What is schizophrenia?
Schizophrenia, also sometimes called split personality disorder, is a chronic, severe, debilitating mental illness that affects about 1% of the population, corresponding to more than 2 million people in the United States alone. Other statistics about schizophrenia include that it affects men about one and a half times more commonly than women. It is one of the psychotic mental disorders and is characterized by symptoms of thought, behavior, and social problems. The thought problems associated with schizophrenia are described as psychosis, in that the person's thinking is completely out of touch with reality at times. For example, the sufferer may hear voices or see people that are in no way present or feel like bugs are crawling on their skin when there are none. The individual with this disorder may also have disorganized speech, disorganized behavior, physically rigid or lax behavior (catatonia), significantly decreased behaviors or feelings, as well as delusions, which are ideas about themselves or others that have no basis in reality (for example, experience the paranoia of thinking others are plotting against them when they are not).
There are five types of schizophrenia, each based on the kind of symptoms the person has at the time of assessment:
Although there have been fewer studies on schizophrenia in children compared to adults, researchers are finding that in children as young as 6 years old can be found to have all the symptoms of their adult counterparts and to continue to have those symptoms into adulthood.
The term schizophrenia has only been in use since 1911. Soon before that, it was deemed a separate mental illness in 1887 by Emil Kraepelin. Despite that relatively recent history, it has been described throughout written history. Ancient Egyptian, Hindu, Chinese, Greek, and Roman writings described symptoms similar to the positive symptoms of schizophrenia. During medieval times, schizophrenia, like other illnesses, was often viewed as evidence of the sufferer being possessed by spirits or evil powers.
A number of accomplished individuals suffer from schizophrenia. The film A Beautiful Mind depicts the life of John Nash, a noted scientist, and his struggles with paranoid schizophrenia. The film The Soloist explores the challenges faced by Juilliard-trained musician Nathaniel Ayers as a result of schizophrenia
Sign & Symptoms:
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:
Source: MedicineNet.com
http://www.medicinenet.com/schizophrenia/article.htm
Negative symptoms refer to a diminishment or absence of characteristics of normal function. They may appear months or years before positive symptoms. They include:
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:
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.
When to see a doctor
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.
Causes
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.
Individuals with schizophrenia have more than twice the rate of death than those without the disorder. Almost half of people with schizophrenia will suffer from a substance-use disorder (for example, alcohol, marijuana, or other substance) during their lifetime. Research shows that people with schizophrenia or schizoaffective disorder have a better quality of life if their family members tend to be more supportive and less critical of them.
As is true with virtually any mental-health diagnosis, there is no one test that definitively indicates that someone has schizophrenia. Therefore, health-care practitioners diagnose this disorder by gathering comprehensive medical, family, and mental-health information. Patients tend to benefit when the professional takes into account their client's entire life and background. This includes but is not limited to the person's gender, sexual orientation, cultural, religious and ethnic background, and socioeconomic status. The practitioner will also either perform a physical examination or request that the individual's primary-care doctor perform one. The medical examination will usually include lab tests to evaluate the person's general health and to explore whether or not the individual has a medical condition that might produce psychological symptoms.
In asking questions about mental-health symptoms, mental-health professionals are often exploring if the individual suffers from hallucinations or delusions, depression and/or manic symptoms, anxiety, substance abuse, as well as some personality disorders (for example, schizotypal personality disorder) and developmental disorders (for example, autism spectrum disorders). Since some of the symptoms of schizophrenia can also occur in other mental illnesses, the mental-health screening is to determine if the individual suffers from schizoaffective disorder or other psychotic disorder, bipolar disorder, an anxiety disorder, or a substance abuse or personality disorder. Any disorder that is associated with bizarre behavior, mood, or thinking, like borderline personality disorder or another psychotic disorder, as well as dissociative identity disorder (DID), formally known as multiple personality disorder (MPD) may be particularly challenging to distinguish from schizophrenia. In order to assess the person's current emotional state, health-care providers perform a mental-status examination as well.
In addition to providing treatment that is appropriate to the diagnosis, determining the presence of mental illnesses that may co-occur (be comorbid) with schizophrenia is important in improving the life of individuals with schizophrenia. For example, people with schizophrenia are at increased risk of having a depressive or anxiety disorder and of committing suicide.
Treatments and drugs
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.
MedicationsMedications 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 antipsychoticsThese newer medications are generally preferred, because they pose a lower risk of debilitating side effects than do conventional medications. They include:
Conventional, or typical, antipsychoticsThese 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:
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 treatmentsAlthough medications are the cornerstone of schizophrenia treatment, once psychosis recedes, psychosocial treatments also are important. These may include:
Prevention
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.
Schizophrenia, also sometimes called split personality disorder, is a chronic, severe, debilitating mental illness that affects about 1% of the population, corresponding to more than 2 million people in the United States alone. Other statistics about schizophrenia include that it affects men about one and a half times more commonly than women. It is one of the psychotic mental disorders and is characterized by symptoms of thought, behavior, and social problems. The thought problems associated with schizophrenia are described as psychosis, in that the person's thinking is completely out of touch with reality at times. For example, the sufferer may hear voices or see people that are in no way present or feel like bugs are crawling on their skin when there are none. The individual with this disorder may also have disorganized speech, disorganized behavior, physically rigid or lax behavior (catatonia), significantly decreased behaviors or feelings, as well as delusions, which are ideas about themselves or others that have no basis in reality (for example, experience the paranoia of thinking others are plotting against them when they are not).
What are the different types of schizophrenia?
There are five types of schizophrenia, each based on the kind of symptoms the person has at the time of assessment:
- Paranoid schizophrenia: The individual is preoccupied with one or more delusions or many auditory hallucinations but does not have symptoms of disorganized schizophrenia.
- Disorganized schizophrenia: Prominent symptoms are disorganized speech and behavior, as well as flat or inappropriate affect. The person does not have enough symptoms to be characterized as catatonic schizophrenic.
- Catatonic schizophrenia: The person with this type of schizophrenia primarily has at least two of the following symptoms: difficulty moving, resistance to moving, excessive movement, abnormal movements, and/or repeating what others say or do.
- Undifferentiated schizophrenia: This is characterized by episodes of two or more of the following symptoms: delusions, hallucinations, disorganized speech or behavior, catatonic behavior or negative symptoms, but the individual does not qualify for a diagnosis of paranoid, disorganized, or catatonic type of schizophrenia.
- Residual schizophrenia: While the full-blown characteristic positive symptoms of schizophrenia (those that involve an excess of normal behavior, such as delusions, paranoia, or heightened sensitivity) are absent, the sufferer has less severe forms of the disorder or has only negative symptoms (symptoms characterized by a decrease in function, such as withdrawal, disinterest, and not speaking).
How common is schizophrenia in children?
Although there have been fewer studies on schizophrenia in children compared to adults, researchers are finding that in children as young as 6 years old can be found to have all the symptoms of their adult counterparts and to continue to have those symptoms into adulthood.
What is the history of schizophrenia?
The term schizophrenia has only been in use since 1911. Soon before that, it was deemed a separate mental illness in 1887 by Emil Kraepelin. Despite that relatively recent history, it has been described throughout written history. Ancient Egyptian, Hindu, Chinese, Greek, and Roman writings described symptoms similar to the positive symptoms of schizophrenia. During medieval times, schizophrenia, like other illnesses, was often viewed as evidence of the sufferer being possessed by spirits or evil powers.
A number of accomplished individuals suffer from schizophrenia. The film A Beautiful Mind depicts the life of John Nash, a noted scientist, and his struggles with paranoid schizophrenia. The film The Soloist explores the challenges faced by Juilliard-trained musician Nathaniel Ayers as a result of schizophrenia
Sign & Symptoms:
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:
Source: MedicineNet.com
http://www.medicinenet.com/schizophrenia/article.htm
- 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 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 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
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.
When to see a doctor
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.
Causes
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.
What is the prognosis for schizophrenia?
Individuals with schizophrenia have more than twice the rate of death than those without the disorder. Almost half of people with schizophrenia will suffer from a substance-use disorder (for example, alcohol, marijuana, or other substance) during their lifetime. Research shows that people with schizophrenia or schizoaffective disorder have a better quality of life if their family members tend to be more supportive and less critical of them.
How is schizophrenia diagnosed?
As is true with virtually any mental-health diagnosis, there is no one test that definitively indicates that someone has schizophrenia. Therefore, health-care practitioners diagnose this disorder by gathering comprehensive medical, family, and mental-health information. Patients tend to benefit when the professional takes into account their client's entire life and background. This includes but is not limited to the person's gender, sexual orientation, cultural, religious and ethnic background, and socioeconomic status. The practitioner will also either perform a physical examination or request that the individual's primary-care doctor perform one. The medical examination will usually include lab tests to evaluate the person's general health and to explore whether or not the individual has a medical condition that might produce psychological symptoms.
In asking questions about mental-health symptoms, mental-health professionals are often exploring if the individual suffers from hallucinations or delusions, depression and/or manic symptoms, anxiety, substance abuse, as well as some personality disorders (for example, schizotypal personality disorder) and developmental disorders (for example, autism spectrum disorders). Since some of the symptoms of schizophrenia can also occur in other mental illnesses, the mental-health screening is to determine if the individual suffers from schizoaffective disorder or other psychotic disorder, bipolar disorder, an anxiety disorder, or a substance abuse or personality disorder. Any disorder that is associated with bizarre behavior, mood, or thinking, like borderline personality disorder or another psychotic disorder, as well as dissociative identity disorder (DID), formally known as multiple personality disorder (MPD) may be particularly challenging to distinguish from schizophrenia. In order to assess the person's current emotional state, health-care providers perform a mental-status examination as well.
In addition to providing treatment that is appropriate to the diagnosis, determining the presence of mental illnesses that may co-occur (be comorbid) with schizophrenia is important in improving the life of individuals with schizophrenia. For example, people with schizophrenia are at increased risk of having a depressive or anxiety disorder and of committing suicide.
Treatments and drugs
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.
MedicationsMedications 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 antipsychoticsThese 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)
Conventional, or typical, antipsychoticsThese 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
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 treatmentsAlthough 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.
Prevention
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.
