Overview and Facts – What is Schizophrenia?
Are you having trouble separating reality from fantasy? Do you hear voices? Do you believe someone is reading your mind and controlling your thoughts? Are your thoughts “off” and are you having difficulty expressing how you feel, act, and think? If so, you may be suffering from schizophrenia, a debilitating brain and behavioral disorder with chronic and acute symptoms that occur continuously or intermittently throughout your lifespan.
Heavily stigmatized in American culture, schizophrenia is often confused with multiple personalities and the propensity to cause severe danger to others. Schizophrenic individuals may appear agitated, withdrawn, or unresponsive, inciting additional fear within the general public. Most do not realize that if you are suffering from schizophrenia, medications and psychological counseling have been found to substantially improve the lives of those suffering from this condition. And it’s most important to get treatment if you are suffering from schizophrenia, as it poses one of the highest risks of suicide among the general population, with up to 10 to 13% of schizophrenics carrying out successful suicide attempts within the first decade of diagnosis. The overall prevalence of the disorder is extremely low, affecting only 0.3% to 1% of Americans, though what makes this illness monumental is the severity of its symptoms.
Though able to occur at any age, if you are suffering from schizophrenia, the likely onset for men is between the late teens and early 20s and the late 20s to early 30s for women. It is very unlikely for a diagnosis of schizophrenia to occur in individuals less than 12 years old and older than 40 years old. Life expectancy for schizophrenic individuals is reduced by approximately 10 to 25 years less than the average, though this is likely caused by the increased occurrence of physical symptoms and much higher suicide rates than the general population.
Symptoms and Types of Schizophrenia
Signs and symptoms of schizophrenia are often categorized into positive and negative classifications and cognitive deficits. If you are suffering from schizophrenia and are undergoing treatment, you may have noticed that treatments tend to diminish positive symptoms pretty well. Negative symptoms are more prone to not respond to treatment as readily as positive symptoms. Deficits in cognitive abilities are large indicators of the impact schizophrenia has on the quality of life of an individual. If you are suffering from numerous cognitive deficits, your functioning as an adult with the illness will be minimized and successful treatment interventions will be harder to attain.
Positive Symptoms include:
• Delusions – false beliefs that stay stable even when presented with facts contradictory of the beliefs
• Hallucinations (tactile, auditory, olfactory, and gustatory) – including hearing voices, seeing things
• Thought Disorders (dysfunctional thinking)
• Movement Disorders (agitated body movements)
Negative Symptoms include:
• Emotionally flat (flat affect)
• Dull speaking, monotone, disconnected from reality
• Inability to start of follow through with activities
• Lack of motivation
• Poverty of Speech (i.e., speaking less)
• Little or no interest in life or relationships
Cognitive Symptoms include:
• Inability to understand information and use it to for decision-making purposes
• Trouble focusing or paying attention
• Disorganized thinking, thoughts, and speech
• Difficulty remembering things; problems with working memory
• Lack of Insight – termed “anosognosia” – where the affected individual has no awareness they are suffering from schizophrenia
Paranoid Schizophrenia: The most common type of schizophrenia characterized by psychosis misaligned with reality. If you are suffering from paranoid schizophrenia, you may be unreasonably paranoid of others, have paranoid delusions that someone is after you and that they are trying to hurt you. Common paranoid delusions include coworkers, spouses, the government, and neighbors plotting to hurt you in some way. You may believe others are out to try to kill you, spy on your, make your life miserable, poison you, or cheat on you. Paranoid schizophrenia has a severe impact on relationships, understandably so, as if you are suffering from this disorder, you believe those that are close to you are trying to hurt you in some way. This may cause you to feel angered and agitated. To cause an even deeper impact on the situation, your paranoid delusions may be accompanied by hallucinations where you hear voices that are insulting you or prompting you to do bad things.
Schizoaffective Disorder: Schizoaffective disorder is a type of combination disorder that combines symptoms of schizophrenia with a mood disorder – most likely either major depression or bipolar disorder. This type of schizophrenia is chronic and appears in intermittent episodes. Mood (affective) symptoms occur at the same time as the schizophrenic symptoms and the schizophrenic symptoms often stay put after the mood symptoms disperse. Common symptoms of schizoaffective disorder include depression, mania, and classic schizophrenia.
Brief Psychotic Disorder: This is a short-term occurrence of schizophrenia, where there is a sudden onset of symptoms that only persist for less than one month. The causes of these brief stints of psychoses include an obvious stressor (e.g., death of a loved one, trauma from natural disasters), no apparent stressor (i.e., the symptoms come on due to no obvious reaction to a disturbing event), and postpartum psychoses – occurring in women within 4 weeks of giving birth. During this brief episode of psychosis, you might experience hallucinations, delusions, and cognitive deficits, as present during more general schizophrenia. It is unknown what causes brief psychotic disorder to affect certain individuals, but certain genetic and environment factors have been examined as culprits, including predisposition to develop mood disorders and psychoses within the family history.
Schizophreniform Disorder: This is another short-form occurrence of full-blown schizophrenia, where the affected individual experiences distorted thinking, emotional reactions, and perceptions of reality. If you are suffering from this disorder, you likely have a very hard time distinguishing between what’s real and what’s imagined. Though the symptoms of schizophreniform disorder and general schizophrenia overlap, the major difference is the length of duration. If you suffer from schizophreniform disorder, you experience psychosis symptoms for six months or less. If they persist longer than this time frame, you are likely to receive a diagnosis of schizophrenia instead.
Delusional Disorder: As the name suggests, this is a form of psychosis where the main symptom is delusions – the inability to shake untrue beliefs. If you are suffering from this form of psychosis, it is not likely you are making up unbelievable scenarios – most delusions involve someone trying to poison you or harm you in some type of way. In reality, these delusions may be a heightened exaggeration of reality or just false altogether. A distinguishing characteristic of individuals suffering from this condition is that among other things, there is no bizarre behavior – you wouldn’t know someone is suffering from this condition if it weren’t for the delusions.
Shared Psychotic Disorder: Also known as “folie a deux” (the folly of two), this is a rare form of psychosis where an otherwise healthy individual begins to adopt the psychotic beliefs/delusions of someone suffering from schizophrenia. For example, if you are suffering from schizophrenia and believe monsters are after you and trying to abduct you, if your spouse (otherwise healthy) also starts to believe that monsters are out to get you, your spouse would be considered to suffer from shared psychotic disorder. If you and your partner separate, the delusions resolve.
Causes of Schizophrenia
Researchers have yet to pinpoint an exact case of schizophrenia, but the usual genetic and environment factors are lead agents in the causes of schizophrenia. It is no secret that schizophrenia runs in families. Research has shown that while schizophrenia occurs in less than 1% of the general population, if you have a first-degree relative with the illness, your chances of developing it increase to 10%. In twins, the risk is substantially increased, with there being a 50% chance of developing schizophrenia in the undiagnosed identical twin. But, this does not mean if your mother suffers from schizophrenia, you are automatically going to suffer from it as well. Though genes increase the risk of occurrence of schizophrenia, they only lay the groundwork. The right mix of environmental factors seem to need to mix with the genetic makeup to propel the development of schizophrenia into a full-blown illness.
Research has shown that some of the most prominent environmental factors that are conducive to interacting with pre-disposed schizophrenic genetic makeups include problems during birth, malnutrition before birth, exposure to certain viruses, and psychosocial factors.
The brain’s makeup is also thought to be a leading cause of the development of schizophrenia. An imbalance between neurotransmitters, dopamine, and glutamate seems to point to higher occurrence levels of schizophrenia in the general population. Similarly, impaired brain development during the gestational phase of life may lead to imbalanced connections between the brain chemistry and structure of the brain, in addition to hormonal changes/imbalances that occur during puberty.
There is some evidence that substance abuse/use may also predispose you to developing schizophrenia. Using mind-altering drugs in the teenage years and early adulthood can increase your risk of schizophrenia, including the use of marijuana.
Complications of Schizophrenia
As mentioned previously, the occurrence of suicide in schizophrenics is abnormally higher than other mental illness disorders. Such that, an estimated 20% to 40% of individuals suffering from schizophrenia will attempt suicide at some point in their lifetimes. Up to 13% are likely to successfully complete the act, the majority being males. Suicide is a tricky complication of schizophrenia because many suffering from this condition are unaware they have it, making treatment that much more difficult.
Substance abuse is another common complication of schizophrenia. Nicotine addiction is the most common substance abuse among schizophrenics, with schizophrenics being addicted to nicotine three times the rate of the general population. If you are suffering from schizophrenia, you have an increased propensity to abuse more harder substances in addition to nicotine, including marijuana, alcohol, and cocaine. Certainly compounding the already detrimental impact of substance abuse on one’s general health, taking medications to treat schizophrenia while abusing drugs makes the medication less effective, in fact, potentially dangerous. In addition, amphetamines (stimulants) make schizophrenic symptoms considerably worse.
Diagnosis and Tests of Schizophrenia
Diagnosis of schizophrenia occurs based on the presence of symptoms and the duration of symptoms. Generally speaking, the presence of two or more psychotic symptoms (e.g., delusions, hallucinations, disorganized speech, catatonic behavior) must be significant and occur for at least one month. In more severe cases, the presence of significant delusions and hallucinations can alone be used to make a diagnosis of schizophrenia.
Prior to initial diagnosis, a health care provider will rule out any other possible causes of the schizophrenic symptoms, including medical conditions, other mental illnesses, and brain tumors.
Treatment and Care
There are several treatments and therapies focused on eliminating the symptoms of schizophrenia. If you suffer from this condition, you might take antipsychotics, undergo psychosocial treatments, or coordinated treatment care. Antipsychotics are the most common form of treatment for individuals with schizophrenia. They significantly reduce positive symptoms – impacting the neurotransmitter systems. Commonly used medications for treatment include Haldol, and the more modern atypical antipsychotic medications such as Clozapine, Geodon, Seroquel, Risperdal, Abilify and Zyprexa.
The second tier of treatment includes cognitive and behavioral therapy to “retrain” the brain once the antipsychotics reduce the positive symptoms associated with schizophrenia. Additionally, cognitive behavioral therapy improves self-care and teaches coping mechanisms so that schizophrenics can lead somewhat normal lives – going to work, going to school, and staying in relationships.
Coordinated specialty care (CSC) integrates a full course of treatments, including medication, psychosocial therapies, family involvement, and employment services to round out the schizophrenic treatment plans and courses back to normalcy. CSC projects to alter the normal trajectory of those suffering from schizophrenia and orient them toward productive, independent lives.
Living and Managing Life With Schizophrenia
It takes a village, that’s for sure. Family involvement, peer help, and care and support of a loved one with schizophrenia is no small feat. How do you respond to someone claiming aliens are after them? Or that the government set up spyware in their home? When faced with caring for a loved one suffering from schizophrenia, it’s helpful to keep in mind this is a biological illness. Express your concern and motivate them to seek treatment. Once they get in treatment, encourage them to stay there. Don’t make fun of their delusions, downplay them, or make light of any hallucinations that may be occurring. After all, to someone suffering from schizophrenia, these things are quite real.
Support and Resources
If you are suffering from schizophrenia, stay in treatment and join a support group. Joining clinical trials is also a beneficial way to explore different prevention, detection, and treatment options. Don’t abruptly stop medications – and don’t skip medicine dosages. Keep in mind that while there is no cure for this disorder, there are thousands suffering from the same condition. You are not alone. And schizophrenia is very treatable and manageable, especially when diagnosed early. You can still enjoy life while living with schizophrenia.