Add a Disease

Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions and disordered thinking and behavior. The ability of people with schizophrenia to function normally and to care for themselves tends to deteriorate over time. Contrary to some popular belief, schizophrenia isn't split personality or multiple personality. The word "schizophrenia" does mean "split mind," but it refers to a disruption of the usual balance of emotions and thinking. Schizophrenia is a chronic condition, requiring lifelong treatment.

Complications of Schizophrenia

Left untreated, schizophrenia can result in severe emotional, behavioral and health problems, as well as legal and financial problems that affect every area of life. Complications that schizophrenia may cause or be associated with include:

  • Suicide
  • Self-destructive behavior, such as self-injury
  • Depression
  • Abuse of alcohol, drugs or prescription medications
  • Poverty
  • Homelessness
  • Family conflicts
  • Inability to work or attend school
  • Health problems from antipsychotic medications
  • Being a victim or perpetrator of violent crime
  • Heart disease, often related to heavy smoking

Causes of Schizophrenia

  • It's not known what causes schizophrenia, but researchers believe that a combination of genetics and environment contributes to development of the disease.
  • Problems with certain naturally occurring brain chemicals, including the neurotransmitters dopamine and glutamate, also may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren't certain about the significance of these changes, they support evidence that schizophrenia is a brain disease.

Signs & Symptoms of Schizophrenia

The symptoms of schizophrenia also can be attributed to other mental illnesses, and no one symptom can pinpoint a diagnosis of schizophrenia. In men, schizophrenia symptoms typically start in the teens or 20s. In women, schizophrenia symptoms typically begin in the 20s or early 30s. It's uncommon for children to be diagnosed with schizophrenia and rare for those older than 40. Signs and symptoms of schizophrenia generally are divided into three categories — positive, negative and cognitive.

Positive symptoms

In schizophrenia, positive symptoms reflect an excess or distortion of normal functions. These active, abnormal symptoms may include:

  • Delusions. These beliefs are not based in reality and usually involve misinterpretation of perception or experience. They are the most common of schizophrenic symptoms.
  • Hallucinations. These usually involve seeing or hearing things that don't exist, although hallucinations can be in any of the senses. Hearing voices is the most common hallucination among people with schizophrenia.
  • Thought disorder. Difficulty speaking and organizing thoughts may result in stopping speech midsentence or putting together meaningless words, sometimes known as "word salad."
  • Disorganized behavior. This may show in a number of ways, ranging from childlike silliness to unpredictable agitation.

Negative symptoms

Negative symptoms refer to a diminishment or absence of characteristics of normal function. They may appear months or years before positive symptoms. They include:

  • Loss of interest in everyday activities
  • Appearing to lack emotion
  • Reduced ability to plan or carry out activities
  • Neglect of personal hygiene
  • Social withdrawal
  • Loss of motivation

Cognitive symptoms

Cognitive symptoms involve problems with thought processes. These symptoms may be the most disabling in schizophrenia, because they interfere with the ability to perform routine daily tasks. A person with schizophrenia may be born with these symptoms, but they may worsen when the disorder starts. They include:

  • Problems with making sense of information
  • Difficulty paying attention
  • Memory problems

Affective symptoms

Schizophrenia also can affect mood, causing depression or mood swings. In addition, people with schizophrenia often seem inappropriate and odd, causing others to avoid them, which leads to social isolation.

Diagnosis of Schizophrenia

When doctors suspect someone has schizophrenia, they typically ask for medical and psychiatric histories, conduct a physical exam, and run a battery of medical and psychological tests and exams. These tests and exams generally include:

  • Laboratory tests. These may include a complete blood count (CBC), other blood tests that may help to rule out other conditions with similar symptoms, screening for alcohol and drugs, and imaging studies, such as an MRI or CT scan.
  • Psychological evaluation. A doctor or mental health provider will assess mental status and presence of psychosis by observing appearance and demeanor and asking about thoughts, moods, delusions, hallucinations, substance abuse and potential for violence or suicide.

Treatments of Schizophrenia

Schizophrenia is a chronic condition that requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep and basic hygiene. A psychiatrist experienced in treating schizophrenia usually guides treatment. The treatment team also may include psychologists, social workers and psychiatric nurses and possibly a case manager to coordinate care. The full-team approach may be available in clinics with expertise in schizophrenia treatment.

Medications

Medications are the cornerstone of schizophrenia treatment. But because medications for schizophrenia can cause serious but rare side effects, people with schizophrenia may be reluctant to take them. Antipsychotic medications are the most commonly prescribed to treat schizophrenia. They're thought to control symptoms by affecting the brain neurotransmitters dopamine and serotonin. A person's willingness to cooperate with treatment may affect medication choice. Someone who is uncooperative may need to be given injections instead of taking a pill. Someone who is agitated may need to be calmed initially with benzodiazapine such as lorazepam (Ativan), which may be combined with an antipsychotic.

Atypical antipsychotics

These newer medications are generally preferred, because they pose a lower risk of debilitating side effects than do conventional medications. They include:

  • Aripiprazole (Abilify)
  • Clozapine (Clozaril)
  • Olanzapine (Zyprexa)
  • Paliperidone (Invega)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)

The Food and Drug Administration has approved Abilify and Risperdal for use in people ages 13 to 17. Side effects of atypical antipsychotic medications include weight gain, diabetes and high blood cholesterol.

Conventional, or typical, antipsychotics

These medications have frequent and potentially significant neurological side effects, including the possibility of developing a movement disorder (tardive dyskinesia) that may or may not be reversible. This group of medications includes:

  • Chlorpromazine (Thorazine)
  • Fluphenazine
  • Haloperidol
  • Perphenazine

These typical antipsychotics are often cheaper than newer counterparts, especially the generic versions, which can be an important consideration when long-term treatment is necessary. It can take several weeks after first starting a medication to notice an improvement in symptoms. In general, the goal of treatment with antipsychotic medications is to effectively control signs and symptoms at the lowest possible dosage. The psychiatrist may try different medications, different dosages or combinations over time to achieve the desired result. Other medications also may be helpful, such as antidepressants or anti-anxiety medications.

Psychosocial treatments

Although medications are the cornerstone of schizophrenia treatment, once psychosis recedes, psychosocial treatments also are important. These may include:

  • Social skills training. This focuses on improving communication and social interactions.
  • Family therapy. This provides support and education to families dealing with schizophrenia.
  • Vocational rehabilitation and supported employment. This focuses on helping people with schizophrenia find and keep jobs.
  • Individual therapy. Learning to cope with stress and identify early warning signs of relapse can help people with schizophrenia manage their illness. Many communities have programs to help people with schizophrenia with jobs, housing, self-help groups and crisis situations. A case manager or someone on the health care team can help find one. With appropriate treatment, most people with schizophrenia can manage their condition.

Prevention of Schizophrenia

  • There's no sure way to prevent schizophrenia. However, early treatment may help get symptoms under control before serious complications develop and may help improve the long-term outlook. Sticking with the treatment plan can help prevent relapses or worsening of schizophrenia symptoms. In addition, researchers hope that learning more about risk factors for schizophrenia may lead to earlier diagnosis and earlier treatment.
  • For people at increased risk of schizophrenia, taking proactive steps such as avoiding illicit drug use, reducing stress, getting enough sleep and starting antipsychotic medications as soon as necessary may help minimize symptoms or prevent them from worsening.

When to seek Medical Advice

People with schizophrenia often lack awareness that their difficulties stem from a mental illness that requires medical attention. So it usually falls to family or friends to get them help.

Helping someone who may have schizophrenia

If you think someone you know may have symptoms of schizophrenia, talk to him or her about your concerns. Although you can't force someone to seek professional help, you can offer encouragement and support and help your loved one find a qualified doctor or mental health provider. If your loved one poses a danger to self or others or can't provide his or her own food, clothing or shelter, you may need to call the police or other emergency responders for help. In some cases, emergency hospitalization may be needed. Laws on involuntary commitment for mental health treatment vary by state. You can contact community mental health agencies or police departments in your area for details.

Suicidal thoughts

Suicidal thoughts and behavior are common among people with schizophrenia. If you suspect or know that your loved one is considering suicide, seek immediate help. Contact a doctor, mental health provider or other health care professional.


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