© Borgis - New Medicine 3/2010, s. 92-93
*Ewa Ogłodek, Aleksander Araszkiewicz
The First Episode of Schizophrenia
Chair and Clinic of Psychiatry of the Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Poland
Head of Clinic: Prof. Aleksander Araszkiewicz, MD, PhD
Summary
Schizophrenia is a mental disease which usually affects young people. More than half of cases begin before the age of 25. The first episode of schizophrenia is a difficult time for a patient and his family. During this period patients experience personality breakdown, their youthful ideals collapse, their dreams face reality. Sudden appearance of hallucinations causes alienation from society. A person diagnosed with schizophrenia may experience hallucinations, delusions and disorganized thinking and speech. The latter may range from loss of train of thought, to sentences only loosely connected in meaning, to incoherence known as word salad in severe cases. There is often an observable pattern of emotional difficulty, for example lack of responsiveness or motivation. During their first episode of schizophrenia patients need specific services that provide rapid and easy access to specialist assessments, swift initiation of treatment in a setting which does not have stigma attached to it, and comprehensive psychosocial interventions and support. The purpose of this study is to present the clinical picture, pathogenesis and ways of treatment of schizophrenia including its first episode. Currently in Poland and worldwide there is a trend to start treatment at the early stage of the disease and to put strong emphasis on breaking down barriers between sane people and those suffering from schizophrenia.
The term "schizophrenia" was introduced in 1911 by the Swiss psychiatrist Eugen Bleuler, pointing out that it covers a group of disorders of common characteristics, called axial symptoms, which occur in every case of schizophrenia. These symptoms, according to Bleuler, include: formal thinking disorders, affective disorders, ambivalence and autism (1, 2, 3). To diagnose schizophrenia using the ICD-10 classification, one has to observe for a month at least one of the typical symptoms: thought echo, imposition and taking away thoughts, as well as revealing thoughts; delusions of influence, impact or capture, delusional observations; commenting hallucination voices, pseudo-hallucinations discussing with one another; fixed delusions of other type, the content of which is bizarre, namely not adjusted culturally and completely unreal, or at least two of the following: fixed hallucinations, if accompanied by delusions or fixed hyperquantivalent thoughts; dissociation or failure to adjust statements, neologisms; catatonic behaviour; "negative" symptoms; significant, consistent and wide-ranging change of behaviour. In addition, after diagnosing the symptoms one has to make sure that they are not only the effect of mood disorders or determined by somatic factors (4, 5).
Epidemiology of schizophrenia
Schizophrenia can be considered as a social disease since it occurs relatively often. 400 000 Poles, i.e. 1% of the population, suffer from it. Incidence, dissemination and even intensification of schizophrenia are higher in cities than villages. Most commonly it affects people between puberty and full maturity, namely between 15 and 30 years of age. Death rate among people with schizophrenia is twice as high as in the general population. It is to a large extent associated with unnatural causes of death, first of all suicide (6, 7, 8).
Aetiology of schizophrenia
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Piśmiennictwo
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