Schizophrenia

Schizophrenia: An Overview

 

Schizophrenia is a serious brain disorder that distorts the way a person thinks, acts, expresses emotions, perceives reality, and relates to others. People with schizophrenia -- the most chronic and disabling of the major mental illnesses -- often have problems functioning in society, at work, at school, and in relationships. Schizophrenia can leave its sufferer frightened and withdrawn. It is a life-long disease that cannot be cured but usually can be controlled with proper treatment.

Contrary to popular belief, schizophrenia is not a split personality. Schizophrenia is a psychosis, a type of mental illness in which a person cannot tell what is real from what is imagined. At times, people with psychotic disorders lose touch with reality. The world may seem like a jumble of confusing thoughts, images, and sounds. The behavior of people with schizophrenia may be very strange and even shocking. A sudden change in personality and behavior, which occurs when schizophrenia sufferers lose touch with reality, is called a psychotic episode.

Schizophrenia varies in severity from person to person. Some people have only one psychotic episode while others have many episodes during a lifetime but lead relatively normal lives between episodes. Still other individuals with this disorder may experience a decline in their functioning over time with little improvement between full blown psychotic episodes. Schizophrenia symptoms seem to worsen and improve in cycles known as relapses and remissions.

Schizophrenia is a term given to a complex group of mental disorders. However, different types of schizophrenia may have some of the same symptoms. There are several subtypes of schizophrenia based on symptoms:

• Paranoid schizophrenia: People with this type are preoccupied with false beliefs (delusions) about being persecuted or being punished by someone. Their thinking, speech, and emotions, however, remain fairly normal.
• Disorganized schizophrenia: People with this type often are confused and incoherent and have jumbled speech. Their outward behavior may be emotionless or flat or inappropriate, even silly or childlike. Often they have disorganized behavior that may disrupt their ability to perform normal daily activities such as showering or preparing meals.
• Catatonic schizophrenia: The most striking symptoms of this type are physical. People with catatonic schizophrenia are generally immobile and unresponsive to the world around them. They often become very rigid and stiff and unwilling to move. Occasionally, these people have peculiar movements like grimacing or assume bizarre postures. Or, they might repeat a word or phrase just spoken by another person. At times, the opposite may be true and these individuals appear to engage in restless ongoing activity with no specific purpose or desired outcome (for example, walking a straight line over and over; repeatedly jumping in place). People with catatonic schizophrenia generally go back and forth between more sedentary behaviors and the restless, purposeless behaviors and are at increased risk of malnutrition, exhaustion, or self-inflicted injury.
• Undifferentiated schizophrenia: This subtype is diagnosed when the person's symptoms do not clearly represent one of the other three subtypes.
• Residual Schizophrenia: In this type of schizophrenia, the severity of schizophrenia symptoms has decreased. Hallucinations, delusions, or other symptoms may still be present but are considerably less than when the schizophrenia was originally diagnosed. In addition, there must still be evidence of the disturbance as indicated by the presence of some negative symptoms (for example, inexpressive faces, blank looks, monotone speech, seeming lack of interest in the world and other people, inability to feel pleasure).

What Are the Symptoms of Schizophrenia?

People with schizophrenia may have a number of symptoms involving changes in ability, behavior, and personality, and they may display different kinds of behavior at different times. When the illness first appears, symptoms usually are sudden and severe.

The most common symptoms of schizophrenia can be grouped into three categories: Positive symptoms, disorganized symptoms, and negative symptoms.

Positive Symptoms of Schizophrenia

In this case, the word positive does not mean "good." Rather, it refers to obvious symptoms that are not present in people without schizophrenia. These symptoms, which are sometimes referred to as psychotic symptoms, include:

• Delusions: Delusions are strange beliefs that are not based in reality and that the person refuses to give up, even when presented with factual information. For example, the person suffering from delusions may believe that people can hear his or her thoughts, that he or she is God or the devil, or that people are putting thoughts into his or her head or plotting against them.
• Hallucinations: These involve perceiving sensations that aren't real, such as seeing things that aren't there, hearing voices, smelling strange odors, having a "funny" taste in your mouth, and feeling sensations on your skin even though nothing is touching your body. Hearing voices is the most common hallucination in people with schizophrenia. The voices may comment on the person's behavior, insult the person, or give commands.
• Catatonia (a condition in which the person becomes fixed in a single position for a very long time).

Disorganized symptoms of schizophrenia are a type of positive symptom that reflects the person's inability to think clearly and respond appropriately.  Examples of disorganized symptoms include:

• Talking in sentences that do not make sense or using nonsense words, making it difficult for the person to communicate or engage in conversation
• Shifting quickly from one thought to the next
• Moving slowly
• Being unable to make decisions
• Writing excessively but without meaning
• Forgetting or losing things
• Repeating movements or gestures, such as pacing or walking in circles
• Having problems making sense of everyday sights, sounds, and feelings

  Cognitive Symptoms of Schizophrenia

  Cognitive symptoms include:
• Poor executive functioning (the ability to understand information and to use it to make decisions)
• Trouble focusing or paying attention
•  Difficulty with working memory (the ability to use information immediately after learning it)

Negative Symptoms of Schizophrenia

In this case, the word negative does not mean "bad," but reflects the absence of certain normal behaviors in people with schizophrenia. Negative symptoms of schizophrenia include:

• Lack of emotion or a very limited range of emotions
• Withdrawal from family, friends, and social activities
• Reduced energy
• Reduced speech
• Lack of motivation
• Loss of pleasure or interest in life
• Poor hygiene and grooming habits

What Causes Schizophrenia?

The exact cause of schizophrenia is not yet known. It is known, however, that schizophrenia -- like cancer and diabetes -- is a real illness with a biological basis. It is not the result of bad parenting or personal weakness. Researchers have uncovered a number of factors that appear to play a role in the development of schizophrenia, including:

• Genetics (heredity): Schizophrenia tends to run in families, which means a greater likelihood to develop schizophrenia may be passed on from parents to their children.
• Brain chemistry: People with schizophrenia may have an imbalance of certain chemicals in the brain. They may be either very sensitive to or produce too much of a brain chemical called dopamine. Dopamine is a neurotransmitter, a substance that helps nerve cells in the brain send messages to each other. An imbalance of dopamine affects the way the brain reacts to certain stimuli, such as sounds, smells, and sights and can lead to hallucinations and delusions.
• Brain abnormality: Research has found abnormal brain structure and function in people with schizophrenia. However, this type of abnormality doesn't happen in all schizophrenics and can occur in people without the disease.
• Environmental factors: Evidence suggests that certain environmental factors, such as a viral infection, extensive exposure to toxins like marijuana, or highly stressful situations, may trigger schizophrenia in people who have inherited a tendency to develop the disorder. Schizophrenia more often surfaces when the body is undergoing hormonal and physical changes, such as those that occur during the teen and young adult years.

Who Gets Schizophrenia?

Anyone can get schizophrenia. It is diagnosed all over the world and in all races and cultures. While it can occur at any age, schizophrenia typically first appears in the teenage years or early 20s. The disorder affects men and women equally, although symptoms generally appear earlier in men (in their teens or 20s) than in women (in their 20s or early 30s). Earlier onset of symptoms has been linked to a more severe course of illness. Children over the age of 5 can develop schizophrenia, but it is very rare before adolescence.

How Common Is Schizophrenia?

Schizophrenia occurs in about 1% of the population. About 2.2 million Americans, ages 18 and older, will develop schizophrenia.

How Is Schizophrenia Diagnosed?

If symptoms of schizophrenia are present, the doctor will perform a complete medical history and physical exam. While there are no laboratory tests to specifically diagnose schizophrenia, the doctor may use various tests, such as X-rays and blood tests, to rule out a physical illness or intoxication (substance-induced psychosis) as the cause of the symptoms.

If the doctor finds no physical reason for the schizophrenia symptoms, he or she may refer the person to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a psychotic disorder. The therapist bases his or her diagnosis on the person's report of symptoms and his or her observation of the person's attitude and behavior. A person is considered to have schizophrenia if he or she has characteristic symptoms that last for at least six months.

How Is Schizophrenia Treated?

The goal of schizophrenia treatment is to reduce the symptoms and to decrease the chances of a relapse, or return of symptoms. Treatment for schizophrenia may include: 

• Medications: The primary medications used to treat schizophrenia are called antipsychotics. These drugs do not cure schizophrenia but help relieve the most troubling symptoms, including delusions, hallucinations, and thinking problems. Older medications used include: Thorazine, Prolixin, Haldol, Navane, Stelazine, Trilafon, Loxapine, and Mellaril. Newer drugs used to treat schizophrenia include: Abilify, Clozaril, Geodon, Invega, Latuda, Risperdal, Saphris, Seroquel, and Zyprexa.
• Psychosocial therapy: While medication may help relieve symptoms of schizophrenia, various psychosocial treatments can help with the behavioral, psychological, social, and occupational problems associated with the illness. Through therapy, patients also can learn to manage their symptoms, identify early warning signs of relapse, and develop a relapse prevention plan. Psychosocial therapies include:
  • Rehabilitation, which focuses on social skills and job training to help people with schizophrenia function in the community and live as independently as possible.
  • Individual psychotherapy, which can help the person better understand his or her illness, and learn coping and problem-solving skills.
  • Family therapy, which can help families deal more effectively with a loved one who has schizophrenia, enabling them to better help their loved one.
  • Group therapy/support groups, which can provide continuing mutual support.
• Hospitalization: Many people with schizophrenia may be treated as outpatients. However, people with particularly severe symptoms, or those in danger of hurting themselves or others may require hospitalization to stabilize their condition.
• Electroconvulsive therapy (ECT): This is a procedure in which electrodes are attached to the person's head and a series of electric shocks are delivered to the brain. The shocks induce seizures, causing the release of neurotransmitters in the brain. This form of treatment is rarely used today in the treatment of schizophrenia. ECT may be useful when all medications fail or if severe depression or catatonia makes treating the illness difficult.
• Psychosurgery: Lobotomy, an operation used to sever certain nerve pathways in the brain, was formerly used in some patients with severe, chronic schizophrenia. It is now performed only under extremely rare circumstances. This is because of the serious, irreversible personality changes that the surgery may produce and the fact that far better results are generally attained from less drastic and hazardous procedures

Are People With Schizophrenia Dangerous?

Popular books and movies often depict people with schizophrenia and other mental illnesses as dangerous and violent. This is usually not true. Most people with schizophrenia are not violent. More typically, they prefer to withdraw and be left alone. In some cases, however, people with mental illness may engage in dangerous or violent behaviors that are generally a result of their psychosis and the resulting fear from feelings of being threatened in some way by their surroundings.

On the other hand, people with schizophrenia can be a danger to themselves. Suicide is the number one cause of premature death among people with schizophrenia.

What Is the Outlook for People With Schizophrenia?

With proper treatment, most people with schizophrenia can lead productive and fulfilling lives. Depending on the level of severity and the consistency of treatment received they are able to live with their families or in community settings rather than in long-term psychiatric institutions.

Ongoing research on the brain and how brain disorders develop will likely lead to more effective medicines with fewer side effects.

Can Schizophrenia Be Prevented?

There is no known way to prevent schizophrenia. However, early diagnosis and treatment can help avoid or reduce frequent relapses and hospitalizations and help decrease the disruption to the person's life, family, and relationships.

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Reviewed by Noëlle Santorelli, PhD on April 26, 2013

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“Never give up on someone with a mental illness. When "I" is replaced by "We", illness becomes wellness.”
― Shannon L. Alder

 

Take care,  Shawn. Happy Thursday.