Schizophrenia

Psychologists

SchizophreniaSchizophrenia

Schizophrenia affects about 1% of the world population. In the United States one in a hundred people, about 2.5 million, have this disease. It knows no racial, cultural or economic boundaries. Symptoms usually appear between the ages of 13 and 25, but often appear earlier in males than females.

Understanding Schizophrenia

Schizophrenia is a mental disorder characterized by impairments in the perception or expression of reality and by significant social or occupational dysfunction. A person experiencing schizophrenia is typically characterized as demonstrating disorganized thinking (moving from one topic to another, in a nonsensical fashion, or making up new words and sounds), and as experiencing delusions (false ideas) or hallucinations ( a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel). Someone with schizophrenia may have difficulty distinguishing between what is real and what is imaginary; may be unresponsive or withdrawn; and may have difficulty expressing normal emotions in social situations.

People with schizophrenia may hear voices other people don't hear or they may believe that others are reading their minds, controlling their thoughts, or plotting to harm them. These experiences are terrifying and can cause fearfulness, withdrawal, or extreme agitation. People with schizophrenia may not make sense when they talk, may sit for hours without moving or talking much, or may seem perfectly fine until they talk about what they are really thinking. Because many people with schizophrenia have difficulty holding a job or caring for themselves, the burden on their families and society is significant as well.

Contrary to public perception, schizophrenia is not synonymous with dissociative identity disorder, also known as multiple personality disorder or "split personality", and people with schizophrenia are generally not more violent or dangerous than other members of the population.  Most people diagnosed with schizophrenia don't commit violent crimes. People with drug problems or alcohol problems are twice as likely to commit a violent crime as someone diagnosed with schizophrenia.

While violence against others is not an issue with schizophrenia, there is an extremely high suicide rate associated with schizophrenia. A recent study showed that 30% of patients diagnosed with this condition had attempted suicide at least once during their lifetime.   Another study suggested that 10% of persons with schizophrenia die by suicide.

Schizophrenia is often described (adapted from Wikipedia) in terms of "positive" and "negative" symptoms. Positive symptoms include delusions, auditory hallucinations and thought disorder and are typically regarded as manifestations of psychosis. Negative symptoms are so named because they are considered to be the loss or absence of normal traits or abilities, and include features such as flat, blunted or constricted affect and emotion, poverty of speech and lack of motivation. Some models of schizophrenia include formal thought disorder and planning difficulties in a third group, a "disorganization syndrome".  Additionally, neurocognitive deficits may be present. These may take the form of reduced or impaired psychological functions such as memory, attention, problem-solving, executive function or social cognition.

Warning Signs of Schizophrenia

The early warning signs (adapted from National Mental Health Association) of schizophrenia are different for everyone and symptoms may develop slowly over months or years, or may appear very abruptly. The disease may come and go in cycles of relapse and remission.  No one symptom positively identifies schizophrenia. In general  the behaviors that are signs of schizophrenia include:

Hallucinations. A hallucination is something a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel. "Voices" are the most common type of hallucination in schizophrenia. Many people with the disorder hear voices that may comment on their behavior, order them to do things, warn them of impending danger, or talk to each other (usually about the patient). They may hear these voices for a long time before family and friends notice that something is wrong. Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects (although this can also be a symptom of certain brain tumors), and feeling things like invisible fingers touching their bodies when no one is near.

Delusions. Delusions are false personal beliefs that are not part of the person's culture and do not change, even when other people present proof that the beliefs are not true or logical. People with schizophrenia can have delusions that are quite bizarre, such as believing that neighbors can control their behavior with magnetic waves, people on television are directing special messages to them, or radio stations are broadcasting their thoughts aloud to others. They may also have delusions of grandeur and think they are famous historical figures. People with paranoid schizophrenia can believe that others are deliberately cheating, harassing, poisoning, spying upon, or plotting against them or the people they care about. These beliefs are called delusions of persecution.

Thought Disorder. People with schizophrenia often have unusual thought processes. One dramatic form is disorganized thinking, in which the person has difficulty organizing his or her thoughts or connecting them logically. Speech may be garbled or hard to understand. Another form is "thought blocking," in which the person stops abruptly in the middle of a thought. When asked why, the person may say that it felt as if the thought had been taken out of his or her head. Finally, the individual might make up unintelligible words, or "neologisms."

Disorders of Movement. People with schizophrenia can be clumsy and uncoordinated. They may also exhibit involuntary movements and may grimace or exhibit unusual mannerisms. They may repeat certain motions over and over or, in extreme cases, may become catatonic. Catatonia is a state of immobility and unresponsiveness. It was more common when treatment for schizophrenia was not available; fortunately, it is now rare.

Activity level and hygiene.  People with schizophrenia often neglect basic hygiene and need help with everyday activities. Because it is not as obvious that negative symptoms are part of a psychiatric illness, people with schizophrenia are often perceived as lazy and unwilling to better their lives.

Cognitive symptoms.  These include a decrease in the ability to absorb and interpret information and make decisions based on that information, an inability to sustain attention,
and problems with "working memory" (the ability to keep recently learned information in mind and use it right away).

Personality changes.  The person may be much more irrational, angry or fearful response to loved ones, they may show increased withdrawal from social situations, have a diminished ability to initiate and sustain planned activity, and may speaking infrequently even when forced to interact.

Diagnosis of Schizophrenia

Similar to some other genetically-related illnesses, schizophrenia appears when the body undergoes hormonal and physical changes, like those that occur during puberty in the teen and young adult years.  In the western world, it is found approximately equally in men and women, though the onset tends to be later in women, who also tend to have a better course and outcome. Although rare, there are also instances of childhood onset schizophrenia and late-onset schizophrenia that occurs in the elderly.

Like many mental illnesses, the diagnosis of schizophrenia is based upon the behavior of the person being assessed. The most commonly used criteria for diagnosing schizophrenia are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD). Historically, schizophrenia in the West was classified into simple, catatonic, hebephrenic, and paranoid. The classifications of schizophrenia now generally include the following::

Paranoid schizophrenia -- a person feels extremely suspicious, persecuted, or grandiose, or experiences a combination of these emotions.  Delusions and hallucinations are present but thought disorder, disorganized behavior, and affective flattening is absent.

Disorganized schizophrenia -- a person is often incoherent in speech and thought, but may not have delusions. In this type of schizophrenia, thought disorder and flat affect are present together.

Catatonic schizophrenia -- a person is withdrawn, mute, negative and often assumes very unusual body positions (called waxy flexibility). Prominent psychomotor disturbances are also evident.

Undifferentiated schizophrenia -- psychotic symptoms are present but the criteria for paranoid, disorganized, or catatonic types has not been met).

Residual schizophrenia -- a person is no longer experiencing delusions or hallucinations, but has no motivation or interest in life.

Schizoaffective disorder--a person has symptoms of both schizophrenia and a major mood disorder such as depression.

Causes of Schizophrenia

Mental health experts do not know the specific causes of schizophrenia, but research has shown that the brains of people with schizophrenia are different, as a group, from the brains of people without the illness. Like many other medical illnesses such as cancer or diabetes, schizophrenia seems to be caused by a combination of problems including genetic vulnerability and environmental factors that occur during a person's development.

Some theories about the cause of schizophrenia include: genetics (heredity), biology (the imbalance in the brain’s chemistry); and/or possible viral infections and immune disorders.  Although no common cause of schizophrenia has been identified in all individuals diagnosed with the condition, currently most researchers and clinicians believe it results from a combination of both brain vulnerabilities (either inherited or acquired) and stressful life-events.

Substantial evidence suggests that the diagnosis of schizophrenia has a heritable component (some estimates are as high as 80%). Current research suggests that environmental factors play a significant role in the expression of any genetic disposition towards schizophrenia (i.e. if someone has the genes that increase risk, this will not automatically result in a diagnosis of schizophrenia later in life).  Considerable evidence indicates that stressful life events can trigger schizophrenia.   Childhood experiences of abuse or trauma have also been implicated as risk factors for a diagnosis of schizophrenia later in life.

Studies have also revealed that some people may develop symptoms of schizophrenia as a result of using cannabis or other street drugs. It's already been established that using cannabis, cocaine and amphetamines makes the problem worse.

Treatment of Schizophrenia

While no cure for schizophrenia exists, many psychiatrists and psychologists believe that it can be managed and many people with this illness can lead productive and fulfilling lives with the proper treatment. Available treatments can relieve many of the disorder's symptoms, but most people who have schizophrenia must cope with some residual symptoms as long as they live.

The first line pharmacological therapy for schizophrenia is usually the use of medication. The primary medications for schizophrenia are called antipsychotics. Antipsychotics help relieve the positive symptoms of schizophrenia by helping to correct an imbalance in the chemicals that enable brain cells to communicate with each other. As with drug treatments for other physical illnesses, many patients with severe mental illnesses may need to try several different antipsychotic medications before they find the one, or the combination of medications, that works best for them.

Like diabetes or high blood pressure, schizophrenia is a chronic disorder that needs constant management. At the moment, it cannot be cured, but the rate of recurrence of psychotic episodes can be decreased significantly by staying on medication. Although responses vary from person to person, most people with schizophrenia need to take some type of medication for the rest of their lives as well as use other approaches, such as supportive therapy or rehabilitation. Relapses occur most often when people with schizophrenia stop taking their antipsychotic medication because they feel better, or only take it occasionally because they forget or don't think taking it regularly is important. It is very important for people with schizophrenia to take their medication on a regular basis and for as long as their doctors recommend. If they do so, they will experience fewer psychotic symptoms.

Psychotherapy or other forms of talk therapy may be offered, with cognitive behavioral therapy being the most frequently used. This may focus on the direct reduction of the symptoms, or on related aspects, such as issues of self-esteem, social functioning, and insight.  Talking therapies, such as psychotherapy, counseling and cognitive behavior therapy (CBT), can help people to overcome some of the negative effects of the illness by helping the schizophrenic to recognize their problem, deal effectively with its consequences, develop coping strategies and learn how to prevent crisis situations from developing.

Self-help groups for people with schizophrenia and their families are becoming increasingly common. Although professional therapists are not involved, the group members are a continuing source of mutual support and comfort for each other, which is also therapeutic. People in self-help groups know that others are facing the same problems they face and no longer feel isolated by their illness or the illness of their loved one. The networking that takes place in self-help groups can also generate social action. Families working together can advocate for research and more hospital and community treatment programs, and patients acting as a group may be able to draw public attention to the discriminations many people with mental illnesses still face in today's world.

Electroconvulsive therapy (also known as ECT or electroshock therapy) may be used in countries where it is legal. It is not considered a first line treatment but may be prescribed in cases where other treatments have failed. Psychosurgery, which at one time was much more prevalent, has now become a rare procedure and is not a recommended treatment for schizophrenia.

Alternative medicine tends to hold the view that schizophrenia is primarily caused by imbalances in the body's reserves and absorption of dietary minerals, vitamins, fats, and/or the presence of excessive levels of toxic heavy metals. The body's adverse reactions to gluten are also strongly implicated in some alternative theories (see gluten-free, casein-free diet).

Transcranial magnetic stimulation (TMS) is a fairly new treatment, and is not generally available. It uses magnetic impulses to stimulate underactive frontal regions of the brain. This may be helpful for people who have mainly negative symptoms. Although still on trial, it's non-invasive and seems to be quite safe.

If you feel there's a serious risk that harm may come to the schizophrenic, or to anyone else, it may be necessary to consider compulsory hospital admission, as a last resort. People who experience acute symptoms of schizophrenia may require intensive inpatient treatment. Hospitalization is necessary to treat severe delusions or hallucinations, serious suicidal thoughts, an inability to care for oneself, or severe problems with drugs or alcohol. It also is important to protect people from hurting themselves or others.

Additional Information

For more information about Schizophrenia and other mental health problems, please click on the linked websites listed below.

 Schizophrenia.com
 NIHI about schizophrenia
 National Alliance on Mental Illness
 NIMH  publication on schizophrenia
 Behavenet capsule on schizophrenia
 National Mental Health Association on Schizophrenia

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