Schizophrenia is a serious mental health condition that is considered as a type of psychosis by medical professionals. With self-help and effective treatment, you can manage to overcome this disorder and live a meaningful life.
What Is Schizophrenia?
Schizophrenia is a chronic mental disorder that often causes hallucinations and delusions, leading the sufferer to experience distorted realities. The term was originally coined in 1908 by Swiss psychiatrist Eugen Bleuler. It is derived from the Greek words “schizo”, meaning splitting, and “phren”, meaning mind.
MindJournal explains “Although schizophrenia is a severe psychiatric disorder, it can have a disabling effect on the sufferer. It affects their thoughts, emotions, behaviors, actions, relationships and how they perceive reality.” As they start to interpret reality in a distorted way, patients tend to develop excessively disordered thinking which disrupts their daily functioning. A recent research paper 1 stated, “schizophrenia is a functional psychotic disorder characterized by the presence of delusional beliefs, hallucinations, and disturbances in thought, perception, and behavior.”
According to the American Psychiatric Association (APA), common symptoms of schizophrenia include hallucinations, delusions, lack of motivation, abnormal thinking and disorganized speech. The APA also states that less than 1% of Americans are affected by this brain disorder. As per data from the World Health Organization (WHO) over 20 million people across the globe are affected by this condition. Moreover, it causes substantial disability in patients worldwide and leads to educational & occupational difficulties. Moreover, sufferers are also “2-3 times more likely to die early” when compared to the general population, according to WHO.
Unfortunately, people with schizophrenia often experience discrimination, stigma and violation of human rights. Fortunately, with early and lifelong treatment, sufferers can improve their symptoms significantly, actively engage in education or work and build healthy relationships in the long run.
How It Affects Us?
People with schizophrenia often appear to have a disconnection with reality. Hallucinations and delusions are a common aspect of this mental disorder. They tend to hear or see things that aren’t actually there and are unable to distinguish between reality and imagination. They experience a lot of distress as they don’t have any clarity of thought, have difficulty in relating with others, experience difficulty with managing their emotions properly and are mostly unable to function normally on a daily basis. This mental disorder distorts their sense of self, their perception of the world and how they interact with their environment. According to the National Institute of Mental Health (NIMH) 2 , “People with schizophrenia may seem like they have lost touch with reality, which causes significant distress for the individual, their family members, and friends.”
Patients often struggle with performing well in school, at work, in personal relationships as well in society. They may also become withdrawn as they tend to feel threatened by others. Although, most people tend to confuse schizophrenia with split personality 3 or multiple personality, both are separate mental illnesses. Schizophrenia is a form of psychosis that merges reality and imagination and creates a distorted world filled with confusing emotions, thoughts, visuals and sounds. Moreover, when a person with this disorder experiences a psychotic episode, their personality might also change suddenly. The severity of the condition mostly depends on the individual. Some people can seem to live “normal lives” with only a single psychotic episode, while others may experience numerous psychotic episodes during their lifetime. The symptoms tend to either improve or worsen during remissions and relapses.
According to the National Alliance On Mental Illness (NAMI) 4 , “schizophrenia can occur at any age.” Generally, onset is experienced between late teens to the early 20s in male patients and between late 20s to early 30s in female patients. However, it is “possible to live well with schizophrenia,” states NAMI.
Types Of Schizophrenia
Previously, experts classified it into a series of disorders that was categorized in the same spectrum. Hence, various types of schizophrenia were referred to by health professionals. These different subtypes included:
1. Paranoid schizophrenia
This type is characterized by positive symptoms of schizophrenia and involves repeated frequent visual or auditory hallucinations and one or more delusions. Paranoid schizophrenia is now a defunct subtype which includes extreme paranoia.
Read more to know about: Paranoid schizophrenia
2. Disorganized schizophrenia
Also known as Hebephrenia 5 , this subtype is marked by disorganized speech and behavior. This may also involve impairment in emotional expression or reactions of the patient. Although hallucinations and delusions may occur, these are less prominent.
3. Catatonic schizophrenia
This is a severe and rare subtype that is “associated with multiple psychomotor abnormalities and behavioral dysregulation. 6 ” Catatonic schizophrenia is characterized by noticeable motor behavior. This may include substantial decrease in voluntary movement or agitation and hyperactivity. In extreme cases, the sufferer may enter a state of total immobility and assume positions like a statue. They may not move or say anything for hours and become unable to care for themselves.
4. Undifferentiated schizophrenia
This type of schizophrenia is primarily characterized by multiple vague symptoms. The patient may behave in ways that can be seen in two or more of the other subtypes of schizophrenia. This can involve symptoms like hallucinations, delusions, paranoia, catatonic behavior or disorganized speech or behavior.
5. Residual schizophrenia
This subtype is often considered as the recovery phase as severe symptoms usually begin to reduce or fade. Residual schizophrenia occurs when a person, previously affected by at least one schizophrenia episode, has reduced or no symptoms, such as hallucinations, delusions or disorganized speech & behavior. However, the person may still feel paranoid or have strange beliefs or may be socially withdrawn.
However, the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) modified the process of classification and combined all the subtypes into a single category – schizophrenia. Today, the previous classification and categorization is not used by medical experts any longer.
Symptoms Of Schizophrenia
The symptoms of this disorder tend to vary in duration, intensity and frequency depending on the individual. However, hallucinations and delusions are the most common signs of schizophrenia. Hallucinations may be visual hallucinations, auditory hallucination or tactile hallucination or a combination of all of them. Some other common symptoms are disordered thought and disorganized speech. Sufferers may also experience episodes while the illness is active. This is characterized by an inability to differentiate between real and imaginary experiences. However, the occurrence of severe psychotic symptoms tends to reduce with age and maturity.
According to the APA, symptoms for this disorder can be categorized under the following 3 sections:
1. Positive symptoms
These refer to symptoms which are abnormally present. It includes hallucinations like seeing things or hearing voices that are not real, having distorted perceptions & beliefs etc.
2. Negative symptoms
These are symptoms which are abnormally absent, like a lack of or reduced ability to make and implement plans, express emotion or speak effectively, or experience pleasure.
3. Disorganized symptoms
This involves disordered and confused thinking as well as speech. Moreover, it also includes abnormal behavior, movements or actions and having difficulty with logical thinking.
Moreover, cognitive abilities may also get affected by this mental disorder. This can result in difficulty with memory, concentration and attention, leading to reduced performance in work or education. Apart from these, these are many other signs and symptoms of schizophrenia that are mentioned below:
- Psychosis, hallucinations & delusions
- Thought disorder & unusual thinking
- Movement disorders & catatonia 7
- Abnormal motor behavior
- Disorganized & confused speech
- Reduced speaking
- Irritability & agitation
- Lack of motivation
- Trouble beginning and conducting activities
- Reduced feelings of pleasure
- Decreased expression of emotions
- Difficulty in paying attention, concentrating or focusing
- Difficulty in processing information & making decisions
- Social withdrawal & isolation
- Abnormal behavior like strange appearance, wandering aimlessly, laughing to self etc
- Troubled relationships
- Poor academic performance
Symptoms can increase if the patient is left untreated, if medications are not taken properly, through stressful experiences or substance abuse.
Causes Of Schizophrenia
According to the APA, “a number of genetic and environmental factors” can lead to the development of this disorder. Moreover, life stressors can also significantly contribute towards the onset of the condition. As multiple factors play a role, researchers are unable to identify the exact cause of the development of schizophrenia. However, the NIMH outlines the following factors which play a crucial role in the risk of developing this mental illness:
1. Genetic factors
Genetics play a vital role in the onset of this disorder as it can often run in the family. But, simply because a family member is schizophrenic doesn’t necessarily mean that other members will be affected as well. A 2017 study 8 revealed that “Pre-molecular and molecular genetic studies have demonstrated that genetics form a strong risk factor for schizophrenia.” However, no single gene has yet been identified that may cause the illness in someone. Hence, genetic information is unreliable when anticipating if someone may develop the disorder.
2. Environmental factors
NIMH explains that a person’s environment may be a significant factor in developing schizophrenia in people with a genetic risk. Common environmental factors that may increase the risk of this disorder include:
- Stressful surroundings
- Exposure to viruses or viral infections
- Exposure to toxins
- Malnutrition before birth
- Trauma during birth
- Psychosocial factors, like trauma
One 2012 study 9 found that prenatal viral and/or bacterial infections “play major roles in the genesis” of this mental illness. Another study 10 revealed that viral infections in the central nervous system during childhood can increase the risk of adult schizophrenia. Another 2019 study 11 showed that childhood trauma often impairs verbal learning, executive function, attention and working memory in schizophrenic individuals. Apart from these physical and hormonal changes 12 during the teenage years may also cause this condition.
3. Brain structure and chemistry
The National Institute of Mental Health (NIMH) claims that brain structure and interconnection with neurotransmitters can be a leading cause of this disorder. Hence, chemical abnormalities in the brain may also lead to this condition. When an imbalance is noticed in neurotransmitters, like serotonin and dopamine, in the brain, schizophrenia may develop in some individuals. Patients are often unable to manage these neurotransmitters or brain chemicals which regulate certain circuits or pathways of nerve cells. These are known to affect our thoughts and behavior.
According to a 2014 study 13 , dopamine is involved in the pathology of this disorder and “dopamine abnormalities in the mesolimbic and prefrontal brain regions exist in schizophrenia.” Moreover, research 14 also shows that patients tend to have abnormalities in brain structures, as evident from imaging tests.
4. Drugs & medications
One 2017 study 15 has revealed that cannabis exposure can also be a contributing factor in the onset of schizophrenia. Researchers concluded that certain substances found in cannabis may trigger the mental illness, especially those who are already at risk of developing it. However, some scientists have found evidence 15 that schizophrenia can make a patient prone to using cannabis and marijuana to begin with.
Diagnosis Of Schizophrenia
For a proper diagnosis of schizophrenia to be conducted, the symptoms must persist for at least 6 months, according to the American Psychiatric Association (APA). However, a mental health professional, like a psychiatrist or psychologist, must conduct a detailed medical examination, including a physical exam, blood tests, & imaging tests, to make sure that the symptoms are not caused by other mental disorders with similar symptoms. Moreover, it should also be determined that the condition is not caused by substance abuse or any other neurological issues. The DSM–5 outlines the following criteria 16 for schizophrenia:
A. A person must experience two or more of the following symptoms for a duration of 1 month:
- Disorganized speech (frequent derailment or incoherence).
- Grossly disorganized or catatonic behavior.
- Negative symptoms (diminished emotional expression, lack of speech, lack of motivation etc).
At least one of these must be 1, 2, or 3.
B. They should experience significant disturbance in their level of functioning in major areas like education, work, self-care or interpersonal relations.
C. Constant signs of the disorder persist for at least 6 months.
D. Other mental illnesses with psychotic features, like bipolar disorder, major depressive disorder or schizoaffective disorder, have been ruled out.
E. The symptoms are not caused by the physiological effects of a substance, like drugs or medication.
F. If the patient has experienced a childhood onset of a communication disorder or autism spectrum disorder, then diagnosis of schizophrenia can be done if only hallucinations or delusions are present for at least 1 month, along with other required symptoms of the condition.
Children and people over 45 years of age are rarely diagnosed with the disorder. Moreover, diagnosis is usually done after the first episode of psychosis.
Treatment Of Schizophrenia
If you or a loved one has been diagnosed with schizophrenia, then it is important that you seek medical help immediately. The best and most effective treatment for this condition includes a combination of psychological interventions, medications and social support. Effective treatment can help to manage psychotic episodes and improve the quality of life in patients. However, it is imperative that the patient communicates their issues and symptoms openly with a doctor or mental health professional, like a psychiatrist, psychologist or therapist. The doctor may also assess the medical and family history of the patient and try to understand their finances, personal and social life.
Some probable treatment options generally include the following:
Psychotherapy and counseling can be effective in helping the patient to develop useful coping skills to overcome the symptoms and live a healthier life. However, to ensure that therapy works, the patient must trust the doctor and needs to develop a good relationship so that they can work together to figure out a helpful treatment plan. The patient also needs to follow the treatment plan and attend therapy sessions regularly. Some common types of therapy used in treatment of this condition include:
- Individual therapy
- Cognitive behavioural therapy (CBT)
- Family therapy
- Social skills training
According to a 2001 study 17 , CBT has been found to be effective in the treatment of schizophrenia. The study states “Patients receiving routine care and adjunctive CBT have experienced additional benefits above and beyond the gains achieved with routine care and adjunctive supportive therapy.”
Medications like antipsychotic drugs are a crucial aspect of schizophrenia treatment. However, medication can prove to be highly effective when used in conjunction with psychological interventions. Some of the most common medications prescribed for this disorder includes:
- Clozapine (Clozaril)
- Haloperidol (Haldol)
- Risperidone (Risperdal)
- Quetiapine (Seroquel)
- Olanzapine (Zyprexa)
- Ziprasidone (Geodon)
According to research 18 , the antipsychotic Clozapine has been highly beneficial and effective in treating treatment-resistant schizophrenia. The researchers state “This drug is approximately 30% effective in controlling schizophrenic episodes in treatment-resistant patients, compared with a 4% efficacy rate with the combination of chlorpromazine and benztropine.” However, some of these medications can have side effects such as weight gain and neurological symptoms. Hence, you should always consult a doctor or mental health professional before taking any medicines for schizophrenia.
Moreover, it is also important that the patient follows the treatment plan once the symptoms start to improve as symptoms may get worse if the patient stops taking medication.
Read more: Treatment Of Schizophrenia
Growing Through Schizophrenia
Schizophrenia is a lifelong condition that may require long-term treatment. Although it can substantially influence the patient’s ability to function, treatment can be highly rewarding and productive. Moreover, support from friends, family members and community can also greatly help in recovery as well.
If you or a loved one is suffering from schizophrenia, then educating yourself about the disorder, understanding available treatment options and encouraging the sufferer to seek professional help and sustain treatment can make a lot of difference and enable them to live a relatively normal life.
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