Schizophrenia is a mental disorder that generally appears in late adolescence or early adulthood. Characterized by delusions, hallucinations, and other cognitive difficulties, schizophrenia can often be a life-long struggle.
In this article, we will cover the causes, symptoms, and treatment of schizophrenia.
Fast facts on schizophrenia
Here are some key points about schizophrenia. More detail and supporting information is in the main article.
- Schizophrenia effects and estimated 1 percent of the population
- Symptoms include delusions, hallucinations, and disorganized thoughts
- Diagnosing schizophrenia comes only after other disease have been ruled out
What is schizophrenia?
Schizophrenia is often a life-long condition.
Individuals with schizophrenia may hear voices that are not there. Some may be convinced that others are reading their minds, controlling how they think, or plotting against them.
This can distress patients severely and persistently, making them withdrawn and, at times, frantic.
Others may find it hard to make sense of what a person with schizophrenia is talking about. In some cases, the individual may spend hours completely still, without talking.
On other occasions, he or she may seem fine until they start explaining what they are truly thinking.
The effects of schizophrenia reach far beyond the patient - families, friends, and society are affected too.
A sizable proportion of people with schizophrenia have to rely on others because they are unable to hold a job or care for themselves. Many may also resist treatment, arguing that there is nothing wrong with them.
With proper treatment, patients can lead productive lives. Treatment can help relieve many of the symptoms of schizophrenia. However, the majority of patients with the disorder have to cope with the symptoms for life.
Schizophrenia most commonly strikes between the ages of 16 and 30, and males tend to show symptoms at a slightly younger age than females. In many cases, the disorder develops so slowly that the sufferer does not know they have it for many years. However, in other cases, it can strike suddenly and develop quickly.
Schizophrenia affects approximately 1 percent of all adults, globally. Experts say schizophrenia is probably many illnesses masquerading as one. Research suggests that schizophrenia may be the result of faulty neuronal development in the brain of the fetus, which later in life emerges as a full-blown illness.
Symptoms of schizophrenia
Symptoms and signs of schizophrenia will vary, depending on the individual. The symptoms are classified into four categories:
- Positive symptoms - also known as psychotic symptoms. For example, delusions and hallucinations.
- Negative symptoms - these refer to elements that are taken away from the individual. For example, absence of facial expressions or lack of drive to do things.
- Cognitive symptoms - these affect the person's thought processes. They may be positive or negative symptoms, for example, poor concentration is a negative symptom.
- Emotional symptoms - these are usually negative symptoms, such as blunted emotions.
Below is a list of the major symptoms:
- Delusions - The patient has false beliefs which can take many forms, such as delusions of persecution, or delusions of grandeur. They may feel others are attempting to control them through remote control. Or, they may think they have extraordinary powers and gifts.
- Hallucinations - hearing voices is much more common than seeing, feeling, tasting, or smelling things which are not there, however, people with schizophrenia may experience a wide range of hallucinations.
- Thought disorder - the person may jump from one subject to another for no logical reason. The speaker may be hard to follow.
Other symptoms may include:
- Lack of motivation (avolition) - the patient loses their drive. Everyday actions, such as washing and cooking, are abandoned.
- Poor expression of emotions - responses to happy or sad occasions may be lacking, or inappropriate.
- Social withdrawal - when a patient with schizophrenia withdraws socially, it is often because they believe somebody is going to harm them.
- Unaware of illness - as the hallucinations and delusions seem so real for patients, many of them may not believe they are ill. They may refuse to take medication for fear of side-effects, or for fear that the medication may be poison, for example.
- Cognitive difficulties - the patient's ability to concentrate, remember things, plan ahead, and to organize their life are affected. Communication becomes more difficult.
What causes schizophrenia?
Nobody has been able to pinpoint one single cause. Experts believe several factors are generally involved in contributing to the onset of schizophrenia.
Evidence suggests that genetic and environmental factors act together to bring about schizophrenia. The condition has an inherited element, but it is also significantly influenced by environmental triggers.
Below is a list of the factors that are thought to contribute towards the onset of schizophrenia:
If there is no history of schizophrenia in a family, the chances of developing it are less than 1 percent. However, that risk rises to 10 percent if a parent was diagnosed.
Chemical imbalance in the brain
Experts believe that an imbalance of dopamine, a neurotransmitter, is involved in the onset of schizophrenia. Other neurotransmitters, such as serotonin, may also be involved.
Although there is no evidence to prove or even indicate that family relationships might cause schizophrenia, some patients with the illness believe family tension triggers relapses.
Although there is no definite proof, many suspect that prenatal or perinatal trauma and viral infections may contribute to the development of the disease.
Stressful experiences often precede the emergence of schizophrenia. Before any acute symptoms are apparent, people with schizophrenia habitually become bad-tempered, anxious, and unfocused. This can trigger relationship problems, divorce, and unemployment.
These factors are often blamed for the onset of the disease, when really it was the other way round - the disease caused the crisis. Therefore, it is extremely difficult to know whether schizophrenia caused certain stresses or occurred as a result of them.
Cannabis and LSD are known to cause schizophrenia relapses. For people with a predisposition to a psychotic illness such as schizophrenia, usage of cannabis may trigger the first episode.
Some researchers believe that certain prescription drugs, such as steroids and stimulants, can cause psychosis.
Before diagnosing schizophrenia, other conditions need to be ruled out first.
A schizophrenia diagnosis is reached by observing the actions of the patient. If the doctor suspects possible schizophrenia, they will need to know about the patient's medical and psychiatric history.
Certain tests will be ordered to rule out other illnesses and conditions that may trigger schizophrenia-like symptoms. Examples of some of the tests may include:
- Blood tests
- Imaging studies - to rule out tumors and problems in the structure of the brain
- Psychological evaluation - a specialist will assess the patient's mental state by asking about thoughts, moods, hallucinations, suicidal traits, violent tendencies or potential for violence, as well as observing their demeanor and appearance
Schizophrenia - diagnostic criteria
Patients must meet the criteria outlined in the DSM (Diagnostic and Statistical Manual of Mental Disorders). This is an American Psychiatric Association manual used by healthcare professionals to diagnose mental illnesses and conditions.
The health care professional needs to exclude other possible mental health disorders, such as bipolar disorder or schizoaffective disorder.
It is also important to establish that the signs and symptoms have not been caused by, for example, a prescribed medication or substance abuse.
Also, the patient must:
1) Have at least two of the following typical symptoms of schizophrenia -
- Disorganized or catatonic behavior
- Disorganized speech
- Negative symptoms that are present for much of the time during the last 4 weeks
2) Experience considerable impairment in the ability to attend school, carry out their work duties, or carry out everyday tasks
3) Have symptoms which persist for 6 months or more
Treatments for schizophrenia
Psychiatrists say the most effective treatment for schizophrenia patients is usually a combination of medication, psychological counseling, and self-help resources. Anti-psychosis drugs have transformed schizophrenia treatment. Thanks to them, the majority of patients are able to live in the community, rather than stay in hospital.
The primary schizophrenia treatment is medication. Sadly, compliance (following the medication regimen) is a major problem. People with schizophrenia often come off their medication for long periods during their lives, at huge personal costs to themselves and often to those around them.
Ensuring the patient continues with medication is the key to successful treatment.
The patient must continue taking medication even when symptoms are gone, otherwise they will come back.
The majority of patients come off their medication within the first year of treatment. To address this, successful schizophrenia treatment needs to consist of a life-long regimen of both drug and psychosocial support therapies.
The medication can help control the patient's hallucinations and delusions, but it cannot help them learn to communicate with others, get a job, and thrive in society.
Although one may readily suggest that all a person with schizophrenia has to do is "comply with treatment" and they will live a happy and productive life. Unfortunately, impaired insight is one of the symptoms of schizophrenia.
The person with schizophrenia often does not have insight into their condition and, as a result, does not believe that they are sick. This often contributes to non-compliance with medication.
The first time a person experiences schizophrenia symptoms, it can be very unpleasant. They may take a long time to recover, and that recovery can be a lonely experience. It is crucial that a schizophrenia sufferer receives the full support of their family, friends, and community services when onset appears for the first time.
Medications for schizophrenia
- Risperidone (Risperdal) - less sedating than other atypical antipsychotics. Weight gain and diabetes are possible side effects, but are less likely to happen, compared with Clozapine or Olanzapine.
- Olanzapine (Zyprexa) - may also improve negative symptoms. However, the risks of serious weight gain and the development of diabetes are significant.
- Quetiapine (Seroquel) - risk of weight gain and diabetes, however, the risk is lower than Clozapine or Olanzapine.
- Ziprasidone (Geodon) - the risk of weight gain and diabetes is lower than other atypical antipsychotics. However, it might contribute to cardiac arrhythmia.
- Clozapine (Clozaril) - effective for patients who have been resistant to treatment. It is known to lower suicidal behaviors in patients with schizophrenia. The risk of weight gain and diabetes is significant.
Other newer agents also exist, and still more agents are currently being examined for their use in treating schizophrenia.