Understanding Schizophrenia

What are the symptoms of schizophrenia?

People with schizophrenia may have a number of symptoms involving changes in ability 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 three categories: Positive symptoms, disorganized symptoms, and negative symptoms.

Positive symptoms

In this case, the word positive does not mean "good." Rather, it refers to obvious symptoms that are not present in people without schizophrenia. These symptoms, which are sometime 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.

* 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.

Disorganized symptoms

Disorganized symptoms reflect 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

Negative symptoms

In this case, the word negative does not mean "bad," but reflects the absence of certain normal behaviors in people with schizophrenia. Negative symptoms include:

* Lack of emotion and expression; or emotions, thoughts and moods that do not fit with situations or events (for example, crying instead of laughing at a joke)
* Withdrawal from family, friends and social activities
* Reduced energy
* Lack of motivation
* Loss of pleasure or interest in life
* Poor hygiene and grooming habits
* Problems functioning at school, work or other activities
* Moodiness (being very sad or very happy, or having swings in mood)
* Catatonia (a condition in which the person becomes fixed in a single position for a very long time)

What causes schizophrenia?

The exact cause of schizophrenia is not yet known. It is known, however, that schizophrenia -- like cancer and diabetes -- is a real illness with a biological basis. It is not the result of bad parenting or personal weakness. Researchers have uncovered a number of factors that appear to play a role in the development of schizophrenia, including:

* Genetics (heredity): Schizophrenia tends to run in families, which means the likelihood to develop schizophrenia may be passed on from parents to their children.

* Brain chemistry: People with schizophrenia may have an imbalance of certain chemicals in the brain. They may be either very sensitive to or produce too much of a brain chemical called dopamine. Dopamine is a neurotransmitter, a substance that helps nerve cells in the brain send messages to each other. An imbalance of dopamine affects the way the brain reacts to certain stimuli, such as sounds, smells and sights, and can lead to hallucinations and delusions.

* Brain abnormality: Newer research has found abnormal brain structure and function in people with schizophrenia. However, this type of abnormality doesn't happen in all schizophrenics and can occur in people without the disease.

* Environmental factors: Evidence suggests that certain environmental factors, such as a viral infection, poor social interactions or highly stressful situations, may trigger schizophrenia in people who have inherited a tendency to develop the disorder. Schizophrenia more often surfaces when the body is undergoing hormonal and physical changes, such as those that occur during the teen and young adult years.

Who gets schizophrenia?

Anyone can get schizophrenia. It is diagnosed all over the world and in all races and cultures. While it can occur at any age, schizophrenia typically first appears in the teenage years or 20s. The disorder affects men and women equally, although symptoms generally appear earlier in men (in their teens or 20s) than in women (in their 20s or early 30s). Children over the age of 5 can develop schizophrenia, but it is very rare before adolescence.

How common is schizophrenia?

Schizophrenia is a relatively common disorder. About 1% of the population, or 2.2 million Americans ages 18 and older, will develop schizophrenia.

How is schizophrenia diagnosed?

If symptoms are present, the doctor will perform a complete medical history and physical examination. While there are no laboratory tests to specifically diagnose schizophrenia, the doctor may use various tests, such as X-rays and blood tests, to rule out physical illness as the cause of the symptoms.

If the doctor finds no physical reason for the symptoms, he or she may refer the person to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists use specially designed interview and assessment tools to evaluate a person for a psychotic disorder. The therapist bases his or her diagnosis on the person's report of symptoms and his or her observation of the person's attitude and behavior. A person is considered to have schizophrenia if he or she has characteristic symptoms that last for at least six months.

How is schizophrenia treated?

The goal of treatment is to reduce the symptoms of schizophrenia and to decrease the chances of a relapse, or return of symptoms. Treatment may include:

* Medications: The primary medications used to treat schizophrenia are called antipsychotics. These medicines do not cure schizophrenia but help relieve the most troubling symptoms, including delusions, hallucinations and thinking problems. Older medications used include: Thorazine, Prolixin, Haldol, Navane, Stelazine, Trilafon and Mellaril. Newer medications used to treat schizophrenia include: Risperdol, Clozaril, Seroquel, Geodon and Zyprexa.

* 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 control 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; 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: Most people with schizophrenia may be treated as outpatients. However, people with particularly severe symptoms, or those in danger of hurting themselves or others may require hospitalization to stabilize their condition.

* Electroconvlusive therapy (ECT): This is a procedure in which electrodes are attached to the person's head and a series of electric shocks are delivered to the brain. The shocks induce seizures, causing the release of neurotransmitters in the brain. This form of treatment is rarely used today in the treatment of schizophrenia. ECT may be useful when all medications fail or if severe depression or catatonia makes treating the illness difficult.

* Psychosurgery: Lobotomy, an operation used to sever certain nerve pathways in the brain, was formerly used in some patients with severe, chronic schizophrenia. It is now performed only under extremely rare circumstances. This is because of the serious, irreversible personality changes that the surgery may produce and the fact that far better results are generally attained from less drastic and hazardous procedures.

Are people with schizophrenia dangerous?

Popular books and movies often depict people with schizophrenia and other mental illnesses as dangerous and violent. This is not true. Most people with schizophrenia are not violent; more typically, they prefer to withdraw and be left alone. In some cases, however, people with mental illness who also abuse alcohol or drugs may engage in dangerous or violent behavior.

On the other hand, people with schizophrenia can be a danger to themselves. Suicide is the number one cause of premature death among people with schizophrenia. According to the World Fellowship for Schizophrenia and Allied Disorders, 1 in 10 people with schizophrenia commits suicide and 4 in 10 are known to have attempted suicide.

What is the outlook for people with schizophrenia?

With proper treatment, most people with schizophrenia can lead productive and fulfilling lives. They are able to live with their families or in community settings rather than in long-term psychiatric institutions.

Ongoing research on the brain and how brain disorders develop will likely lead to more effective medicines with fewer side effects.

Can schizophrenia be prevented?

There is no known way to prevent schizophrenia. However, early diagnosis and treatment can help avoid or reduce frequent relapses and hospitalizations, and help decrease the disruption to the person's life, family and friendships.

Source: http://www.medscape.com/viewarticle/472320