Diagnosis and therapy of schizophrenia

In the public consciousness, mental illness, and especially schizophrenia, is often shrouded in myths and prejudices, and even more myths have been created around psychiatrists and their activities. Mentally ill people are afraid, they are considered “possessed” and instead of going to a doctor in time , relatives of patients are more willing to resort to alternative medicine or the occult, while they are often afraid to go to a psychiatrist or do not consider it necessary. Nevertheless , schizophrenia is a disease (although its manifestations are really frightening, since the character and behavior of a person changes in a pathological way ), and therefore it can only be treated by a qualified specialist, a psychiatrist who diagnoses, prescribes treatment, and monitors the patient’s condition. , monitors the course of the disease, conducts psychotherapy and helps patients return to the social environment. Moreover, the earlier patients visit a doctor, the more effective the treatment is and the less damage the illness inflicts on the psyche.                        

In modern psychiatry , a complex biopsychosocial approach is used in the treatment of schizophrenia , which includes several components:    

  • Diagnostics
  • Biological therapy
  • Psychotherapy
  • Social adaptation

Diagnosis of schizophrenia

Qualified diagnostics implies a clinical assessment of the patient’s condition – during a conversation, the doctor reveals the presence of symptoms characteristic of schizophrenia: productive (delirium, hallucinations, affective disorders), negative symptoms (emotional impoverishment, decreased drives, withdrawal, decreased energy potential), as well as the severity of neurocognitive deficiency (impaired memory, attention, thinking). Also, paraclinical research methods are carried out, as a result of which the peculiarities of the structure and functioning of the nervous system, the presence of concomitant diseases are determined, it is possible to identify pathologies in the nervous and endocrine systems. This allows you to more accurately assess the severity of the disease, carry out differential diagnostics, navigate the selection of drugs for the most effective treatment with a minimum of side effects. The paraclinical examination methods include: MRI (magnetic resonance imaging of the brain – allows us to see the presence of disease in most tissues of the brain); EEG (encephalogram – records electrical activity in the brain tissue, which makes it possible to judge the features of the functioning of its various parts at rest and during exercise), induced galvanic skin potentials – this is a study of the characteristics of the autonomic nervous system, cognitive potentials (P300) help to assess neurophysiological features of perception, thinking, memory, attention; transcranial duplex scanning of the vessels of the brain reveals the pathology of the blood supply; it is also necessary to check the hormonal status, to investigate the functioning of vital organs to exclude concomitant somatic pathology. The paraclinical examination also includes neuropsychological (detection of pathology in various cortical centers of the brain using psychological tests ) and pathopsychological research (detection of impaired thinking, attention, memory), determination of the patient’s personality traits.                       

Schizophrenia therapy

The main method of treating schizophrenia is medication, so the selection of drugs is an important step. For the treatment of schizophrenia, drugs from the group of antipsychotics (or antipsychotics) are used. They eliminate productive symptoms, prevent the progression of negative symptoms, and have a positive effect on cognitive function. If earlier, until the advent of modern (atypical) antipsychotics, patients were forced to take a large number of drugs that have a fairly noticeable side effects (eg, such as disorders in the motor area), then to the present day modern treatment – a monotherapy (using one drug) moreover, the medication is taken, as a rule, only once a day, which greatly facilitates adherence to the regimen, and therefore ensures the effectiveness of treatment. Modern antipsychotics act on all the symptoms of schizophrenia, with virtually no side effects when the dose is chosen correctly. It has been proven that atypical antipsychotics also have a positive effect on cognitive functions, that is , they restore the violation of mental activity, and therefore the performance of patients. However, with a complex picture of the disease, it is possible to add other groups of drugs: antidepressants, mood stabilizers (finlepsin, depakin, lithium preparations), drugs that improve the microcirculation of cerebral vessels (cinnarizine, cavinton). Since quite often patients are asthenized, that is, their nervous system is exhausted, and there is often concomitant neurological symptoms, then general strengthening therapy with vitamins and drugs that improve the metabolism in the nervous tissue (gliatilin, milgama, piracetam, picamilon, phenibut) is used.                             

After completing the main course of treatment, it is necessary to take maintenance therapy with antipsychotics for some time (over a period of two years, as a rule), since in addition to preventing exacerbations of schizophrenia, it is necessary to restore the functions lost due to the disease, which takes time. In this case, it is convenient to switch to prolonged-release forms of drugs. The dose of the drug is administered by injections for a long time (one injection is enough for 2-4 weeks), so there is no need to take pills every day. If within a two-year period there is a positive dynamics of the condition and there are no exacerbations, then after consulting a doctor, taking drugs can be completely stopped.            

Social adaptation of patients with schizophrenia

Schizophrenia is a disease that knocks a person out of public life. Due to specific changes in the emotional and mental sphere, patients turn out to be outsiders, unable to maintain social contacts, work effectively, and start a family. However, all this can be prevented if the patient is taught to live and cope with his illness. For this , psychotherapy and rehabilitation are needed . The brigade approach, when not only a psychiatrist, but also a clinical psychologist and social worker takes part in the treatment of a patient, allows this to be done. Sessions of various types of psychotherapy are conducted with patients. Since a person’s illness cannot but affect his family, it is necessary to conduct family psychotherapy, which helps to restore harmony in the family, to teach the patient’s relatives to treat his illness correctly (i.e. to be able to see the symptoms of the disease and interpret them as signs of the disease, and not as for example, excessive laziness or manifestations of a bad nature), and the patient – to restore emotional ties with family members. Group psychotherapy helps to re-learn how to build social contacts. And individual psychotherapy, therapy for creative self-expression, art therapy, not only helps the patient to better understand what is happening to him, but also allows him to believe in his own strength and restore the creative potential inherent in a healthy person. Landscape therapy, swimming pool, balneotherapy, physiotherapy strengthen the body, level out the emotional background, promote the best effect of medications and psychotherapy.                                    

Thus, with a timely visit to a doctor, a full examination, adequate drug treatment and active psychotherapy, it is possible not only to significantly improve even a seemingly hopeless condition, but also to obtain a stable remission, in some forms of schizophrenia, even a complete cure. In any case, the progression of the disease stops in patients, their working capacity is restored, they are able to live a full life, create a family, although there is still some risk of relapse (since schizophrenia is most often a chronic disease), as well as peculiar character traits (isolation, emotional coldness, eccentricity ). The main thing in the treatment of schizophrenia is not its complete eradication, which is far from always possible, although they always strive for this, but learning the ability to live fully in society, despite the presence of the disease.                    

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