Schizophrenia is one of the most serious and disabling mental illnesses. Some people diagnosed with schizophrenia are able to manage their symptoms adequately with the lifelong use of powerful antipsychotic medications and a strong support system. However, far too many experience significant suffering, with bouts of homelessness, institutionalization, regular and lengthy hospital stays and seemingly endless trials of different medications.
A complex interplay of genetics, environment, substance use and brain chemistry are thought to play a role in schizophrenia.1 Like almost all types of mental illness, schizophrenia knows no boundaries with regard to gender, race or socioeconomic status. Autopsies and brain scans have revealed differences in the brain structure of schizophrenics compared to individuals without the disorder.
Schizophrenia is frequently diagnosed when the first “psychotic break” or psychotic episode occurs. Psychosis can be difficult to define, but essentially means a person is out of touch with reality. Determining what is real and what is not can be difficult, if not impossible, when a person is in the throes of a psychotic episode.
Diagnosing schizophrenia is challenging because drugs such as meth or LSD can cause schizophrenia-like symptoms. Several other disorders also share a few common characteristics of schizophrenia. While there is no single physical or lab test used to diagnosis schizophrenia, evaluation of a person’s illness for a minimum of six months by a mental health professional can help ensure a correct diagnosis. Potential comorbidities such as brain tumors, medical conditions and other psychiatric diagnoses including bipolar disorder must be ruled out. To be diagnosed with schizophrenia, two or more primary symptoms must occur persistently in context with reduced functioning.1
The way the disease manifests and progresses depends on the age of onset, severity and duration of symptoms. Schizophrenia sometimes affects young children and older adults, although symptoms most frequently begin to emerge between late adolescence and one’s mid- to late-20s. An individual begins to act increasingly bizarre, paranoid, withdrawn or disorganized. Typically, a family member, spouse, close friend, coworker or employer notices something is seriously wrong and advises the person to visit a mental health professional. Warning signs of a possible schizophrenic episode include:
Hallucinations and delusions: These are two of the most common symptoms of schizophrenia, especially when paranoia is present. Hallucinations may involve sight, hearing, touch, taste or smell (e.g. a person insists he or she sees or smells something that does not exist). Hallucinations are most often “auditory” in nature and involve hearing one or more voices — even though no one else is present or actually talking. The voices may give commands, comment on the individual’s actions or say harsh, hurtful things. Command hallucinations can be dangerous if the voices are instructing the person to hurt him or herself or others.1,3,5
Delusions involve a firmly and persistently held belief that is not realistic, true or feasible. Delusions may be bizarre (e.g. the belief one’s brain has been surgically removed and replaced with an alien brain) or non-bizarre (e.g. a woman insists she is pregnant despite medical proof she is not).1,3,5
Disorganized behavior: This may manifest in thoughts, speech and/or behavior. Someone with disorganized speech may frequently jump from one topic to the next, say things with no relevance to the current conversation or speak complete gibberish. In order to qualify as a symptom of schizophrenia, disorganized speech must be severe enough to interfere with the ability to communicate.1,3,5
Catatonic behavior: Some individuals with schizophrenia become catatonic. This can manifest as extreme obliviousness to one’s surroundings (stupor), a rigid stance or bizarre posture, resistance to being moved or being told to move or excessive, excited movement that serves no purpose.1,3,5
Negative symptoms: Often confused with clinical depression, these symptoms include a lack of emotional expression, speaking in a dull, limited or disconnected manner (alogia) and an inability to initiate and follow through with tasks (avolition).1,3,5
Other psychotic disorders such as delusional disorder share some similarities with schizophrenia, although the following two disorders are closely related:
Schizoaffective disorder: This is characterized by persistent symptoms of psychosis resembling schizophrenia, with additional periodic symptoms of mood or affective disorders including depression, mania and psychosis. This disorder is frequently confused with bipolar disorder, even though psychotic symptoms are present.6
Schizophreniform disorder: Although symptoms of schizophrenia are present, this condition has a shorter duration of at least one month, but less than six months. While impaired social and occupational functioning may be present, unlike in schizophrenia, this is not required for diagnosis.7
Schizophrenia is generally regarded as a lifelong disorder requiring ongoing treatment. In many cases, the first psychotic episode leads to hospitalization — for safety as well as stabilization. Future hospitalizations are often necessary if the individual stops taking medication and becomes severely symptomatic. Treatment is often made more challenging because people with schizophrenia have a lack of insight, thereby making them oblivious to the fact that they have an illness.
Medication is often the primary treatment for schizophrenia. Antipsychotic medications, including newer atypical antipsychotics, reduce the risk of psychotic episodes, lessen the severity when they do occur and improve a person’s ability to function. Unfortunately, antipsychotic medications often have undesirable side effects, leading some individuals to stop taking their medication (against their doctor’s advice). In some cases, medication may not work or its effectiveness may be limited or minimal. Of course, when the medication is working and an individual starts feeling good, he or she may stop taking it, believing it is no longer necessary.8 It is not uncommon for individuals with schizophrenia to end up back in the hospital not long after discontinuation of medication.
Some antipsychotic medications such as haloperidol (Haldol), fluphenazine (Prolixin) and perphenazine (Trilafon), are available in long-acting injectable forms that eliminate the need to take pills every day. This methodology may result in better adherence to treatment. A major goal of schizophrenia research is to develop a wider variety of long-acting antipsychotics, especially newer injectable agents with milder side effects.8
Treatment for schizophrenia may include any combination of the following:
Because schizophrenia is a highly challenging disorder, it often triggers the development of other disorders or life choices that compound the issue. For example, many people with schizophrenia become depressed due to the stress of the disorder. Others may engage in self-harming behavior and suicide attempts due to command auditory hallucinations, depression and feelings of hopelessness.1
Although there is no cure for schizophrenia, research has led to significant progress, with new medications continually being developed. It is frightening when individuals and loved ones are confronted with a schizophrenia diagnosis, but hope should not be lost. Many individuals with this serious disorder are able to lead fulfilling lives with proper, diligent treatment and a strong support system.
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