Schizophrenia

What is Schizophrenia?

Schizophrenia is a chronic psychiatric disorder. People with this disorder experience distortions of reality, often in the form of delusions or hallucinations.

Misconceptions about this disorder are common. For example, some people think schizophrenia creates a “split personality.” In fact, schizophrenia and split personality — properly termed dissociative identity disorder — are two different disorders.

Schizophrenia can occur in men and women of all ages. Men often develop symptoms in their late teens or early 20s. Women tend to show signs in their late 20s and early 30s. The disorder is more common in men than women. Worldwide, schizophrenia is most debilitating disorders.

Schizophrenia symptoms can go away for a while and then return, but it’s possible to enjoy a healthy, symptom-free life. Following your doctor’s recommendations will improve your prognosis.

According to the Royal College of Psychiatrists, 3 out of every 5 people diagnosed with schizophrenia will get better with treatment. To get on the road to improvement, it’s important to:

learn about your condition
understand the risk factors
follow your doctor’s treatment plan

Symptoms

Early Symptoms

Symptoms of this disorder commonly show up in the teenage years and early 20s. At these ages, the earliest signs may get overlooked because they mirror certain “typical” adolescent behaviors.

Early symptoms can include:

isolating oneself from friends and family
changing friends or social groups
a change in focus and concentration
sleep problems
irritability and agitation
difficulties with schoolwork, or poor academic performance
anxiety
vague suspiciousness
odd ideas
feeling different from others

When it comes to more advanced symptoms, these tend to fall into three distinct categories: positive symptoms, negative symptoms, and disorganized symptoms.

Positive symptoms (mean added thoughts or actions to one’s typical experience).

“Positive” symptoms of schizophrenia aren’t typical in individuals without schizophrenia or other types of severe mental illness. These behaviors include:

experiences that appear real but are created by your mind. They include seeing things, hearing voices, or smelling things that others around you don’t experience.
A delusion occurs when you believe something despite evidence or facts to the contrary.
Paranoia. Paranoia is when someone is unusually distrustful of others, or firmly believes they are being followed or persecuted.
Disorganized speech or behavior
Dysfunctional thinking
Catatonia or other movement disorders

Negative symptoms (are the absence of typical behaviors).

Negative symptoms of schizophrenia interrupt a person’s typical emotions, behaviors, and abilities. These symptoms include:

reduction in speaking
odd emotional responses to situations
a lack of emotion or expressions
loss of interest or excitement for life
social isolation
trouble experiencing pleasure
difficulty beginning or following through with plans
difficulty completing normal everyday activities

Cognitive symptoms

Sometimes referred to as “cognitive” symptoms, these symptoms are labeled as such because they illustrate that someone is having trouble with certain cognitive or mental functions. They include:

disorganized thinking or speech, such as when a person changes topics rapidly when speaking or uses made-up words or phrases
forgetfulness
disorganized thinking, such as trouble focusing or paying attention
poor “executive functioning,” or understanding information and using it to make decisions
problems learning information and using it

Symptoms of schizophrenia can vary in severity and type, and may be exasperated if an individual is experiencing heightened stress, using substances, or is not taking their prescribed medications correctly.

Schizophrenia causes

The exact cause of schizophrenia is unknown. Medical researchers believe several factors can contribute, including:

biological
genetic
environmental

Risk factors

Even though it’s still not known what causes schizophrenia, researchers believe genetics may play a role. People with a family history of schizophrenia have a higher risk of developing this disorder.

Other risk factors for schizophrenia may include:

exposure to toxins, a virus, or malnutrition before birth or during infancy
using mind-altering drugs
living in a highly stressful situation
taking mind-altering drugs in adolescence or young adulthood

How Is Schizophrenia Diagnosed?

The diagnosis of schizophrenia is made both by ruling out other medical disorders that can cause the behavioral symptoms (exclusion), and by observation of the presence of characteristic symptoms of the disorder. The doctor will look for the presence of delusions, hallucinations, disorganized speech or behavior, and/or negative symptoms, along with social withdrawal and/or dysfunction at work or in daily activities for at least six months.

The doctor may use physical examination, psychological evaluation, and laboratory testing of blood, and imaging scans to produce a complete picture of the patient’s condition.

There isn’t a single test to diagnose schizophrenia. A complete psychiatric exam can help a doctor make a diagnosis. You’ll need to see a psychiatrist or mental health professional.

At your appointment, expect to answer questions about your:

medical history
mental health
family medical history

a physical exam
blood work
imaging tests, including magnetic resonance imaging (MRI) or computed tomography (CT) scan

Sometimes, there can be other reasons for your symptoms, even though they may be similar to those of schizophrenia. These reasons may include:

substance use
certain medications
other mental illnesses

Schizophrenia complications

Schizophrenia is a serious mental illness that shouldn’t be ignored or left untreated. The illness increases the risk of serious complications, such as:

self-injury or suicide
anxiety
phobias
depression
alcohol or drug use
family problems
risk for poverty and homelessness.

Schizophrenia can also make it difficult to work or attend school. If you can’t work or support yourself financially,

Types of schizophrenia

Catatonic schizophrenia

Catatonia refers to a set of symptoms that might develop in some patients with schizophrenia. It can include periods where the individual moves very little and does not respond to instructions.

The clinical picture of catatonia is dominated by at least three of the following symptoms:

Stupor – no psychomotor activity, no interaction with the environment
Catalepsy – includes adopting unusual postures
Waxy flexibility – if an examiner places the patient’s arm in a position, they will maintain this position until it is moved again
Mutism – limited verbal responses
Negativism – little or no response to instructions or external stimuli
Posturing – actively holding a posture against gravity
Mannerism – carrying out odd, exaggerated actions
Stereotypy – repetitive movements without an apparent reason
Agitation – for no known reason
Grimacing
Echolalia – mimicking another person’s speech
Echopraxia – mimicking another person’s movements

Paranoid schizophrenia

A person with disorganized-type schizophrenia will exhibit behaviors that are disorganized or speech that may be bizarre or difficult to understand. They may display inappropriate emotions or reactions that do not relate to the situation at-hand. Daily activities such as hygiene, eating, and working may be disrupted or neglected by their disorganized thought patterns

Hebephrenic/ Disorganized Schizophrenia

Undifferentiated Schizophrenia

Undifferentiated-type schizophrenia is a classification used when a person exhibits behaviors which fit into two or more of the other types of schizophrenia, including symptoms such as delusions, hallucinations, disorganized speech or behavior, or catatonic behavior.

Residual Schizophrenia

When a person has a past history of at least one episode of schizophrenia, but the person currently has no symptoms (delusions, hallucinations, disorganized speech or behavior), they are considered to have residual-type schizophrenia. The person may be in complete remission, or may at some point resume symptoms.

Schizophrenia Treatments

There’s no cure for schizophrenia. Current treatments focus on managing or reducing the severity of symptoms. It’s important to get treatment from a psychiatrist or mental health professional that has experience treating people with this disorder.

Possible treatments include the following:

Medications

Antipsychotic medication is the most common treatment for schizophrenia.

Psychosocial intervention

Another treatment option for schizophrenia is psychosocial intervention. This includes individual therapy to help you cope with stress and your illness.

Social training can improve your social and communication skills.

Vocational Rehabilitation

Vocational rehabilitation can provide you with the skills you need to return to work. It may make maintaining a regular job easier.

Family support and education

If you or someone you care about has been diagnosed with schizophrenia, having support from family and friends can help lower stress and create a feeling of inclusion.

Childhood schizophrenia

A diagnosis of schizophrenia is common in people in their teens and early 20s. Although less common, it can begin earlier. When symptoms occur before the age of 13, the condition is sometimes called early-onset or childhood schizophrenia.

Diagnosing this condition is difficult. Behavior changes aren’t unusual as children and teens develop. Plus, some of the most common symptoms of this mental health disorder also show up in other conditions. These include:

depression
bipolar disorder
attention disorders

Symptoms of childhood schizophrenia include:

unusual fears or anxieties (paranoia)
sleep problems
emotional swings
hearing voices or seeing things (hallucinations)
decreased attention to self-care
sudden changes in behavior
deterioration in academic performance
odd beliefs or thinking

It’s important to separate the behaviors that may occur in growing children and teenagers with symptoms of a serious mental health condition. However, if you are concerned that your child has acquired some new, worrying behaviors, it’s essential to talk with a mental health professional as soon as you can. No matter what the issue is, a professional can support you to make the best decision for your family.

Schizophrenia prognosis

While a schizophrenia diagnosis can come with an increased risk of mortality due to co-occurring conditions and the risk of suicide, proper treatment can help an individual live a productive and happy life.

Like many chronic illnesses, the prognosis depends on a lot of personal factors, including how early a diagnosis was made, how much an individual is able and willing to follow a treatment plan, and the support system they have.

Living with schizophrenia

Without treatment, schizophrenia can significantly disrupt a person’s life, including their ability to work, study, and care for themselves.

Some helpful strategies include:

- following the treatment plan carefully, including taking medications as prescribed
- bringing up any concerns about treatment with a healthcare provider
- making use of available support, which may involve friends, crisis services, and specialized healthcare facilities
- making healthful choices regarding the diet, exercise, and the use of drugs, alcohol, and tobacco

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