see if it is schizophrenia or something else that contributes to develop that psychotic episode. “If there is a family history, the person is more likely to develop the condition.”
“If there is a close relative, there is a high probability that the person will develop schizophrenia, the important thing is if a dramatic change in behavior is suspected or occurs.” Certain conditions that occur in pregnancy can also increase the probability, so history is important.
“If the brain, at an early age, is exposed to substances, such as alcohol, nicotine or cannabis, this could interfere with the circuit or the connections that are formed, causing it to develop or increasing the probability of suffering from psychotic episodes or suffering from schizophrenia. ”.
Regarding the predisposition in men and women “there is a greater tendency to see it in men, they tend to present it earlier and with a predominance of positive symptoms. Women may start a little later and with less dramatic symptoms, so it may go unnoticed. Sometimes they are also attributed to hormonal changes, and this can delay the diagnosis, so the tendency is to diagnose it more in men than in women, which does not mean that it does not happen to them”.
Many times patients, due to the condition, are uncooperative with treatment, so getting them to start treatment is a challenge. On many occasions the challenge is not to take them to treatment, but to cooperate in the treatment. There are many treatment alternatives, patients respond to this initial treatment, but many will have to resort to hospitalization to comply with treatment, but when they improve, perhaps after 6 months, patients stop taking the medication because they understand that they are better, that they experienced a crisis and not that they have a condition, so the episodes recur. There are medications that are injected and this can help, especially if the patient cannot be followed up.
If you have a patient with schizophrenia and another medical condition, if you don’t treat the schizophrenia, he’s also not going to cooperate with the other medical condition.
“These treatments for schizophrenia have side effects, they can increase appetite, decrease libido, increase prolactin – alterations in menstruation or discharge of secretions in the breasts – increase blood glucose level. Increase the risk of a metabolic syndrome. If the patient is better in her condition, a plan can be established on how to manage these side effects, but the risk and benefit must be weighed, “if a patient does not comply with the medications, his brain will continue to deteriorate.
Once the patient is better, options can be given for him to resort to other medical disciplines that could contribute to his well-being, since what is sought is to reintegrate him and make him functional at a family, educational or work level.
Referring these patients to the psychiatric area is important because many times the family member needs guidance, as it is a complex condition that requires the support of a psychiatrist. “We are in the area of clinical research. More medications are emerging to add and we work with new medications that can improve cognitive aspects so that the patient can reintegrate”, concludes Dr. Fumero.
Previously, these patients were imprisoned, tortured and considered heretics, from a religious point of view, or given insulin or electroconvulsive therapy, although the latter is still applied these days, but more controlled and pharmacological treatments are much more sophisticated. Schizophrenia does not discriminate where it is going to be, there is a population of adolescents exposed to substances, so episodes or schizophrenia can be seen because they are more exposed.
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