What Can Trigger Schizophrenia?

A person with disorganized-type schizophrenia will exhibit behaviors that are disorganized or speech that may be bizarre or difficult to understand.

Schizophrenia usually shows its first signs in men in their late teens or early 20s and women in their early 20s and 30s. It’s rare before adolescence. Men and women are equally affected. The period between when symptoms first start and before full psychosis is called the prodromal period. It may last for days to years and be difficult to identify because there’s usually no specific identifiable trigger. 

Though the exact triggers and causes of schizophrenia aren’t known, several risk factors can contribute to schizophrenia, including

• Genetics (heredity): Positive family history increases the risk.
• 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: Abnormalities in the brain structure may increase risk.
• Environment: Environmental factors like infections, exposure to toxins, drug abuse, and severe stress increase risk. 

Schizophrenia is a chronic, severe mental disorder which is one of the most disabling mental conditions. Schizophrenia affects the person’s perception of reality, thoughts, emotions, actions and their interaction with others. Patients often have difficulty  maintaining relationships and performing at work or school. This is a lifelong disease with no cure, but it can be controlled with appropriate medical treatment and psychological therapy. 

Schizophrenia involves psychosis characterized by hallucinations, delusions and changes in personality and behavior. Patients are unable to distinguish between reality and their imagination. Patients eventually tend to lose touch with reality. They may become a danger to themselves or others.

The severity of schizophrenia varies in patients. Some patients have only one psychotic episode, whereas others have many recurring psychotic episodes. Some patients tend to have repeated cycles of psychotic episodes and periods of remission (asymptomatic periods) during which they can lead normal lives. Others show very little improvement between psychotic episodes.

Initial symptoms
There are usually only subtle behavioral changes that may go unnoticed, especially in teens. These include

• Changes in school or work performance 
• Social withdrawal
• Irritability and mood swings 
• Difficulty focusing 
• Difficulty sleeping

Psychotic symptoms

• Delusions: These are false and sometimes unrealistic beliefs that the person refuses to stop believing despite providing proof. For example, believing they are God or that aliens are reading their minds, etc.
• Hallucinations: These involve having unreal sensations. The common hallucinations experienced are auditory hallucinations (hearing voices), visual hallucinations (seeing things) and tactile hallucinations (feeling sensations on the skin). Other rare hallucinations are smelling strange odors or having a strange taste in the mouth.
• Catatonia: The person may stop speaking with their body in a single fixed position for a long time.

Disorganized symptoms
These are symptoms that indicate the person is unable to think clearly, comprehend or respond, which include

• Speaking meaningless sentences that don’t make sense
• Difficulty in communicating or holding conversations
• Shifting quickly from one thought to the next without logic
• Moving slowly
• Difficulty making decisions
• Writing excessively but without meaning
• Forgetfulness 
• Repeating movements or gestures, like pacing or walking in circles
• Having problems making sense of everyday sights, sounds and feelings

Cognitive symptoms
The person will have the following symptoms

• Difficulty comprehending and making decisions
• Difficulty concentrating
• Poor memory
• Inability to recognize symptoms

Negative symptoms
These indicate the absence of normal behavior in people with schizophrenia. Negative symptoms of schizophrenia include

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

The doctor performs a complete medical and psychiatric evaluation. Complete blood analysis and brain imaging studies are performed to rule out other medical conditions, substance-induced psychosis or structural abnormalities in the brain. 

For a person to be diagnosed with schizophrenia, they should have at least two of these symptoms for at least six months which negatively affect their work or social life and can’t be explained by any other condition

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

One of the symptoms has to be

• Delusions
• Hallucinations
• Disorganized speech

With early diagnosis, proper treatment and psychosocial therapy, most people with schizophrenia can lead productive and fulfilling lives. Treatment for schizophrenia may include

• Medication: Medications don’t cure schizophrenia, but they help relieve the most troubling symptoms. Medications include
  • Older (first-generation) antipsychotics such as chlorpromazine (Thorazine), haloperidol (Haldol), etc.
  • Newer (atypical or second-generation) antipsychotics such as risperidone (Risperidal), iloperidone (Fanapat), clozapine (Clozaril), etc. Clozapine is used to treat schizophrenia that is resistant to other treatments.
• Psychosocial therapy: Psychosocial therapy can help with behavioral, social and occupational problems. 
• Hospitalization: Hospitalization may be indicated in patients with the following
  • Severe symptoms
  • Risk of harm to others
  • Suicidal tendencies 
  • Inability to care for themselves 
• Electroconvulsive therapy (ECT): Electrodes are attached to the patient's scalp and small electric shocks are administered to the brain under anesthesia. ECT may help when medications are no longer effective.