About Schizophrenia

Schizophrenia Criteria for DSM 5

schizophrenia
Self-portrait of a person with schizophrenia, representing that individual’s distorted perception of reality

It is not easy discussing schizophrenia, its etiology remains unknown and the treatment does not significantly help the bizarre cognitive dysfunction.

There are still a lot of misunderstandings about schizophrenia but one factor that is very necessary is using a lot of compassion.

It’s very important to gain the trust of families or individuals affected by schizophrenia because it’s a constant battle with reality. Being sympathetic is the best approach to truly building a therapeutic alliance because schizophrenia can greatly impact everything.

About Psychosis

Frequent reorientation is key but even with medications and early treatment, there’s still a progressive decline in cognition. Overall, compassion and having patience are the most important virtues to guide the care:

Schizophrenia Statistics

  • Schizophrenia is a chronic and severe mental disorder affecting more than 21 million people worldwide.
  • Schizophrenia is characterized by distortions in thinking, perception, emotions, language, sense of self, and behavior. Common experiences include hallucinations – hearing voices or seeing things that are not there and delusions – fixed, false beliefs.
  • Worldwide, schizophrenia is associated with considerable disability and may affect educational and occupational performance.
  • People with schizophrenia are 2-3 times more likely to die early than the general population. This is often due to preventable physical diseases, such as cardiovascular disease, metabolic disease, and infections.
  • Stigma, discrimination, and violation of the human rights of people with schizophrenia are common.
  • Schizophrenia is treatable. Treatment with medicines and psychosocial support is effective.
    Facilitation of assisted living supported housing and supported employment are effective management strategies for people with schizophrenia.

–World Health Organization

Overview of Schizophrenia 

Schizophrenia is a progressively severe mental disorder that affects how a person thinks, feels, and behaves. It is a chronic mental disorder and the purpose of treatment is to promote the person’s activities of daily living or independence and reduce or stabilize the symptoms. People with schizophrenia also may have communication disorders, their effect may be flat or their conversations will have bizarre content:

  • Tangent Speech: train of thought lacks focus or wanders and never returning to the initial topic.
  • Circumstantial Tangent: talks at length about irrelevant and trivial details but relates it or returns to the original thought.

Signs and Symptoms

Symptoms of schizophrenia usually start between ages 16 and 30. In rare cases, children have schizophrenia too. The symptoms of schizophrenia fall into three categories: positive, negative, and cognitive:

Positive Symptoms: “Positive” symptoms are psychotic behaviors not generally seen in healthy people. People with positive symptoms may “lose touch” with some aspects of reality. Symptoms include:

  • Hallucinations
  • Delusions
  • Thought disorders (unusual or dysfunctional ways of thinking)
  • Movement disorders (agitated body movements)

Negative Symptoms: “Negative” symptoms are associated with disruptions to normal emotions and behaviors. Symptoms include:

  • “Flat affect” (reduced expression of emotions via facial expression or voice tone)
  • Reduced feelings of pleasure in everyday life
  • Difficulty beginning and sustaining activities
  • Reduced speaking

Cognitive Symptoms: For some patients, the cognitive symptoms of schizophrenia are subtle, but for others, they are more severe and patients may notice changes in their memory or other aspects of thinking. Symptoms include:

  • Poor “executive functioning” (the ability to understand information and use it to make decisions)
  • Trouble focusing or paying attention
  • Problems with “working memory” (the ability to use the information immediately after learning it)

Risk Factors of Schizophrenia

There are several factors that contribute to the risk of developing schizophrenia.

Genes & Environment: Scientists have long known that schizophrenia sometimes runs in families. However, there are many people who have schizophrenia who don’t have a family member with the disorder, and conversely, many people with one or more family members with the disorder do not develop it themselves.

Scientists believe that many different genes may increase the risk of schizophrenia, but that no single gene causes the disorder by itself. It is not yet possible to use genetic information to predict who will develop schizophrenia.

Scientists also think that interactions between genes and aspects of the individual’s environment are necessary for schizophrenia to develop. Environmental factors may involve:

  • Exposure to viruses
  • Malnutrition before birth
  • Problems during birth
  • Psychosocial factors

Different brain chemistry and structure: Scientists think that an imbalance in the complex, interrelated chemical reactions of the brain involving the neurotransmitters (substances that brain cells use to communicate with each other) dopamine and glutamate, and possibly others, plays a role in schizophrenia.

Some experts also think problems during brain development before birth may lead to faulty connections. The brain also undergoes major changes during puberty, and these changes could trigger psychotic symptoms in people who are vulnerable due to genetics or brain differences.

Treatments and Therapies

Because the causes of schizophrenia are still unknown, treatments focus on reducing the symptoms of the disease. Treatments include:

Antipsychotics
Antipsychotic medications are usually taken daily in pill or liquid form. Some antipsychotics are injections that are given once or twice a month. Some people have side effects when they start taking medications, but most side effects go away after a few days. Doctors and patients can work together to find the best medication or medication combination, and the right dose.

Psychosocial Treatments
These treatments are helpful after patients and their doctor finds a medication that works. Learning and using coping skills to address the everyday challenges of schizophrenia helps people to pursue their life goals, such as attending school or work. Individuals who participate in regular psychosocial treatment are less likely to have relapsed or be hospitalized. For more information on psychosocial treatments, see the Psychotherapies webpage on the NIMH website.

Coordinated Specialty Care (CSC)
This treatment model integrates medication, psychosocial therapies, case management, family involvement, and supported education and employment services, all aimed at reducing symptoms and improving quality of life. The NIMH Recovery After an Initial Schizophrenia Episode (RAISE) research project seeks to fundamentally change the trajectory and prognosis of schizophrenia through coordinated specialty care treatment in the earliest stages of the disorder. RAISE is designed to reduce the likelihood of long-term disability that people with schizophrenia often experience and help them lead productive, independent lives.

-National Institute of Mental Health

Services
More than 50% of people with schizophrenia are not receiving appropriate care. 90% of people with untreated schizophrenia live in low- and middle-income countries. Lack of access to mental health services is an important issue. Furthermore, people with schizophrenia are less likely to seek care than the general population.

Management
Schizophrenia is treatable. Treatment with medicines and psychosocial support is effective. However, the majority of people with chronic schizophrenia lack access to treatment.

There is clear evidence that old-style mental hospitals are not effective in providing the treatment that people with mental disorders need and violate the basic human rights of persons with mental disorders. Efforts to transfer care from mental health institutions to the community need to be expanded and accelerated. The engagement of family members and the wider community in providing support is very important.

Programs in several low- and middle-income countries (e.g. Ethiopia, Guinea-Bissau, India, Iran, Pakistan, Tanzania) have demonstrated the feasibility of providing care to people with severe mental illness through the primary health-care system by:

  • Training primary healthcare personnel
  • Providing access to essential drugs
  • Supporting families in providing home care
  • Educating the public to decrease stigma and discrimination
  • Enhancing independent living skills through recovery-oriented psychosocial interventions (e.g., life skills training, social skills training) for people with schizophrenia and for their families and/or caregivers
  • Facilitating independent living, if possible, or assisted living, supported housing, and supported employment for people with schizophrenia. This can act as a base for people with schizophrenia to achieve recovery goals. People affected by schizophrenia often face difficulty in obtaining or retaining normal employment or housing opportunities

–World Health Organization

In Summary

  • A diagnosis of schizophrenia is made clinically, as there are no psychological assessments, brain imaging, or laboratory examinations that confirm the diagnosis.
  • The goals of treatment are to reduce symptomatology, decrease psychotic relapses, and improve patient functioning and social outcomes.
  • Patients presenting with odd behaviors, illogical thought processes, bizarre beliefs, and hallucinations should be assessed for schizophrenia.
  • The cornerstone of treatment is antipsychotic medications. Because most patients with schizophrenia relapse when not medicated, long-term treatment is usually necessary.
  • Psychosocial support is needed to help improve functional outcomes.
  • Compared to the older antipsychotics (first-generation antipsychotics [FGAs]), the more recently developed second-generation antipsychotics (SGAs) are associated with a lower risk of motor side effects (tremor, stiffness, restlessness, and dyskinesia); may offer greater benefits for affective, negative, and cognitive symptoms; and may prolong the time to psychotic relapse.
  • SGAs as a class are heterogeneous with regard to side-effect profiles. Many SGAs carry an increased risk for weight gain and for the development of glucose and lipid abnormalities; therefore careful monitoring is essential.
  • Education of the patient and family regarding the benefits and risks of antipsychotic medications and the importance of adherence to their therapeutic regimens must be integrated into pharmacologic management.

In most cases, schizophrenia is a chronically debilitating disorder and is likely one of the most devastating chronic medical illnesses.

Conceptually, schizophrenia might better be thought of as a clinical syndrome, comprising several disease entities that manifest with psychotic symptoms, including hallucinations, delusions, and disordered thinking.

Commonly, these more flagrant symptoms are accompanied by more insidious ones, including cognitive impairment (abnormalities in thinking, reasoning, attention, memory, and perception), impaired insight and judgment, loss of motivation (avolition), loss of emotional range (restricted affect), and a decrease in spontaneous speech (poverty of speech).

The latter three symptoms are termed negative symptoms, and when taken together, are frequently called the deficit syndrome. Cognitive impairments and negative symptoms account for much of the poor social and functional outcomes observed in schizophrenia.

Schizophrenia is the fourth leading cause of disability among adults and is associated with substantially lower rates of employment, marriage, and independent living compared to population norms. Approximately 10% of people with schizophrenia die by suicide. However, earlier diagnosis and treatment, as well as advances in research and newer treatment developments, have led to better outcomes for people who suffer from this complex and challenging illness.

-Doctor Lib

Different Forms of Symptoms & Conditions

Forms of Schizophrenia & Psychosis

Additional Information and References

How can I help someone I know with schizophrenia?
Caring for and supporting a loved one with schizophrenia can be hard. It can be difficult to know how to respond to someone who makes strange or clearly false statements. It is important to understand that schizophrenia is a biological illness.

Here are some things you can do to help your loved one:

  • Get them treatment and encourage them to stay in treatment
  • Remember that their beliefs or hallucinations seem very real to them
  • Tell them that you acknowledge that everyone has the right to see things their own way
  • Be respectful, supportive, and kind without tolerating dangerous or inappropriate behavior

Research and Statistics

-National Institute of Mental Health

Quick Links 

Barch, D. M. (2019). Schizophrenia spectrum disorders. In R. Biswas-Diener & E. Diener (Eds), Noba textbook series: Psychology. Champaign, IL: DEF publishers. Retrieved from http://noba.to/5d98nsy4

My Brother’s Schizophrenia: a great article by a woman that wrote about her brother’s struggles with schizophrenia.

What Schizophrenia Does to Families: the distress, pain, and confusion that schizophrenia causes in the family, a personal account.

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