Schizophrenia

Schizophrenia is a serious mental disorder that affects a person’s thoughts, feelings, and behaviors. People with this disorder may have delusions, hallucinations, and disturbances in thoughts and behavior. There are treatments for schizophrenia, but there is no cure. It is a lifelong, chronic condition.

Definition & Facts

Schizophrenia can be a debilitating disorder; its key characteristic is a person losing grip of reality. The symptoms of schizophrenia typically begin in late adolescence to the mid-20s. In women, symptoms typically begin in the late 20s. It is not common for children to be diagnosed with schizophrenia, and the disorder rarely develops after the age of 45. Though a definitive cause has not been identified, schizophrenia is suspected to stem from abnormalities in brain structure and brain chemistry.

Symptoms & Complaints

Delusions are false beliefs that are not based in reality. Examples of delusions include paranoid thoughts that people are out to harm an individual or that the individual has an exceptional talent or fame. People with delusions might believe that his or her body is not working properly. Delusions occur in the majority of people with schizophrenia.

Disordered thinking results in speech that may not make sense or be difficult to understand. People with schizophrenia often put together strings of unrelated words that do not make sense. Examples of disorganized behaviors include not dressing properly for the weather such as wearing a heavy winter coat in the summer or shorts in extremely cold weather.

Other disorganized behaviors include aggression or excessive movement. Those suffering from schizophrenia may also experience symptoms such as lacking emotion, impaired social skills, distorted facial expressions, monotone speech, and impaired ability to perform daily tasks of living such as personal hygiene.

Causes

Although the exact cause of schizophrenia is not known, researchers believe that both genetic factors and environmental factors contribute to the development of this disorder. Problems with naturally occurring brain chemicals, such as glutamate and dopamine, have been found to be present in people with schizophrenia. Neuroimaging studies have found differences in the central nervous system and brain structure of people with schizophrenia. Some scientists suspect that malnutrition during pregnancy and even certain viruses may contribute to the onset of schizophrenia.

Diagnosis & Tests

When doctors suspect someone has schizophrenia, they typically gather comprehensive medical, mental health, and family information. A psychiatrist will often conduct a thorough physical examination to rule out other causes for the symptoms. Some of the medical tests might include blood tests or imaging screenings, such as a CT scan or MRI.

Psychological tests could include a complete psychosocial assessment. These types of assessments include information about the patient’s entire background so that a mental health professional can determine if the person has impairments in their psychosocial functioning that may be caused by schizophrenia.

A mental health professional will typically conduct a mental status examination to look for impairments in the person’s mental status. Alcohol tests and drug tests are conducted to rule out the possibility that symptoms could be caused by a substance. Since schizophrenia often co-occurs with other mental health disorders, it is important to assess for other disorders.

Treatment & Therapy

Treatment for schizophrenia usually includes a multipronged approach. Often a treatment team approach is used, and the team may include a psychiatrist, counselor, psychiatric nurse, skills trainer, and case manager. Individuals on the team may provide medication management, case coordination, and psychosocial treatment. Psychiatric hospitalization may be needed during periods of crisis or severe symptoms.

Medications are an important part of treatment, though many individuals with schizophrenia are not willing to cooperate with treatment due to a lack of awareness of their disorder. Someone who refuses to take medication on a consistent basis may need to be given injections rather than taking oral medications.

Antipsychotic drugs are typically used to treat the disorder. They control symptoms by changing levels of neurotransmitters in the brain. Newer atypical antipsychotics are preferred in the treatment of schizophrenia because they pose a lower risk of serious side effects. These medications include clozapine, aripiprazole, and risperidone. Older antipsychotics, such as haloperidol, are sometimes used if newer medications do not work. These first-generation medications are much cheaper than newer medications, but they pose the risk for serious neurological side effects that may not be reversible.

It can take several weeks after first starting a medication to notice an improvement in symptoms. Other medications used in the treatment of the disorder include mood stabilizers, such as benzodiazepine. These are used to reduce agitation. Anti-anxiety medications are sometimes used too.

Psychosocial interventions are an important part of treatment for schizophrenia. These interventions are typically used concurrently with medications. Psychosocial treatments include individual psychotherapy to help the person learn to cope with stress and identify the early warning signs of relapse.

Social skills training helps improve communication and appropriate social interactions. Family therapy can help improve family functioning by providing education and support to families dealing with schizophrenia. Vocational rehabilitation helps people with schizophrenia learn vocational skills to help improve their functioning at work and school.

Daily living skills interventions help people with schizophrenia find housing, manage their money, and respond appropriately to crisis situations. Case management is used to help the individual locate and apply for community resources. With a multi-approach treatment, many people with schizophrenia can manage their illness and live a happy, productive life.

Prevention & Prophylaxis

Other approaches that can prevent a relapse include joining a support group to help individuals with schizophrenia reach out to others for help, and learning relaxation techniques and stress management such as yoga or progressive muscle relaxation.