Schizophrenia

What is Schizophrenia?

Schizophrenia is a chronic, severe and disabling brain disorder that has been recognized throughout recorded history. 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 These experiences can terrify them, and make them extremely agitated or withdrawn. Individuals suffering from schizophrenia may not make sense when they talk, may sit for hours barely moving or talking, or may seem perfectly fine until they talk about what they are really thinking.

The cause and course of the illness is unique to the individual, but schizophrenia generally interferes with a person's ability to think clearly, manage emotions, make decisions and relate to others. It impairs people’s ability to function to their potential when it is not treated. Unfortunately, no single, simple course of treatment exists, although treatments can relieve many of the disorder's symptoms. Most people who have schizophrenia must cope with some residual symptoms throughout their lives.

Because many people with schizophrenia have difficulty holding a job or caring for themselves, it places a significant burden on their families and society at large. The good news is that treatments have become more effective over the years, and many people with the disorder lead rewarding and meaningful lives. Ongoing research is leading to new tools and medications focused on prevention and improved treatment of schizophrenia.

+ How Common is Schizophrenia?

Schizophrenia affects about 1 percent of Americans – 2.4 million American adults over the age of 18. The disorder affects men and women with equal frequency, and occurs at similar rates in all ethnic groups around the world. Most often, symptoms such as hallucinations and delusions appear in men in their late teens or early twenties, and in women in their late twenties or early thirties. This disorder rarely occurs in children, but awareness of childhood-onset schizophrenia is increasing.

+ Signs and Symptoms

No single symptom positively identifies schizophrenia; an individual may have any combination of symptoms. What’s more, an individual's symptoms can change over time. The symptoms of schizophrenia are divided into three broad categories: positive symptoms, negative symptoms and cognitive symptoms.

Psychosis

Schizophrenia is a psychotic illness. The term “psychosis” is defined as experiencing the loss of contact with reality, and usually involves hallucinations and delusions. Psychosis is common in people with schizophrenia, as they often lose touch with reality. These symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether the individual is receiving treatment.

Positive symptoms include:

Hallucinations – When a person sees, hears, smells or feels things that do not exist. The most common experience is “hearing voices” that give commands or comments, or warn the person of danger. This may happen for a long time before family and friends notice the problem.
Delusions – These are false ideas the person believes are true. For example, individuals with schizophrenia may believe that people on the radio or television are directing special messages to them, or that they are someone famous. Or, they may have paranoid delusions that other people are trying to hurt them, or harm people they care about.
Disorganized speech – People with disordered thinking and speech may have trouble organizing their thoughts or connecting them logically. They may make up their own words or sounds, jump from one topic to another or abruptly stop talking mid-thought. Grossly disorganized or catatonic behavior – A person may repeat certain motions over and over or make other agitated body movements. At the opposite extreme, a person may become catatonic, where they stop moving, responding or communicating entirely. Catatonia is rare today, now that treatment for schizophrenia is available.

Negative symptoms

Negative symptoms are capabilities that are “lost” from the person’s personality. These disruptions to emotions or behavior can be mistaken for depression or other conditions. Negative symptoms include the following:

Emotional flatness – the person's face does not move, or he or she speaks in a dull or monotonous voice
Inability to start or follow through with activities
Lack of content in speech – speaking very little, even when forced to interact
Inability to experience pleasure

People with negative symptoms need help with everyday tasks. They often neglect basic personal hygiene. This may make them seem lazy or helpless themselves, but these are symptoms caused by the schizophrenia.

Cognitive Symptoms

Cognitive symptoms relate to thinking processes and can be difficult to recognize as part of the disorder.

They include the following:

Poor "executive functioning" (the ability to understand information and use it to make decisions)
Trouble focusing or paying attention
Problems with "working memory" (the ability to use information immediately after learning it)

Cognitive symptoms often make it hard to lead a normal life and earn a living. They can cause great emotional distress. Another common cognitive deficit associated with schizophrenia is anosognosia, which means lack of insight. Approximately one-half of individuals with schizophrenia do not believe that they are ill. This condition is the most common reason why individuals with schizophrenia do not take their medications.

Behaviors that are early warning signs of schizophrenia include:

Hearing or seeing something that isn’t there
A constant feeling of being watched
Peculiar or nonsensical way of speaking or writing
Strange body positioning
Feeling indifferent to very important situations
Deterioration of academic or work performance
A change in personal hygiene and appearance
A change in personality
Increasing withdrawal from social situations
Irrational, angry or fearful response to loved ones
Inability to sleep or concentrate
Inappropriate or bizarre behavior
Extreme preoccupation with religion or the occult

+ Co-occurring Conditions

People diagnosed with schizophrenia may also have another medical or psychiatric condition, making it important to coordinate all aspects of care, including medications. It is not uncommon for people with schizophrenia to experience depression, although it may be difficult to distinguish depression from negative symptoms that affect someone's ability to display emotions. However, if someone with schizophrenia is experiencing symptoms of depression it is very important to address them, as they can significantly increase the likelihood of suicide.

About 25 percent of people with schizophrenia also have a substance abuse disorder. This is frequently referred to as a "dual diagnosis". Although most experts believe drugs and alcohol do not cause schizophrenia, substance abuse is often a byproduct of the illness. It can make antipsychotic medications less effective and make patients less likely to follow their treatment plan.

It is also very common for patients with schizophrenia to smoke cigarettes. Beyond the normal health risks, those who smoke are more likely to relapse and be readmitted to a hospital. Smoking may also make their medications less effective.

+ Treatment

Because the causes of schizophrenia are still unknown, current treatments focus on eliminating the symptoms of the disease. Even though there is no cure, effective treatments have enabled many people with schizophrenia to improve enough to lead independent, satisfying lives.Two primary types of treatment can help control symptoms: antipsychotic medications and psychosocial treatments.

Medication

The new generation of antipsychotic medications helps people with schizophrenia to live fulfilling lives. They help to reduce the biochemical imbalances that cause schizophrenia and decrease the likelihood of relapse. Like all medications, however, anti-psychotic medications should be taken only under the supervision of a psychiatrist.

Because multiple antipsychotic medications have proven effective, the type used depends on the patient. Sometimes a person needs to try different medications to see which work best for him or her.

Psychosocial treatments

Psychosocial treatments can help people with schizophrenia once they are stabilized on antipsychotic medication. Psychosocial treatments help these patients deal with the everyday challenges of the illness, such as difficulty communicating, taking care of themselves, working, and forming and maintaining relationships. In addition, patients who receive regular psychosocial treatment are more likely to continue taking their medication, and less likely to have relapses or be hospitalized. A therapist can help patients better understand and adjust to living with schizophrenia. Psychosocial treatments include:

Illness management skills. These help people with schizophrenia learn about the illness and manage it on a day-to-day basis. They can make informed decisions about their care, learn how to prevent relapses, and know how to cope with persistent symptoms.

Integrated drug and alcohol treatment. Substance abuse is the most common co-occurring disorder in people with schizophrenia. When treatment of the illness is integrated with alcohol/drug treatment tailored specifically to people with schizophrenia, patients see better results.

Rehabilitation. Rehabilitation programs address vocational, social and practical skills of daily living. They work well when they encompass both job training and specific therapy designed to improve cognitive or thinking skills. [Programs can include job counseling and training; budgeting; cooking; shopping; stress management; help in learning to use public transportation, and opportunities to practice communication skills.]

Family education. With the help of a therapist, family members can learn coping strategies and problem-solving skills to help their loved ones stick with treatment and stay on their medications. Families also should learn where to find outpatient and family services.

Cognitive behavioral therapy. Cognitive behavioral therapy (CBT) is a type of psychotherapy that focuses on thinking and behavior. It helps patients with symptoms that do not go away even when they take medication. The therapist teaches people with schizophrenia how to test the reality of their thoughts and perceptions, how to ignore the voices they hear, and how to manage their symptoms overall. CBT can help reduce the severity of symptoms and reduce the risk of relapse.

Self-help groups. Self-help groups provide ongoing support and information to people with schizophrenia and their families. Sharing with others who face the same problems helps everyone feel less isolated.

Other services that can help people with schizophrenia live independently and lead productive lives:

Case management helps people access services, financial assistance, treatment and other resources.
Drop-in centers are places where individuals with mental illness can socialize and/or receive informal support and services on an as-needed basis.
Housing programs offer a range of support and supervision from 24-hour supervised living to drop-in support as needed.
Employment programs assist individuals in finding employment and/or gaining the skills necessary to reenter the workforce.
Therapy/counseling includes different forms of “talk” therapy – individual and group – that can help the patient and family members alike better understand the illness and share their concerns.
Crisis services include 24-hour hotlines, after-hours counseling, residential placement and inpatient hospitalization.