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Schizophrenia
What is it?
What Causes it?
Signs / Symptoms
Treatment / Therapies
Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with Schizophrenia may seem like they have lost touch with reality, which causes significant distress for the individual, their family members, and friends. If left untreated, the symptoms of Schizophrenia can be persistent and disabling. However, effective treatments are available. When delivered in a timely, coordinated, and sustained manner, treatment can help affected individuals to engage in school or work, achieve independence, and enjoy personal relationships.
Source: National Institute of Mental Health (NIMH)
The cause of Schizophrenia is not known, but researchers believe that a combination of genetics, brain chemistry, and environment contribute to the development of the disorder.
Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to Schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with Schizophrenia. While researchers aren't certain about the significance of these changes, they indicate that Schizophrenia is a brain disease. Schizophrenia is typically diagnosed in the late teen years to the early thirties and tends to emerge earlier in males (late adolescence – early twenties) than females (early twenties – early thirties). A diagnosis of Schizophrenia often follows the first episode of psychosis, when individuals first display symptoms of Schizophrenia. Gradual changes in thinking, mood, and social functioning often begin before the first episode of psychosis, usually starting in mid-adolescence. Schizophrenia can occur in younger children, but it is rare for it to occur before late adolescence.
Source: National Institute of Mental Health (NIMH),
Schizophrenia involves a range of problems with thinking (cognition), behavior and emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized speech, and reflect an impaired ability to function.
Symptoms may include:
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Delusions: These are false beliefs that are not based in reality. For example, an individual may think that: they are being harmed or harassed, certain gestures or comments are directed at them, they have exceptional ability or fame, another person is in love with them, or a major catastrophe is about to occur. Delusions occur in most people with Schizophrenia.
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Hallucinations: These usually involve seeing or hearing things that do not exist. Yet for the person with Schizophrenia, they have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.
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Disorganized thinking (speech): Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad.
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Extremely disorganized or abnormal motor behavior: This may show in a number of ways, from childlike silliness to unpredictable agitation. Behavior isn't focused on a goal, so it's hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
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Negative symptoms: This refers to reduced or complete lack of ability to function normally. For example, the individual may neglect personal hygiene or appear to lack emotion (doesn't make eye contact, doesn't change facial expressions or speaks in a monotone). Also, the individual may lose interest in everyday activities, socially withdraw or lack the ability to experience pleasure.
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Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present.
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In men, Schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It's uncommon for children to be diagnosed with Schizophrenia and rare for those older than age 45.
Source: National Institute of Mental Health (NIMH)
Since the causes of Schizophrenia are complex and are not fully understood, current treatments focus on managing symptoms and solving problems related to day-to-day functioning.
Treatments include:
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Antipsychotic Medications: Antipsychotic medications can help reduce the intensity and frequency of psychotic symptoms. They are usually taken daily in pill or liquid forms. Some antipsychotic medications are given as injections once or twice a month, which some individuals find to be more convenient than daily oral doses. Individuals whose symptoms do not improve with standard antipsychotic medication typically receive clozapine and must undergo routine blood testing to detect a potentially dangerous side effect that occurs in 1-2% of individuals. Many individuals taking antipsychotic medications have side effects such as weight gain, dry mouth, restlessness, and drowsiness when they start taking these medications. Some of these side effects subside over time, but others may persist, which may cause some people to consider stopping their antipsychotic medication. Suddenly stopping medication can be dangerous and it can make Schizophrenia symptoms worse. People should not stop taking antipsychotic medication without talking to a health care provider first. Shared decision-making between doctors and patients is the recommended strategy for determining the best type of medication or medication combination and the right dose.
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Psychosocial Treatments: Cognitive Behavioral Therapy (CBT), behavioral skills training, supported employment, and cognitive remediation interventions may help address the negative and cognitive symptoms of Schizophrenia. A combination of these therapies and antipsychotic medication is common. Psychosocial treatments can be helpful for teaching and improving coping skills to address the everyday challenges of Schizophrenia. They can help people pursue their life goals, such as attending school, working, or forming relationships. Individuals who participate in regular psychosocial treatment are less likely to relapse or be hospitalized.
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Family Education & Support: Educational programs for family members, significant others, and friends offer instruction about Schizophrenia symptoms and treatments, and strategies for assisting the person with the illness. Increasing key supporters’ understanding of psychotic symptoms, treatment options, and the course of recovery can lessen their distress, bolster coping and empowerment, and strengthen their capacity to offer effective assistance. Family-based services may be provided on an individual basis or through multi-family workshops and support groups.
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Coordinated Specialty Care: Coordinated Specialty Care (CSC) is a general term used to describe recovery-oriented treatment programs for people with first-episode psychosis, an early stage of Schizophrenia. A team of health professionals and specialists deliver CSC, which includes psychotherapy, medication management, case management, employment and education support, and family education and support. The individual with early psychosis and the team work together to make treatment decisions, involving family members as much as possible. Compared to typical care for early psychosis, CSC is more effective in reducing symptoms, improving quality of life, and increasing involvement in work or school.
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Assertive Community Treatment: Assertive Community Treatment (ACT) is designed especially for individuals with Schizophrenia who are at risk for repeated hospitalizations or homelessness. The key elements of ACT include a multidisciplinary team, including a medication prescriber, a shared caseload among team members, direct service provision by team members, a high frequency of patient contact, low patient-to-staff ratios, and outreach to patients in the community. ACT reduces hospitalizations and homelessness among individuals with Schizophrenia.
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Talk to your doctor or mental health professional to discuss possible options and side effects.