Schizophrenia is a chronic, disabling brain disorder that affects about 1% of Americans. It may cause people to hear voices, see imaginary sights, or believe other people are controlling their thoughts. These sensations can be frightening and often lead to erratic behavior. There is no cure, but treatment can usually control the most serious symptoms.
Symptoms of schizophrenia may include:
Hallucinations -- hearing or seeing imaginary things
Delusions -- wildly false beliefs
Paranoia -- the fear others are plotting against you
Some symptoms, such as lack of enjoyment in everyday life and withdrawal from social activities, may mimic depression.
How Schizophrenia Affects Thoughts
People with schizophrenia often have abnormal ways of thinking. They may have trouble organizing their thoughts or making logical connections. They may feel like the mind is racing from one unrelated thought to another. Sometimes they experience "thought blocking," a feeling that thoughts are removed from their head. Schizophrenia is not dissociative identity disorder (multiple personality disorder.)
How Schizophrenia Affects Behavior
Schizophrenia causes a wide range of behaviors. People may speak incoherently or even make up words. They may act agitated or appear stone-faced. Many people have trouble maintaining basic hygiene or order in their homes. Schizophrenia can also cause repetitive behaviors, such as pacing. In contrast to common stereotypes, the risk of violence against others is small.
Who Gets Schizophrenia?
Schizophrenia affects men and women at the same rate, and occurs almost equally in all ethnic groups around the world. Symptoms usually begin between ages 16 and 30. The onset tends to be earlier in men than in women. Schizophrenia rarely begins during childhood or after age 45. People with schizophrenia in their family may have a higher risk for the illness.
What Causes Schizophrenia?
The exact cause is not known, but scientists suspect genes and environment both play a role. Inside the brain, levels of the chemical messengers dopamine and glutamate may be out of balance. And brain structures may be abnormal, too. For example, brain scans of identical twins show that the fluid-filled "ventricles" can be larger in a twin with schizophrenia, compared with a twin who does not have the illness. Activity levels can also be higher or lower than normal in some areas of the schizophrenic brain.
There are no lab tests to detect schizophrenia, so a diagnosis is usually based on clinical history and symptoms. Tests may be ordered to rule out other medical causes of symptoms. In teenagers, a combination of family history and certain behaviors can help predict the onset of schizophrenia. These behaviors include withdrawing from social groups and expressing unusual suspicions.
Medicine for Schizophrenia
Prescription drugs can reduce symptoms such as abnormal thinking, hallucinations, and delusions in people with schizophrenia. They work by blocking certain brain chemicals. Some people have troubling side effects, including tremors and major weight gain. Drugs may also interfere with other medicines or supplements being taken. In most cases, long-term use of medication is an essential part of managing schizophrenia.
Counseling can help people cope with their problem behaviors and thoughts, and improve how they relate to others. In cognitive behavioral therapy (CBT), people learn to test the reality of their thoughts and better manage symptoms. Other forms of therapy aim to improve self-care, communication, and relationship skills. These strategies are not meant to replace medication, but can help people already stable on medication manage everyday challenges.
Rehabilitation may include job training, money management counseling, and guidance in using public transportation or shopping for groceries. The goal is to help people with schizophrenia stay employed and maintain as much independence as possible. Rehabilitation programs are particularly effective when combined with psychotherapy.
People with schizophrenia sometimes quit their medications because of side effects or a poor understanding of their illness. This raises the risk of serious symptoms returning and triggering a full psychotic episode. Regular psychosocial therapy can help people stay on medication and avoid a relapse or the need for hospitalization.
Schizophrenia and the Workplace
People with schizophrenia often have trouble finding or keeping a job. This is partially because the disease impairs normal thinking, concentration, and communication. But it also stems from the fact that symptoms begin in young adulthood, which may interfere with education and job training. Vocational training can help people develop practical job skills.
Schizophrenia and Relationships
Relationships can be a challenge for people with schizophrenia. Their unusual thoughts and behaviors may alienate friends, co-workers, and family members. Sticking to a treatment plan can reduce antisocial symptoms. One form of therapy focuses on forming and nurturing interpersonal relationships. In addition, support groups or family therapy can help loved ones better understand the illness.
Schizophrenia and Substance Abuse
People with schizophrenia are much more likely than the general population to abuse drugs or alcohol. Some drugs, including marijuana and cocaine, can make symptoms worse. Drug abuse can also interfere with treatments for schizophrenia. Patients with a drug problem may benefit from substance abuse programs specifically designed for people with schizophrenia.
Schizophrenia and Pregnancy
Women with schizophrenia should tell their doctors if they’re thinking of becoming pregnant. Drugs used to treat schizophrenia may increase the risk of birth defects, especially if they're taken during the first trimester. Some medications have a lower risk than others, so a patient's doctor may recommend switching drugs before getting pregnant.
Tips for Family Members
It can be difficult to convince someone with schizophrenia to get help. Treatment often begins when a psychotic episode results in a hospital stay. Once the person is stabilized, family members can help prevent a relapse by:
Encouraging the person to stay on medication
Tagging along on follow-up appointments
Being supportive and respectful
Where to Learn More
To learn more about schizophrenia, contact the National Institute of Mental Health (NIMH) or the National Alliance on Mental Illness (NAMI). NAMI can put you in touch with local support groups for patients and their families.
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