INTRODUCTION :- Schizophenia is a mental illness which afflicts apporximately 1 percent of population,usually begins before age 25 and may persist thoughout life if not treated properly.If affects people of all social clasesses.Patient of Schizophenia suffer from poor care and social discremination due to wide spread ignorance about illness.Diagnosis of Schizophenia is based on psychiatric history and MentalStatus Examination(MSE)of pt.Hence relatives must give detailed history of pt.to psychiatrist so that he can come to correct diagnisis.

CAUSES: Stress Diasthesis Model states that anidividual may have a specific vulanrabity(Diasthesis Model) that when acted upon by some stressful enviornmental influence(Stress)allows the symptoms. It can be bilogica or enviornmental or both.Possible causes can be.

*Family history of mental illness situation * Infection. * Stessful family
*Death of a close relative stess * Drug abuse. *Psychological stress
*Tranuma.

BILOGICAL CASUSES.
*Dopamine Hypothesis. Neutotioransimtters are chemicals which are released rapidly by one nerve cell,diffuse across the space between two cells and have excitatory or inhibitory effect on another cell. According to Dopamine Hypothesis there is increased activity in areas which release a neurotran smitter,called Dopamice.

*Gross Changes in brain Computed Tomography(CT)scan(highly sophesticated x-ray technique)studies of brains of Schizophenia pts have shown changes in brain like; enlargment of ventriacles(space incontaining cerebraospnal fluid)&decrease in density and size of brain matter (cerbral atroph).More sophesticated studes have proved decresed metablic activty in frontal part of brain.Total activity of whole brain is also reduced.

*Genitic causes Genetic studies of pts. of Schizophenia have proved that there is a genetic basis of Schizophenia and the gences of the affected persons confer a vulnerability of Schizophenia.
   Incedence means number of persons in a perticular population having illness in a perticular time.The incedence studies of Schizophenia prove genetic basis.

population Incedence(%)
General Population 1 %
Brother or sister of pt. 8%
Child with one schizophrenic parents 12%
Child with both chiziprenia parents 40%
Twin of a Schizophenia patient 47%

PSYCHOLOGICAL CAUSES
*Psychoanalytical Theory : The curcula defect in Schizophenia in a distrubace in ego organistion which affects the jinterpretation of reality and contro for inner drives like sex and aggression.
Learing Theory :As children pts.with Schizophenia learn irrational reactions and ways of thinking by imitating parenst who may have their own emotional problems.The pts.may have deficiecncy in social skills leading to poor interpersonal relationships.

There are three differnt theoris regaruding family.
I)Double bind theory by Greagry Bateson in this family situation a chaild is put into a state where he has to make a choice between two alternatives,both of which will produce confusion
II)jSchism' &'skewed' family patterns theory by TheodorsLidz.In 'schism pattern of family one parent gets overly close is child of opposite sex. In 'schsim pattern of family there is power struggle and one parent is dominant.
III)Psudohositle psedomutulal verbal communication theory by Lyman Wynne. Accoring to this theory emotional expression is suppressed by the consistent use of certain ways of varbal communication,in the family.

SOCIAL CAUSES
Social changes like industrialization and urbanization may contrubte of Schizophenia

SYMPTOMS OF SCHIZORHRENIA 1)Bizrre dilusions: These are false unshakable belief which are not in keeping with person's socail,cultural or educational backgound e.g.being controlled by a dead person,being prosectued by authorities,police military etc.
2)Prominent halfucinations:The person hears a voice,or diffrent voices talking about him abusing,praising or instructing him.
3)Inchohernce speech : Whatevr pt.speaks has no corelation. pt's speech becomes meaningless and does not convey proper massage.
4)Catatonic behavior :Pt. may be mute(mutism),not obeying instrucation(negativism) excited(stupor)or immobile for long hours(catatonia).
5)Blunt affect :This is flat mask like expression less face :During the period of distubace functioning in areas like work,social relations and self care deteriorated.

PHASES OF ILLNESS
The sings of disturbace are for at least 6 month.Period which includes prodromal phase,active phase and residual phase.
Prodromal phase:It is a clear deterioration in fuctioning before the active phase of disturbace.
Active phase:The pt shows two or more of charectoristic symptom described above.
Residual phaseAfter the active phase there is deterioration in functioning which is not due to a mood problem drug addication.
Prodromal or ersidnal symptoms:
*Marked social isolation.
*Abnormal speech.
*Lack of initative,interest,energy

Course:
The course of schizophrenia often begins with prodromal symptoms. However somtimes pronounced symptoms may be gradually develop over days or months. Onset in usual in adolescence and there may be an identifiable precipitating event. The pt. may have exarcerbation and & remission . Some pts. of schizophirenia do not return to perfectly normal state of functionaing. The pt. may develop post-psychotic depression afert an actual episode. Through out the life pt. is vulnerable to stress. Schizophrenia does not always run a deteriorating course. The reasonable estimate about fate of schiophrenia pts. is as follows.
*1/3rd Lead normal life. * 1/3rd Experience modrate symptoms *1/3rd Deteriote.
TREATMENT:
When pt. becomes violent, aggresive & relatives are unable to control him at home or he does not take medicine than he has to be hospitalised.
* To give medicine to pt. regurarly.
* To give ECT ( Shock Treatment) to pt.
* To educate realatives about illness.
* To rehabilitate teh pt.
DRUG TREATMENT
Antipsychotiecs are the medicines given to pt. to treat synptomes of schizohrenia. Following things are kept in mind while giveng medicaines.
*Target symptoms to be terated.Hence relatives must describe sympotms properly so that psychiatrist can give proper medicines.
*Antipsychotic effective in the past for the pt. is used again.Hence relatives must keep the record properly so that Dr. gives proper drug.
*The minimum period for an antipsychotic medicine to be effective is about 4 to 6 weeks, at adequate doses.
*Maintananace doses of antipsychotics should,be as low as possible. The pt. may not respond to medicines if,
*Diagnosis is wrong .
*Medicine given is wrong.
*Medicine is given in inadiquate dose.
*pt. is not given medicine regulerly.
Pt.is kept on Antipsychotics for a considerable period depending on severity of symptoms. A pt.who continues to have symtom is likely to reapse if medication is discontinued intermittently. Pt. is removed from antipsychotic treatment when he is completly free from symptoms for sufficiently long period. At the first sign of relapse drugs are reinstituted for sufficiently long period. Most common side effects of antipsychotics are certain neurologic singns,weght gain and impotence.

Electro-Convulsive-Therapy
ECT is given along with antipsychotics for rapid improvement of symptoms. Pt who is ill for a period of less than 1 yr. is more likely to respond. Generally a course of 6 ECTs (Shocks) is given. Some pts. may require more shocks say upto 10 ECT can be given on alternate days (Bilateral inusoidal Current ECT) or daily (Unilateral Constant Current brief pulse ECT).

ECT is given after making pt unconsious and giving him muscle relaxant. This prevents pain, fractures, dislocations etc.

PSYCHOSCIAL ASPECTS OF TREATMENT
Antipsychotic medicines & ECTs play major role in treatment of schizophrena however psychosocial modalities can be integeratid in to drug treatment regiman to get optimum results. Behaviour theropy is utilised in the form of appreciating desirable behavious & discouraging maladeptive behaviour Family therapy can reduce relapse rate of schizophrenic pts. if psychiatrist modifies negative behaviour of family member of schizopenic pts. like hostelity, critisism, emotional, over-involvement & pt is given social skill training so as to be a productive componant of society
in conclusion schizophrenia is a mental illness which can be cure with co-ordination between psychiatrist and family member and of pt.
(Author is Consultant Psychiatrist at Raahat Hospital, Aurangabad.)