Does schizophrenia have a cure?
Schizophrenia is the main and best known psychotic disorder, suffered by about 1% of the world population.
However, despite being relatively well known there are still a lot of mysteries and aspects to investigate regarding this disorder. What is it? Why is it produced? And what is perhaps the most important question ... does schizophrenia have a cure?
What is schizophrenia? Diagnostic criteria
Schizophrenia is a disorder of the psychotic type characterized by the presence for more than six months of symptoms such as hallucinations (the most prototypical symptom, especially in the form of auditory hallucinations that are attributed to people or beings foreign to the self), delusions and disorganization of the speech, being able to also present symptoms like the alogia and the abulia, chaotic behavior and catatonía. These symptoms usually appear in the form of psychotic outbreaks, the disorder can have different courses (with complete or partial remission, with progressive deterioration ...), and generate a significant interference in the life of the subject in all or almost all vital areas.
These symptoms are usually classified as positive and negative, the former being the ones that activate the subject or add something to their habitual functioning (for example hallucinations and delusions) and the latter those that suppose a limitation of this due to the decrease of faculties (case of the alogia and poverty of speech and thought).
Previously, the existence of different subtypes was considered based on the most characteristic symptoms, although in the latest version of the American reference manual, the DSM-5, has come to be considered as a single diagnostic label.
What are your causes?
The causes of schizophrenia remain largely unknown to this day . It has been observed the influence of genetic factors, which generate a vulnerability that predispose (but do not necessarily have to generate) the disorder. The environment also has a great influence, being the interaction between both factors what can trigger the disorder. The experience of highly stressful events or the consumption of some drugs can increase and trigger outbreaks in people with this vulnerability.
People with schizophrenia often have particularities in the brain, some of which are directly associated with the symptoms. Among them is the alteration of some dopaminergic pathways, being the mesolimbic pathway and the mesocortical path the most related. In the mesolimbic pathway there is an excess of dopamine that is associated with the existence of positive symptoms, while a deficit of this hormone in the mesocortical pathway is responsible for the negative ones. The knowledge of these brain alterations can and in fact is used in their treatment (especially in what refers to the medical and pharmacological).
Currently some authors propose the hypothesis that Schizophrenia is the result of a problem in the process of neuronal migration , how neuronal interconnections develop throughout development.
Is there a cure?
Schizophrenia is a disorder currently considered chronic, there is currently no curative treatment for this condition. However, it is treatable: there are treatments and therapies that allow to control the symptoms and keep the patient stabilized, avoiding the appearance of more psychotic outbreaks and allowing them to carry out a normal life.
However, it is necessary that the treatment be carried out continuously throughout the life of the subject. This last point is important in order to prevent relapses, which tend to be frequent when the subjects, already feeling well, decide to stop treating and medicating themselves. Likewise, the continued monitoring allows to regulate or vary the taking of medication, in those cases in which the prescribed drug is not effective or presents excessive side effects.
However, it is also true that this disorder is not unknown to science, there is still a wide margin for improvement regarding its understanding. As with other chronic disorders, both mental and organic, there is still much to be analyzed and discovered, and it is possible that a future will find a solution that can be considered a cure as such.
As we have said, although without cure for the moment, schizophrenia is a treatable disorder, and this treatment is carried out in a multidisciplinary way. The joint use of both psychotherapy and psychotropic drugs is recommended.
1. Pharmacological and medical treatments
At the pharmacological level, antipsychotics or neuroleptics are mainly used . It is especially advisable to use atypicals, since they allow to reduce and control to a great extent both the positive and negative symptoms and do not have as many side effects as the typical ones. The pharmacological treatment must be maintained throughout the life of the subject, since it prevents the appearance of new psychotic outbreaks (although the type of drug in question, the dose and its level of effectiveness will depend on the person).
It may also be necessary to apply other types of medications, such as antidepressants, in cases where it is necessary due to the symptoms presented.
With regard to other medical procedures, although it is not a widespread practice, different surgical techniques are being tested, such as the implantation of electrodes in certain brain areas (such as the nucleus accumbens).
2. Psychological treatments
On a psychological level, the treatments to be applied will depend on the problems expressed by the patient . One of the most fundamental aspects is to make the subject see the need to continue the treatment on an ongoing basis, since many affected end up abandoning the medication. Another aspect that is fundamental is the psychoeducation of both the subject and the immediate environment, so that it is understandable to all the situation of the subject, which means for the patient, the need for treatment or aspects such as the symptoms that may be indicating the arrival of a psychotic outbreak. Family and social support is essential both to continue with the treatment and to deal with the disorder (still very stigmatized).
Focusing on the symptomatology itself, in the case of the presence of hallucinations can be used the technique of focusing on the voices so that little by little the subject learns to attribute them to himself and not to an external entity. Cognitive restructuring is fundamental when trying to combat beliefs and delusions. Always keep in mind that these are real mental contents for the patient, not being generally advisable to use a direct confrontation. They must explore both the form and the content of their hallucinations and delusions. It is important to take into account the meaning and provenance that the subject attributes to them, so that these aspects can be worked on. Likewise, another therapy that generates positive results is acceptance and commitment therapy.
The training in social skills or the incorporation of this in multimodal programs are highly recommended, given that it is an area that tends to suffer in patients with schizophrenia. Occupational therapy may also be useful, especially in cases of cognitive impairment.
The set of treatments previously presented, although they do not suppose the cure of schizophrenia, they allow as we have told the patient to keep the disorder under control and to make a normal life .
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona
- Vallina, O. and Lemos, S. (2001). Effective psychological treatments for schizophrenia. Psicothema, 13 (3); 345-364.