Schizophrenia is the main and best known psychotic disorder, suffered by about 1% of the world’s population.

However, despite being relatively well known, there are still many mysteries and aspects to investigate regarding this disorder. What is it? Why does it occur? And what is perhaps the most important question… is there a cure for schizophrenia?

What is schizophrenia? Diagnostic Criteria

Schizophrenia is a psychotic-type disorder 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 attributed to people or beings outside one’s own self), delusions and disorganization of speech, and may also present symptoms such as alogia and abulia, chaotic behavior and catatonia. These symptoms usually appear in the form of psychotic outbreaks, and the disorder can have different courses (with complete or partial remission, with progressive deterioration…), and generate a significant interference in the subject’s life in all or almost all areas of life.

These symptoms are usually classified as positive and negative, the former activating the subject or adding to his/her normal functioning (e.g. hallucinations and delusions) and the latter limiting him/her due to diminished faculties (e.g. alogia and poverty of speech and thought).

Previously, the existence of different subtypes was considered according to the most characteristic symptoms, although in the latest version of the American reference manual, the DSM-5, it has come to be considered as a single diagnostic label.

What are its causes?

The causes of schizophrenia are still largely unknown today . The influence of genetic factors has been observed, which generate a vulnerability that predisposes (but does not necessarily have to generate) the disorder. Likewise, 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 use of some drugs can increase and trigger outbreaks in people with such vulnerability.

People with schizophrenia often have brain-level peculiarities, some of which are directly associated with the symptoms. Among them is the alteration of some dopaminergic pathways, being the mesolimbic and mesocortical pathways the most related. In the mesolimbic pathway there is an excess of dopamine which 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 is used in their treatment (especially with regard to medical and pharmacological aspects).

Some authors currently propose the hypothesis that schizophrenia is the result of a problem in the process of neuronal migration , of how neuronal interconnections develop throughout development.

Is there a cure?

Schizophrenia is a disorder currently considered to be chronic, and there is currently no curative treatment for this condition. However, it is treatable: treatments and therapies are available to control the symptoms and keep the patient stabilized, preventing further psychotic outbreaks and allowing them to lead a normal life.

However, it is necessary that the treatment be carried out continuously throughout the subject’s life. This last point is important in order to prevent relapses, which are usually frequent when subjects, already feeling well, decide to stop treatment and medication. Likewise, continuous monitoring allows for regular or varied medication intake, in those cases where the prescribed drug is not effective or has excessive side effects.

However, it is also true that this disorder is not unknown to science and there is still ample room for improvement in its understanding. As with other chronic mental and organic disorders, there is still much to be analyzed and discovered, and it is possible that a solution will be found in the future that can be considered a cure.

Treatments applied

As we have said, although without a cure at the moment, schizophrenia is a treatable disorder, with such treatment being carried out in a multidisciplinary manner. 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 . The use of atypicals is especially recommended, given that they allow both positive and negative symptoms to be reduced and controlled to a great extent and do not have as many side effects as typical ones. Pharmacological treatment should be maintained throughout the life of the subject, given that it avoids 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 medication, such as antidepressants, in cases where it is necessary because of the symptoms presented.

As far as other medical procedures are concerned, 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 manifested by the patient . One of the most fundamental aspects is to make the subject aware of the need to continue with the treatment, given that many affected persons end up abandoning their medication. Another aspect that is fundamental is psychoeducation both to the subject and to the immediate environment, so that the subject’s situation is understandable to everyone, which means that the patient needs treatment or aspects such as the symptoms that may be indicating the arrival of a psychotic break. Family and social support is essential both to continue treatment and to cope with the (still highly stigmatized) disorder.

Focusing on the symptomatology itself, in the case of the presence of hallucinations, the technique of focusing on the voices can be used so that the subject gradually learns to attribute them to himself and not to an external entity. Cognitive restructuring is fundamental when trying to combat beliefs and delusions. It must always be taken into account that these are real mental contents for the patient, and it is not generally advisable to use direct confrontation. Both the form and content of their hallucinations and delusions should be explored. It is important to take into account the meaning and origin that the subject attributes to them, so that these aspects can be worked on. Likewise, another therapy that generates positive results is the therapy of acceptance and commitment.

Training in social skills or incorporating it into multimodal programs is highly recommended, as it is an area that tends to suffer from schizophrenia patients. Occupational therapy may also be helpful, especially where cognitive impairment is present.

The set of treatments presented above, although not a cure for schizophrenia, allow the patient, as we have said, to keep the disorder under control and lead a normal life .

Bibliographic references:

  • 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.