Schizophrenia is a serious brain disorder that distorts the way a person thinks, acts, expresses emotions, perceives reality, and relates to others. People with schizophrenia -- the most chronic and disabling of the major mental illnesses -- often have problems functioning in society, at work, at school, and in relationships. Schizophrenia can leave its sufferer frightened and withdrawn. It is a life-long disease that cannot be cured but can be controlled with proper treatment.
Contrary to popular belief, schizophrenia is not a split or multiple personality. Schizophrenia is a psychosis, a type of mental illness in which a person cannot tell what is real from what is imagined. At times, people with psychotic disorders lose touch with reality. The world may seem like a jumble of confusing thoughts, images, and sounds. The behavior of people with schizophrenia may be very strange and even shocking. A sudden change in personality and behavior, which occurs when schizophrenia sufferers lose touch with reality, is called a psychotic episode.
Schizophrenia varies in severity from person to person. Some people have only one psychotic episode while others have many episodes during a lifetime but lead relatively normal lives between episodes. Still other individuals with this disorder may experience a decline in their functioning over time with little improvement between full blown psychotic episodes. Schizophrenia symptoms seem to worsen and improve in cycles known as relapses and remissions.
At one time, doctors classified schizophrenia based on distinct subtypes:
Paranoid: Where someone feels he is being persecuted or spied on.
Disorganized: Where people appear confused and incoherent.
Catatonic: Where people can be physically immobile or unable to speak.
Undifferentiated schizophrenia: Asubtype in which no paranoid, disorganized or catatonic features are prominent.
Residual Schizophrenia: In which psychotic symptoms are markedly diminished or no longer present.
Scientists think the above distinctions are no longer as accurate or useful as once thought and therefore instead just focus on describing symptoms and their severity.
People with schizophrenia may have a number of symptoms involving changes in ability, thinking, perception, behavior, and personality, and they may display different kinds of behavior at different times. When the illness first appears, symptoms usually are sudden and severe.
The most common symptoms of schizophrenia can be grouped into several categories including positive symptoms, cognitive symptoms, and negative symptoms.
Positive Symptoms of Schizophrenia
In this case, the word positive does not mean "good." Rather, it refers to obvious symptoms that are exaggerated forms of thinking or behavior that become irrational. These symptoms, which are sometimes referred to as psychotic symptoms, include:
Delusions: Delusions are strange beliefs that are not based in reality and that the person refuses to give up, even when presented with factual information. For example, the person suffering from delusions may believe that people can hear his or her thoughts, that he or she is God or the devil, or that people are putting thoughts into his or her head or plotting against them.
Hallucinations: These involve perceiving sensations that aren't real, such as seeing things that aren't there, hearing voices, smelling strange odors, having a "funny" taste in your mouth, and feeling sensations on your skin even though nothing is touching your body. Hearing voices is the most common hallucination in people with schizophrenia. The voices may comment on the person's behavior, insult the person, or give commands.
Catatonia (a condition in which the person becomes physically fixed in a single position for a very long time).
Disorganized symptoms of schizophrenia are a type of positive symptom that reflects the person's inability to think clearly and respond appropriately. Examples of disorganized symptoms include:
Talking in sentences that do not make sense or using nonsense words, making it difficult for the person to communicate or engage in conversation
Shifting quickly from one thought to the next
Moving slowly
Being unable to make decisions
Writing excessively but without meaning
Forgetting or losing things
Repeating movements or gestures, such as pacing or walking in circles
Having problems making sense of everyday sights, sounds, and feelings
Cognitive Symptoms of Schizophrenia
Cognitive symptoms include:
Poor executive functioning (the ability to understand information and to use it to make decisions)
Trouble focusing or paying attention
Difficulty with working memory (the ability to use information immediately after learning it)
Negative Symptoms of Schizophrenia
In this case, the word negative does not mean "bad," but reflects the absence of certain normal behaviors in people with schizophrenia. Negative symptoms of schizophrenia include:
Lack of emotion or a very limited range of emotions
Withdrawal from family, friends, and social activities
Reduced energy
Reduced speech
Lack of motivation
Loss of pleasure or interest in life
Poor hygiene and grooming habits
Although there is no proven way to prevent schizophrenia, scientists are looking for ways to make it less likely.
Schizophrenia is a complex illness that may partly involve your genes. But events in your life may also play a role.
The condition can sometimes run in families. But there isn't one specific gene that causes it. And in some people who get schizophrenia, there are no signs of a family history of the illness.
It's possible that someone has genes linked to schizophrenia and then faces events that make them more likely to develop the disorder.
Some of these events are in your control, and some aren't:
Pregnancy complications - Infection, stress, and complications during pregnancy such as preeclampsia may raise the chance that your child will one day have schizophrenia. But that’s not certain.
Depression or other major stressful events during pregnancy may also play a role. "A woman who experiences a death or other tragedy during pregnancy is also more likely to have a child at risk.
Harmful childhood experiences. Brain injury, sexual abuse, and traumatic early experiences may raise the risk.
"Children who were exposed to any trauma before age 16 were three times more likely to become psychotic," Samton says. If the trauma was severe, children were 50 times more likely.
Drug abuse. Early and long-term use of marijuana and other illicit drugs may raise the risk.
What to Do if Schizophrenia Runs in Your Family?
Don't use drugs. This is especially important for teens, because their brains are still developing. Remember, alcohol is a drug, so you should limit or avoid it.
Avoid abusive or traumatic situations. If you're in an abusive relationship or you're going through trauma, get help. For instance, you can call a doctor, therapist.
Keep strong social ties. Socializing helps you maintain self-esteem, lower stress, not feel lonely, and keep busy. Teens, especially, should be encouraged to connect with friends and avoid isolation.
Learn how to manage stress . Ongoing stress and anxiety are bad for your health.
Set up strategies to manage stress. You can do this in therapy or learn from your parents, teachers, or other role models who seem to manage stress well.
Take care of your body. Good nutrition and plenty of exercise are important.
Take steps to protect yourself from head injuries, too. For example, wear helmets when biking or playing contact sports.
Try fish oil. One study suggests that omega-3 fatty acids (found in fish oil) may help prevent psychotic disorders from getting worse, and might even prevent them in young children who are at risk of them. This isn’t certain, though.
Take steps to stay well if you're pregnant or trying to get pregnant. Make sure you get good medical care for your physical and mental health.
See a psychiatrist. If you have any symptoms, such as feeling suspicious or having unusual thoughts, see a psychiatrist. Cognitive behavioral therapy (a type of counseling) may help you better spot the early signs of schizophrenia and limit its impact on your work, school, and social life. In this type of therapy, a trained psychiatrist, psychologist, or social worker helps people recognize negative patterns of thought and come up with new ways of thinking about problems.
Remember, it’s not likely. Even if schizophrenia runs in your family, there’s a good chance that you won't get it. About 85% of people with a family history of schizophrenia don't develop it themselves. "So along with doing all of these things, keep these numbers in mind and try not to worry."
The goal of schizophrenia treatment is to reduce the symptoms and to decrease the chances of a relapse, or return of symptoms.
Treatment for schizophrenia may include:
Medications: The primary medications used to treat schizophrenia are called antipsychotics. These drugs do not cure schizophrenia but help relieve the most troubling symptoms, including delusions, hallucinations, and thinking problems. Older (commonly referred to as "first generation") medications used include: chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), loxapine (Loxapine), perphenazine (Trilafon), thioridazine (Mellaril), thiothixene (Navane), and trifluoperazine (Stelazine). Newer ("atypical" or second generation) drugs used to treat schizophrenia include: aripiprazole (Abilify), aripiprazole lauroxil (Aristada), asenapine (Saphris), clozapine (Clozaril), iloperidone (Fanapt), lurasidone (Latuda), paliperidone (Invega Sustenna), paliperidone palmitate (Invega Trinza), quetiapine (Seroquel), risperidone (Risperdal), and olanzapine (Zyprexa), and ziprasidone (Geodon). Other, even newer atypical antipsychotics include brexpiprazole (Rexulti) and cariprazine (Vraylar).
Psychosocial therapy: While medication may help relieve symptoms of schizophrenia, various psychosocial treatments can help with the behavioral, psychological, social, and occupational problems associated with the illness. Through therapy, patients also can learn to manage their symptoms, identify early warning signs of relapse, and develop a relapse prevention plan. Psychosocial therapies include:
Rehabilitation, which focuses on social skills and job training to help people with schizophrenia function in the community and live as independently as possible.
Cognitive remediation involves learning techniques to compensate for problems with information processing, often through drills, coaching and computer-based exercises, to strengthen specific mental skills involving attention, memory and planning/organization.
Individual psychotherapy, which can help the person better understand his or her illness, and learn coping and problem-solving skills.
Family therapy, which can help families deal more effectively with a loved one who has schizophrenia, enabling them to better help their loved one.
Group therapy/support groups, which can provide continuing mutual support.
Hospitalization: Many people with schizophrenia may be treated as outpatients. However, people with particularly severe symptoms, or those in danger of hurting themselves or others or who cannot take care of themselves at home may require hospitalization to stabilize their condition.
Electroconvulsive therapy (ECT): This is a procedure in which electrodes are attached to the person's scalp and, while asleep under general anesthesia, a small electric shock is delivered to the brain. A course of ECT treatment usually involves 2-3 treatments per week for several weeks. Each shock treatment causes a controlled seizure, and a series of treatments over time leads to improvement in mood and thinking. Scientists do not fully understand exactly how ECT and the controlled seizures it causes have a therapeutic effect, although some researcher think that ECT-induced seizures may affect the release of neurotransmitters in the brain. ECT is less well established for treating schizophrenia than depression or bipolar disorder, and it is therefore not used very often when mood symptoms are absent. ECT is sometimes helpful when medications fail or if severe depression or catatonia makes treating the illness difficult.
Psychosurgery: In the 1940s and 1950s, a neurosurgical procedure called a prefrontal lobotomy was sometimes used to treat severe agitation associated with psychosis. Because it caused serious and irreversible negative effects that dulled personality and motivation, the procedure is no longer performed as a psychiatric treatment. Other, more modern neurosurgical procedures being studied to treat schizophrenia include deep brain stimulation (DBS) -- an entirely different operation that is not at all related to lobotomy -- in which stimulating electrodes are surgically implanted in brain areas believed to control thinking and perception. DBS is an established treatment for severe Parkinson's Disease and essential tremor, and remains experimental for the treatment of psychiatric disorders.