Schizophrenia: what is it?
Schizophrenia is the most common chronic mental illness. It is manifested by the disintegration of the personality and the loss of contact with reality. It strikes about 0.7% of the world population including 600 000 people in France. 12 million men and 9 million women are affected worldwide. She is most often in adolescence, between the ages of 15 and 25. Even if treatments today make it possible to live better with the disease, it is still subject to stigmatization or even discrimination.
Causes of schizophrenia
The research did not highlight a single cause. There is probably a genetic factor. Inserm speaks in particular of point mutations that could alter genes involved in neuronal plasticity, ie the ability of neurons to adapt their activity to the environment.
Environmental factors could also have a role, for example:
problems during fetal development, such as contamination of the mother's flu during pregnancy;
consumption of psychotropic substances, such as cannabis. Its regular consumption before 18 years multiplies the risks by two;
in vulnerable people, urban urban life or migration may increase risk.
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Symptoms of schizophrenia
SIGNS ANNOUNCING THE DISEASE
In many cases, schizophrenia is preceded by "schizoid states" which still allow the individual to lead a life almost normal in appearance and which is only an accentuation of its characteristic features. He appears pensive, withdrawn, subject to irrational impulses.
At first, the teenager gets off academically. He has more and more trouble concentrating, keeping his attention. These disorders result from the progressive incapacity of the patient to use his intellectual capacities. The entourage often tries to minimize the pathological nature of these behaviors, and provides explanations: somatic cause, laziness, growth crisis, adolescent crisis, consideration of failure as the cause and not as a consequence of the loss of life. efficiency.
Affective disorders are also misleading because they are also experienced by any adolescent who reaches adulthood. The character seems to change: the young is morose, cold, indifferent, he has no emotional impulses, he isolates himself more and more and gives up his external investments. He flees the company of his comrades and is irascible, hostile when he is in his family. His quirks become more numerous. His gaze disappears. He smiles without reason or sketches movements whose cause is not perceived. His sexuality is disrupted, "poorly integrated". Sometimes the teenager instinctively fights against the depersonalization that threatens him. He then attaches himself to an idea, a religious concept, a political ideal, a philosophical system around which he tries to "gather".
This behavior of the pre-schizophrenic recalls in its various aspects the crisis of the adolescent who is normal, and it is not always easy to separate things.
A START AT TIMES BRUTAL
In 35 to 40% of cases, the onset of the disease is sudden. The person does not go through the preliminary stages. She can be absolutely indifferent and feel the impression of being split. The acute delirium is a mode of entry into the disease particularly brutal: it settles in a few hours, in a patient between 18 and 45 years, who has no psychiatric history except sometimes similar episodes. From the outset the delirium is constituted and the person will act according to the latter, which explains the bizarre behavior often observed (fugues, fights, forensic acts). At times the patient may be aware of his illness, which increases his anxiety.
In the acute phase of the disease, the schizophrenic does not even manage to verify his own reality in objects and the beings around him. There is even an alteration of the concept of body schema. Being does not take shape anymore in one's own eyes. The patient is out of sync. He smiles in the wrong direction, does not finish his gestures or makes them mechanical like those of a puppet. He thinks he's stealing his thought.
A CLASSIFICATION IN THREE GROUPS OF SYMPTOMS
Depending on the manifestations described above, specialists classify the symptoms into 3 groups:
Positive symptoms facilitate diagnosis, while negatives can be interpreted as depression, which can delay diagnosis for many years.
Treatment of schizophrenia
Schizophrenia requires long-term management, the patient will often have to follow the treatments throughout his life to better control his disease. Hospitalization is often necessary, especially at the time of the first crisis. In all cases, care will be on a case by case basis. The earlier it is, the more likely it is to have a positive response to treatment, remission and good social integration.
Management is both medically and psychosocial:
Medication alleviates symptoms and reduces relapse rates (but does not "cure" the disease). The treatments are today based on neuroleptics, drugs that act on the brain receptors. As first-line, so-called "atypical" second-generation antipsychotics are usually prescribed: clozapine, risperidone, olanzapine, aripiprazol. Monotherapy (treatment with a single drug) is always preferred, an association of antipsychotics being considered only in case of failure;
For best results, these drug treatments should be combined with supportive and supportive psychotherapy. This will reduce the intensity and impact of delusions but also facilitate the taking of drugs, reducing the risk of relapse. It will also help the patient to accept his illness.
When treatments are well followed, about a third of patients are in durable remission after a few years.
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