Schizophrenia

What Is Schizophrenia?

Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. The person finds it difficult to tell the difference between real and imagined experiences, to think logically, to express feelings, or to behave appropriately.

People with schizophrenia may hear internal voices not heard by others or may see things that are not really there. These experiences can seem threatening and can make them fearful and withdrawn. They also may have trouble organizing their thoughts and expressing themselves. Their speech and behavior can be so disorganized that they may seem frightening to others.

Schizophrenia is one of the most misunderstood mental illnesses. Contrary to popular belief, it does not involve a “Jekyll-and-Hyde” type of split personality. Instead, it means that all the attributes that go into the makeup of the human personality – logical thinking, feelings and expression, perception, and relating to others – become separated from one another.

Schizophrenia affects about one percent of the world’s population and is found all over the world, in all ethnic and social groups.

People with schizophrenia often have difficulty functioning in society, at work, and in school. The illness can be taxing on both the individuals who are affected and on their families.

But the symptoms of schizophrenia vary widely from one person to another. In some people, the dissociated feelings caused by the illness are a constant part of life. In others, the symptoms will come and go.

People with schizophrenia do not always act abnormally. They may appear perfectly responsible and in control, even when experiencing hallucinations or delusions.

Schizophrenia cannot be cured, but the symptoms can be reduced significantly with treatment.

The vast majority of people with schizophrenia are living either full and productive lives or relatively independent lives.

What Causes Schizophrenia?

Schizophrenia is a complex illness, and no single cause has been found. There are several theories about the causes, which include:

• Heredity. Schizophrenia runs in some families. A person can inherit a tendency to develop the illness, especially if a parent has the disorder. The risk for inheriting schizophrenia is 10 percent in those who have an immediate family member with the illness, and 40 percent if the illness affect both parents or an identical twin. However, about 60 percent of people with schizophrenia have no close relatives with the illness
• Brain chemistry. Many researchers believe that people with schizophrenia are either very sensitive to a brain chemical called dopamine, or produce too much of it. Dopamine is a neurotransmitter, which are substances that allow nerve cells in the brain to send messages to each other. An imbalance of this chemical can affect the way a person’s brain reacts to stimuli.
• An abnormality within the brain. Better imaging technology has allowed researchers to study the brain structure and function in people with schizophrenia. They have concluded that many individuals with the disorder have subtle abnormalities in brain structure. These abnormalities include a slight enlargement of the fluid-filled cavities (ventricles) in the brain, and a slightly smaller size of some areas of the brain. But this is not true in all people with schizophrenia, and such abnormalities also have been identified in people who do not have schizophrenia.
• Complications during pregnancy and birth. Some researchers believe that an infection or malnutrition during pregnancy, or by complications during birth, may increase the chances of that child developing schizophrenia when he or she is older.

What Are The Symptoms Of Schizophrenia?

In schizophrenia, the world appears changed. Familiar things like colors, sounds, or tastes may appear altered in a strange way. The brain receives information from the senses but interprets it in an abnormal fashion.

The symptoms of schizophrenia vary from one person to another, and they can appear either gradually or suddenly. At first, symptoms may include mild feelings of tension, inability to sleep or concentrate, and a loss of interest in school, work, or friends.

As the illness progresses, people with schizophrenia experience symptoms that include psychosis, which is a general term for a number of major psychiatric illnesses in which a person incorrectly evaluates the accuracy of his or her perceptions and thoughts and makes incorrect conclusions about reality.

These symptoms, which may come and go in cycles, include:

• Hallucinations and illusions
• Delusions
• Disordered thinking
• Lack of emotional expression
• Inappropriate reactions

Symptoms of schizophrenia in children are different from symptoms in adults.

Hallucinations And Illusions

Hallucinations and illusions are disturbances of perception that are common in people with schizophrenia.

• Hallucinations are perceptions that occur without connection to an appropriate source and can occur in any sensory form – sound, sight, touch, taste, and smell.
• Illusions occur when a sensory stimulus is present but is incorrectly interpreted by the individual. For example, a person may be convinced there are voices in the wind.

The most common type of hallucination is hearing imaginary voices that give commands, make comments, or warn of impending danger. The person experiences these voices talking to them as “he” or “she” (third-person auditory hallucinations).

Some people may think they see, feel, taste, or smell something that doesn’t really exist.

Delusions

Delusions are false ideas about oneself or one’s life. People with schizophrenia may believe they are being conspired against, or that they are a famous or important individual. These false beliefs are held with absolute certainty, dominating in the person’s mind.

Typical experiences are of thoughts being taken out of one’s head or inserted into one’s mind. These delusions can be bizarre (for example, invisible creatures entering a room through an electrical outlet) or non-bizarre (for example, a paranoid belief in being spied on).

Disordered Thinking

People with schizophrenia may find it difficult to think and reason clearly. In conversation, they may jump from one topic to another without making much sense. They also may make up their own words or sounds.

A person’s speech can become incoherent because of the disjointed way in which thoughts are processed. Some people will connect words because of similarity of sound rather than by meaning (known as “clang” association).

Lack Of Emotional Expression

People with schizophrenia may not show the signs of normal emotion. This can include speaking in a monotonous voice, having diminished facial expressions, and appearing to be extremely apathetic.

Inappropriate Reactions

People with schizophrenia may react with inappropriate behavior to certain circumstances. For example, they may laugh hysterically over a sad event.

Symptoms Of Schizophrenia In Children

The behavior of children and teens with schizophrenia is different from that of adults with this illness. It is rare for symptoms to develop before age 12. Schizophrenic behavior develops gradually in children and may begin with children talking about strange fears or ideas.

Early warning signs of schizophrenia in children include:

• Trouble distinguishing dreams from reality
• Confusing television or movies with reality
• Seeing things and hearing voices that are not real
• Confused thinking
• Extreme moodiness
• A belief that people are “out to get them”
• Behaving younger than one’s age
• Severe anxiety and fearfulness
• Severe problems in making and keeping friends

Who Gets Schizophrenia?

Schizophrenia affects about one percent of all people. Schizophrenia affects individuals who span the full range of intelligence and education, from the most intelligent to the most simple minded.

No cultural group is immune to schizophrenia, but the content of delusions varies in different parts of the world, according to one study. In Europe, people with schizophrenia were more likely to have delusions of poisoning or religious guilt, while in Japan the delusions most often were related to being slandered.

A person is at higher risk for developing schizophrenia if they:

• Are a male between the ages of 15 and 24
• Are a female between the ages of 25 and 34
• Have a close relative with the illness
• Had a medical problem surrounding their birth

Schizophrenia runs in some families. A person with an immediate family member who has schizophrenia has a 10 percent chance of developing it, and a 40 percent chance if the illness affects both parents or an identical twin.

How Is Schizophrenia Diagnosed?

There are no chemical tests for schizophrenia. Doctors make the diagnosis based on the symptoms and an interview with the individual.

A number of brain imaging techniques are becoming useful in determining if parts of the brain are damaged. These techniques include:

• Magnetic resonance imaging (MRI), which uses magnets to produce cross-sectional images of the inner brain structure.
• Single-photon emission computed tomography (SPECT), which uses a scanner that revolves around the person’s head, with multiple detectors to reduce the imaging time.
• Positron emission tomography (PET), which involves injecting the person with a safe radioactive substance, which travels through the blood vessels to the brain and is picked up by the PET device to create images on film.

For more information about MRI, go to MRI.

Conditions That May Produce Some Symptoms Similar To Schizophrenia

Certain conditions may produce symptoms that can be mistaken for schizophrenia, and they must be ruled out before a diagnosis of schizophrenia can be made. They include:

• Drug abuse. The use of certain hallucinogenic drugs such as LSD or mescaline may cause an individual to see or hear things that are not there.
• Epilepsy. This disorder causes disturbances in the electrical signaling in the brain and can trigger a seizure, which may be marked by involuntary movement or seeing or hearing things that are not there.
• Brain tumor. A growth in any area of the brain may cause changes in behavior.
• Encephalitis. Inflammation of the brain
• Thyroid disorders. An overactive thyroid may cause too much of the thyroid hormone to be released into the bloodstream. When this happens, a person may seem delirious or apprehensive.
• Hypoglycemia. If the level of sugar in the blood is low, a person may become lethargic and confused.
• Wilson’s disease. This is a rare hereditary disease characterized by the accumulation of copper in the red blood cells, which affects the brain and can cause dementia.
• Alzheimer’s disease

In addition, many medications have side effects that can mimic some of the symptoms of schizophrenia by causing delusions and severe confusion, particularly in the elderly. And other psychiatric conditions have symptoms similar to schizophrenia.

There are also a number of disorders that are not quite like schizophrenia, but there are some similarities. It is thought that they may be variations of other psychiatric disorders and are classified as ‘schizoaffective disorders’.

How Is Schizophrenia Treated?

Because the progression and symptoms of schizophrenia vary from one person to another, treatment must be an individualized decision. Schizophrenia cannot be cured, but it can be effectively managed in many people.

Treatment options include:

• Antipsychotic medications
• Atypical medications
• Other useful medications
• Electroconvulsive (“shock”) therapy
• Psychotherapy
• Family support
• Rehabilitation

Antipsychotic Medications

Antipsychotic medication has been available since the mid-1950s, and it has greatly improved the outlook for people with schizophrenia.These medications reduce the symptoms of psychosis and usually allow a person to function more effectively and appropriately.

Typical antipsychotic drugs (also called neuroleptic drugs) work by blocking receptors in the brain of the chemical messenger dopamine, which is thought to play a role in schizophrenia. These medications have the most significant impact on the symptoms of hallucinations and delusions.

Antipsychotic drugs include:

• Chlorpromazine (Thorazine)
• Haloperidol (Haldol)
• Perphenazine (Trilafon)
• Thioridazine (Mellaril)
• Mesoridazine (Serentil)
• Trifluoperazine (Stelazine)
• Fluphenazine (Prolixin)

Side effects of antipsychotic medications include:

• Sleepiness and lethargy (which usually decreases over time)
• Dry mouth
• Eye problems
• Allergic reactions
• Weight gain
• Menstrual irregularities in women
• Sexual dysfunction

Nearly every antipsychotic drug can cause abnormal muscle spasms or involuntary movement of the nerves and muscles controlling movement and coordination. These are known as extrapyramidal symptoms. If this occurs, the doctor will reduce the dosage or switch to a different type of medication.

Tardive dyskinesia is a syndrome of involuntary movements especially around the mouth, and it is associated with long-term antipsychotic drug treatment. It occurs in about 15 to 20 percent of people who have been taking antipsychotic medication for many years. It also can develop in people who have been treated with these drugs for shorter periods of time. In many cases, the symptoms of tardive dyskinesia are mild, and the person may be unaware of them.

Atypical Medications

Since 1990, a number of newer medications have been introduced to treat schizophrenia. These so-called “atypical drugs” work in areas of the brain that are different from those affected by typical antipsychotic drugs.

Atypical drugs include:

• Clozapine (Clozaril) – The first of these newer drugs, clozapine is particularly useful in younger people. Side effects include nasal congestion, drooling, low blood pressure, headache, sleepiness, and weight gain. Serious side effects include seizures and, rarely, a potentially life-threatening decrease in a person’s white blood cells (a condition called agranulocytosis). People taking this medication must be monitored with blood tests every one to two weeks.
• Risperidone (Risperdal) – This drug works better than typical antipsychotic drugs in many people. Common side effects include sleepiness, weight gain, and dizziness.
• Olanzapine (Zyprexa) – This drug has a lower risk for seizures and agranulocytosis. As with risperidone, common side effects include sleepiness, weight gain, and dizziness.

Other Useful Medications

Other medications that can help symptoms of schizophrenia in some people include:

• Antidepressants. Depression is common in people with schizophrenia. One study concluded that antidepressants may help prevent relapse of schizophrenic symptoms.
• Antianxiety drugs. Benzodiazepines are normally used to treat anxiety, but they have been found to reduce schizophrenic symptoms in some people.
• Lithium. Ordinarily used for bipolar disorder, lithium is useful for some individuals, particularly those who have no family history of schizophrenia.
• Antiepileptic drugs. Drugs ordinarily prescribed for epilepsy can help people who are violent and who do not respond to other drugs.

Electroconvulsive (“Shock”) Therapy

Electroconvulsive therapy (ECT) is commonly called shock therapy because a low-voltage electric current is used to cause a seizure. It is the seizure, not the shock, that is therapeutic. The methods of conducting ECT have been refined over the years, and some physicians today feel it is safer than drug therapy.

Psychotherapy

Psychotherapy is any of a large number of related methods of treating mental and emotional disorders by psychologic techniques rather than by physical means. Professionals trained in psychotherapy include psychiatrists, psychologists, social workers, and some nurses.

Psychotherapy is used along with medication. Most experts believe that an integrated program that offers both medical and psychological treatment of the individual and support to the family is important for the long-term improvement of people with schizophrenia.

Most effective are cognitive-behavioral methods of therapy, which attempt to strengthen the person’s capacity for normal thinking using mental exercises and self-observation. Cognitive therapy teaches people to change their negative patterns of thought and behavior by helping them learn problem-solving techniques and other strategies.

A psychotherapy session may focus on current or past problems, experiences, thoughts, feelings, or relationships. By sharing such experiences, people with schizophrenia may gradually come to understand more about themselves and their disorder. They also may learn to sort out the real from the unreal.

Family Support

It is deeply painful for anyone to see the behavior of a loved one determined not by a healthy response to the real world, but by a mysterious internal mechanism. Fewer than 10 percent of families of people with schizophrenia receive support and education, even though studies have shown the benefits of such a program for both the person and the family.

Many studies have shown that people with schizophrenia do worse in families who are overly emotional, hostile, or critical. Support groups can be helpful, and studies have shown that individuals improve when families are in self-help groups.

Rehabilitation

Rehabilitation includes a wide variety of nonmedical interventions for people with schizophrenia. Such programs emphasize social and vocational training.

People with schizophrenia often have a difficult time performing ordinary life skills such as cooking and personal grooming. Rehabilitation can help a person regain the confidence to take care of themselves and lead a productive life.

How Can The Family Help The Person With Schizophrenia?

The families of people with schizophrenia are on the “front line.” While the community has support groups, the family is the main one. Often the role is difficult. The person may deny there is a problem and resist efforts at treatment.

If A Person Resists Treatment

Often, a person with schizophrenia will resist treatment, believing that delusions or hallucinations are real and that psychiatric help is not necessary. Family members may need to take an active role in having the person seen and evaluated by a professional.

The issue of civil rights enters into any attempt to provide treatment against a person’s will. In the U.S., laws protecting individuals from involuntary commitment have become very strict and vary from state to state.

Generally, if people are dangerous to themselves or others due to a mental disorder, they can be hospitalized and treated even if it is against their will. Many hospitals offer crisis intervention services and hotlines in cases of emergency.

What Is The Outlook For Individuals With Schizophrenia?

The outlook for people with schizophrenia has improved over the last 25 years. Although the illness cannot be cured, most people go on to lead independent, satisfying lives.

The outcome in schizophrenia varies greatly.

• About 30 percent of individuals are independent, working full time, and raising families.
• About 50 percent of individuals can live relatively independent lives, with varying levels of support, but require continuing medication.
• About 20 percent of individuals will remain highly dependent on caregivers and will required long-term, structured care, sometimes in secure conditions.

Researchers continue to improve even more on medications used to treat schizophrenia. Under development are medications that are designed to target the specific biochemical systems that are believed to be abnormal in people with schizophrenia.

Schizophrenia: Frequently Asked Questions

Here are some frequently asked questions related to schizophrenia:

Q: My son constantly forgets his medication. How I can help?

A: Try organizing his medications with medication calendars or pillboxes that are marked with each day. Purchase an electronic timer that beeps when medications should be taken. Plan for him to takes the medication at a certain time – for example, with meals. Another option is to ask his doctor about long-acting injected forms of medication.

Q: Are people with schizophrenia likely to be violent?

A: The popular media tends to link mental illness such as schizophrenia with criminal violence. But the fact is that most people with schizophrenia are not violent; they are much more likely to be withdrawn. People with schizophrenia are not especially prone to violence. When violence does occur, it usually takes place at home and is directed at family members and friends.

Q: Does stress play a part in schizophrenia?

A: There is no evidence that stress is a cause of schizophrenia. Sometimes emotionally significant events in people’s lives will precede an episode of illness, but the basis for the illness must already be present.

Q: Can children develop schizophrenia?

A: Although it is extremely rare, children as young as age 5 have been diagnosed with the illness. They are often described as being different from other children from an early age. However, most people do not show symptoms until adolescence or young adulthood.

Schizophrenia: Putting It All Together

Here is a summary of the important facts and information related to schizophrenia:

• Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. A person has difficulty telling the difference between real and imagined experiences, thinking logically, expressing feelings, or behaving appropriately.
• People with schizophrenia may hear internal voices and experience hallucinations. They may have trouble organizing their thoughts and expressing themselves.
• Schizophrenia is a complex illness, and no single cause has been found. Theories about causes include heredity, brain chemistry, brain abnormalities, and complications during pregnancy and birth.
• Early symptoms may include mild feelings of tension, inability to sleep or concentrate, and a loss of interest in school, work, or friends.
• As the illness progresses, people with schizophrenia experience symptoms that include hallucinations and illusions, delusions, disordered thinking, lack of emotional expression, and inappropriate reactions.
• Schizophrenia is treated with a wide variety of medications that include antipsychotic drugs, as well as with electroconvulsive therapy, psychotherapy, family support services, and rehabilitation programs.
• Although the illness cannot be cured, most people go on to lead independent, satisfying lives.

Schizophrenia: Glossary

Here are definitions of medical terms related to schizophrenia:

Antipsychotics: Medications that block receptors in the brain of the chemical messenger dopamine, which is thought to play a role in schizophrenia; these medications have the most significant impact on the symptoms of hallucinations and delusions

Delusion: False ideas about oneself or one’s life

Dementia: A mental disorder characterized by a disintegration of personality, confusion, disorientation, decreased intelligence, and difficulty controlling memory, judgment, and impulses

Dopamine: A chemical messenger (neurotransmitter) in the brain that allows nerve cells to send communicate with each other

Hallucination: Seeing, hearing, feeling, tasting, or smelling something that doesn’t really exist.

Illusion: A false interpretation of an external sensory stimulus, usually seen or heard, such as a mirage in the desert or voices on the wind.

Psychosis: A general term for a number of major psychiatric illnesses, including schizophrenia, in which a person incorrectly evaluates the accuracy of his or her perceptions and thoughts and makes incorrect conclusions about reality.

Tardive dyskinesia: A syndrome of involuntary movements, especially around the mouth, associated with long-term use of antipsychotic medication

Schizophrenia: Additional Sources Of Information

Here are some reliable sources that can provide more information on schizophrenia:

British Columbia Schizophrenia Society 
http://www.mentalhealth.com

Canadian references to healthcare but an excellent practical site; with clearly written information

The National Alliance for the Mentally Ill (NAMI) 
Phone: 1-800-950-NAMI (6263)
http://www.nami.org

National Institute of Mental Health (NIMH) Office of Communications and Public Liaison Information Resources and Inquiries Branch 
Phone: 301-443-4513
http://www.nimh.nih.gov

National Mental Health Association (NMHA) 
Phone: 1-800-969-6942
http://www.nmha.org