INTRODUCTION

Schizophrenia is a severe disorder that is often associated with considerable impairments in

functioning. Schizophrenia occurs in people from all cultures and from all walks of life. The disorder
is characterized by an array of diverse symptoms, including extreme oddities in perception, thinking,
action, sense of self, and manner of relating to others. However, the hallmark of schizophrenia is a
significant loss of contact with reality, referred to as psychosis.

The first detailed clinical description of what we now recognize as schizophrenia was given in 1810
by John Haslam, the apothecary at Bethlem Hospital in London, England. Haslam described the case
of a patient who appeared to have suffered from various symptoms - including delusions - that were
typical of schizophrenia. In 1911, Bleuler used schizophrenia (from the Greek roots of sxizo,
pronounced “schizo” and meaning “to cut up or crack,” and phren, meaning “mind”) due to the fact
he believed the situation became characterised mostly with the aid of using disorganization of idea
processes, a loss of coherence among idea and emotion, and an inward orientation away (cut up off)
from reality.

The risk of developing schizophrenia over the course of one’s lifetime is a little under 1 percent—
actually around 0.7 percent (Saha et al., 2005). What this means is that approximately 1 out of every
140 people alive today who survive until at least age 55 will develop the disorder. Of course, a
statistic like this does not mean that everyone has exactly the same risk. This is an average lifetime
risk estimate.

CLINICAL PICTURE

Delusional disorder, formerly known as paranoid disorder, is a type of severe mental illness known
as "psychosis," in which one cannot distinguish between what one imagines to be real. The main
feature of this disorder is the presence of delusions. Delusions are unwavering beliefs about
something that is not true. People with delusional disorders do not experience the strange delusions
that can occur in real life, such as persecution, addiction, deception, plotting, and being loved from a
distance. These delusions are usually accompanied by misunderstandings of perception and
experience. But in reality, the situation is not at all true or is significantly exaggerated.

Hallucinations are sensory experiences that appear real but are created by your mind. They can
affect all five of your senses. For example, you might hear a voice that no one else in the room can
hear or see an image that isn’t real. These symptoms may be caused by mental illnesses, the side
effects of medications, or physical illnesses like epilepsy or alcohol use disorder.

Disorganized Speech
Schizophrenia can cause people to have difficulty concentrating and maintaining a train of thought,
which manifests in the way they speak. People with disorganized speech might speak incoherently,
respond to questions with unrelated answers, say illogical things, or shift topics frequently. Signs of
disorganized speech involves Loose associations: Rapidly shifting between topics with no
connections between topics; Perseveration: Repeating the same things over and over again; Made
up words that only have meaning to the speaker; Use of rhyming words without meaning; When
cognitive disorganization is severe, it can be nearly impossible to understand what the person is
saying.

Disorganized Behavior
Schizophrenia negatively impacts goal-directed behavior. A person with disorganized schizophrenia
is likely to have difficulty beginning a specific task (ex: cooking a meal) or difficulty finishing a task.
Independent functioning is exceptionally difficult due to this gross disorganization.
Disorganized behavior can manifest as A decline in overall daily functioning; Unpredictable or
inappropriate emotional responses; Lack of impulse control; Behaviors that appear bizarre or lack
purpose; Routine behaviors such as bathing, dressing, or brushing teeth can be severely impaired or
lost.

Negative Symptoms

Negative symptoms refer to an absence or lack of normal mental function involving thinking, behavior,
and perception. Lack of pleasure. The person may not seem to enjoy anything anymore. A doctor will call
this anhedonia; Trouble with speech. They might not talk much or show any feelings. Doctors call this
alogia; Flattening: The person with schizophrenia might seem like they have a terrible case of the blahs.
When they talk, their voice can sound flat, like they have no emotions. They may not smile normally or
show usual facial emotions in response to conversations or things happening around them. A doctor
might call this affective flattening; Withdrawal. This might include no longer making plans with friends or
becoming a hermit. Talking to the person can feel like pulling teeth: If you want an answer, you have to
really work to pry it out of them. Doctors call this apathy; Struggling with the basics of daily life. They
may stop bathing or taking care of themselves; No follow-through. People with schizophrenia have
trouble staying on schedule or finishing what they start. Sometimes they can't get started at all. A doctor
might call this avolition. Depression has some of the same symptoms, too. They can be hard to spot,
especially in teens, because even healthy teens can have big emotional swings between highs and lows.

Etiological causes

Genetics

Schizophrenia tends to run in families, but no single gene is thought to be responsible.

It's more likely that different combinations of genes make people more vulnerable to the
condition. However, having these genes does not necessarily mean you'll develop
schizophrenia.

Evidence that the disorder is partly inherited comes from studies of twins. Identical twins
share the same genes.

In identical twins, if a twin develops schizophrenia, the other twin has a 1 in 2 chance of
developing it, too. This is true even if they're raised separately. 
In non-identical twins, who have different genetic make-ups, when a twin develops
schizophrenia, the other only has a 1 in 8 chance of developing the condition.

While this is higher than in the general population, where the chance is about 1 in 100, it
suggests genes are not the only factor influencing the development of schizophrenia.

Brain development

Studies of people with schizophrenia have shown there are subtle differences in the structure
of their brains.

These changes are not seen in everyone with schizophrenia and can occur in people who do
not have a mental illness. But they suggest schizophrenia may partly be a disorder of the
brain.

Neurotransmitters

Neurotransmitters are chemicals that carry messages between brain cells.

There's a connection between neurotransmitters and schizophrenia because drugs that alter
the levels of neurotransmitters in the brain are known to relieve some of the symptoms of
schizophrenia. 

Research suggests schizophrenia may be caused by a change in the level of 2

neurotransmitters: dopamine and serotonin.

Some studies indicate an imbalance between the 2 may be the basis of the problem. Others
have found a change in the body's sensitivity to the neurotransmitters is part of the cause of
schizophrenia.

Pregnancy and birth complications

Research has shown people who develop schizophrenia are more likely to have experienced
complications before and during their birth, such as:

 a low birthweight
 premature labour
 a lack of oxygen (asphyxia) during birth
It may be that these things have a subtle effect on brain development.

Triggers
Triggers are things that can cause schizophrenia to develop in people who are at risk.
These include:

Stress

The main psychological triggers of schizophrenia are stressful life events, such as:

 bereavement
 losing your job or home
 divorce
 the end of a relationship
 physical, sexual or emotional abuse
These kinds of experiences, although stressful, do not cause schizophrenia. However, they
can trigger its development in someone already vulnerable to it.

Drug abuse
Drugs do not directly cause schizophrenia, but studies have shown drug misuse increases the
risk of developing schizophrenia or a similar illness.

Certain drugs, particularly cannabis, cocaine, LSD or amphetamines, may trigger symptoms

of schizophrenia in people who are susceptible.

Using amphetamines or cocaine can lead to psychosis, and can cause a relapse in people
recovering from an earlier episode.

Research has shown that teenagers and young adults who use cannabis regularly are more
likely to develop schizophrenia in later adulthood.

CASE STUDY

Myles was a 20-year-old man who was rushed to the emergency room by university campus police
who were suspended a few months ago. The professor called and reported that Myles had entered
the classroom, accused him of receiving tuition, and refused to leave the classroom. Although
Myles has achieved many academic achievements as a teenager, his behavior has grown strangely
over the past year. He seems to have stopped meeting his friends and no longer cares about his
appearance and social activities. He started wearing the same clothes every day and rarely took a
bath. He lived with some families, but rarely talked to any of them. When talking to them, he said
he found evidence that his college was just the front of organized crime. He was absent from
college because he was absent from many courses. His sister often saw him mutter softly to
himself, and sometimes he seemed to be talking to people who weren't there, she said. He came
out of his room and asked him to be quiet even if his family wasn't making noise. Myles began
talking about organized crime so often that his father and sister took him to the emergency room.
His family said they had never met him from drug or alcohol use and his drug test results were
negative. He did not want to eat the food provided by hospital staff and expressed concern that
they might try to hide the medicine in his food. His father and sister told staff that Myles great-
grandmother was seriously ill and lived in a state hospital for 30 years, believing that it was a
mental hospital. Myres' mother left her family when she was young. She was no longer in contact
with them and she suspected she had been treated for mental health problems. Myles has agreed
to enroll in the Mental Health Department for his treatment. The story reflects the common case
where a very functional young adult experiences a significant decline in daily skills. Even if family
and friends feel that this is the loss of someone they knew, the illness can be treated and good
results can be achieved. In the case of Myles, he suffered from paranoia, hallucinations, and
negative symptoms that lasted for at least a year. All of these symptoms are suitable for the
diagnosis of schizophrenia. It is important for doctor to quickly rule out other causes of the problem,
such as substance use, head injuries, and medical illnesses. Treatment of these conditions can save
lives, unlike schizophrenia.