Schizophrenia: An Overview

Schizophrenia is a chronic, severe mental disorder that affects the way a person thinks, acts, expresses emotions, perceives reality, and relates to others. Though schizophrenia isn’t as common as other major mental illnesses, it can be the most chronic and disabling.

People with schizophrenia often have problems doing well in society, at work, at school, and in relationships. They might feel frightened and withdrawn, and could appear to have lost touch with reality. This lifelong disease can’t be cured but can be controlled with proper treatment.

Contrary to popular belief, schizophrenia is not a split or multiple personality. Schizophrenia involves a psychosis, a type of mental illness in which a person can’t tell what’s real from what’s imagined. At times, people with psychotic disorders lose touch with reality. The world may seem like a jumble of confusing thoughts, images, and sounds. Their behavior may be very strange and even shocking. A sudden change in personality and behavior, which happens when people who have it lose touch with reality, is called a psychotic episode.

How severe schizophrenia is varies from person to person. Some people have only one psychotic episode, while others have many episodes during a lifetime but lead relatively normal lives in between. Still others may have more trouble 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.

What Are the Early Symptoms of Schizophrenia?

The condition usually shows its first signs in men in their late teens or early 20s. It mostly affects women in their early 20s and 30s. The period when symptoms first start and before full psychosis is called the prodromal period. It can last days, weeks, or even years. It can be hard to spot because there’s usually no specific trigger. You might only notice subtle behavioral changes, especially in teens. This includes:

  • A change in grades
  • Social withdrawal
  • Trouble concentrating
  • Temper flares
  • Difficulty sleeping

Positive Symptoms of Schizophrenia

In this case, the word positive doesn’t mean good. It refers to added thoughts or actions that aren’t based in reality. They’re sometimes called psychotic symptoms and can include:

  • Delusions: These are false, mixed, and sometimes strange beliefs that aren’t based in reality and that the person refuses to give up, even when shown the facts. For example, a person with delusions may believe that people can hear their thoughts, that they are God or the devil, or that people are putting thoughts into their head or plotting against them.
  • Hallucinations: These involve sensations that aren't real. Hearing voices is the most common hallucination in people with schizophrenia. The voices may comment on the person's behavior, insult them, or give commands. Less common types include seeing things that aren't there, smelling strange odors, having a funny taste in your mouth, and feeling sensations on your skin even though nothing is touching your body.
  • Catatonia: In this condition, the person may stop speaking, and their body may be fixed in a single position for a very long time.

 

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Disorganized Symptoms of Schizophrenia

These are positive symptoms that show that the person can’t think clearly or respond as expected. Examples include:

  • Talking in sentences that don’t make sense or using nonsense words, making it difficult for the person to communicate or hold a conversation
  • Shifting quickly from one thought to the next without obvious or logical connections between them
  • Moving slowly
  • Being unable to make decisions
  • Writing excessively but without meaning
  • Forgetting or losing things
  • Repeating movements or gestures, like pacing or walking in circles
  • Having problems making sense of everyday sights, sounds, and feelings

Cognitive Symptoms of Schizophrenia

The person will have trouble:

  • Understanding information and using it to make decisions (a doctor might call this poor executive functioning)
  • Focusing or paying attention
  • Using their information immediately after learning it (this is called working memory)
  • Recognizing that they have any of these problems

Negative Symptoms of Schizophrenia

The word "negative" here doesn’t mean "bad." It notes the absence of normal behaviors in people with schizophrenia. Negative symptoms of schizophrenia include:

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

What Causes Schizophrenia?

The exact cause of schizophrenia isn’t known. But like cancer and diabetes, schizophrenia is a real illness with a biological basis. Researchers have uncovered a number of things that appear to make someone more likely to get schizophrenia, including:

  • Genetics (heredity): Schizophrenia can run in families, which means a greater likelihood to have schizophrenia may be passed on from parents to their children.
  • Brain chemistry and circuits: People with schizophrenia may not be able to regulate brain chemicals called neurotransmitters that control certain pathways, or "circuits," of nerve cells that affect thinking and behavior.
  • Brain abnormality: Research has found abnormal brain structure in people with schizophrenia. But this doesn’t apply to all people with schizophrenia. It can affect people without the disease.
  • Environment: Things like viral infections, exposure to toxins like marijuana, or highly stressful situations may trigger schizophrenia in people whose genes make them more likely to get the disorder. Schizophrenia more often surfaces when the body is having hormonal and physical changes, like those that happen during the teen and young adult years.

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Who Gets Schizophrenia?

Anyone can get schizophrenia. It affects people all over the world, from all races and cultures. While it can happen 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. The earlier the symptoms start, the more severe the illness tends to be. Children over the age of 5 can have schizophrenia, but it’s rare before adolescence.

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, they may refer the person to a psychiatrist or psychologist, mental health professionals 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 her diagnosis on the person's and family's report of symptoms and her observation of the person's attitude and behavior.

A person is diagnosed with schizophrenia if they have at least two of these symptoms for at least 6 months:

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Disorganized or catatonic behavior
  • Negative symptoms

One of the symptoms has to be

  • Delusions
  • Hallucinations
  • Disorganized speech

During the 6 months, the person must have a month of active symptoms. (It can be less with successful treatment.) Symptoms should negatively affect them socially or at work, and can’t be caused by any other condition.

How Is Schizophrenia Treated?

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

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Note: Clozapine is the only FDA-approved medication for treating schizophrenia that is resistant to other treatments. It’s also used to lessen suicidal behaviors in those with schizophrenia who are at risk.

  • Coordinated specialty care (CSC) : This is a team approach toward treating schizophrenia when the first symptoms appear. It combines medicine and therapy with social services, employment, and educational interventions. The family is involved as much as possible. Early treatment is key to helping patients lead a normal life.
  • Psychosocial therapy: While medication may help relieve symptoms of schizophrenia, various psychosocial treatments can help with the behavioral, psychological, social, and occupational problems that go with the illness. Through therapy, patients also can learn to manage their symptoms, identify early warning signs of relapse, and come up with 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, which involves learning techniques to make up for problems with information processing. It often uses drills, coaching, and computer-based exercises to strengthen mental skills that involve attention, memory, planning, and organization.
    • Individual psychotherapy, which can help the person better understand his illness, and learn coping and problem-solving skills
    • Family therapy, which can help families deal 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. But hospitalization may be the best option for people:
    • With severe symptoms
    • Who might harm themselves or others
    • Who can’t take care of themselves at home
  • Electroconvulsive therapy (ECT): In this procedure, electrodes are attached to the person's scalp. While they’re asleep under general anesthesia, doctors send a small electric shock to the brain. A course of ECT therapy usually involves 2-3 treatments per week for several weeks. Each shock treatment causes a controlled seizure. A series of treatments over time leads to improvement in mood and thinking. Scientists don’t fully understand exactly how ECT and the controlled seizures it causes help, but some researchers think ECT-induced seizures may affect the release of neurotransmitters in the brain. ECT is less well-proven to help with schizophrenia than depression or bipolar disorder, so it isn’t used very often when mood symptoms are absent. It can help when medications no longer work, or if severe depression or catatonia makes treating the illness difficult.
  • Research: Researchers are looking at a procedure called deep brain stimulation (DBS) to treat schizophrenia. Doctors surgically implant electrodes that stimulate certain brain areas believed to control thinking and perception. DBS is an established treatment for severe Parkinson's disease and essential tremor, but it’s still experimental for the treatment of psychiatric disorders.

 

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Are People With Schizophrenia Dangerous?

Popular books and movies often depict people with schizophrenia and other mental illnesses as dangerous and violent. This usually isn’t true. Most people with schizophrenia are not violent. More typically, they prefer to withdraw and be left alone. When people with mental illness do take part in dangerous or violent behaviors, it’s generally a result of their psychosis and the fear that they’re being threatened in some way by their surroundings. Drug or alcohol use can make it worse.

On the other hand, people with schizophrenia can be a danger to themselves. Suicide is the top 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 how severe the condition is and how well they get and stick with treatment, they should be able to live with their families or in community settings rather than in long-term psychiatric hospitals.

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

Can Schizophrenia Be Prevented?

There’s no known way to prevent schizophrenia. But early diagnosis and treatment can help avoid or ease frequent relapses and hospitalizations, and help cut the disruption to the person's life, family, and relationships.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on December 19, 2018

Sources

SOURCES:

National Institute of Mental Health: "Schizophrenia."

MedicineNet.com: "Schizophrenia."

National Alliance on Mental Illness: "Schizophrenia."

Johns Hopkins Medicine: "Schizophrenia."

Brain & Behavior Research Foundation: "Schizophrenia."

Sunovion Pharmaceuticals Inc.

Medscape: “What are the DSM-5 criteria for schizophrenia?”

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