Schizophrenia

Perhaps you remember Russell Crowe in the movie “A Beautiful Mind,” in which he played mathematical genius John Nash, who lived with schizophrenia yet won the Nobel Memorial Prize in Economic Sciences. Or maybe you recall darker accounts of people who suffer from schizophrenia like John Lennon’s killer Mark David Chapman, who after shooting Lennon four times in the back, stayed at the scene reading The Catcher in the Rye until police arrived and arrested him. No matter how schizophrenia is portrayed in the media or whether the illness brings to mind delusions, hallucinations or homeless people roaming the streets, it’s a serious condition that affects 2.4 million American adults over the age of 18.[1] Read on to learn more about this severe mental illness.

What is Schizophrenia?

Schizophrenia is a chronic, severe, and disabling brain disorder that interferes with a person’s ability to think clearly, manage emotions, make decisions and relate to others. It affects men and women equally and occurs at similar rates in all ethnic groups around the world. [1]

Types of Schizophrenia

There are several types of schizophrenia. Many of the symptoms in each type can be present in other types. Below are the characteristics that make each type unique.

Paranoid schizophrenia is characterized by delusions and auditory hallucinations that involve false beliefs of being persecuted or plotted against. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety and argumentativeness.[2,3]

Disorganized (also called hebephrenic) schizophrenia is characterized by strange, aimless behavior and often nonsensical speech. The disorganized behavior may interfere with a person’s ability to perform normal activities of daily living, such as showering, dressing and making meals.[2,4]

Catatonic schizophrenia includes episodes of behavior at extreme opposite ends of the spectrum. The person may seem like he/she’s in coma-like daze, unable to speak, move or respond or he may talk and behave in a bizarre, hyperactive way. Catatonic episodes can last for a month or longer without treatment.[5]

Undifferentiated schizophrenia is characterized by some symptoms seen in all of the above types but not enough of anyone to categorize it as a particular type.[2]

Residual schizophrenia is identified when a person has had a past history of at least one episode of schizophrenia, but currently doesn’t have positive symptoms (such as, delusions, hallucinations, disorganized speech or behavior). The person may be in a transition between a full-blown episode and complete remission or may live for years without any more psychotic episodes.[2]

Signs & Symptoms of Schizophrenia

No particular symptom can determine a diagnosis of schizophrenia and schizophrenia symptoms can also be caused by other mental illnesses. However, in men, schizophrenia symptoms typically start in the teens or 20s while women tend to show symptoms in their 20s or early 30s. It’s uncommon for children to be diagnosed with schizophrenia and rare for people older than 45.[1,6]

Signs and symptoms of schizophrenia generally are divided into the following categories.[6]

Positive (or psychotic) symptoms

In schizophrenia, positive symptoms reflect an excess or distortion of normal functions. These active, abnormal symptoms may include the following.[7]

  • Delusions are beliefs not based in reality and usually involve misinterpretation of perception or experience. They are the most common symptom of schizophrenia.
  • Hallucinations usually involve seeing or hearing things that don’t exist, although hallucinations can be in any of the senses. Hearing voices is the most common hallucination among people with schizophrenia.
  • Thought disorder involves difficulty speaking and organizing thoughts. People may stop speech midsentence or put together meaningless words, known as word salad.
  • Disorganized behavior may appear in different ways, ranging from childlike silliness to unpredictable agitation.

Negative symptoms

Negative symptoms involve a diminishment or absence of characteristics of normal function. They are the main reason patients with schizophrenia cannot live independently, hold jobs, establish personal relationships and manage everyday social situations. Negative symptoms may appear with or without positive symptoms.[8]. They include:

  • Appearing to lack emotion and showing inexpressive faces, blank looks
  • Monotone and monosyllabic speech
  • Few gestures
  • Loss of interest in everyday activities and lack of interest in the world and other people
  • Inability to feel pleasure or act spontaneously
  • Reduced ability to plan or carry out activities
  • Neglect of personal hygiene
  • Social withdrawal
  • Loss of motivation

Cognitive symptoms

Cognitive symptoms involve problems with thought processes. These symptoms may be the most disabling in schizophrenia because they interfere with the ability to perform routine daily tasks. A person with schizophrenia may be born with these symptoms. They include the following:[7]

  • Problems with making sense of information
  • Difficulty paying attention
  • Memory problems

Symptoms in teenagers

While schizophrenia symptoms are similar in adults and teenagers, they may be harder to recognize in teens because some of the early symptoms are common during teen years, such as the following:[6]

  • Withdrawal from friends and family
  • A drop in performance at school
  • Trouble sleeping
  • Irritability

Compared with schizophrenia symptoms in adults, teens may be:

  • Less likely to have delusions
  • More likely to have visual hallucinations

Causes of Schizophrenia

While it’s not known exactly what causes schizophrenia, researchers believe that a combination of genetics and environment contribute to development of the disease.

Genetics. A particular gene that causes schizophrenia hasn’t been identified, but researchers believe that several genes are associated with an increased risk of the illness. Additionally, 10 percent of people with a first-degree relative who has schizophrenia are affected by the disease. People who have second-degree relatives with the disease also develop schizophrenia more often than the general population. The highest risk occurs when an identical twin is diagnosed with schizophrenia. The unaffected twin has about a 50 percent chance of developing the disorder.[9].

Environment. Scientists believe that it takes more than just genes to cause schizophrenia. Exposure to viruses or malnutrition before birth and potentially psychosocial and socioeconomic factors all interact with the way a gene’s influence develops over time, interfering with the natural process. Early childhood trauma is one factor that researchers think might affect how a gene develops.[9,10]

Substance abuse. Most researchers do not believe that substance abuse causes schizophrenia, however some people who abuse drugs show symptoms similar to those of schizophrenia, and therefore, may be mistaken for people who are affected by drugs. Additionally, people who have schizophrenia are much more likely to have a substance or alcohol abuse problem than the general population.[11]

Brain chemistry and structure. Scientists believe that an imbalance involving the neurotransmitters (substances that allow brain cells to communicate with each other) dopamine and glutamate, and possibly others, plays a role in schizophrenia.[9]

Also, brain imaging technologies, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), which provide a detailed map of the brain, have shown that individuals diagnosed with schizophrenia have changes in both brain structure and chemistry. For example, fluid-filled cavities at the center of the brain, called ventricles, are larger in some people with schizophrenia.[9,10]

Effects of Schizophrenia

There is a perception that people with schizophrenia are violent, yet most violent crimes are not committed by people with schizophrenia.[12] However, some symptoms of schizophrenia are associated with violence, such as delusions of persecution. Substance abuse may also increase the chance a person will become violent.[13]

Self-harm is a concern with schizophrenic people since they attempt suicide much more often than others. About 10 percent of people with schizophrenia (especially young adult males) die by suicide.[14,15]

Treatments for Schizophrenia

A combination of medication and therapy are used to treat schizophrenia.

Medications. Antipsychotic medications are the most effective treatment for schizophrenia. They work by changing the balance of chemicals in the brain and can help control symptoms. However, antipsychotics can cause side effects, such as persistent muscle spasms, tremors and restlessness.[7,16]

Therapies and support programs. Behavioral therapies can help patients understands their disease and provide illness management, which can help them learn how to take medication correctly and manage side effects, notice early signs of a relapse and what to do if symptoms return and cope with symptoms that occur even while taking medication. Therapy can also help improve social and work functioning. Programs that offer outreach and community support services can help people who lack family and social support.[7,16]

Family support. People with schizophrenia are often discharged from the hospital into the care of their families. Therapists can help family members learn coping strategies and problem-solving skills so they can help ensure their loved one continues treatment and stays on medication. Outpatient and family services are also available to family members.[16]

References

  1. National Alliance on Mental Illness. What is Schizophrenia? Retrieved April 4, 2013, from http://www.nami.org/Template.cfm?Section=schizophrenia9.
  2. WebMD. Types of Schizophrenia. Retrieved April 5, 2013, from http://www.webmd.com/schizophrenia/guide/schizophrenia-types.
  3. MedlinePlus. Schizophrenia-paranoid type. Retrieved April 5, 2013, from http://www.nlm.nih.gov/medlineplus/ency/article/000936.htm.
  4. MedlinePlus. Schizophrenia-disorganized type. Retrieved April 5, 2013, from http://www.nlm.nih.gov/medlineplus/ency/article/000937.htm.
  5. Mayo Clinic. Catatonic schizophrenia. Retrieved April 5, 2013, from http://www.mayoclinic.com/print/catatonic-schizophrenia/DS00863.
  6. Mayo Clinic. Schizophrenia Definition. Retrieved April 4, 2013, from http://www.mayoclinic.com/health/schizophrenia/DS00196.
  7. MedlinePlus. Schizophrenia. Retrieved April 7, 2013, from http://www.nlm.nih.gov/medlineplus/ency/article/000928.htm.
  8. The Harvard Medical School Family Health Guide. The negative symptoms of schizophrenia. Retrieved April 7, 2013, from http://www.health.harvard.edu/fhg/updates/update0706c.shtml.
  9. National Institute of Mental Health. What causes schizophrenia? Retrieved April 6, 2013, from http://www.nimh.nih.gov/health/publications/schizophrenia/what-causes-schizophrenia.shtml.
  10. National Alliance on Mental Illness. The Causes of Schizophrenia. Retrieved April 4, 2013, from http://www.nami.org/Template.cfm?Section=schizophrenia9.
  11. Blanchard JJ, Brown SA, Horan WP, Sherwood AR. Substance use disorders in schizophrenia: Reviews, integration and a proposed model. Clinical Psychological Review. 2000;20:207-234.
  12. Walsh E, Buchanan A, Fahy T. Violence and schizophrenia: examining the evidence. British Journal of Psychiatry. 2002 Jun;180:490-495.
  13. Swanson JW, Swartz MS, Van Dorn RA, Elbogen E, Wager HR, Rosenheck RA, Stroup S, McEvoy JP, Lieberman JA. A national study of violent behavior in persons with schizophrenia. Archives of General Psychiatry. 2006 May;63(5):490-499.
  14. Jones RT and Benowitz NL. Therapeutics for Nicotine Addiction. In Davis KL, Charney D, Coyle JT & Nemeroff C (Eds.), Neuropsychopharmacology: The Fifth Generation of Progress (pp15331544). 2002. Nashville, TN:American College of Neuropsychopharmacology.
  15. Cardno AG and Gottesman II. Twin studies of schizophrenia: from bow-and-arrow concordances to star wars Mx and functional genomics. American Journal of Medical Genetics. 2000 Spring;97(1):12-17.
  16. National Institute of Mental Health. How is schizophrenia treated? Retrieved April 2, from http://www.nimh.nih.gov/health/publications/schizophrenia/how-is-schizophrenia-treated.shtml.

By C. J. Newton, MA, Therapists.com Editor

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