SCHIZOPHRENIA

By: Esther Moreno Cidoncha.

NEW: ONLINE COURSE ON PERSONALITY DISORDERS AND THEIR

CLINICAL APPROACH
Of schizophrenia has been written and talked a lot but the reality is that in the
background is the great unknown, or rather, they are sufferers. We could give
many book reviews, but with this article I intend to approach and overview to this
disease, so I do not want to overstretch on technical issues we can find in any
handbook of psychopathology.

People with mental illness have affected their emotional tone, behavior, and how
they communicate with others. We are more prepared to accept and understand
the case of physical illnesses. Other elements that tend to confuse is that these
disorders have no known cause or causes or easy to recognize, vary from person
to person and treatment is also unclear.

Mental health and mental illness depends on our lifestyle, the quality of close
relationships we have, our ability to love and accept others, to give confidence and
support, and receive, our tolerance.

This set of values, attitudes and skills can support a variety of definitions, there are
no absolute parameters and every culture and every human group and every
family and individual makes their own.

It could be considered psychologically normal everyone to behave and act like

most people around, if someone does not behave like most people said it was sick.
From a medical perspective would be that a mental disorder that wound
maladaptive behavior to any particular outcome, which departs from reality. From
the social point of view a mental patient would not meet their environment.

The term schizophrenia was introduced by the Swiss psychiatrist Bleuler in 1911.
This disorder has already been identified by the German psychiatrist Kraepelin in
1896 under the name "dementia praecox," meaning that those affected will
necessarily suffer severe cognitive and behavioral impairments similar to dementia
is experienced by some elderly, but This could be the case in a young age.

Bleuler noted however that was not so in all cases and considered more
appropriate to give the name of schizophrenia as a split in the association of ideas
or as a retreat from reality and social life. The term schizophrenia does mean "mind
game."

The age of onset is between 15 and 45 years, but usually begin at the end of
adolescence, there are also cases of childhood onset, often masked with school
problems or bad behavior.

Who suffers from schizophrenia experience a distorted thoughts and feelings.

What characterizes schizophrenia is that it affects the person in a total, so the
sufferer begins to feel, think and speak differently than they did before. This person
can begin to be more isolated strange, you can avoid going out with friends,
sleeping little or too much, just talk or laugh for no apparent reason (although these
symptoms do not have to appear in all patients.)

It is very important to remember that the person with schizophrenia can not explain
what is happening, is afraid to do or believe you are ill and therefore not seek help
or complain in most cases what happens. For all that most of them and especially
at the beginning of the disease does not agree to take medication or see a
specialist.

Those symptoms are called manifestations of the subject that announce an

anomaly or disease. Symptoms would be pain, inflammation, changes in biological
rhythms. The problem of schizophrenia is that most symptoms are subjective,
dependent on what the patient relates. There are two types of symptoms in
schizophrenia:

Positive symptoms: those events that the patient does or experiences and that
healthy people do not usually present.

Negative symptoms: are those things that the patient is doing and that healthy
individuals can carry every day, how to think logically and fluidly, experience
feelings toward others, a willingness to get up every day.

Positive symptoms: the pattern of positive symptoms is as follows: may be in other

disorders.
Mental positive symptoms (psychotic)
Hallucinations are deceptions of the senses, inner perceptions that occur without
an external stimulus. Is unable to recognize that what is perceived comes only from
their inner experiences and is not presented in the outside world. , May be within
hearing, touch, visual, gustatory and olfactory.

Delirium: this is a mistaken belief that manifests pathological origin despite counter
arguments and sensible. The scope is restricted with reality. The patient sees the
madness as the only valid reality. Although thoughts are contrary to the laws of
logic, the patient is inaccessible to this objection. When this condition is noticed,
sometimes do not think the start of treatment or hospitalization, as the
hopelessness that can produce in the patient who has made suicide attempts.
types: persecution, guilt, grandiose, religious, somatic, reference ...

Disorders of thought: how often to give us significant clues about the thinking
upset. Often relate that they have lost control over his thoughts, that these have
been removed, or taxes that are directed by foreign powers or forces related to
language are: derailment, tangentiality, ilogicalidad, pressure of speech,
distractibility ...

in a psychotic episode, these symptoms described above may be accompanied by:

Positive symptoms in the field of emotions: anxiety, excitability

Vegetative positive symptoms: insomnia, palpitations, sweating, dizziness,

gastrointestinal disorders, respiratory disorders. Types of schizophrenia: we have
pointed out the individual character of the picture of the disease, so subordination
to one of several types of the disease often means a simplification. Also often
present mixed pictures, which can be difficult to classify. It is also noted many
times that the picture of the disease varies over time.

Paranoid Schizophrenia: characterized by the prevalence of delusions and

hallucinations, especially auditory. The delusions and hallucinations sometimes
form a unity. It is the most common, usually begins between 20 and 30 years and
is the best evolving despite the showiness of the table.
Catatonic schizophrenia: the predominant movement disorder or motor
movements. Experts speak of "catatonic stupor." Despite having awareness, the
patient does not respond to attempts to contact him. His face remains motionless
and expressionless, not seen any movement inside and even strong pain stimuli
may not cause any reaction. In more severe cases may become not talk or eat or
drink for periods long enough to endanger his life. But inside the patient may have
real feelings storms, which often only manifest themselves in a fast pulse. There
are also constant repetition of the same movement (automatic) and facial
expressions. The pictures of extreme gravity, in which the patient is maintained eg
on one leg for several weeks, only very rarely seen due to the current treatment
options. They only occur when no one is concerned with the sick or when
treatment is not effective. The prognosis for this type of schizophrenia is usually
poor.
Disorganized or hebephrenic schizophrenia: a predominantly absurd affection not
appropriate (it usually laugh when given bad news, children's behaviors are often
the mood is absurd, there is uninhibited feelings. They often have strange
behaviors, such as laughing no apparent reason and make faces. They often show
a lack of interest and participation. There are cases in which manifest
hallucinations and delusions, although this is not fair condition this type of
schizophrenia in most cases the outbreaks are not clearly demarcated. It usually
starts at an early age as puberty, why they are called juvenile schizophrenia and
there are even cases where the disease is in infancy (infantile psychosis.)
Developments slow and unnoticed by hebephrenic have few symptoms are rated
and simple schizophrenia. In the absence of symptoms is difficult to recognize, (the
signs are usually self-neglect, solitary behavior ...). The prognosis is unfavorable
compared with other schizophrenia, due to the immature personality of the patient.
Undifferentiated schizophrenia: a type of schizophrenia in which there prevails a
particular symptom for the diagnosis, as the mixture of the previous ones.
Residual schizophrenia: in these cases must have been at least one episode of
schizophrenia earlier, but at present there is no significant psychotic symptoms. Is
the phase in which negative symptoms are more evident. Not seen in all patients.
Disease Course: When symptoms of schizophrenia are presented for the first time
in the life of a person and completely disappear after a short time, speech and a
schizophrenic or psychotic episode, in general after these episodes are not
negative symptoms .

We can speak of schizophrenia when the first opportunity that presents

manifestations of the disease are kept for a longer or shorter period, when
symptoms reappear after some time and when the disease results in negative
symptoms. we can distinguish three phases:

Prodromal phase 1: the phase in the life of the person occurs before the onset of
the disease. You can see that in some people with the disease had been different
in childhood and youth, lonely, silent, slow performance. But not necessarily have
to be so, there are cases where that is not detected any anomaly in the person
suffering from schizophrenia. It is called the prodromal phase to the phase that
occurs before a crisis, so there are a number of symptoms that we can help in
some cases has identified: stress and nervousness, loss of appetite or disruption in
food, difficulty concentrating, disturbed sleep, less of the things you enjoy, can not
remember exactly, depression and sadness, concerned with one or two things, you
see less of their friends, who laugh think or speak ill of him, lost interest in things,
feel bad for no reason of course, is very restless or excited, feel useless, other
changes ...

2 active phase: the phase where the disease is triggered, are called outbreaks or
crisis, the symptoms that occur are the positive, hallucinations, delusions,
disordered thinking ... is the phase in which the family is alarmed and often seek
medical help. These crises can emerge suddenly and develop a complete picture
in a few days. In other cases the onset of the disease may occur very slowly and
unnoticed. The duration of outbreaks varies from person to person and can range
from a few weeks to a year. The same patient usually have outbreaks of similar
durations. The same applies to the intervals between outbreaks, according to the
characteristics of the person can range from months to several years and are
generally of the same duration in the same person.
Residual Phase 3: not all patients suffer at this stage the negative symptoms reach
their peak and declining personal, social and labor is severe.

Theory of the three thirds: one third is recovered, one third still have some
limitations after an outbreak. , Third grave course of the disease and can not live
independently.

Causes of Schizophrenia: It is logical that has been investigated intensively on

such a serious disease like schizophrenia and striking. Research has found
significant partial results, which are located in very different fields. So we can say
with some certainty that there is a cause for some people to suffer this disease, but
there are attributing responsibility to a whole set of causes.

these causes are defined in different conceptual models:

1: Vulnerability-Stress Model
It is assumed that there is a particular psychological vulnerability to schizophrenia
may occur. The first responsibility is due to certain hereditary conditions. It is
known that schizophrenia in some families are common, while others do not.
Because of this predisposition a person may be vulnerable to the disease but this
is not a fair condition for its development. As a trigger for the disease must be
added a special emotional (stress). The pathological symptoms of schizophrenia to
be understood as an attempt to escape in some way to this excessive burden.

What are the charges? They can be stressful life events, often unpredictable, as
the death of someone close, military service, the loss of a job ... also a happy
event, like the birth of a child, a wedding, ie situations involving a change in life.
Mostly a lifelong emotional burden may mean an excessive demand for a
vulnerable person: overly concerned attitude of the family or even self-conscious to
the person and diminish their autonomy, there are cases where the person
suffering from schizophrenia is yes, more withdrawn, due to this cause others want
to help. Another approach would be when family members have an attitude of
rejection hidden, ie not talking about the problem but is manifested in the
expressions and attitudes, the affected critical and devaluing. Excessive emotional
burdens triggered the first outbreak, but subsequent outbreaks are caused by
stress load even if mild.

We must mention the existence of other medical models such as: a genetic model,
neurochemistry, brain abnormalities, functional disorders, and neuropsychological
electrofisilógicas, birth complications, infections by viruses.
So far, none of these possible causes has proved to be final and continuing
investigations to confirm them.

Treatment: The treatment of schizophrenia is mainly based on drugs called

antipsychotics, which control the active symptoms, but it is necessary while the
patient receives additional psychosocial treatment (psychological, occupational and
social), it is essential that the person ceases hallucinations, delirious, but so is
being reunited with his lifestyle, that throughout the busy day, you have your group
of friends, ie, integration into society, standardization.

Antipsychotic medications: Pharmacological treatment of schizophrenia is made by

the top few drugs called neuroleptics (nl) for their cataleptic effects and more
recently there is some consensus on calling antipsychotics (p).

Since the introduction of antipsychotic chlorpromazine in 1954, psychotropic

medications have become the mainstay of treatment for schizophrenia and other
psychiatric illnesses. Numerous studies have documented the effectiveness of
antipsychotics in the treatment of schizophrenia and lithium and antidepressants in
the treatment of affective disorders. Antipsychotics or neuroleptics have shown
their effectiveness in both the acute treatment of psychotic symptoms at relapse.

Antipsychotics are also called neuroleptics. They were discovered in the early 50s.
are especially useful for the characteristic symptoms of schizophrenia. From five
chemical families but all offer the same therapeutic effects. No difference in
efficacy between one type of antipsychotic over another. Only through drug
therapies have opened the possibilities of rehabilitation and a speedy return to the
social environment.

Schizophrenia is accompanied by an alteration of brain metabolism, it is an

excessive function of dopamine. Antipsychotic drugs block the effect of excessive
dopamine and restore the balance in brain metabolism. But neuroleptics also
modify other metabolic brain areas, resulting therefrom, as well as the desired
effects, lateral or unfortunately also undesirable side effects.

The effect of p is described as reassuring for cases of motor restlessness,

aggressive behavior and inner tensions. The hallucinations, delusions, and
schizophrenic disorders of perception almost disappear with drugs. When
outbreaks of the disease recurring, ongoing treatment with neuroleptics offers an
important and relatively safe protection against relapse to acute crises.

There are two main groups of ap: the so-called classical or typical characterized by
blocking dopamine D2 receptors, are very effective on positive symptoms, but
cause many side effects and atypical acting on serotonin receptors, producing
fewer side effects and being more effective in negative symptoms.

An important innovation is the deposit or injectable neuroleptics, which are injected

into the buttocks and act over many days. Its advantage lies in the fact secure the
release of the substance, the possibility of reducing the dose to be administered,
plasma drug level in predictable and consistent and can treat patients with
absorption difficulties with oral medication.

Just as those affected in each case can react very differently to life situations, is
also highly variable reactions to neuroleptics. Patients respond in very different
ways and sometimes the treatment may produce side effects are milder or
stronger.

We distinguish between side effects that appear in the first phase of treatment with
neuroleptics and their side effects in cases of long-term medication. Most side
effects appear in the first weeks of treatment. It should be mentioned especially the
fatigue, dry mouth, dizziness and lightheadedness, circulatory disorders and vision,
constipation and difficulty urinating.

Some other side effects may persist for a longer time or even start later. All side
effects are described in the papers of instruction included in the packets of drugs.
Often, these descriptions cause profound insecurity for those affected and their
families, so it is very important to give accurate information.

Other side effects may occur: muscle spasms, Parkinson's syndrome caused by
medication, akathisia, tardive dyskinesia, neuroleptics increase sensitivity to
sunlight, weight gain, Limitations in the sexual sphere: to them belongs the loss of
normal excitability. But some drugs may also cause the opposite, ie a constant
excitation. For women it is particularly important to take into account that the taking
of neuroleptics leads to menstrual irregularities or even amenorrhea.

It should be mentioned that there contrarestantes to file the side effects, other drug
therapy for the treatment of schizophrenia is not based solely on antipsychotics,
these are usually accompanied by antidepressants, anxiolytics, mood stabilizers.

Psychosocial Rehabilitation: The psychopharmacological treatment is essential in

the treatment of schizophrenia and other psychoses, but we need a good
therapeutic support for the orderly development of the disease, this support is the
psychosocial rehabilitation. For instance, commented that it is useless to the
patient to take treatment if their only activity is to spend all day in bed, or have
prescribed a medication and lack of awareness of disease control and not take it,
These are some examples of the many that we see what we work on rehabilitation
of these patients having a diagnosis and do not know their fate and that his life can
not be the same as before.

Having a psychotic disorder can not be the obstacle to the development of valuable
social roles, such as work or at least a job, housing, relationships interpesonales
and affective, social consideration and use of community resources. The
rehabilitation is understood today as the proportion of aid that requires the person
for the psychosocial functioning.

Psychosocial rehabilitation centers are part of the Community, working with the
sick in their family and not in an institution.

It will try to reduce or eliminate the deficit or deterioration in the different areas that
prevent normal integration of the patient in his environment, training the skills that
will allow greater autonomy and social integration, improving the quality of life of
patients and their social and family environment.

For each patient an individualized plan of rehabilitation differently depending on

their disease state, impairment, behavior problems and social and employment
situation.

they work the following areas:

Psychoeducation of patient and family: To provide an updated and comprehensive

information about mental illness, teaching them to discriminate symptoms,
prodromal importance of antipsychotic medication, awareness of illness, accepting
and learning to live with it.

Social skills: working through group activities rewarding and educational

techniques of social intercourse. progressive staggering settings ranging from
small groups to play or perform cooperative tasks to specific social skills training,
such as asking for favors, accepting criticism, conversational skills ...

Health education: health promotion as well you can get active. working through
modules, which are: Sexuality, food, sleep, prevention of anxiety, self-esteem and
self-image, cognitive abilities.
Guidance and mentoring to guide and advise on any question submitted by the
user problem and can not be treated from the programs developed in the field
group to assess the achievement of the objectives previously marked for the user.

Activities of daily living: the measure is aimed to bring about the acquisition and
maintenance of a wide range of skills necessary for everyday life, this is done
through programs such as personal care, domestic activities and cultural
orientation

Personal Development: development of the patient's community environment:

carry out actions of daily living, support guidance to the social, cultural, sports,
politics, teaching job search resources.

Sports: physically stimulate the user through sport skills while they work
coordination techniques, group work, cleanliness and hygiene.

Other areas: health and socioeconomic benefits, job training, residential

alternatives, use of leisure time, education of the person concerned, Employment
and supports.

As I mentioned at the beginning, all the issues presented here need more words
and time to develop in full, but I think that we can get it here an overview of this
disease that unfortunately, despite all the scientific advances made Genuine
change the lives of many people who suffer, because suffering or because his son,
his wife, his father or mother began a day to hear voices.
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Positive symptoms of motor: behavior, aggressive and / or agitated, restless body,

bizarre and absurd movements, repetitive behavior.
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Negative symptoms:

In schizophrenia there is another set of symptoms, less alarming but are often
mistaken as signs of laziness or bad behavior, are called negative symptoms such
as apathy, lack of energy, lack of pleasure, being antisocial, etc., which must be
treated in the same extent as active or positive symptoms.

All these symptoms affect all areas: social, occupational, family. In some respects
the schizophrenic patient has less capacity for action than a healthy person. These
deficiencies we call negative symptoms.

You can see these symptoms before the onset of hallucinations and delusions, but
most clearly manifest themselves only after the disappearance of positive
symptoms. Speak of the residual phase of the disease.

Must be stressed that not every person suffering from schizophrenia have these
impediments or symptoms. About one third of patients do not have it at all or only
slightly marked so that just bother you in everyday life.
Negative Symptoms
Poverty affective impoverishment is manifested as an expression of emotions and
feelings, reduces the emotional capacity that manifests itself in such features as:
unchanging facial expression, the face seems frozen, wooden, mechanical.,
Decreased spontaneous movement and lack of expressive gestures: Do not use
your hands to express themselves, stand still and sitting ... Poor eye contact: You
can look at others shy away, stay with a vacant stare, Inconsistency affective
expressed affection is inappropriate. He smiles when talking about serious issues.
Giggle, Lack of vocal inflections: speech quality is monotonous and the important
words are not emphasized by changes in tone or volume.

Alogia: Refers to the impoverishment of thought and cognition. It manifests itself

through: Poverty of language restricting the amount of spontaneous speech, the
answers are brief and rarely is no additional information, poverty of content of
speech: even though the answers are long, the content is poor. The vague
language is repetitive and stereotyped, block: interruption of the language before a
thought or idea is complete. After a period of silence that can last a few seconds
can not remember what he was saying or what he meant, increased response
latency: the patient takes longer than usual to answer the question.

Avolition: The apathy is manifested as a lack of energy, momentum. Apathy is the

lack of interest. Unlike the lack of energy of depression in schizophrenia is
relatively chronic and is usually not accompanied by a sad emotion. manifested in:
Problems with cleanliness and hygiene, lack of persistence in work, school or any
other task, Feeling tired, slow, proneness to physical and mental exhaustion.

Anhedonia - unsociability: The Anhedonia is the difficulty in experiencing interest or

pleasure in things you like to do or leisure activities usually considered: it has little
or no hobbies, they tend to show a decrease of sexual interest and activity in terms
of what would be normal for age and state of the same, may show an inability to
create close and intimate relationships appropriate to their age, sex and familial
status, relations with friends and fellow restricted. They do little or no effort to
develop these relations.
Cognitive problems of care: Problems in concentration and attention, is able to
focus only sporadically, was distracted in the middle of an activity or conversation
is manifested in social situations, it will look, do not follow the plot of a
conversation, I have little interest in the subject, just a discussion or task suddenly
apparent.
Types of schizophrenia: we have pointed out the individual character of the picture
of the disease, so subordination to one of several types of the disease often means
a simplification. Also often present mixed pictures, which can be difficult to classify.
It is also noted many times that the picture of the disease varies over time.

Paranoid Schizophrenia: characterized by the prevalence of delusions and

hallucinations, especially auditory. The delusions and hallucinations sometimes
form a unity. It is the most common, usually begins between 20 and 30 years and
is the best evolving despite the showiness of the table.
Catatonic schizophrenia: the predominant movement disorder or motor
movements. Experts speak of "catatonic stupor." Despite having awareness, the
patient does not respond to attempts to contact him. His face remains motionless
and expressionless, not seen any movement inside and even strong pain stimuli
may not cause any reaction. In more severe cases may become not talk or eat or
drink for periods long enough to endanger his life. But inside the patient may have
real feelings storms, which often only manifest themselves in a fast pulse. There
are also constant repetition of the same movement (automatic) and facial
expressions. The pictures of extreme gravity, in which the patient is maintained eg
on one leg for several weeks, only very rarely seen due to the current treatment
options. They only occur when no one is concerned with the sick or when
treatment is not effective. The prognosis for this type of schizophrenia is usually
poor.
Disorganized or hebephrenic schizophrenia: a predominantly absurd affection not
appropriate (it usually laugh when given bad news, children's behaviors are often
the mood is absurd, there is uninhibited feelings. They often have strange
behaviors, such as laughing no apparent reason and make faces. They often show
a lack of interest and participation. There are cases in which manifest
hallucinations and delusions, although this is not fair condition this type of
schizophrenia in most cases the outbreaks are not clearly demarcated. It usually
starts at an early age as puberty, why they are called juvenile schizophrenia and
there are even cases where the disease is in infancy (infantile psychosis.)
Developments slow and unnoticed by hebephrenic have few symptoms are rated
and simple schizophrenia. In the absence of symptoms is difficult to recognize, (the
signs are usually self-neglect, solitary behavior ...). The prognosis is unfavorable
compared with other schizophrenia, due to the immature personality of the patient.
Undifferentiated schizophrenia: a type of schizophrenia in which there prevails a
particular symptom for the diagnosis, as the mixture of the previous ones.
Residual schizophrenia: in these cases must have been at least one episode of
schizophrenia earlier, but at present there is no significant psychotic symptoms. Is
the phase in which negative symptoms are more evident. Not seen in all patients.
Disease Course: When symptoms of schizophrenia are presented for the first time
in the life of a person and completely disappear after a short time, speech and a
schizophrenic or psychotic episode, in general after these episodes are not
negative symptoms .

We can speak of schizophrenia when the first opportunity that presents

manifestations of the disease are kept for a longer or shorter period, when
symptoms reappear after some time and when the disease results in negative
symptoms. we can distinguish three phases:

Prodromal phase 1: the phase in the life of the person occurs before the onset of
the disease. You can see that in some people with the disease had been different
in childhood and youth, lonely, silent, slow performance. But not necessarily have
to be so, there are cases where that is not detected any anomaly in the person
suffering from schizophrenia. It is called the prodromal phase to the phase that
occurs before a crisis, so there are a number of symptoms that we can help in
some cases has identified: stress and nervousness, loss of appetite or disruption in
food, difficulty concentrating, disturbed sleep, less of the things you enjoy, can not
remember exactly, depression and sadness, concerned with one or two things, you
see less of their friends, who laugh think or speak ill of him, lost interest in things,
feel bad for no reason of course, is very restless or excited, feel useless, other
changes ...

2 active phase: the phase where the disease is triggered, are called outbreaks or
crisis, the symptoms that occur are the positive, hallucinations, delusions,
disordered thinking ... is the phase in which the family is alarmed and often seek
medical help. These crises can emerge suddenly and develop a complete picture
in a few days. In other cases the onset of the disease may occur very slowly and
unnoticed. The duration of outbreaks varies from person to person and can range
from a few weeks to a year. The same patient usually have outbreaks of similar
durations. The same applies to the intervals between outbreaks, according to the
characteristics of the person can range from months to several years and are
generally of the same duration in the same person.

Residual Phase 3: not all patients suffer at this stage the negative symptoms reach
their peak and declining personal, social and labor is severe.

Theory of the three thirds: one third is recovered, one third still have some
limitations after an outbreak. , Third grave course of the disease and can not live
independently.

Causes of Schizophrenia: It is logical that has been investigated intensively on

such a serious disease like schizophrenia and striking. Research has found
significant partial results, which are located in very different fields. So we can say
with some certainty that there is a cause for some people to suffer this disease, but
there are attributing responsibility to a whole set of causes.

these causes are defined in different conceptual models:

1: Vulnerability-Stress Model
It is assumed that there is a particular psychological vulnerability to schizophrenia
may occur. The first responsibility is due to certain hereditary conditions. It is
known that schizophrenia in some families are common, while others do not.
Because of this predisposition a person may be vulnerable to the disease but this
is not a fair condition for its development. As a trigger for the disease must be
added a special emotional (stress). The pathological symptoms of schizophrenia to
be understood as an attempt to escape in some way to this excessive burden.

What are the charges? They can be stressful life events, often unpredictable, as
the death of someone close, military service, the loss of a job ... also a happy
event, like the birth of a child, a wedding, ie situations involving a change in life.
Mostly a lifelong emotional burden may mean an excessive demand for a
vulnerable person: overly concerned attitude of the family or even self-conscious to
the person and diminish their autonomy, there are cases where the person
suffering from schizophrenia is yes, more withdrawn, due to this cause others want
to help. Another approach would be when family members have an attitude of
rejection hidden, ie not talking about the problem but is manifested in the
expressions and attitudes, the affected critical and devaluing. Excessive emotional
burdens triggered the first outbreak, but subsequent outbreaks are caused by
stress load even if mild.

We must mention the existence of other medical models such as: a genetic model,
neurochemistry, brain abnormalities, functional disorders, and neuropsychological
electrofisilógicas, birth complications, infections by viruses.

So far, none of these possible causes has proved to be final and continuing
investigations to confirm them.

Treatment: The treatment of schizophrenia is mainly based on drugs called

antipsychotics, which control the active symptoms, but it is necessary while the
patient receives additional psychosocial treatment (psychological, occupational and
social), it is essential that the person ceases hallucinations, delirious, but so is
being reunited with his lifestyle, that throughout the busy day, you have your group
of friends, ie, integration into society, standardization.

Antipsychotic medications: Pharmacological treatment of schizophrenia is made by

the top few drugs called neuroleptics (nl) for their cataleptic effects and more
recently there is some consensus on calling antipsychotics (p).

Since the introduction of antipsychotic chlorpromazine in 1954, psychotropic

medications have become the mainstay of treatment for schizophrenia and other
psychiatric illnesses. Numerous studies have documented the effectiveness of
antipsychotics in the treatment of schizophrenia and lithium and antidepressants in
the treatment of affective disorders. Antipsychotics or neuroleptics have shown
their effectiveness in both the acute treatment of psychotic symptoms at relapse.
Antipsychotics are also called neuroleptics. They were discovered in the early 50s.
are especially useful for the characteristic symptoms of schizophrenia. From five
chemical families but all offer the same therapeutic effects. No difference in
efficacy between one type of antipsychotic over another. Only through drug
therapies have opened the possibilities of rehabilitation and a speedy return to the
social environment.

Schizophrenia is accompanied by an alteration of brain metabolism, it is an

excessive function of dopamine. Antipsychotic drugs block the effect of excessive
dopamine and restore the balance in brain metabolism. But neuroleptics also
modify other metabolic brain areas, resulting therefrom, as well as the desired
effects, lateral or unfortunately also undesirable side effects.

The effect of p is described as reassuring for cases of motor restlessness,

aggressive behavior and inner tensions. The hallucinations, delusions, and
schizophrenic disorders of perception almost disappear with drugs. When
outbreaks of the disease recurring, ongoing treatment with neuroleptics offers an
important and relatively safe protection against relapse to acute crises.

There are two main groups of ap: the so-called classical or typical characterized by
blocking dopamine D2 receptors, are very effective on positive symptoms, but
cause many side effects and atypical acting on serotonin receptors, producing
fewer side effects and being more effective in negative symptoms.

An important innovation is the deposit or injectable neuroleptics, which are injected

into the buttocks and act over many days. Its advantage lies in the fact secure the
release of the substance, the possibility of reducing the dose to be administered,
plasma drug level in predictable and consistent and can treat patients with
absorption difficulties with oral medication.

Just as those affected in each case can react very differently to life situations, is
also highly variable reactions to neuroleptics. Patients respond in very different
ways and sometimes the treatment may produce side effects are milder or
stronger.

We distinguish between side effects that appear in the first phase of treatment with
neuroleptics and their side effects in cases of long-term medication. Most side
effects appear in the first weeks of treatment. It should be mentioned especially the
fatigue, dry mouth, dizziness and lightheadedness, circulatory disorders and vision,
constipation and difficulty urinating.

Some other side effects may persist for a longer time or even start later. All side
effects are described in the papers of instruction included in the packets of drugs.
Often, these descriptions cause profound insecurity for those affected and their
families, so it is very important to give accurate information.
Other side effects may occur: muscle spasms, Parkinson's syndrome caused by
medication, akathisia, tardive dyskinesia, neuroleptics increase sensitivity to
sunlight, weight gain, Limitations in the sexual sphere: to them belongs the loss of
normal excitability. But some drugs may also cause the opposite, ie a constant
excitation. For women it is particularly important to take into account that the taking
of neuroleptics leads to menstrual irregularities or even amenorrhea.

It should be mentioned that there contrarestantes to file the side effects, other drug
therapy for the treatment of schizophrenia is not based solely on antipsychotics,
these are usually accompanied by antidepressants, anxiolytics, mood stabilizers.

Psychosocial Rehabilitation: The psychopharmacological treatment is essential in

the treatment of schizophrenia and other psychoses, but we need a good
therapeutic support for the orderly development of the disease, this support is the
psychosocial rehabilitation. For instance, commented that it is useless to the
patient to take treatment if their only activity is to spend all day in bed, or have
prescribed a medication and lack of awareness of disease control and not take it,
These are some examples of the many that we see what we work on rehabilitation
of these patients having a diagnosis and do not know their fate and that his life can
not be the same as before.

Having a psychotic disorder can not be the obstacle to the development of valuable
social roles, such as work or at least a job, housing, relationships interpesonales
and affective, social consideration and use of community resources. The
rehabilitation is understood today as the proportion of aid that requires the person
for the psychosocial functioning.

Psychosocial rehabilitation centers are part of the Community, working with the
sick in their family and not in an institution:
}

It will try to reduce or eliminate the deficit or deterioration in the different areas that
prevent normal integration of the patient in his environment, training the skills that
will allow greater autonomy and social integration, improving the quality of life of
patients and their social and family environment.

For each patient an individualized plan of rehabilitation differently depending on

their disease state, impairment, behavior problems and social and employment
situation.

they work the following areas:

Psychoeducation of patient and family: To provide an updated and comprehensive

information about mental illness, teaching them to discriminate symptoms,
prodromal importance of antipsychotic medication, awareness of illness, accepting
and learning to live with it.

Social skills: working through group activities rewarding and educational

techniques of social intercourse. progressive staggering settings ranging from
small groups to play or perform cooperative tasks to specific social skills training,
such as asking for favors, accepting criticism, conversational skills ...

Health education: health promotion as well you can get active. working through
modules, which are: Sexuality, food, sleep, prevention of anxiety, self-esteem and
self-image, cognitive abilities.

Guidance and mentoring to guide and advise on any question submitted by the
user problem and can not be treated from the programs developed in the field
group to assess the achievement of the objectives previously marked for the user.

Activities of daily living: the measure is aimed to bring about the acquisition and
maintenance of a wide range of skills necessary for everyday life, this is done
through programs such as personal care, domestic activities and cultural
orientation

Personal Development: development of the patient's community environment:

carry out actions of daily living, support guidance to the social, cultural, sports,
politics, teaching job search resources.

Sports: physically stimulate the user through sport skills while they work
coordination techniques, group work, cleanliness and hygiene.

Other areas: health and socioeconomic benefits, job training, residential

alternatives, use of leisure time, education of the person concerned, Employment
and supports.

As I mentioned at the beginning, all the issues presented here need more words
and time to develop in full, but I think that we can get it here an overview of this
disease that unfortunately, despite all the scientific advances made Genuine
change the lives of many people who suffer, because suffering or because his son,
his wife, his father or mother began a day to hear voices.
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