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What is schizophrenia?
Sometimes colloquially but inaccurately referred to as split personality disorder, schizophrenia is a chronic, severe, debilitating mental illness. It affects about 1% of the general population, corresponding to more than 2 million people in the United States alone. Other statistics about schizophrenia include that it affects men about one and a half times more commonly than women.
While the first episode of schizophrenia tends to occur from 18-25 years of age for men, the age of onset for women peaks initially from 25-30 years of age and again at about 40 years of age. People who experience the first episode of this mental illness after the age of 40 years are considered to have late-onset schizophrenia.
Schizophrenia is one of the psychotic mental disorders and is characterized by symptoms of thought, behavior, and social problems. The thought problems associated with schizophrenia are described as psychosis, in that the person's thinking is completely out of touch with reality at times. For example, the sufferer may hear voices, smell odors, detect tastes, see people that are in no way present, or feel like bugs are crawling on their skin when there are none.
Given that an individual can have various predominant symptoms of schizophrenia at different times as well as at the same time, the most recent Diagnostic Manual for Mental Disorders (DSM-5) has done away with what used to be described as five types of schizophrenia.
What are schizophrenia symptoms and signs?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), symptoms of schizophrenia include the following:
Positive, more overtly psychotic symptoms
- Delusions are beliefs that have no basis in reality. Types of delusions include erotic, grandiose (for example, religious or false belief or superiority), jealous, persecutory, physical (somatic), mixed, and nonspecific.
- Hallucinations: hearing (for example, hearing voices), seeing, feeling (for example, feeling like bugs are crawling on the skin), smelling, or tasting things that have no basis in reality
- Disorganized speech: incoherent or often grossly off-topic (derailed) speech
- Disorganized behaviors
Negative symptoms, potentially less overtly psychotic
- Inhibition of facial expressions and/or a lack of emotional responsiveness
- Catatonic behaviors: difficulty moving, resistance to moving, hyperactivity, repetitive or otherwise abnormal movements, and/or nonsense word repetition or of what others say or do
- Self-neglect, poor grooming, and lack of good hygiene
- Lack of speech
- Apathy/lack of motivation
Prior to the development of the full-blown disorder, people who go on to develop schizophrenia often exhibit subtler and/or less specific symptoms, also called prodromal symptoms. Some characteristics of prodromal schizophrenia are thought to include
- slowness in activity and thought, lower cognitive functioning, including memory loss, disorientation, and mental confusion;
- abnormal speech, including circumstantial, vague, or stereotyped speech;
- odd ideas that have not reached the level of being delusions, like feeling detached from themselves, having beliefs that an ordinary event has special and personal meaning, or a belief that their thoughts aren't their own;
- mood problems, like general discontent, inappropriate emotional responses, fear, mistrust, hostility, anger, aggression, excitability, agitation, and inability to feel pleasure in activities they used to enjoy; and
- social isolation, the self-centeredness that borders on narcissism, and other problems socializing.
What causes schizophrenia?
A frequently asked question about schizophrenia is if it is hereditary. As with most other mental disorders, schizophrenia is not directly passed from one generation to another genetically, and there is no single specific cause for this illness. Rather, it is the result of a complex group of genetic and other biological vulnerabilities, as well as psychological and environmental risk factors. The causes of schizophrenia are believed to be
- Biological: It is thought that people who have abnormalities in the brain's neurochemical dopamine and lower brain matter in some areas of the brain are at higher risk for developing the condition. Other brain issues that are thought to predispose people to develop schizophrenia include
- abnormalities in the connections between different areas of the brain and
- potential abnormalities in the transmission of the brain neurochemical glutamate.
- Genetic: Schizophrenia is thought to have a significant but not solely genetic component. People who have immediate family members (first-degree relatives) with psychosis are more vulnerable to developing schizophrenia compared to people who do not have such a family history.
- Environmental: The risks of developing schizophrenia can even occur before birth. For example, the risk of schizophrenia is increased in individuals whose father is of advanced age or whose mother was malnourished or had one of the certain infections during pregnancy. Difficult life circumstances during childhood, like
- the early loss of a parent, parental poverty, bullying, witnessing domestic violence;
- being the victim of emotional, sexual, or physical abuse or of physical or emotional neglect; and
- insecure attachment have been associated with increased risks of developing this illness.
- Drug use: Use of marijuana (cannabis), amphetamines, and hallucinogens have been found to increase the risk of developing schizophrenia.
How common is schizophrenia in children?
Although there have been fewer studies on schizophrenia in children compared to adults, researchers are finding that children as young as 6 years of age can be found to have all the symptoms of their adult counterparts and continue to have those symptoms into adulthood.
How is schizophrenia diagnosed?
As is true with virtually any mental health diagnosis, there is no one test that definitively indicates that someone has schizophrenia. Therefore, healthcare professionals diagnose this illness by gathering comprehensive medical, family, and mental health information.
Patients tend to benefit when the practitioner performs a systematic review of their client's entire life and background. Examples of this include the person's gender, sexual orientation, cultural, religious, and ethnic background, socioeconomic status, family, and other social relationships. The symptom sufferer might be asked to fill out a self-test that the professional will review if the person being evaluated is able to complete it.
The practitioner will also either perform a physical examination or request that the individual's primary care doctor perform one. The medical assessment will usually include lab tests to evaluate the person's general health and to explore whether or not the individual has a medical condition or has been exposed to certain medications that might produce psychological symptoms.
In asking questions about mental health symptoms, mental health professionals are often exploring if the individual suffers from hallucinations or delusions, depression and/or mania (for example, excessive anger or elevated mood, inappropriate emotional responses, rapid, pressured, and/or frenzied speaking, a lack of behavioral restraint, overexcitement, decreased need for sleep) symptoms as occurs in bipolar disorder or schizoaffective disorder, anxiety, substance abuse, as well as some personality disorders (like schizotypal personality disorder) and developmental disorders (for example, autism spectrum disorders including the condition that was formerly called Asperger disorder).
How long symptoms occur is a factor in determining a diagnosis. For example, psychosis sufferers whose symptoms resolve in no more than a month may qualify for the diagnosis of the schizophreniform disorder rather than schizophrenia. Since some of the symptoms of schizophrenia can also occur in other psychiatric illnesses, the mental health screening is to assess if the individual suffers from schizoaffective disorder or other psychotic disorder, depressive disorder, bipolar disorder, an anxiety disorder, a personality disorder, or a substance-abuse/drug-induced psychosis (for example, marijuana, cocaine, amphetamines, or psychedelic drugs).
Any disorder that is associated with bizarre behavior, mood, or thinking, like another psychotic disorder, borderline personality disorder, or dissociative identity disorder (DID), previously called multiple personality disorder (MPD), may be particularly challenging to distinguish from schizophrenia. However, people with DID often suffer from feeling detached from themselves, as well as what looks like amnesia for their dissociative episodes, which does not tend to be a characteristic of schizophrenia. In order to assess the person's current emotional state, healthcare professionals perform a mental status examination, as well.
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What are the treatments for schizophrenia?
Medications for schizophrenia
Given the seriousness and chronic nature of schizophrenia, self-care without also getting treatment by a professional or home remedies are not deemed appropriate treatment for this illness. There is currently no cure for schizophrenia, but there are a number of helpful treatments available, of which medication remains the cornerstone of treatment for people with this condition. These medications are often referred to as antipsychotics since they help decrease the intensity of psychotic symptoms. Many health care professionals prescribe one of these medications, sometimes in combination with one or more other psychiatric medications, in order to maximize the benefit for the person with schizophrenia.
Mood-stabilizer medications can be useful in treating mood swings that sometimes occur in individuals who have diagnosable mood disorder in addition to psychotic symptoms. These medications may take a bit longer to work compared to antipsychotic medications.
Antidepressant medications are the primary medical treatment for depression that can often accompany schizophrenia . Examples of antidepressants that are commonly prescribed for that purpose include serotonergic (SSRI) medications that affect levels of the neurotransmitter serotonin and combination serotonergic/adrenergic medications (SNRIs).
Despite its stigmatized history, electroconvulsive therapy (ECT) can be a viable treatment for people whose schizophrenia has inadequately responded to a number of medication trials and psychosocial interventions.
Psychosocial interventions for schizophrenia
- Family psycho-education and support: In addition to educating family members about the symptoms, course, and treatment of schizophrenia, this form of treatment consists of providing the family with supportive therapy, problem-solving skills, and access to ongoing community support, including care providers during times of crises. When this intervention is consistently provided for at least several months, it has been found to decrease the relapse rate for a person with schizophrenia and improve social and emotional outcomes.
- Assertive community treatment (ACT): This intervention consists of members of the person's treatment team meeting with that individual on a daily basis, in community settings (for example, at home, work, or other places the person with schizophrenia frequents) rather than in an office or hospital setting. The treatment team is made up of a variety of professionals. For example, a psychiatrist, nurse, case manager, employment counselor, and substance-abuse counselor often make up an ACT team. Over the long term, ACT tends to be successful in reducing how often people with schizophrenia are psychiatrically hospitalized or become homeless.
- Substance abuse treatment: Providing medical and psychosocial interventions that address substance abuse should be an integral part of treatment as about 50% of individuals with schizophrenia suffer from some kind of substance abuse or dependence.
- Social skills training: Also called illness management and recovery programming, social-skills training involves teaching clients ways to handle social situations appropriately. It may be conducted as part of individual or group psychotherapy and often involves the person scripting (thinking through or role-playing) situations that occur in social settings in order to prepare for those situations when they actually occur.
- Supported employment: This intervention provides support like a job coach (someone who periodically or consistently counsels the client in the workplace), as well as instruction on constructing a résumé, interviewing for jobs, and education and support for employers to hire individuals with chronic mental illness. Supported employment has been found to help schizophrenia sufferers secure and maintain employment, earn more money, and increase the number of hours they are able to work.
- Cognitive behavioral therapy (CBT): CBT is a reality-based intervention that focuses on helping a client understand and change patterns that tend to interfere with his or her ability to interact with others and otherwise function. Except for people who are actively psychotic, CBT has been found to help individuals with schizophrenia decrease symptoms and improve their ability to function socially. This intervention can be done either individually or in group therapy.
- Group therapy: Group therapy is usually supportive and expressive, in that participants are encouraged in their efforts to care for themselves and otherwise engage in healthy, appropriate behaviors in the community.
- Weight management: Educating people with schizophrenia about weight gain and related health problems that can be a side effect of some antipsychotic and other psychiatric medications has been found to be helpful in resulting in modest weight loss. That is also true when schizophrenia sufferers are provided with behavioral interventions to help with weight loss.
What is the prognosis for schizophrenia?
Possible complications for schizophrenia range from more medical conditions (morbidity) or shortened life span (mortality) to negative impacts on their family members as well. For example, people with schizophrenia who continue to suffer from residual symptoms have more trouble thinking than those whose negative symptoms are adequately managed with treatment.
Individuals with schizophrenia have more than twice the rate of death than those without the disorder. Almost half of people with schizophrenia will suffer from a drug-use disorder (for example, alcohol, marijuana, or other drug) during their lifetime. Research shows that people with schizophrenia or schizoaffective disorder have a better quality of life when their family members tend to be more supportive and less critical of them.
Is it possible to prevent schizophrenia?
Prevention of schizophrenia for individuals who have yet to develop even the early symptoms of the disorder focuses on decreasing many of the environmental insults that increase the likelihood of developing the disorder. Therefore, improving prenatal care, ameliorating poverty, bullying, child abuse, and neglect, as well as protecting people from family and community violence are important aspects of preventing schizophrenia.
For people who show early signs of schizophrenia, some clinical trial research is exploring the potential use of medications to prevent full-blown schizophrenia.
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