What is Schizophrenia? This is illness effects 1% of the US population. Schizophrenia consists of a person having delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior; and negative symptoms (flat affect and social isolation). Two or more of these symptoms need to be present unless the delusions are bizarre or the hallucinations consist of two people conversing together or about the person’s behaviors or thoughts. At this point, only one of the symptoms just mentioned need to be present to warrant an investigation of schizophrenia. Another symptom which is almost exclusively associated with schizophrenia is an idea of reference. Ideals of reference occur when someone believes that people are esoterically communicating with them through gestures or on the television. This article should give you a better understanding of schizophrenia and more information about this disease. Other symptoms of schizophrenia that help diagnosing this illness include social and or occupational dysfunction, and a duration of 6 months in which at least 1 month of the symptoms previously described are persistent prior to the beginning of treatment.
There are a few exclusions to the diagnosis of schizophrenia which include schizoaffective disorder, and other mood disorders along with substance abuse and extenuating medical conditions which need to be ruled out.
There are generally 5 types or manifestations of schizophrenia depending on the person’s main symptomatology. These are paranoid schizophrenia, disorganized schizophrenia, catatonic schizophrenia, undifferentiated schizophrenia, and residual type schizophrenia.
What are the causes of Schizophrenia? We think that it is an plethora of the neurotransmitter dopamine in the brain. This causes the aforementioned symptoms. The medications that we use to treat it allow for the decrease in the levels of dopamine in the brain and thus reducing the symptoms such as hallucinations, delusions, and other cognitive problems. We are not sure what causes this plethora of dopamine in each case; however, research is making some great strides in discovering various aspects of the neuron and connections between them for answers to this question.
Schizophrenia Information – Some of the Possible Causes
We don’t know exactly what causes this chemical imbalance of an overabundance of dopamine in the brain; but some possible causes that are being looked at are the deficiency of vitamin D during pregnancy, some studies point to fetal alcohol syndrome causing poisoning of the infant to the degree that only two drinks during pregnancy can cause the illness, environmental factors as well as genetic factors. Much study is being dedicated to the mechanisms which create this plethora and if discovered, better treatments should come forth.
A person usually starts having symptoms of schizophrenia at either late adolescence or early adulthood. There are some cases in childhood and in the elderly; but these are rare. A person with schizophrenia diagnosed in early adulthood, usually has some premorbid symptoms. These premorbid symptoms can mimic a lot of other mental illnesses, such as, conduct disorder, antisocial personality disorder, bipolar disorder, depression, etc. This is why it can be a challenge, if even possible for child psychiatrists to diagnose this illness.
There are early signs of schizophrenia that give us some insight into what may be developing along with the accompanying symptoms. Usually the person develops schizophrenia in early adulthood, so they are either going to school or are working. There is usually a deterioration in their level of functioning, such that, they are unable to bathe, work, sometimes not able to eat or care for themselves. This deterioration is seen usually over a period of 6 to 12 months and it is generally first seen by the patient’s family members or employer. With this they generally have the accompanying signs of feeling that others can read their minds, or they are receiving messages from the TV, radio, or newspaper. They may feel that others are talking about them at work, when this isn’t a reality; but they think they can hear others talking about them. People many times feel that the FBI is after them. This in and of itself can be very traumatizing to these individuals. Once medication is started and these delusional thoughts are gone, the person feels very disillusioned by what they just have experienced and may well need some trauma counseling to help them through this. Other symptoms other than the paranoia just described can be disorganized speech or behavior, listless or flat and inappropriate affect. I don’t see much of the disorganized behavior or speech, and catatonia. One form of schizophrenia is where a patient is displaying motor immobility or show excessive motor activity. Another form of schizophrenia displays extreme negativism and resists all instructions or maintains a rigid posture against attempts to be moved. One form displays peculiar displays of posturing. With the undifferentiated type of schizophrenia the patient meets criteria for schizophrenia; but the patient doesn’t meet criteria for the paranoid, disorganized, or catatonic types.
Patients Lack Insight of Their Disease Which Thwarts the Prognosis
I usually see patients that have more of the paranoid type of schizophrenia. Sometimes the patient has enough insight into his or her illness such as their knowing there is something wrong with them, they aren’t doing well in college and they have just enough knowledge that something is wrong with them; yet they have no insight into the depth and severity of the illness. Other times I find that it is a challenge to convince them that they need to be on medication because for them, this delusional thinking or hallucinations that they are experiencing are so real that they feel that I will look at them as being “crazy”. This is understandable and many theories of perception require there to be an “image” that mediates between the mind and the extended world. Maybe in the case of psychosis the image exists yet there is no causal linkage to something in the extended world to ground the image in reality. Sometimes once the patient is on medication, they can gain enough insight into the delusional thoughts. Many times the patient is having insomnia. This is often an opportunity to get them on the medication since many of the anti-psychotics have a tranquilizing effect. If they are willing to consider that I am here to help them; and they start on the medication, they are then able to notice the auditory hallucinations or the paranoia diminish with time. Then they are more willing to stay on the medication because of the benefits in reducing their symptoms along with treating the insomnia. Sometimes they are also able to see that they are much more functional and able to get back to school or work.
Staying on the medications are crucial. Recent studies have revealed that the earlier a person with schizophrenia is diagnosed and treated with the medication, the better the overall long-term prognosis. The reason for this is that the schizophrenia left untreated is deleterious to our brain cells and can cause cell death. If we can start the medication early, we have less cell damage and death. Also the sooner we can help people get back to their previous level of functioning, the sooner they are able to get back to school or work and get on with their lives. Schizophrenia is probably the most devastating illnesses and one of the toughest to treat; but the sooner someone starts treatment the better chances they have of having a generally better prognosis. Convincing someone of the differences between hallucination vs reality can be a real challenge and is often the greatest hurdle to a good prognosis.
More serious cases of schizophrenia can require court intervention to help get the patient treated; especially if the patient is either a threat to him or herself and others. When this happens and the patient doesn’t have enough insight into his or her illness to know that he or she needs medication, the court can intervene by way of an affidavit filled out by a friend or family member explaining why he or she thinks that a patient is a threat to his or herself and then try to get the patient into the hospital… many times by calling 911. Once admitted to the behavioral health hospital or ER, a psychiatrist will evaluate the patient to determine if the patient should be held on a 72 hour observation. If after 72 hours the psychiatrist feels that the patient is still a threat to him or herself, the psychiatrist can go to court and get court-ordered treatment for the patient if the patient is unwilling to come into the hospital voluntarily. When this occurs the patient is usually given an injectable major tranquilizer that lasts in depot form in the body for 2 to 4 weeks.
I used to work on a PACT (Program for Assertive Community Treatment) in the state system. This program treats on an outpatient basis the mostly severely mentally ill. I learned and treated many cases of schizophrenia in many of the patients who suffered from severe schizophrenia, schizoaffective, and bipolar disorder. Quite a few of them needed to be on court-ordered treatment and some of them were treated for up to 1 year in duration. What’s good about PACT is that it is employs a team effort to help people with severe mental illness stay out of the hospital and live independently. Available 24/7, case managers could go out to the consumers homes to make sure that they were taking their medications and taking them properly. They were also instrumental in helping them meet daily challenges of grocery shopping and managing money. The PACT team of professionals include case managers, a nurse, and a psychiatrist. The case managers are assigned only a very small group of consumers. I recall it being only 7 to 8 to enable them to give all the care that the consumers need.
Schizophrenia is one of the most potentially disabling of all the mental illnesses; but with today’s medications, genetic studies, and neurological research; there is a lot of hope for better treatments and maybe a cure in the near future. Read more on Schizophrenia information.