Espectro de la esquizofrenia y otros trastornos psicóticos
Espectro de la esquizofrenia: qué es, características y síntomas
El espectro de la esquizofrenia y otros trastornos psicóticos se definen por la presencia de anomalías en uno o más de los siguientes cinco dominios: delirios, alucinaciones, pensamientos o discurso desorganizado, comportamientos muy anómalos o catatónicos y síntomas negativos
Los delirios son creencias fijas, inmodificables pese a la argumentación lógica o a las pruebas en su contra. Hay delirios que se consideran extravagantes o inverosímiles, mientras que otros son más plausibles o creíbles.
Las alucinaciones son percepción sin objetos. Son vívidas, claras e involuntarias. Pueden darse en cualquier modalidad sensorial: auditiva, visuales, táctiles, olfativas, cinestésicas, etc.
El pensamiento (discurso) desorganizado se caracteriza por un discurso incomprensible, donde el sujeto puede cambiar de un tema a otro o responder preguntas con otro contenido que no está relacionado en lo absoluto.
El comportamiento motor muy desorganizado o catatónico se puede manifestar de diferentes formas. Desde comportamientos infantiloides a la agitación impredecible. El comportamiento catatónico es una disminución marcada de la reactividad al entorno. También puede incluir la adopción de posturas rígidas, negativismo, mutismo, estupor, movimientos estereotipados.
Los síntomas negativos son especialmente prominentes en la esquizofrenia: expresión emotiva disminuida y la abulia (falta de deseo por un propósito)
Otros síntomas son la alogia (disminución del habla), la anhedonia (disminución de la capacidad para experimentar placer) y la asocialidad (falta de interés por las interacciones sociales)
¿Qué diagnósticos son los más comunes?
El diagnóstico de un trastorno del espectro de la esquizofrenia requiere considerar la exclusión de otras afecciones que pueden dar lugar a psicosis pero que no cumplen todos los criterios de ningún trastorno psicótico.
Los diagnósticos que se incluyen en los trastornos del espectro de la esquizofrenia y otros trastornos psicóticos son:
Esquizofrenia, trastorno esquizotípico (de la personalidad), trastorno delirante, trastorno psicótico breve, trastorno esquizofreniforme, trastorno esquizoafectivo, catatonía, trastorno psicótico inducido por sustancias o medicamentos u otra afección médica.
Síntomas de la esquizofrenia
La esquizofrenia es un trastorno que se caracteriza por la presencia de dos o más de los siguientes síntomas:
1 Delirios
2 Alucinaciones
3 Discurso desorganizado
4 Comportamiento muy desorganizado o catatónico
5 Síntomas negativos
Cada síntoma debe presentarse durante un período de un mes y al menos uno de ellos ha de ser de los 3 primeros criterios.
Características asociadas que apoyan el diagnóstico
Los individuos con esquizofrenia pueden mostrar afecto inapropiado, un estado de ánimo disfórico que puede variar entre la depresión, ansiedad o el enfado, alteraciones en el patrón del sueño, falta de interés por comer o rechazo de la comida.
La despersonalización, la desrealización y las preocupaciones somáticas suelen manifestarse. Los déficits cognitivos son comunes, incluso pueden afectar la memoria, el lenguaje y otras funciones ejecutivas. Algunos individuos con esquizofrenia carecen de conciencia de enfermedad o ausencia de introspección.
Es importante señalar que la gran mayoría de las personas con esquizofrenia no son agresivas.
La prevalencia de la esquizofrenia a lo largo de la vida parece ser aproximadamente del 0, 3 al 0,7 % y es mayor en varones.
El inicio de la enfermedad se sitúa a finales de la adolescencia o principios de la adultez. Puede ser brusco o insidioso, aunque la mayoría de las personas presentan un desarrollo lento y gradual. Los síntomas psicóticos tienden a disminuir con la edad, quizás con la reducción normal de la actividad dopaminérgica asociada a la edad.
Las características esenciales de la esquizofrenia son las mismas en la infancia, pero en esta etapa resulta más difícil realizar el diagnóstico.
Factores de riesgo
Existen factores ambientales relacionados con la incidencia de la esquizofrenia como zonas urbanas o épocas del año.
Hay una importante contribución de los factores genéticos a la hora de evaluar el riesgo de presentar esquizofrenia.
Las complicaciones en el embarazo y el parto con hipoxia se asocian a un riesgo más elevado de padecer esquizofrenia para el feto en desarrollo.
Consecuencias funcionales de la esquizofrenia
La esquizofrenia se asocia a una disfunción social y laboral significativa. A la mayoría de los sujetos se les dificulta conservar un empleo por las manifestaciones típicas del trastorno, casarse o mantener contactos sociales más allá de su familia.
Conoce más sobre la equizofrenia y otros trastornos psicóticos con los programas especializados en psiquiatría de 4Doctors. Pulsa aquí y descubre nuestros programas.
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