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SCHIZOPHRENIA
Schizophrenia is a chronic, severe and debilitating mental illness. It is considered 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.
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.
Types of Schizophrenia
There are five types of schizophrenia, each based on the kind of symptoms the person has
at the time of assessment:
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Paranoid schizophrenia
Disorganized schizophrenia
Catatonic schizophrenia
Undifferentiated schizophrenia
Residual schizophrenia
Paranoid Schizophrenia
Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations but
relatively normal intellectual functioning and expression of affect. The delusions can often be
about being persecuted unfairly or being some other person who is famous. People with
paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and argumentativeness.
Disorganized Schizophrenia
Disorganized-type schizophrenia is characterized by speech and behavior that are
disorganized or difficult to understand, and flattening or inappropriate emotions. People with
disorganized-type schizophrenia may laugh at the changing colour of a traffic light or at
something not closely related to what they are saying or doing. Their disorganized behavior
may disrupt normal activities, such as showering, dressing, and preparing meals.
Catatonic Schizophrenia
Catatonic-type schizophrenia is characterized by disturbances of movement. People with
catatonic-type schizophrenia may keep themselves completely immobile or move all over the
place. They may not say anything for hours, or they may repeat anything you say or do
senselessly. Either way, the behavior is putting these people at high risk because it impairs
their ability to take care of themselves.
Undifferentiated Schizophrenia
Undifferentiated-type schizophrenia 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
Residual-type schizophrenia is characterized by a past history of at least one episode of
schizophrenia, but the person currently has no positive symptoms (delusions, hallucinations,
disorganized speech or behavior). It may represent a transition between a full-blown episode
and complete remission, or it may continue for years without any further psychotic episodes.
Causes of Schizophrenia
There is no single cause for schizophrenia. Rather, it is the result of a complex group of
genetic, psychological, and environmental factors. Genetically, schizophrenia and bipolar
disorder have much in common, in that the two disorders share a number of the same risk
genes. However, the fact is that both illnesses also have some genetic factors that are
unique. Environmentally, the risks of developing schizophrenia can even occur before birth.
For example, the risk of schizophrenia is increased in individuals whose mother had one of
certain infections during pregnancy. Difficult life circumstances during childhood, like the
early loss of a parent, parental poverty, bullying, witnessing parental violence; emotional,
sexual, or physical abuse; physical or emotional neglect; and insecure attachment have been
associated with the development of this illness.
Symptoms:
A person with schizophrenia may not have any outward appearance of being ill. In other
cases, the illness may be more apparent, causing changes in behavior as well as bizarre
behaviors. These may include social withdrawal, depersonalization (intense anxiety and a
feeling of being unreal), loss of appetite, loss of hygiene, delusions, hallucinations, and a
sense of being controlled by outside forces. In order to better understand schizophrenia, the
concept of clusters of symptoms is often used. Thus, people with schizophrenia can
experience symptoms that may be grouped under the following categories shown in the
slides that immediately follow.
1) Positive (More Overtly Psychotic) Symptoms
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Beliefs that have no basis in reality (delusions)
Hearing, seeing, feeling, smelling, or tasting things that have no basis in reality
(hallucinations)
Disorganized speech
Disorganized behaviors
Catatonic behaviors
2) Negative (Deficit) Symptoms
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Social withdrawal
Difficulty in expressing emotions
Difficulty in taking care of themselves
Inability to feel pleasure
3) Cognitive Symptoms
Cognitive symptoms include difficulties attending to and processing of information, in
understanding the environment, and in remembering simple tasks.
4) Affective (or Mood) Symptoms
The most notable affective symptom is depression, which accounts for a very high rate of
attempted suicide in people suffering from schizophrenia.
Diagnosing
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. In order to assess the person's current emotional
state, health-care providers perform a mental-status examination as well
Schizophrenia Treatment - Medications
While there are a number of helpful treatments available, medication remains the
cornerstone of treatment for people with schizophrenia. These medications are often referred
to as antipsychotics since they help decrease the intensity of psychotic symptoms.
Mood-stabilizer medications like lithium (Lithobid), divalproex (Depakote), carbamazepine
and lamotrigine (Lamictal) can be useful in treating mood swings that sometimes occur in
individuals who have a diagnosable mood disorder in addition to psychotic symptoms.
Antidepressant medications are the primary medical treatment for the depression that can
often accompany schizophrenia.
Schizophrenia Treatment - Psychosocial Interventions
Family psycho-education:
This form of treatment consists of providing family support, problem-solving skills, and
access to care providers during times of crises. When this intervention is consistently
provided for at least several months, it has been found to decrease the relapse rate for the
individual with schizophrenia and improve the person's social and emotional outcomes. Also,
the burden that family members experience as a result of having a loved one with
schizophrenia is lessened, family members tend to be more knowledgeable about the
disorder and feel more supported by the professionals involved, and family relationships are
improved.
Assertive community treatment (ACT):
This intervention consists of members of the person's treatment team meeting with that
individual on a daily basis, in community settings (for example, home, work, or other places
the person with schizophrenia frequents) rather than in an office or hospital setting. The
treatment team is made up of a variety of professionals. For example, a psychiatrist, nurse,
case manager, employment counselor, and substance-abuse counselor often make up an
ACT team. ACT tends to be successful in reducing how often people with schizophrenia are
hospitalized or become homeless.
Social skills training:
Also called illness management and recovery programming, social-skills training involves
teaching clients ways to handle social situations appropriately. It often involves the person
scripting (thinking through or role-playing) situations that occur in social settings in order to
prepare for those situations when they actually occur. This treatment type has been found to
help people with schizophrenia resist using drugs of abuse, as well as improve their
relationships with health-care professionals and with people at work.
Supported employment:
This intervention provides supports like a work coach (someone who periodically or
consistently counsels the client in the workplace), as well as instruction on constructing a
résumé, interviewing for jobs, and education and support for employers to hire individuals
with chronic mental illness. Supported employment has been found to help schizophrenia
sufferers secure employment, earn more money, and increase the number of hours they are
able to work.
Cognitive behavioral therapy (CBT):
CBT is a reality-based intervention that focuses on helping a client understand and change
patterns that tend to interfere with his or her ability to interact with others and otherwise
function. Except for people who are actively psychotic, CBT has been found to help
individuals with schizophrenia decrease symptoms and improve their ability to function
socially. This intervention can be done either individually or in group sessions.
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.