Schizophrenia refers to a condition and to a spectrum of disorders that all involve a disconnection from reality, including hallucinations and delusions.
Psychosis (loss of reality awareness), hallucinations (false perceptions), delusions (false beliefs), disorganized speech and behavior, flattened affect (restricted range of emotions), cognitive deficits (impaired reasoning and problem solving), and dysfunction in the workplace and social interactions are all symptoms of schizophrenia. Although the reason is uncertain, there is considerable evidence for genetic and environmental factors. In early adulthood or youth, symptoms typically appear. Before a diagnosis is determined, at least one or more symptomatic episodes must persist six months. Drug therapy, cognitive therapy, and psychosocial rehabilitation make up the course of treatment. The quality of long-term functioning is improved by early detection and therapy.
Who does it affect?
Depending on sex, schizophrenia often begins at various ages. For men, it often begins between 15 and 25 and for women, it typically begins between 25 and 35. Men and women tend to be equally affected by it.
Although uncommon, schizophrenia in children is conceivable, especially before the age of 18. Unfortunately, these situations are frequently exceedingly serious. Early onset usually results in a more serious ailment that is more difficult to treat.
Around 20% of newly diagnosed instances of schizophrenia are in adults over 45. Women are more likely to experience these occurrences. In these situations, unpleasant symptoms and interference with thinking and concentration are less severe but the delusion symptoms are stronger.
Causes
Although its specific causes and mechanisms are unknown, schizophrenia has a biologic basis, as evidenced by
- Alterations in brain structure (eg, enlarged cerebral ventricles, thinning of the cortex, decreased size of the anterior hippocampus and other brain regions)
- Changes in neurochemistry, especially altered activity in markers of dopamine and glutamate transmission
- Recently demonstrated genetic risk factors (1)
Some experts suggest that schizophrenia occurs more frequently in people with neurodevelopmental vulnerabilities and that the onset, remission, and recurrence of symptoms are the result of interactions between these enduring vulnerabilities and environmental stressors.
Neurodevelopmental vulnerability
Although schizophrenia rarely manifests in early childhood, childhood factors influence disease onset in adulthood. These factors include
- Genetic predisposition
- Intrauterine, birth, or postnatal complications
- Viral central nervous system infections
- Childhood trauma and neglect
Genetic factors are heavily involved in schizophrenia, despite the fact that many patients do not have a family history of the disorder. Compared to the general population, those who have a first-degree relative with schizophrenia have a 10–12% increased risk of having the condition. The concordance rate for monozygotic twins is roughly 45%.
Risk factors include hypoxia, maternal hunger and influenza exposure during the second trimester of pregnancy, birth weights under 2500 g, and Rh incompatibility during a subsequent pregnancy.
According to neurobiologic and neuropsychiatric testing, schizophrenia patients are more likely than the general population to have abnormal smooth-pursuit eye tracking, poor cognition and attention, and poor sensory gating. These findings, which can also be seen in individuals with many other psychotic diseases as well as in first-degree relatives of those with schizophrenia, may point to an inherited vulnerability. The similarity of these results across psychotic diseases shows that our traditional diagnostic classifications do not accurately reflect fundamental physiological differences amongst psychoses.
Environmental stressors
Invulnerable individuals may experience a relapse or onset of psychotic symptoms in response to environmental stressors. The main sources of stress may be pharmacological (such as substance abuse, particularly marijuana usage) or social (eg, becoming unemployed or impoverished, leaving home for college, breaking off a romantic relationship, joining the Armed Forces). The possibility that environmental factors can start epigenetic modifications that affect gene transcription and illness development is becoming more and more clear.
Strong psychosocial support, sophisticated coping mechanisms, and antipsychotic medications are protective variables that may lessen the impact of stress on symptom onset or exacerbation.
Symptoms
Schizophrenia usually happens in stages, with different symptoms and behaviors depending on the stage.
- Onset (prodrome). This is an early phase that happens before a person develops more severe symptoms. It can include social withdrawal, anxiety, lack of motivation and neglect of personal hygiene.
- Active. This is when psychotic symptoms take full effect. Another term for this is “psychotic break,” where a person shows a disconnection from reality. That includes showing at least two of the five main symptoms listed immediately below.
- Residual. People in this stage still have some schizophrenia signs and symptoms, but they’re not as severe. Odd beliefs, lack of motivation, decreased feelings of enjoyment or pleasure, limited speaking and reduced emotional expression tend to be the most noticeable effects. Many people often improve to the point where they seem mostly or fully recovered. However, this is usually temporary, and symptoms of schizophrenia will return as a person goes back into the active stage of the condition.
What are the early signs of schizophrenia?
The early symptoms of schizophrenia, which happen in the onset (prodrome) stage, usually aren’t severe enough for a schizophrenia diagnosis but are still a cause for concern. This stage sometimes happens quickly, only taking weeks before moving to the next stage.
The most common symptoms or changes in this stage include:
- Changes in emotional state. People in this phase often are afraid, suspicious or feel paranoid.
- Changes in how they relate to others. They also often stop socializing and stop talking to or spending time with friends and family.
- Changes in behavior. They may struggle with thinking and focusing, aren’t motivated to study or work and their emotions are less visible.
What are the active stage symptoms?
The active stage is when the five main symptoms of schizophrenia are most likely to happen. Those symptoms can include a combination of the following:
- Delusions. These are false beliefs that a person won’t change even when there’s plenty of evidence that those beliefs are wrong. An example of a very severe delusion would be that someone is controlling what you think, say or do.
- Hallucinations. These are things that don’t exist, but you still think you can see, hear, smell, touch or taste them. Hallucinations in schizophrenia (and the related spectrum of conditions) are usually things you can hear, especially hearing voices.
- Disorganized or incoherent speaking. People with schizophrenia often have trouble organizing their thoughts while speaking. They may have trouble staying on topic, or it can be so severe that you can’t understand them because their sentences are jumbled or incoherent.
- Disorganized or unusual movements. This symptom can take various forms, from childish and silly movements to abrupt, upset movements. It can also include catatonic behavior, where a person doesn’t react as expected to the world around them. They might hold a certain pose (even an uncomfortable one), not respond to people speaking to them or might start moving around excessively for no obvious reason.
- Negative symptoms. These refer to decreases in certain behaviors, not symptoms that are bad. Negative symptoms usually involve a decrease in emotion in a person’s facial expressions, how they speak (such as with a flat and emotionless voice), and fewer or no gestures with their hands or other parts of their body. They also involve a lack of motivation, especially when they don’t want to socialize or do things they ordinarily enjoy.
Are there other possible symptoms?
People with schizophrenia often experience the following:
- Feeling suspicious, paranoid or afraid frequently.
- Not caring about their hygiene and appearance.
- Depression, anxiety and suicidal thoughts.
- Using alcohol, nicotine, prescription medications or recreational drugs, often to “self-medicate” their symptoms.
Lack of insight
People with schizophrenia commonly show signs of another condition, anosognosia. This condition, often described as “lack of insight,” means a person can’t recognize that they have a medical problem, disorder or illness. Experts estimate that between 50% and 90% of people with schizophrenia have anosognosia. This is one of the reasons that schizophrenia is so difficult to treat.
Risk factors
While there aren’t any confirmed causes of schizophrenia, there are several factors and circumstances that researchers have connected to the condition.
- Genetics. People with a family history of schizophrenia — especially a parent or sibling with it — have a much higher risk of developing this condition.
- Environment. Many factors in the world around you can increase your risk of developing schizophrenia. Being born during the winter increases your risk slightly. Certain illnesses that affect your brain, including infections and autoimmune diseases (where your immune system attacks part of your body), can also increase your risk. Extreme stress for long periods can also play a role in developing it.
- Development and birth circumstances. How you developed before you were born plays a role in schizophrenia. The risk of having schizophrenia goes up if your mother had gestational diabetes, preeclampsia, malnutrition or a vitamin D deficiency while she was pregnant with you. The risk also increases if you were underweight at birth or if there were complications during your birth (such as your mother needing to undergo an emergency cesarean section).
- Recreational drug use. Researchers have linked schizophrenia with certain recreational drugs, especially in larger amounts and earlier in life. The connection between heavy marijuana (cannabis) use as a teenager is one of the best-studied of these links. However, there’s disagreement on whether or not marijuana use is a direct cause of schizophrenia or if it’s just a contributing factor.
Diagnosis
Your (or your loved one’s) healthcare provider can diagnose schizophrenia or its related disorders based on a combination of questions they ask, the symptoms you describe or by observing your actions. They’ll also ask questions to rule out causes other than schizophrenia. They then compare what they find to the criteria required for a schizophrenia diagnosis.
According to the DSM-5, a schizophrenia diagnosis requires the following:
- At least two of five main symptoms. Those symptoms, explained above, are delusions, hallucinations, disorganized or incoherent speaking, disorganized or unusual movements and negative symptoms.
- Duration of symptoms and effects. The key symptoms you have must last for at least one month. The condition’s effects (whether or not they meet the full criteria for the symptoms) must also last for at least six months.
- Social or occupational dysfunction. This means the condition disrupts either your ability to work or your relationships (friendly, romantic, professional or otherwise).
What tests will be done to diagnose this condition?
There aren’t any diagnostic tests for schizophrenia-spectrum conditions. But healthcare providers will likely run tests to rule out other conditions before diagnosing schizophrenia. The most likely types of tests include:
- Imaging tests. Healthcare providers will often use computerized tomography (CT), magnetic resonance imaging (MRI) and other imaging tests to rule out problems like stroke, brain injuries, tumors and other changes to your brain structure.
- Blood, urine and cerebrospinal fluid (spinal tap) tests. These tests look for chemical changes in bodily fluids that might explain changes in your behavior. They can rule out heavy metal toxicity or other causes of poisoning, infections and more.
- Brain activity testing. An electroencephalogram (EEG) detects and records the electrical activity in your brain. This test can help rule out conditions like epilepsy.
Treatment
Although schizophrenia cannot be cured, it is frequently treatable. In a small number of cases, people can recover from schizophrenia totally. There is no way to predict who would experience a relapse of this ailment and who won’t, therefore this isn’t a cure. As a result, medical professionals refer to patients who recover from this ailment as being “in remission.”
A mix of medication, counseling, and self-management approaches is typically used to treat schizophrenia. While most mental health illnesses can be effectively treated with therapy alone, maintaining schizophrenia typically necessitates medication. Early detection and intervention are crucial since they improve the likelihood of a successful outcome.
Medications
There are two main types of medications that treat schizophrenia.
- Typical antipsychotics. Also known as first-generation antipsychotics, these medications block how your brain uses dopamine, a chemical your brain uses for cell-to-cell communication.
- Atypical antipsychotics. These medications, also called second-generation antipsychotics, work differently from first-generation antipsychotics. These block both dopamine and serotonin, two key communication chemicals in your brain. Clozapine is a particularly effective medication that can treat symptoms of schizophrenia when other drugs don’t work. However, it has a rare serious side effect that requires frequent blood monitoring to keep people safe, which is why healthcare providers usually recommend other antipsychotics first.
Your doctor may also recommend other medications to manage symptoms that develop concurrently with or as a result of your schizophrenia. Also, they may recommend drugs to aid with antipsychotic drug side effects including tremors.
In general, the best person to talk to about the medications they could recommend is your healthcare professional. They may provide you with more detailed information about your particular situation, including your personal preferences, medical history, and living circumstances.
Psychotherapy
Cognitive behavioral therapy is one psychotherapy technique that can assist persons with schizophrenia manage and cope with their condition. In addition to treating schizophrenia, long-term therapy can also help with related conditions including anxiety, sadness, or substance abuse.
Therapy is essential for improving treatment adherence. As was previously noted, persons with schizophrenia frequently feel like they don’t need therapy because they don’t comprehend or identify their symptoms. Individuals with schizophrenia who stay in therapy are more likely to adhere to their treatment regimens and the advice of their medical professionals.
Other therapy methods that might help include art therapy and drama therapy, which can aid with loss of motivation and a person’s ability to recognize their symptoms. Healthcare providers might also recommend techniques that focus on helping with social skills, setting up self-care routines and more.
Electroconvulsive therapy
Healthcare professionals may advise adding electroconvulsive treatment if a patient’s schizophrenia doesn’t get better after trying specific medications and the patient is at risk for injuring himself or others (ECT). In situations where medication alone would take too long to work, this treatment can produce quick results.
ECT is frequently the only treatment that will work when all others have failed, and it can be lifesaving for those who are at high risk of suicide. Despite this, ECT use is uncommon because it has a negative reputation and because TV, movies, and other popular media rarely depict this treatment realistically.
In order to stimulate certain brain regions during this procedure, an electrical current is administered to your scalp. Those with severe depression, agitation, and other issues may benefit from improving brain function, which is brought on by the stimulus that triggers a brief seizure. When receiving ECT, patients are given anesthetic, which causes them to fall asleep during the operation and makes it painless.
How do I take care of myself?
People with schizophrenia should do the following to help care for themselves and manage their condition:
- Take medications as prescribed. One of the most critical things a person with schizophrenia can do to help themselves is to take their medications. If you have schizophrenia, you should not stop your medication without talking to your healthcare provider. Sudden stopping of medication often speeds up the return of psychosis symptoms. Side effects are common with antipsychotics. However, there are many antipsychotic medications, so it’s often possible to work with your healthcare provider to find one that both works well for you and has minimal or no side effects.
- See your healthcare provider as recommended. Your healthcare provider will set up a schedule for you to see them. These visits are especially important to help with managing your condition.
- Don’t ignore or avoid symptoms. Schizophrenia is more likely to respond and have a good outcome with early diagnosis and treatment.
- Avoid alcohol and recreational drug use. Alcohol and drug use can make schizophrenia symptoms worse and can lead to other issues. This includes using prescription medications in a way other than prescribed.
- Consider seeking support. Organizations such as the National Alliance on Mental Illness can offer resources and information that can help.