Schizophrenia is a chronic and often debilitating mental illness. The condition can cause you to withdraw from the people and activities in the world around you and to retreat into a world of delusions or separate reality.
Schizophrenia is a form of psychosis, which is an impairment of thinking in which the interpretation of reality is abnormal. Psychosis is a symptom of disordered brain function.
The illness affects approximately 1 percent of the population worldwide. In men, schizophrenia typically emerges in the teens or 20s. In women, the onset of schizophrenia typically is in the 20s or early 30s.
There's often no cure for schizophrenia, but by working closely with a psychiatrist and other mental health professionals, schizophrenia can be managed successfully — especially with an early diagnosis. Fortunately, newer medications continue to make this poorly understood disorder more manageable.
Researchers haven't identified the cause or causes of schizophrenia, although they believe genetic factors play a role. About 1 percent of the general population develops schizophrenia compared with 10 percent of those with a close family relative who has the disease. Chemical or subtle structural abnormalities in the brain may contribute to causing this illness.
When to seek medical advice :
By its nature, schizophrenia often isn't an illness for which someone is likely to voluntarily seek treatment. To a person with schizophrenia, the delusions and hallucinations are real, and often he or she may believe there's no need for medical help. If you're a family member or friend of someone who is exhibiting possible signs of schizophrenia or another mental disorder, you may need to be the one who takes him or her to a medical professional for evaluation. Additionally, people with schizophrenia are more likely to attempt suicide, so if your loved one talks about committing suicide, seek professional help immediately.
Signs and symptoms of schizophrenia may include :
- Delusions — personal beliefs not based in reality, such as paranoia that you're being persecuted or conspired against
- Bizarre delusions — for example, a belief in Martians controlling your thoughts
- Hallucinations — sensing things that don't exist, such as imaginary voices
- Lack of emotions or inappropriate display of emotions
- A persistent feeling of being watched
- Trouble functioning at work or in social situations
- Social isolation
- Difficulty with personal hygiene
- Clumsy, uncoordinated movements
Generally, schizophrenia causes a slowly progressive deterioration in the ability to function in various roles, especially in your job and personal life. The signs and symptoms of schizophrenia vary greatly. A person may behave differently at different times. He or she may become extremely agitated and distressed, or fall into a trance-like, immobile, unresponsive (catatonic) state, or even behave normally much of the time. Signs and symptoms that occur continuously and progressively may indicate schizophrenia.
In general, schizophrenia has symptoms that fall into three categories — negative, positive and cognitive:
Negative signs and symptoms
Negative signs and symptoms may appear early in the disease, and a person may not think he or she needs treatment. They're referred to as negative because they indicate a loss of behavior or of a personality trait. Negative signs generally accompany a slow deterioration of function, leading to your becoming less sociable. Such signs may include :
- Dulled emotions (lack of expression)
- Inappropriate emotions (laughing while expressing terrifying images)
- A change in speech (speaking in a dull monotone)
Positive signs and symptoms
Positive signs include hallucinations and delusions. They're called positive because they indicate a trait or behavior that's been added to the personality.
- Hallucinations. Hallucinations occur when you sense things that don't exist. The most common hallucination in schizophrenia is hearing voices. You may carry on a conversation with voices that no one else can hear. Or you may perceive that voices are providing you instructions on what to do. Hallucinations may result in injuries to other people.
- Delusions. Delusions are firmly held personal beliefs that have no basis in reality. The most common subtype of schizophrenia is paranoid schizophrenia, in which you hold irrational beliefs that others are persecuting you or conspiring against you. For example, some people with schizophrenia may believe that the television is directing their behavior or that outside forces are controlling their thoughts.
Cognitive signs and symptoms
These signs and symptoms tend to be more subtle than positive and negative ones. Cognitive signs and symptoms may include :
- Problems making sense of incoming information
- Difficulty paying attention
- Memory problems
Misconceptions about schizophrenia
Schizophrenia may exist alone or in combination with other psychiatric or medical conditions. Misconceptions about schizophrenia and its relation to other mental illnesses abound. The following truths will help clarify what it is and is not :
- Schizophrenia isn't the same as a split or multiple personality. Multiple personality disorder is a separate, rare condition.
- Although some people with schizophrenia develop violent tendencies, most don't. Many withdraw into themselves rather than interact with others.
- Not everyone who acts paranoid or distrustful has schizophrenia. Some people have a paranoid personality disorder, a tendency to be suspicious or distrustful of others, without the other features of schizophrenia.
- Not everyone who hears voices is schizophrenic. Some people with depression may hear voices. Hearing voices may also occur as a result of a serious medical illness or from the effects of medication.
Substance abuse and schizophrenia
While not necessarily a sign of schizophrenia, drug abuse is more common in people with schizophrenia. Nicotine is a commonly abused drug by people with schizophrenia; it's estimated that 75 percent to 90 percent of people with schizophrenia smoke compared with about one-quarter of the general population. Unfortunately some drugs, such as amphetamines, cocaine and marijuana, can make schizophrenia symptoms worse. Others, such as nicotine, can interfere with schizophrenia medications.
Before making a diagnosis of schizophrenia, your doctor likely will rule out other possible causes of the signs that may suggest schizophrenia. It's possible that other mental or physical illnesses may cause signs similar to schizophrenia.
Your doctor will want to discuss your family and medical history and do a physical examination. Your doctor may ask for blood or urine samples to see if medications, substance abuse or another physical illness may be a factor in your signs.
Among the other mental illnesses that may at least partly resemble schizophrenia are depression, bipolar disorder, other psychoses, and abuse of alcohol and other drugs.
It's also possible that physical illnesses such as certain infections, cancers, nervous system disorders, thyroid disorders and immune system disorders may produce some psychotic signs. Psychosis is also a possible side effect of some medications.
If no other underlying cause is found, doctors diagnose schizophrenia based on the signs and symptoms.
Antipsychotic medications, also known as neuroleptics, are the cornerstone of treatment. Until the 1990s, antipsychotics generally were much more effective in controlling positive symptoms than negative symptoms. A new generation of antipsychotics provides more effective management of both positive and negative symptoms. These antipsychotics include clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon) and aripiprazole (Abilify).
According to the American Diabetes Association, certain antipsychotic drugs may increase the risk of diabetes, obesity and high blood pressure. For this reason, people who take Clozaril, Risperdal, Zyprexa, Seroquel, Geodon or Abilify should be screened and carefully monitored by their doctors.
Smokers may need higher doses of antipsychotic medication because nicotine interferes with these medications.
Newer antipsychotic medications have fewer side effects. For example, for most people there's a lower incidence of tardive dyskinesia (TD) with the newer drugs than with the older medications. TD results in involuntary movements of your mouth, lips, tongue and other parts of the body. Other possible side effects of the older medications include interactions with other medications, risk of seizures and reductions of the white blood count. The new drugs represent a real advance in the treatment of schizophrenia and have led to greater independence and a higher quality of life for many people with schizophrenia.
In general, the goal of treatment with antipsychotic medications is to effectively control signs and symptoms at the lowest possible dosage. The appropriate medication and dosage vary widely from person to person. Even with good treatment, you may experience relapses despite ongoing drug treatment, but medications may reduce the frequency of relapses.
Failing to take medications is a problem
Although the newer-generation medications have fewer side effects and better adherence rates, nonadherence with medication schedules remains a difficult problem. Unfortunately, some people with schizophrenia fail to adhere to treatment recommendations and deny that anything is wrong with them. The nature of the disorder may prevent them from seeking help or adhering to treatment on their own.
Although medications are the mainstay of treatment to reduce signs and symptoms, many people with schizophrenia also benefit from nondrug therapies. These may include :
- Individual therapy. Cognitive therapy involves a therapist helping you learn ways of coping with stressful thoughts and situations to reduce your risk of a relapse. You may learn to change negative patterns of thought and behavior into ways that put you in control of your thoughts and feelings. Your illness may have made it more difficult for you to do things in your daily life that people without schizophrenia may take for granted. A therapist can also help you comply with your schedule of medications.
- Family therapy. Both you and your family members may benefit from therapy that provides support and education to families. Your symptoms have a better chance of improving if your family members understand your illness, can recognize stressful situations that might trigger a relapse and can help you stick to your schedule of drug treatment. Conversely, you may not do as well if family members distance themselves from you and are less understanding and more critical of your illness.
- Rehabilitation. Training in social and vocational skills necessary to live independently is an important part of recovery. With the help of a therapist, you can learn social skills such as good hygiene, cooking and traveling. People with schizophrenia who are in programs to train them in social skills or for jobs — and help them find and keep jobs — seem to experience much greater improvement in symptoms than do those who don't receive vocational training and job placement.
Today fewer people with schizophrenia require long-term hospitalization because more people respond positively to medications or other forms of treatment for schizophrenia.