Schizophrenia is one of the most mysterious mental disorders. It not only affects the mental health of a person, but decrease the life expectancy by 12-15 years. This disorder was first time named “Dementia Precox (premature dementia)” by Emil Kraepelin. Later Eugen Bleuler renamed it “Schizophrenia”. It is a common disorder with population prevalence of about 1%. The onset is earlier in males than females. Symptoms typically emerge in adolescence and early adulthood but childhood onset may occur.
Causes: There are no specific causes of this disorder, but there are some precipitating or associated factors . These are:
(1) Fetal life stresses like hypoxia, maternal infection, maternal stress during pregnancy and maternal malnutrition.
(2) Some studies have shown that children who as adults will be diagnosed with schizophrenia have, as compared to their peers, a higher incidence of non- specific emotional and behavior disturbances, psycopathological changes and intellectual and language alterations.
(3) Environmental factors include urbanization and migration. Living in an urban environment has been associated with an increased risk of schizophrenia.
(4) Genetic : The incidence of schizophrenia is partly genetic. The greatest risk for developing schizophrenia is having a first-degree relative with the disease (risk is 6.5%); more than 40% of monozygotic twins of those with schizophrenia are also affected.
(5) Drugs like amphetamine, cocaine, and to a lesser extent alcohol.
The diagnosis of schizophrenia is entirely based on clinical features. It is characterised by disturbance in thought, verbal behavior, perception, affect, motor behavior and relation to external environment. The symptoms of schizophrenia are often described as positive and negative symptoms. Positive symptoms are those which most individuals do not normally experience but are present in persons with schizophrenia. Negative symptoms are those which are not present mostly in schizophrenics but if present, respond less to medication.
The positive symptoms are:
(1) Disorders of perception- This includes auditory, visual and sensory hallucinations. Auditory hallucinations are most common. Third person hallucination (voices heard arguing, discussing the patient in third person) is characteristic of schizophrenia.
(2) Disorder of thought- Autistic thinking is one of most important features of schizophrenia. Here the person has his own fixed ideas, e.g. “I can not get up from bed as I cannot walk.” The person may remain buried in thoughts for long and thinks he has solved lots of mysteries. This takes the form of daydreaming.
(3) Thought blocking is a characteristic of schizophrenia. There is a sudden interruption of the stream of speech before the thought is completed. After a pause the subject cannot recall what he had meant to say.
(4) Talking nonsense (neogolism)- The patient, in order to express something, speaks newly formed phrases or words which have no dictionary meaning e.g. stomach as food vessel.
(5) Delusions (false unshakeable belief) – Delusion of persecution, delusion of grandeur, delusion of control (that he is being controlled by an external force).
(6) Disordered speech – This is characterised by loosening of association. The patient’s speech becomes illogical and ideas are juxtaposed which lack meaning. E.g. if a schizophrenic is asked to describe his daily routine, he may say “ If I get up the mouse doctor.” “The sun shines a lot of money.”
(7) “I fell the bed and see eyes.”
(8) Bizzare behavior- The mannerism is bizarre. A patient offers his hand to shake with fingers splayed. In speech mannerism, speech is erratic and dysmodulated.
(9) Disorders of motor behavior – Decrease in spontaneity, restlessness, aggression, agitation, violent behavior, poor self care, poor grooming.
Negative symptoms are- Apathy, lack of motivation (avolition), blunted affect (lack or decline in emotional response), social withdrawal (patient does not relate to or interact with people ), poverty of speech (alogia), inability to express pleasure.
Types of schizophrenia:
(1) Paranoid – Characterised by delusions, disturbance of affect, speech and motor behavior.
(2) Hebephrenic – Characterised by marked thought disorder, emotional disturbance, poor self care and hygiene, social withdrawl.
(3) Catatonic – Characterised by marked disturbance in motor behavior like restlessness, agitation, violent behavior, increase in speech production with increased spontaneity, loosening of association.
(4) Undifferetiated, when features of no subtype are fully present or features of more than one subtype are present.
(5) Simple schizophrenia- Characterised by early onset (early 2nd decade), very insidious, progressive course, negative symptoms. Delusion and hallucinations are usually absent.
According to the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), to be diagnosed with schizophrenia, three diagnostic criteria must be met:
- Characteristic symptoms: Two or more of the following, each present for much of the time during a one-month period (or less, if symptoms remitted with treatment).
- Disorganized speech, which is a manifestation of formal thought disorder
- Grossly disorganized behavior (e.g. dressing inappropriately, crying frequently) or catatonic behavior
- Negative symptoms: Blunted affect, alogia or avolition
If the delusions are judged to be bizarre, or hallucinations consist of hearing one voice participating in a running commentary of the patient’s actions or of hearing two or more voices conversing with each other, only that symptom is required above. The speech disorganization criterion is only met if it is severe enough to substantially impair communication.
- Social or occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care, are markedly below the level achieved prior to the onset.
- Significant duration: Continuous signs of the disturbance persist for at least six months. This six-month period must include at least one month of symptoms (or less, if symptoms remitted with treatment).
If signs of disturbance are present for more than a month but less than six months, the diagnosis of schizophreniform disorder is applied. Psychotic symptoms lasting less than a month may be diagnosed as brief psychotic disorder, and various conditions may be classed as psychotic disorder not otherwise specified. Schizophrenia cannot be diagnosed if symptoms of mood disorder are substantially present (although schizoaffective disorder could be diagnosed), or if symptoms of pervasive developmental disorder are present unless prominent delusions or hallucinations are also present, or if the symptoms are the direct physiological result of a general medical condition or a substance, such as abuse of a drug or medication.
(1) Good prognosis – If acute onset, more than 35 years of age, predominant positive symptoms, first episode and female sex.
(2) Poor prognosis – If insidious onset, less than 20 years of age, predominant negative symptoms, family history and past history of schizophrenia and male sex.
HOMOEOPATHIC APPROACH:- According to Dr. Hahnemann, the mental diseases are classified under chronic disease as one sided disease (Organon of Medicine aphorism 210). To treat such diseases, the symptoms of altered state of mind and disposition (aphorism 210), are to be observed carefully by the physician and to be taken from the patients relatives or attendants along with that the other symptoms (aphorism 208, 210, 213) like physical generals, past and family history of patient, any drug abuse or any trauma in the past, his domestic position, social relations, occupational stress, symptoms of altered behavior in childhood, parental disharmony, any birth trauma or any maternal stress during pregnancy are to be taken into consideration. The medicine is selected which is capable of producing strikingly similar symptoms and especially an analogous disorder of mind and disposition (aphorism 213, 220). Whatever the name of illness, the symptoms play most the important role in homoeopathic prescribing.
Aphorism 215 : Almost all so called mental and emotional diseases are nothing more than corporeal diseases in which the symptoms of derangement of mind and disposition peculiar to each of them is increased, while the corporeal symptoms decline.
Miasmatic analysis: Psora. In aphorism 210, 222, 228 mental diseases are said to be of psoric origin and to be treated with antipsoric medicines.
Treatment: Dr. Hahnemann long ago mentioned the treatment of mental diseases in aphorisms 210-230 which consist of supportive psychotherapy and constitutional antipsoric medicine.
Aphorism 221(a) states that if insanity has suddenly broken out as an acute disease in the patient’s ordinary calm state, although it always arises from internal psora, yet it should not be immediately treated with antipsorics, but in first place with the remedies indicated for it in highly potentised minute doses, in order to subdue that state of psora and revert it back to latent psora.
Aphorism 222 : As the patient has recovered from the acute state he should be immediately treated with prolonged antipsoric treatment.
Aphorism 223 : If antipsoric treatment is not started, then we may expect a more lasting and severe attack of insanity.
Behavior of physician while taking up psychiatric case: Dr. Hahnemann told us how a physician should behave while taking a psychiatric case in aphorisms 228 (a).
(a) To furious mania – we must oppose calm intrepidity and cool, firm resolution
(b) To doleful (expressing sorrow), querulous (complaining in whining manner) lamentation – a mute display of commiseration (the feeling of expression of pity and sorrow) in looks and gestures.