Schizophrenia

The first frank episode of psychosis happened when I was around 16, and I suddenly started walking home from school in the middle of the day. I began to feel the houses were getting weird; they were sending me messages: “You are special. You are especially bad. Now walk. Cries and whispers.” There were also some warning signs in college but I didn’t really “officially” break down until graduate school at Oxford.

Schizophrenia was originally known as dementia praecox describing a syndrome that involved an early,  gradual onset yet a progressive deterioration of brain function.  In 1950 Bleuler introduce the term schizophrenia which translates to "split mind" to refer to a split between thought process and emotions or disorganization in thought and behavior.

Keep in mind that this kind of "split mind"is not the same as dissociation reactions of fugue, amnesia, or multiple personality; in these conditions mentioned above the split is between different states of conscious instead of the between thought and emotion.

Even though most cases have an onset in the late teens to mid-thirties, schizophrenia can be diagnosed at any age; yet men tend to show symptoms at an earlier age than women allowing the men to have better outcomes in the end.  Unlike men that show more negative symptoms, women are more likely to suffer from paranoid delusions, mood symptoms, and hallucinations.  Risk of suicide has also increased, up to 40% attempt suicide but about 10% of the schizophrenics have suicide completion.  

There are different subtypes of schizophrenia:

• Paranoid Type
• In this type there are hallucinations or delusions and involve persecution.  Delusions of grandiose or persecution also associated with anger or jealousy.  These individuals have a later onset of symptoms and a better clinical prognosis but may be at greater risk  for suicidal or violent behavior.
• Disorganized Type
• The features consist of incoherent speech, hallucinations, some delusional beliefs, inappropriate responses frequently involving silly laughter, and stereotyped mannerisms and grimaces.  This type of schizophrenia tends to have an earlier onset while the overall disorganization and impairment are severe and it being chronic without significant remissions.
• Catatonic Type
• The most common feature in this type are psychomotor disturbances involving rigid immobility, excessive motor activity, echolalia, echopraxia, and unresponsiveness to environmental stimuli, for long periods of time.  There may be a presence of waxy flexibility, purposeless movements that may appear aggressive and may result in self-injury or injuries to others.  They are extremely negative; they may remain mute or resist all instructions or attempts to be moved.
• Undifferentiated Type
• This type of schizophrenia meets the criteria for schizophrenia but not the criteria for paranoid, disorganized, or catatonic subtypes.  This subtype reflects the fact that schizophrenic symptoms do not conform to the other subtypes mentioned.
• Residual Type
• This residual type is applied to people who have previously experienced episodes of schizophrenia but who at present show no symptoms or psychotic features like, delusions, hallucinations, or disorganized speech or behavior.  At times residual schizophrenia happens between periods of full blown psychotic symptoms and periods of remission but keep in mind that in some cases the residual state can persist for years.  

Unfortunately individuals with schizophrenia have more than twice the death rate than those without the disorder; while almost half of individuals with schizophrenia will suffer from a substance use disorder, like alcohol, marijuana, or others.  But on the brighter side research does show that individuals who suffer from schizophrenia have a better quality of life if their family members are more supportive and less critical.

Split Mind

Have you ever had those moments that you are being watched or that you are being followed and you start to walk faster and your heart rate increases, but you suddenly get a hold of yourself and kind of chuckle because you realize how stupid those thoughts were.  How could anyone just be watching you or following you  for no apparent reason, so you just throw those kinds of thoughts to the back burner and never think about ever again.
But what if these two thoughts never went away, you just could not seem to let go of these thoughts, but now not only are you being followed or being watched but they have put something in your cereal so that you can ingest it and now they are in you.
As awkward as this might sound there is people out there that suffer with these kinds of thoughts that have become their reality known as, Schizophrenia.
Schizophrenia originally known as dementia praecox but later in 1911 introduced as schizophrenia by Eugen Bleuler a Greek term referred to as "split mind" meaning that there is a split between the emotional and intellectual aspect of experience.
Throughout history people who suffered from schizophrenia were thought to be possessed by demons and were feared and many times locked up forever.  Even though research has advanced in educating and helping the public to better understand schizophrenia it is still easier for the average person to deal with the idea of cancer than to try and understand the strange behavior, hallucinations, or erratic ideas of someone with schizophrenia.
Many people have the misconception that people with schizophrenia are more violent, and so when friends and family learn about their diagnosis they are shocked and afraid.

Onset
Schizophrenia occurs in early adulthood, usually early 20s.  During this time the person may seem without goals in life, unmotivated, becoming very eccentric, isolating themselves from family and friends.

Signs

• Social withdrawal
• Irrational, bizarre or odd statements or beliefs
• Increase paranoia - questioning other's motives 
• Becoming more emotionless 
• Hostility or suspicious
• Drugs or alcohol use
• Inappropriate laughter
• Insomnia or excessive sleeping

Causes

It is not know what causes schizophrenia but it is believe to be a combination of genetics and environment.
Brain chemicals play a big role in schizophrenia such as neurotransmitters of dopamine and glutamate; neuroimaging studies have shown the differences in brain structure and central nervous system of people with schizophrenia.

Risk Factors

• Having a family history of schizophrenia
• Exposure to viruses, toxins, malnutrition while in womb (1st & 2nd trimester)
• Stressful life circumstances
• Older paternal age
• Usage of psychoactive drugs during adolescence and young adulthood

Treatment

Because schizophrenia is a chronic condition it requires lifelong treatment, even if and when symptoms subside; antipsychotic medications are most common for treating schizophrenia.

• Atypical antipsychotics…these are the newer medications with lower risk and debilitating side effects.
• Abilify
• Clozaril, Fazaclo
• Zyprexa
• Invega
• Seroquel
• Risperdal

• Conventional or Typical, Antipsychotic…produce frequent and potentially significant neurological side effects such as tardive dyskinesia.
• Chlorpomazine
• Fluphenazine
• Haldol
• Perphenazine

Conclusion
It can take several weeks to see improvement but the goal is to effectively control signs and symptoms at the lowest possible dosage.  Different medications, different dosage, and or combinations may be given to achieve the desired result; other medication such as andtidepressants or anti anxiety medication may also be helpful.

Fearless

What would it be like to be fearless?  Would it be a good thing or would it be a daily tragedy?  Unfortunately their is a rare genetic disorder known as Urbach-Wiethe Disease.  

What exactly is Urbach-Wiethe Disease??

Also known as Lipoid proteinosis of Urbach and Wiethe; a rare congenital lipoid disease where lipids, carbohydrate and proteins are deposited into the blood vessel wall and other tissues.  It was first seen in 1929 by Erich Urbach and Camillo Wiethe.

Symptoms

The symptoms vary from person to person these are few:

• Inability to cry
• Itchy eyes
• Skin ulcers
• Hoarseness
• Mucosal ulcers
• Mucosal plaque 
• Increased blood phospholipids
• Increase urinary tyrosind
• Vocal cord growths
• Large tongue
• Skin plaque
• Macrocheilia
• Skin bumps
• Skin nodules
• Mental retardation
• Indurated skin plaque

Causes

It is caused by a mutation in the extracellular matrix protein 1 gene, ECM1; but unlike the dermatological symptoms it is caused by a build up of a hyaline material in the dermis and thickening of the basement membranes in the skin, it is seen on the eyelids where beaded papules developed.  Some people may just be carriers of the disease and show no symptoms.

Diagnosis

It may be diagnosed by the dermatological manifestation, especially the noticeable beaded papules on the eyelids, staining of hyaline and testing the antibodies for EMC1.

Treatment

Unfortunately there is no cure but many of the symptoms may be treatable by using oral dimethyl sulfoxide, intralesional heparin, etretinate, anti-seizure medication, and having a tracheostomy if needed.

Prognosis

Patients with this form of disease may have longevity as long as their symptoms are properly treated and cared for such as the thickening mucosa.  But will eventually require a tracheostomy or carbon dioxide laser surgery to keep the patient safe and comfortable. 

Meet the woman without fear……...