Schizophrenia: An Overview
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 sometimes a physical exam. While there are no laboratory tests to specifically diagnose schizophrenia, the doctor may use various tests, and possibly blood tests or brain imaging studies, to rule out another physical illness or intoxication (substance-induced psychosis) as the cause of the symptoms.
If the doctor finds no other 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 interviews and assessment tools to evaluate a person for a psychotic disorder. The therapist bases his or her diagnosis on the person's and family'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 (commonly referred to as "first generation") medications used include: chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), loxapine (Loxapine), perphenazine (Trilafon), thioridazine (Mellaril), thiothixene (Navane), and trifluoperazine (Stelazine). Newer ("atypical" or second generation) drugs used to treat schizophrenia include: aripiprazole (Abilify), aripiprazole lauroxil (Aristada), asenapine (Saphris), clozapine (Clozaril), iloperidone (Fanapt), lurasidone (Latuda), paliperidone (Invega Sustenna), paliperidone palmitate (Invega Trinza), quetiapine (Seroquel), risperidone (Risperdal), and olanzapine (Zyprexa), and ziprasidone (Geodon). Other, even newer atypical antipsychotics include brexpiprazole (Rexulti) and cariprazine (Vraylar).
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.
- Cognitive remediation involves learning techniques to compensate for problems with information processing, often through drills, coaching and computer-based exercises, to strengthen specific mental skills involving attention, memory and planning/organization.
- 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 or who cannot take care of themselves at home may require hospitalization to stabilize their condition.
Electroconvulsive therapy (ECT): This is a procedure in which electrodes are attached to the person's scalp and, while asleep under general anesthesia, a small electric shock is delivered to the brain. A course of ECT treatment usually involves 2-3 treatments per week for several weeks. Each shock treatment causes a controlled seizure, and a series of treatments over time leads to improvement in mood and thinking. Scientists do not fully understand exactly how ECT and the controlled seizures it causes have a therapeutic effect, although some researcher think that ECT-induced seizures may affect the release of neurotransmitters in the brain. ECT is less well established for treating schizophrenia than depression or bipolar disorder, and it is therefore not used very often when mood symptoms are absent. ECT is sometimes helpful when medications fail or if severe depression or catatonia makes treating the illness difficult.
Psychosurgery: In the 1940s and 1950s, a neurosurgical procedure called a prefrontal lobotomy was sometimes used to treat severe agitation associated with psychosis. Because it caused serious and irreversible negative effects that dulled personality and motivation, the procedure is no longer performed as a psychiatric treatment. Other, more modern neurosurgical procedures being studied to treat schizophrenia include deep brain stimulation (DBS) -- an entirely different operation that is not at all related to lobotomy -- in which stimulating electrodes are surgically implanted in brain areas believed to control thinking and perception. DBS is an established treatment for severe Parkinson's Disease and essential tremor, and remains experimental for the treatment of psychiatric disorders.