Schizophrenia is a psychotic disorder. A person experiencing psychosis has a loss of contact with reality, starts hallucinating and often becomes delusional. People with psychosis often feel they want to withdraw from the outside world. The term schizophrenia was coined by German psychiatrist Paul Eugen Bleuler in 1908. It affects one in hundred people across all countries, and usually affects people aged between 15 and 25. Men are slightly more likely to develop schizophrenia and they tend to have an earlier onset.
Currently, no diagnostic tests are available for schizophrenia. A thorough clinical evaluation by a mental health professional is the only way to diagnose the condition.
There have been recent advances in neuroimaging such as Diffusion Tensor Imaging, which helps in studying connectivity of different brain areas, Magnetic Resonance Spectroscopy, which helps in measurement of neurochemicals in the brain, Functional Magnetic Resonance Imaging and Functional Near-Infrared Spectroscopy to study blood-flow changes in different areas of brain during specific activities. Whole genome studies have shown nearly 100 genes such as MHC (major histocompatibility complex) region on Chromosome 6, MIR137 (microRNA-137), ZNF804A (zinc finger protein 804A), DISC1 (disrupted in schizophrenia 1) and DTNBP1 (dystrobrevin-binding protein 1) at different areas of the human genome as possible genes involved in causing schizophrenia. Study of eye movements through simple, non-invasive eye tracking devices has enabled researchers to identify eye-movement abnormalities in schizophrenics.
Treatment is multimodal and includes medication and several methods of psychosocial management such as individual and family psychoeducation, cognitive-behavioural therapy, social skills training and vocational rehabilitation. In the past two decades, many medications, grouped under second generation antipsychotics, have been made available. These include Risperidone, Olanzapine, Aripiprazole, Quetiapine, Ziprasidone, Paliperidone, Asenapine, Lurasidone and Iloperidone. These medications are well tolerated when compared with first generation antipsychotics such as Haloperidol and Chlorpromazine, especially with regards to neurological side effects. However, the SGAs have metabolic side effects such as increased blood glucose levels, increased cholesterol levels and weight gain.
Certain medications such as Haloperidol, Fluphenazine, Risperidone, Flupenthixol and Zuclopenthixol can be injected and are given to manage symptoms during acute phase and as maintenance medications. As schizophrenia is a chronic psychiatric disorder, medication is often required for several years. During follow-up visits, the psychiatrist will evaluate response to medication, psychosocial interventions and check for adverse effects of medications.
Medicines are more affordable in India than in the west. On average, the cost of maintenance medication ranges between Rs300 and Rs3,000 per month. There are significant indirect costs such as transportation, wages of caregiver and hospitalisation during acute phase.
Newer treatment modalities include use of Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation, which seem to benefit select patients with symptoms such as persistent hallucinations.
Sagar is associate professor, department of child and adolescent psychiatry, NIMHANS, Bengaluru