Schizophrenia

Schizophrenia is one of those illnesses that sends shivers up the spine of many people. We might picture a raving lunatic or some poor soul that talks to space men. This disease can exhibit extreme symptoms such as these, but there are many people who are schizophrenic and able to carry on with perfectly normal lives. Either way, schizophrenia is an important disease of our time, and we should seek to understand it as best we can.

What is Schizophrenia?

Schizophrenia is a chronic mental illness that is classified as a psychotic disorder. It is actually considered one of a group of conditions collectively known as “schizophrenias” or “schizophrenic disorders.” It is characterized by very dysfunctional thinking, emotions, and behaviors. Schizophrenics often withdraw into a world of delusions and their own separate reality, behaviors which are typical for psychotic disorders. Psychosis literally means “disordered brain function.” Schizophrenics are unable to process sensory stimuli correctly, and this causes them to withdraw from interactions with others. An analogy might be a person who was the only English speaking person in a society where everyone spoke and understood only Chinese. After a while, he would most likely withdraw due to the frustration of not being able to successfully communicate with those around him.

Schizophrenic disorders have been referred to as far back as Hippocrates in 500 BC. The term schizophrenia was coined from two Greek words meaning “split mind.” (Not to be confused with “split personality” or “multiple personality disorder” which are separate conditions).  It was first called this in 1908 by a Swiss doctor named Eugen Bleuler. He thought it best described his understanding of the disease as one that caused a fracturing of mental functions.

Schizophrenia is a major public health problem because it afflicts relatively large numbers of people with very severe and debilitating symptoms. It is estimated that approximately 1% of the world’s population (over 60 million people) is afflicted with schizophrenia. Approximately 50% of psychiatric hospital patients are schizophrenic, and schizophrenics fill about 25% of all hospital beds worldwide. For most forms of this illness, there is not much disparity between the sexes. Most cases are initially diagnosed in people in their late teens or early twenties. Men generally experience their first acute attack in their early twenties, while it is a bit later for most women, usually closer to 30. Schizophrenia plays no favorites with race, social class, or culture. The prognosis is better for patients in some cultures, based on the prevailing attitude about the disease, the level of familial support, and the availability of treatment. A rare form of schizophrenia found in preadolescent children, some as young as five or six, affects twice as many boys as girls. Statistically, only one or two children out of every 10,000 are affected.

What Are the Symptoms of Schizophrenia?

The typically common symptoms of schizophrenia include the following:

• Delusions: These are erroneous beliefs that a patient believes to be true. Examples might include paranoid thoughts that they are being conspired against or persecuted by others.
• Extreme or bizarre delusions: One man reported that he believed traffic lights to be communicating messages to him in secret code as they turned from green to red.
• Hallucinations: seeing, hearing, or feeling things that do not exist. Auditory hallucinations (hearing voices) seem to be the most common.
• An ongoing feeling that someone is watching you.
• Incoherence
• Emotional flat lining, or inappropriate emotional responses
• Social isolation
• Trouble with work and/or social relationships
• Mental difficulties such as problem solving or processing information
• Clumsiness and uncoordinated, awkward movements
• Decline of personal hygiene

These symptoms are an overview of possible signs that many patients may experience. But it is important to understand that every patient is unique in that they may or may not have certain symptoms, or their symptoms may change as the disease progresses. The behavior of schizophrenics is very hard to predict. Some may act unresponsive or catatonic, some may be aggressive and combative, and some may act perfectly normal. The same patient may exhibit all of these characteristics at different times. To help classify symptoms, they have been broken down into three main categories: negative, positive, and cognitive.

• Negative symptoms:  These often appear in the early stages of schizophrenia. They are called negative because they involve the loss of a behavior or personality trait. Negative symptoms are usually associated with a slower deterioration of function, leading to social withdrawal. They include:
  • Dulled emotions or emotional “flat lining”
  • Inappropriate emotional responses, like laughing about tragedies
  • Changes in speech, often speaking in a dull, monotone voice
  • Poverty of speech:  Brief minimal replies to questions
  • Absence of volition or will: apathetic responses, an “I don’t care” attitude
• Positive symptoms:  They are labeled positive because they indicate an added behavior or personality trait. The most common positive symptoms are:
  • Hallucinations:  This occurs when you sense things that are not real. They may involve any of the senses, but auditory hallucinations are the most common. Sometimes schizophrenic patients will hear voices giving them instructions or information. Sometimes they will carry on conversations with voices that nobody else can hear. These types of hallucinations can be dangerous, as they can lead patients to hurt themselves or others.
  • Delusions:  Beliefs that have no basis in reality. Sometimes these involve grandiose thoughts that the person is chosen to understand or communicate important secret information, perhaps from the government or an alien civilization.
• Cognitive symptoms:  These are not quite as obvious or dramatic as negative or positive symptoms.  They include thinking processes such as organizing your thoughts, memory loss, or difficulty concentrating. Patients may ramble in their speech from topic to topic in loosely related ways, or give inappropriate answers to questions (tangentiality). Sometimes the term “word salad” is used when a patient’s speech is totally nonsensical in regards to language or grammar.

How is Schizophrenia Diagnosed?

There are no laboratory tests that can identify schizophrenia. Diagnosis must be made by analysis of the observed behavior patterns of the patient. CT scans and MRIs can sometimes reveal distinguishing abnormalities in the structure and function of the brain in schizophrenics, but they do not always show this evidence in all patients. Basically, the diagnosis is a three-part process:

• First, any physiological causes for the symptoms should be excluded. Some possible disorders that can mimic schizophrenia are organic brain disorders, traumatic brain injuries, Wilson’s disease (a rare inherited disorder that involves excessive levels of copper in the brain and liver), Huntington’s chorea (an inherited disease that is characterized by loss of brain function and difficulties with movement), encephalitis (inflammation of the brain), and temporal lobe epilepsy.
• Substance abuse, especially of amphetamines or cocaine, should also be eliminated. People abusing these drugs can exhibit schizophrenic-like symptoms. Delirium tremens or DT’s (severe withdrawals from alcohol) can also cause psychotic symptoms.
• Secondly, other psychiatric conditions should be considered. The possibilities are many. They include:
  • Mood disorders with psychotic features
  • Delusional disorder
  • Dissociative disorder
  • Multiple personality disorder
  • Paranoid personality disorders
  • In children, a distinction must be made between an overactive imagination or fantasy life, and psychotic symptoms
• Finally, a patient must meet certain criteria to warrant a diagnosis of schizophrenia:
  • Two or more of the following symptoms during a 30-day consecutive period:
    • Hallucinations
    • Delusions
    • Disorganized or catatonic behavior
    • Disorganized speech
    • Negative symptoms
• A decrease in interpersonal, occupational, and social functions, including personal hygiene or self-care
• Dysfunctional behaviors must be experienced or observed for a minimum of six months

Once a diagnosis of schizophrenia is made, there are subtypes of the illness that can also be determined:

• Paranoid schizophrenia:  This type of schizophrenia is defined by a combination of delusions and auditory hallucinations. Cognitive and emotional functioning is nearly normal in this form. Paranoids can generally function at a higher level than other schizophrenics, but can be at risk of hurting themselves or others if they are delusional.
• Disorganized schizophrenia:  Mainly characterized by cognitive symptoms such as disorganized speech, thinking, and behaviors. Also may exhibit emotional flat lining or inappropriate emotional responses. Sometimes disorganized schizophrenics will socially withdraw to the extreme, or may act silly and nonsensical.
• Catatonic schizophrenia:  This subtype includes symptoms of stupor, agitation, and mimicking the speech and movements of other people. This form is not common in the United States or Europe.
• Undifferentiated schizophrenia:  These patients have a variety of symptoms, and do not specifically fit into any of the above categories.
• Residual schizophrenia:  Individuals who have had at least one acute episode in the past, but currently are not experiencing any major symptoms such as delusion or hallucinations. They may have minor forms of some symptoms such as social withdrawal, so it can’t be said that they are in remission.

What Treatments Are Available for Schizophrenia?

The exact cause of schizophrenia is not known, but research indicates it has something to do with the fact that most schizophrenics have abnormally high levels of dopamine, a neurotransmitter in the brain. There may be a genetic connection as well, but it has yet to be identified. Statistics show that if you have a first-degree relative with schizophrenia, you have a 10 times greater chance of developing the disease than those who don’t have a family history.

The only successful treatments for schizophrenia, other than individual and group or family therapy, are pharmaceutical drugs. This is a mixed blessing. On one hand, there are many individuals that have experienced dramatic turnarounds through wise use of medications. Some schizophrenics could never manage—some of them probably would not survive—without these medications. Thanks to these drugs, they are able to have normal, functional lives. However, there are many others who have great difficulty in getting the right combination of medicines at the right dosages, and for years may experiment with chemical cocktails that leave their bodies as polluted as a toxic waste dump. Either way, whether the meds help or not, there are significant and dangerous side effects with most of these drugs. Some improvement has been made with the more recent drugs, but the long-term effects of taking these medications can have grave consequences. One of the problems is that while these drugs may help with the symptoms, they never cure or reverse schizophrenia, so the meds must be taken for life. That’s a long time to put this foreign matter into your body. My heart goes out to these patients and their families. Mental illness is a hard row to hoe.

I encourage anyone who suffers with schizophrenia to try to do anything they can to minimize the amount of medicine they have to take. Therapeutic counseling and/or support groups help many folks to manage their symptoms as best they can. One quick tip: don’t smoke! Studies have shown that schizophrenics who smoke need more medication than those who don’t.