Schizophrenia

Schizophrenia, also known as Paranoid Schizophrenia, Disorganized Schizophrenia and Catatonic Schizophrenia, is a brain disorder that causes those affected to interpret reality in an abnormal fashion. It is the most chronic and disabling of all mental disorders, and while this disorder can often be managed, there is no cure. It hinders the ability of those suffering from it to care for themselves, becoming gradually worse over their lifetime.

The term Schizophrenia, while meaning “split mind”, is often confused with split or multiple personality disorders. In reality, the term “split mind” refers to the way Schizophrenia distorts a person’s ability to express emotion, think, behave in social settings and their perception of the world around them. Those suffering from Schizophrenia cannot tell the difference between what is real and what is imagined. Without treatment, they are stuck in a frightening and confusing world.

The severity of schizophrenia varies from person to person. There are several subtypes of this mental disorder, with the main ones being Paranoid, Disorganized and Catatonic Schizophrenia. Paranoid Schizophrenics believe that either certain people or all people are attempting to harm them, whether for punishment or revenge.

Variations of the Disease

They are usually fairly in control of their emotions, speech and actions, yet go out of their way to avoid being found or harmed by imaginary villains. Disorganized Schizophrenics often have trouble performing normal activities such as showering, dressing or preparing a meal. They are highly confused, incoherent and childish.

They may come across as emotionless and respond inappropriately to everyday situations. A Catatonic Schizophrenic is generally unable to move or speak. A few assume odd postures and stay in these positions, and may repeat everything said to them. They are at an increased risk of malnutrition or inflicting injury upon themselves.

Symptoms

The first signs of schizophrenia are sudden and severe changes in ability to perform tasks and in a patient’s personality. Symptoms typically begin in the teens or 20s in men, and in the 20s or 30s in women. It is highly uncommon for a child to be diagnosed with schizophrenia, and even rarer for those over 40 years old to develop symptoms. Signs and symptoms of this disorder or usually divided into four categories: positive, negative, cognitive and affective.

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Positive symptoms include anything that distorts a person’s ability to function normally. Delusions, which cause a person to misinterpret an experience, are one of the most common symptoms. Hallucinations cause someone to see or hear things that do not exist. The most common hallucination is hearing voices, though hallucinations can affect any number of the five senses, even smell and touch. Thought disorders and disorganized behavior cause someone to mix words together and excessively lose their train of thought, as well as experience unpredictable anger or silliness.

Negative Symptoms

Negative symptoms are often harder to detect, and includes losing the ability to function at a “normal” level (normal being the way a schizophrenic functioned before the onset of symptoms). Negative symptoms can be a withdrawal from society, loss of interest in usual activities, apparent lack in emotion, and an inability to make or stick to plans, neglect of hygiene and loss of motivation.

Cognitive Symptoms

Cognitive symptoms affect a person’s way of thinking. These symptoms are usually the most apparent to others and the most disabling for the person suffering from them, because they affect one’s ability to go about their daily life. It is thought that those with schizophrenia are born with these symptoms, but they usually do not have a major impact until the disorder itself actually starts. Cognitive symptoms include a lapse or absence of memory, difficulty or inability to pay attention and issues making sense of spoken, written or implied information.

Affective Symptoms

Affective symptoms cause the person to come across as odd, resulting in others avoiding or ignoring them. This leads to isolation, which contributes to a schizophrenic’s severe mood swings and/or depression. It is also common that those suffering from schizophrenia often entertain or act upon suicidal thoughts. Due to the nature of schizophrenia causing one to lose grasp of reality, it is often up to family or friends to find help for a loved one suffering because they are unable to see the problem them self.

Causes

While the exact cause of schizophrenia is currently unknown, it is known that it is primarily biological. Current research indicates that a variety of factors contribute to the development of this disorder, most notably genetics and the chemistry of the brain itself. Schizophrenia often runs in families, meaning the possibility of someone developing this disorder increases if one or both of the parents suffer from schizophrenia.

It is also believed that people with schizophrenia have a chemical imbalance in the brain, most often an extreme sensitivity to or overproduction of dopamine and/or glutamate. These chemicals are neurotransmitters that help nerve cells send messages, or “talk”, to one another. An imbalance of dopamine or glutamate interferes with the way a person reacts to certain smells, sounds and sights, and often leads to hallucinations and delusions, two of the primary symptoms of schizophrenia.

Neuroimaging

The newest research in schizophrenia has found, through neuroimaging, that the actual structure and function of the brain in many schizophrenics is abnormal. Abnormalities can also be found in the entire central nervous system, even the spine. However, this abnormality can also occur in people without the disease, though these findings do support the theory that schizophrenia is a brain disease.

Environmental factors can also play a role, more often than not being the cause of the onset of the disorder rather than the disorder itself. Viral infections, traumatic social experiences and continuous and large amounts of stress can trigger schizophrenia in those already predisposed to the disorder. However, schizophrenia can also become apparent when the body is undergoing hormonal or physical changes, typically puberty (which can last well into the twenties). Interestingly enough, the onset of schizophrenia is not typical in older adults, even women experiencing menopause.

Current Research

Current research is focused on finding one organic or neurobiological cause of schizophrenia, though as of now nothing has been found. Therefore, there is a debate among scientists and doctors as to whether schizophrenia is one disorder or a host of discrete syndromes not yet named. Because schizophrenics can present with one, a few or all of the current recognized symptoms, this theory of more than one disorder is not out of the realm of possibility.

Risk Factors

Among mental disorders, schizophrenia is relatively common. Almost 2.2 million Americans over the age of 18 will develop schizophrenia, and it is diagnosed worldwide in all races and cultures. It is most often developed during or closely after the onset of puberty, though children as young as five have been diagnosed.

Researchers have also identified certain risk factors that either increases the risk of developing schizophrenia or triggering it, including older paternal age, use of psychoactive drugs during young adulthood, stressful life circumstances, a family history of schizophrenia and exposure to toxins, malnutrition and viruses in the womb during the first and second trimesters.

Prevention

Because the exact cause of schizophrenia is unknown and varies from person to person, prevention of this disease is limited. The most effective prevention of schizophrenia is education, and includes public campaigns to provide information on early symptoms and signs. The earlier treatment is begun, the less likely it is to produce permanent damage to the individual.

People who are at a high risk for developing schizophrenia, such as those with a family history of the disease, often begin treatment before any signs of schizophrenia occur. This is highly controversial, as there is a very good chance that even those at increased risk of schizophrenia will never develop it, and the drugs used to treat and manage the disease come with a laundry list of possible debilitating side effects. However, many argue that the effects of late treatment of schizophrenia are more damaging than treating for a disease that may or may not present.

For those already suffering from schizophrenia, continued and thorough treatment is highly recommended. Any lapse in therapy can cause damage to the mental, emotional and physical life of the patient. Schizophrenics should be closely monitored for any lapse in treatment or sudden psychotic episodes even while on treatment.

Tests and Diagnosis

According to the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, three criteria must be met in order for a person to be diagnosed with schizophrenia. Before diagnosis is even begun, all other mental disorders must be ruled out, as well as the use of illegal substances or alcohol. Then the patient must present with at least two of the common symptoms of schizophrenia such as disorganized speech or behavior, catatonic behavior, hallucinations, delusions or the presence of any one of the negative symptoms associated with schizophrenia.

The patient must also experience significant to severe impairment in their ability to perform daily tasks or attend school or work. However, if any one of the symptoms is severe enough (an example would be a patient constantly hearing the same or a number of voices for the majority of the day), diagnosis can be made based on the one severe symptom. Lastly, all of these symptoms must be ongoing for at least six months before an official diagnosis is made.

In order to determine if the requirements for a schizophrenic diagnosis are met, doctors perform a number of laboratory and psychological tests. Blood tests are used to rule out other disorders with similar symptoms as well as screen for alcohol or drug use, as abuse of such could produce schizophrenic-like symptoms. MRI and CT scans are also used to look for any possible brain or central nervous system abnormalities. Lastly, a mental health provider will assess the patient, and base their diagnosis on the patient’s appearance as well as their responses to questions regarding their delusions or hallucinations, moods, thoughts of suicide and potential for violence.

Due to the nature of schizophrenia, diagnosis is often largely based on reports from friends, family and onlookers. Because schizophrenia alters the way a person views themselves and the world around them, the reports of family and friends is often the deciding factor in the diagnosis of schizophrenia.

Treatment

Schizophrenia requires treatment from the onset of the disease until the end of the life of the patient, even if symptoms subside or disappear entirely. Treatment is restricted primarily to medication and psychosocial therapy. During psychotic episodes, hospitalization may be required to ensure the safety and health of the patient.

Treatment is typically administered by a trained psychiatrist, with support from psychologists, social works and psychiatric nurses. In severe cases, a manager may be appointed to coordinate the care of the patient, and the patient may require continued in-hospital treatment, especially in the case of those suffering from catatonic schizophrenia.

Medications

Prescription medications, most typically antipsychotic medications, are the main treatment for schizophrenia. Without medication, no amount of therapy or other natural treatments will be completely effective. However, due to the possible severe side effects of these medications, patients are often reluctant to take them.

Antipsychotic Medications

Antipsychotic medications control symptoms that are caused by an imbalance in the chemical neurotransmitters of the brain. The willingness of the patient to submit to treatment can affect the choice in medication, and may require additional medication such as Lorazepam to calm them enough to submit to treatment.

Atypical antipsychotics are newer medications, and are preferred by doctors for treatment of schizophrenia due to the lower risk of side effects. These medications include Aripiprazole, Ziprasidone, Risperidone, Clozapine, Quetiapine, Olanzapine and Paliperidone. The main side effects of these medications are weight gain, high blood cholesterol and diabetes.

Conventional antipsychotics frequently cause irreversible neurological disorders, such as tardive dyskinesia, a movement disorder. They are typically used only when atypical antipsychotics fail to work, and include medications such as Chlorpromazine (also known as Thorazine), Haloperidol, Perphenazine and Fluphenazine.

Considering the fact that treatment of schizophrenia is a lifelong process, these antipsychotics are also considered for use when cost is a factor, as they are often cheaper than atypical antipsychotics.

Medication Timeframe

It can take nearly a month after starting any medication to notice a significant improvement in a schizophrenic patient. The goal of medication is to use the lowest dosage possible, and doctors often try a number of different types of medications, dosages and combinations of the two to control symptoms. Often, antidepressants and anti-anxiety medications are also utilized to treat suicidal thoughts and the stress and fear of patients caused by their hallucinations, delusions and paranoia.

Psychosocial Treatments

Once medications take effect, psychosocial treatments are extremely important to help the patient return to and maintain a normal-functioning lifestyle. These can include social skills training to improve communication skills, family therapy to aid caregivers in supporting their loved ones, vocational rehabilitation to allow those suffering from schizophrenia to acquire and maintain a job, as well as individual therapy to help the patient deal with their illness as well as monitor medications and identify early signs of relapse.

Other Treatments

Electroconclusive therapy is used only when all other medications have failed. It is only recommended for catatonic schizophrenics, and involves using electric shock to induced seizures while the patient is under anesthesia. Typically, there are six to twelve electroconclusive therapy treatments. While highly controversial, this treatment has been proven relatively safe and effective.

The Soteria method of treatment involves patients living in a communal home with little to no medical staffing. Antipsychotic drugs are taken only by choice, and patients participate in excessive social therapies and classes. Recent studies indicate that those suffering from less debilitating cases of schizophrenia do just as well with the Soteria method as they would with the usual treatment of medication and therapy. The Soteria method is used primarily in Germany, Sweden, Switzerland and Hungary and is considered the more gentle and kinder way to treat the disorder.

Prognosis

The earlier treatment is begun for schizophrenia, the better the outcome. Researchers believe that the first two years of treatment, and continued treatment thereafter, has the most effect on a positive outcome for patients. The goal of treatment is to allow a person suffering from schizophrenia to function properly in society and maintain an independent lifestyle.

Studies indicate that at least 62% of those treated for schizophrenia meet this goal within five years of beginning treatment. Females, those who are older at the onset of symptoms and those in good physical health before symptoms occur are more likely to receive a good prognosis and reach some semblance of remission status, which is not yet clinically defined.

The stigma placed on those suffering from schizophrenia has diminished over the years, though it is still one of the main obstacles in a schizophrenic seeking out treatment. Increased public awareness of this disease, as well as continued research, can increase the rate of a good prognosis for those diagnosed with schizophrenia.