What is schizophrenia? This is a serious medical illness effecting over 2 million American adults. Although schizophrenia is often feared and misunderstood, schizophrenia is a treatable medical condition. Schizophrenia often interferes with a person’s ability to distinguish reality from illusion, to manage emotions, make decisions, and relate to others. These illusions are as true to the person as “reality” because the brain is receiving the same sense datum as one would receive in under normal conditions; therefore, the brain cannot distinguish between what is real and what is an illusion. You may wish to read my article on hallucination vs reality which presents a theory of perception and knowledge that will explain the difficulty convincing someone with psychosis, of their psychosis.
The first signs of schizophrenia typically emerge in the late teenage years or early twenties, often later for females. The premorbid symptoms often appear in early childhood, are varied and very difficult to diagnose until the disease has fully manifested. These symptoms are often dismissed as anti-social behavior. Schizophrenia is not caused by bad parenting or personal weakness, although a few studies have shown that families that are verbose and prone to expressing emotion and dysfunctional may play a role in this illness. Almost all people with schizophrenia are not dangerous or violent towards others while they are receiving treatment. The World Health Organization has identified schizophrenia as one of the ten most debilitating diseases affecting human beings. Schizophrenia is not to be confused with Multiple Personality Disorder, in which, a person takes on the possession of more than one person and displays these persons in their different speech and actions at different times. Multiple Personality Disorder is usually seen in a person that has undergone some very traumatic childhood experiences.
Symptoms of Schizophrenia
No one symptom positively identifies schizophrenia. All of the symptoms of this illness can also be found in other mental illnesses. For example, psychotic symptoms may be caused by the use of illicit drugs, may be present in individuals with Alzheimer’s disease, or may be characteristics of a manic episode of bipolar disorder referred to as “Bipolar disorder with psychotic features”. However, when a doctor observes the symptoms of schizophrenia and carefully assesses the history and the course of the illness over six months, he or she can almost always make a correct diagnosis. “Ideas of reference” are symptoms unique to this illness whereby the individual believes that someone is communicating to them through repeated gestures or comments on television, radio or other behavior that are interpreted as signs or signals. These ideas of reference are telltale signs of schizophrenia.
It is important to have a good medical work-up to be sure the diagnosis is correct. Drug abuse can mimic the symptoms of schizophrenia and may also trigger vulnerability in individuals at risk. Other medical concerns also need to be ruled out before a correct diagnosis can be made. Trauma to the head or tumors can also produce similar symptoms of this and other mental illnesses as well.
Symptoms of Schizophrenia are Generally Divided into Three Categories – Positive, Negative, and Cognitive:
- Positive Symptoms or psychotic symptoms include delusions and hallucinations because the patient has lost touch with reality in certain important ways. “Positive” refers to having overt symptoms that should not be there. Delusions cause individuals to believe that people are reading their thoughts or plotting against them, that others are secretly monitoring and threatening them, or that they can control other people’s minds. Hallucinations cause people to hear or see things that are not present.
- Negative Symptoms include emotional flatness or lack of expression, an inability to start and follow through with activities, speech that is brief and devoid of content, and a lack of pleasure or interest in life. “Negative” does not refer to a person’s attitude but to a lack of certain characteristics that should be there. These symptoms mimic those of someone who is depressed. Patients with Schizophrenia who are displaying negative symptoms tend to be socially withdrawn and reclusive.
- Cognitive Symptoms pertain to thinking processes. For example, people may have difficulty with prioritizing tasks, certain kinds of memory functions, and organizing their thoughts. Most persons with this illness are not aware of it and have no insight into their condition. The sensory data presented to their minds is every bit as “real” as reality itself and convincing to the individual. Often their delusions can and do have a bit of grounding in reality and are difficult to separate the truth from the delusion. Other signs of cognitive symptoms include their inability to communicate in a normal way. Their speech is often tangential, i.e. they go off on tangents mid-sentence, or are very circumstantial taking a very long time to come to the logical end or importance of the sentence. Other times, their speech is so disorganized that it makes no logical sense to the person listening.
Schizophrenia also affects mood. While many individuals affected with schizophrenia become depressed, some also have apparent mood swings and even bipolar-like states. When mood instability is a major feature of the illness, it is called schizoaffective disorder, meaning that elements of schizophrenia and mood disorders are prominently displayed by the same individual. It is not clear whether schizoaffective Disorder is a distinct condition or simply a subtype of schizophrenia. Bipolar disorder with psychotic features has symptoms very similar to Schizophrenia as well.
Causes of Schizophrenia
Scientists still do not know the specific causes of schizophrenia, but research has shown that the brains of people with schizophrenia are different from the brains of people without the illness. Like many other medical illnesses such as cancer or diabetes, schizophrenia seems to be caused by a combination of problems including genetic vulnerability and environmental factors that occur during a person’s development. Recent research has identified certain genes that appear to increase risk for Schizophrenia. Like cancer and diabetes, the genes only increase the chances of becoming ill; they alone do not cause the illness. Other studies have revealed that causes of Schizophrenia linked to vitamin D or a lack or plethora of certain vitamins, possibly fetal alcohol poisoning, or the pregnant mother’s inability to produce sufficient amounts of GABA that “might” be a factor of schizophrenia as well; and some studies claim that verbose, dysfunctional families that were highly expressive of their emotions may contribute to the illness as well. Understand that none of these studies are conclusive. There is new genetic data that claims that prenatal stressors can actually change the genes of the fetus and therefore provide the genetic basis for many mental illnesses. The good news is that other studies have shown that genetic engineering is making strides in identifying and manipulating these genes, thus giving us hope for a cure someday.
Treatment for Schizophrenia
The absolute most difficult aspect of treating this disease is getting the individual to have insight into the disorder and understand the differences between hallucination vs reality. This insight may or may not be present depending on the particular individual’s illness. Some people have some insight, others don’t and cannot be persuaded to believe. Sometimes, the medication initiation and diminution of symptoms can help people have more insight. Until one has some insight, it is nearly impossible to treat a non-compliant person with schizophrenia.This is when court-ordered treatment comes into play. With this, people with schizophrenia can receive shots that will time take away their symptoms and also give them sometimes insight into their illnesses. There is no cure for schizophrenia, yet it is a treatable illness. Patients sometimes stop treatment because of medication side effects, the lack of insight noted above, or because they feel the medication is no longer working. People with schizophrenia who stop taking prescribed medication are at risk of relapse into an acute psychotic episode. It’s important to realize that the needs of the person with schizophrenia may change over time. Here are a few examples of supports and interventions:
- Recovery Supports/Relapse Prevention: There is increasing recognition of the benefits of learning from “someone who has been there.” NAMI’s Peer to Peer program is designed to help individuals with mental illness learn from those who have become skilled at managing their illness. Peer support groups are also recognized as invaluable as individuals living with mental illness report better recovery outcomes as the shared experience is recognized as extremely beneficial. NAMI C.A.R.E. support groups are available in many communities and are expanding to better meet this need.
- Family Support: Caregivers benefit greatly from NAMI’s Family-to-Family education program, taught by family members who have the knowledge and the skills needed to cope effectively with a loved one with a mental disorder. This program is available in all 50 states through many NAMI affiliates, and is offered in multiple languages in many communities.
- Hospitalization: Individuals who experience acute symptoms of schizophrenia may require intensive treatment, including hospitalization. Hospitalization is necessary to treat severe delusions or hallucinations, serious suicidal thoughts, an inability to care for oneself, or severe problems with drugs or alcohol. Hospitalization may be essential to protect people from hurting themselves or others.
- Medication:The primary medications for schizophrenia are the antipsychotics. Antipsychotics help relieve the positive symptoms of schizophrenia by helping to correct an imbalance in the chemicals that enable brain cells to communicate with each other. Some of these are major tranquilizers that inhibit the production of dopamine. As with drug treatments for other physical illnesses, many patients with severe mental illnesses may need to try several different antipsychotic medications before they find the one, or the combination of medications, that works best for them.
- Conventional Antipsychotics: were introduced in the 1950’s and all had similar ability to relieve the positive symptoms of schizophrenia. However, most of these older “conventional” anti-psychotics differed in the side effects they produced. Some of the risks that may be incurred from taking these medicines include dry mouth, blurred vision, drowsiness, constipation, liver disease, and movement disorders such as stiffness, a sense of restless motion, and tardive dyskinesia.
- “Atypical” Antipsychotics were introduced in the 1990’s. When compared to the older “conventional” antipsychotics, these medications appear to be equally effective for helping reduce the positive symptoms such as hallucinations and delusions, but may be better than the older medications at relieving the negative symptoms of the illness, e.g., withdrawal, thinking problems, and lack of energy. All the antipsychotics have serious side effects such as weight gain and the risk of diabetes, but they all do not carry the same relative risk for these conditions.
All medications have side effects. Different medications produce different side effects, and people differ in the amount and severity of side effects they experience. Side effects can often be treated by changing the dose of the medication, switching to a different medication, or treating the side effect directly with an additional medication. NAMI’s fact sheets on medications, developed by independent pharmacists, are a starting point to understand the risks and benefits of any individual medication. As with many issues in life, one has to consider the benefits with the side effects and determine which they care to live with based on the impact to their quality of life. Individuals thinking of starting or changing their medication should always gather good information, consider the risks and benefits, consult with their doctor and loved ones and work together to develop the most safe and effective treatment plan possible.
- Psychosocial Rehabilitation: Research shows that people with schizophrenia who attend structured psychosocial rehabilitation programs and continue with their medical treatment manage their illness best. One example of an effective psychosocial approach for the most severely ill, or those with both mental illness and substance abuse, is the Program for Assertive Community Treatment (PACT), an intensive team effort in local communities to help people stay out of the hospital and live independently. Available 24-hours a day, seven-days a week, PACT professionals meet their clients where they live, providing at-home support at whatever level is needed. Professionals work with clients to address problems effectively, to make sure medications are being properly taken, and to meet the routine daily challenges of life, such as grocery shopping and managing money
- Substance use counseling, housing, work and educational skill development are among other supports frequently required to maximize a person’s prospects for a higher functional level. Additional information on these topics about schizophrenia are available at NAMI’s website.
Individuals with schizophrenia face enormous challenges, including society’s stigmatization of people living with schizophrenia, and the discrimination that results from these prejudices. Consider getting involved in NAMI, The National Alliance on Mental Illness, in order to contribute to and benefit from NAMI’s core activities that support the NAMI mission: support, advocacy, education and improved research for this important and challenging condition.