Text of João Cardoso, psychiatrist. Schizophrenia is a complex syndrome that affects behavior and the cognitive capacity of patients. Today we know that it is due to neurodevelopmental changes, in which causes genetic and environmental (socio-economic environment, family, migration, etc.).
We can divide the symptoms into 3 large groups:
Positive symptoms (what arose with the disease): as hallucinations, delusional ideas and changes in the organization of thought, what is called psychotic symptoms. These are usually the symptoms that worry those around you most. people with schizophrenia, because they can be accompanied (not always) of agitation and may lead the patient toif in danger. However, they tend to remit or become residuals over time.
Negative symptoms (things that were lost): are the symptoms less exuberant, but the most important in schizophrenia. They are a decrease in initiative and willingness to participate or do activities, social isolation and decreased speech spontaneous.
Cognitive symptoms: people with schizophrenia tend to have worse results in multiple cognitive tests, which limits the ability to participate in the life of society.
Although the positive symptoms are those that the majority of the population identifies as part of the syndrome, are the negative and cognitive skills that have a greater impact on the lives of people with schizophrenia.
Disease numbers
Unfortunately We do not have concrete data on the prevalence of the disease in the Brazilian population. Normally, schizophrenia has its initial presentation between 16 and 30 years of agewith the onset being earlier in men (still in adolescence and early adulthood) than in women (closer to 30 years of age). Sometimes there is a time difference between the onset of symptoms and diagnosis.
In truth, There are several manifestations of the same disease, but the most important thing is that, like all diseases, the longer it goes untreated, the worse the future results, and the greater the deficits recorded.
The factors that can contribute to the development of the disease are numerous and It cannot yet be said that there is a specific reason that leads to the onset of the disease. However, we know that there is a genetic predisposition to the disease, but not enough for it to appear. It is a combination between genetic predisposition and environmental factors: consumption of cannabinoids, stress, migration (risk is greater in the first and second generation), low socioeconomic environment, pre- and perinatal factors, growing up and living in an urban environmentbetween others.
Biggest challenge
The biggest challenge in identifying the disease is the delay in diagnosis, and then stigma plays a determining role. As the disease usually begins in At young ages, many of the more bizarre early behaviors are thought to be changes typical of developing personalities.
It is difficult for a person who is sick to be critical of their illness, however family members also postpone going to the appointment because they will have to face the fact that their family member has a mental illness. Another challenge is the distinction from other illnesses that also manifest with psychotic symptomsthat is, they have identical clinical presentation, but a more favorable evolution.
Treatment must be multidisciplinary. You must have specialized medical monitoring and pharmacological intervention, which is usually quite effective in treating positive symptoms.
But there is all work that has to be carried out by a multidisciplinary team so that the person with schizophrenia can be an active citizen and participant in society like any other personwithin the limitations that your illness may condition you. One of the barriers to therapeutic adherence is the stigma regarding the disease and ideas related to older medications and their side effects.
Unfortunately, there are not many psychotherapeutic models with demonstrated efficacy in the treatment of schizophrenia, with the exception of cognitive-behavioral psychotherapy and interpersonal psychotherapy (this is for negative symptoms), but this does not mean that other models will not be developed in the future.
Not all patients have access to multidisciplinary interventions because the services themselves lack the necessary human resources. Intervention in schizophrenia is expensive, requires many human resources, and the results are not immediate and have inter-individual variability (for some it will be having an active working life, for others it will be getting them to be in a socio-occupational forum, for example).
Like this, The biggest barrier for patients to the necessary interventions is that the services themselves are lacking the necessary resources, and the weak implementation of truly community services in the country.
Difficulties
The proposals of the they follow the guidelines of what are today considered best practices in terms of organizing interventions at the mental health level. However, there are difficulties in implementing them. As an example, there is still a low implementation of community mental health structures in the country, with a model centered on the hospital, far from communities, their structures and organizations.
Happily Science has made some advances in the area of neurosciences, which has allowed us to understand schizophrenia a little better. Today We know that it is a disease of the central nervous system, as There are diseases of other organs, and there are effective treatments.
As with any illness, the earlier the intervention, the lower the damage caused. Finally, I would like to make it clear that people with schizophrenia can have rich and complete lives, they can work, love and be loved and be free to make their own decisions. Just like anyone else.
