It’s often been said that depression is the “common cold” when it comes to psychiatric disorders, while schizophrenia is likened to “cancer.” While those metaphors may be oversimplified, they’re not far off the mark in many ways.
Schizophrenia is one of the most serious — and often one of the most disabling — types of mental illness. About 1% of the adult population suffers from it. Due to its severity, psychiatric inpatient units are a frequent stop for many individuals who live with this chronic, complex and challenging psychiatric disorder.
Some people diagnosed with schizophrenia are able to manage their symptoms well enough — usually with the lifelong use of powerful antipsychotic medication and a strong support system — to function quite well and live a fulfilling life. Far too many, though, are relegated to a difficult life that includes bouts of homelessness, institutionalization, and / or regular and lengthy hospital stays and seemingly endless trials of yet one more medication. Many schizophrenic individuals also have to endure the frequent whispers, snickers, pointed fingers, taunts and stares of ignorant or cruel individuals who cross their paths.
Who Develops Schizophrenia?
Like almost all types of mental illness, schizophrenia knows no boundaries with regard to gender, race, or socioeconomic status. Both men and women develop the disorder in about equal numbers. Although schizophrenia has been known to develop in young children and older adults, the symptoms most frequently begin to emerge between late adolescence to the mid- to late-20s. As a general rule, males tend to develop the disorder at a younger age than females.
Heredity is believed to play a role in the development of schizophrenia, although it can develop in individuals who have no family history of the disorder. Individuals with the greatest risk are those in which both biological parents are schizophrenic, followed by those with only one biological parent.
Years ago, the symptoms of schizophrenia were attributed to everything from poor mothering to demonic possession. Although most old myths have been dispelled, experts still don’t know exactly what causes schizophrenia. Autopsies and brain scans have revealed differences in the brain structure of schizophrenics compared to individuals without the disorder. Recent research suggests that the absence of certain genes – causing the brain to be “wired” incorrectly – may also play an important part in the development of schizophrenia.
Schizophrenia is frequently diagnosed initially when the first “psychotic break” or psychotic episode occurs. The individual begins to act increasingly bizarre, paranoid, withdrawn, and / or disorganized. They may say things that don’t make sense or appear to be having conversations even though there’s no one responding. School or work performance begins to decline. Someone close – a family member or spouse, close friend, or coworker or employer – usually notices that something is seriously wrong and gets the person in to see a medical or mental health professional for an evaluation.
There’s no specific diagnostic test for schizophrenia. Rather, the diagnosis comes from a combination of interviewing and / or observing the patient and information obtained from family, friends, or others who know the patient. The patient is typically screened for drugs that might be causing the psychotic symptoms before being given a diagnosis of schizophrenia.
When schizophrenia is diagnosed, one of five types is specified:
One of the often confusing aspects of schizophrenia is that there are actually five types or subtypes of the disorder. So, the symptoms of someone with catatonic schizophrenia can be notably different than those observed in an individual with paranoid schizophrenia.
Schizophrenia is classified as a “psychotic disorder” by clinicians. Psychosis can be difficult to define, but it essentially means that a person is out of touch with reality. Determining what’s real and what’s not can be very difficult to completely impossible in the throes of a psychotic episode.
Hallucinations and Delusions
Hallucinations and delusions are two of the most common symptoms of schizophrenia, especially paranoid schizophrenia.
Hallucinations may involve any of the senses (i.e. sight, hearing, touch, taste, or smell). For example, the person believes he is seeing or smelling that isn’t actually there. With schizophrenia, hallucinations are most often “auditory” in nature and involve hearing one or more voices – even though no one else is present or actually talking. The voices may give commands, comment on the individual’s actions, or say harsh, hurtful things. Command hallucinations can be dangerous if the voices are instructing the person to hurt himself or others. Auditory hallucinations can be very distressing, especially when they occur for hours on end or say troubling things.
Delusions involve a firmly and persistently held belief that isn’t realistic, true, and / or possible. Delusions may be bizarre (e.g. the belief one’s brain has been surgically removed and replaced with an alien brain) or non-bizarre (e.g. a woman insists she is pregnant despite medical proof that she’s not). When someone is delusional, it’s impossible to convince them that what they believe is not true or couldn’t possibly happen. (It should be noted that a belief is not considered a delusion if it is normal for that person’s particular religion, culture, etc.)
Delusions typically involve themes. The most common types of delusional themes involve paranoia (e.g. conspiracies), persecution (e.g. someone is harassing them or trying to harm them), grandiosity (e.g. the person has special powers), erotomania (e.g. someone famous is in love with the person), or something somatic (e.g. having some rare disease). Another fairly common type of delusion involves the belief that a person’s thoughts are being controlled by someone else.
The disorganization in individuals with schizophrenia may involve their thoughts and speech, and / or their behavior. Someone with disorganized speech may frequently jump from one topic to the next, say things that have no relevance whatsoever to the current conversation, or speak gibberish in which nothing they say makes any sense at all. In order to qualify as a symptom of schizophrenia, the disorganized speech must be severe enough to interfere with their ability to communicate.
“Grossly disorganized behavior” is a clinical term that includes a variety of things. Examples include becoming agitated for no reason, bizarre or extreme silliness, problems carrying out goal-directed tasks, refers to the person’s inability to initiate and carry out basic or simple tasks, and neglecting personal hygiene.
Some individuals with schizophrenia become catatonic. Catatonic behavior can include extreme obliviousness to one’s surroundings (stupor), holding a rigid stance or bizarre posture, resistance to being moved or being told to move, or excessive, excited movement that serves no purpose.
All of the above symptoms of schizophrenia are called positive symptoms. Negative symptoms – which involve a deficit of some sort – include lack of emotional expression (“flat affect” – the person has no response, facial movement, or eye contact), alogia (very limited speech), and avolition (the inability to initiate and follow through with a task. The negative symptoms of schizophrenia can be particularly debilitating. They are also the most difficult to treat effectively.
Although other psychotic disorders, such as delusional disorder, share some similarities with schizophrenia, there are two disorders that are particularly closely related:
- Schizoaffective Disorder
- Schizophreniform Disorder
Schizoaffective disorder involves significant mood symptoms – depression, mania, or a mixed mood – along with the psychotic symptoms. Very specific criteria help clinicians distinguish between schizophrenia and a co-occurring mood disorder or schizoaffective disorder.
Schizophreniform disorder is often a precursor to schizophrenia. The differences between the two lie in 1) the length of occurrence (between 1 and 6 months for schizophreniform disorder) and 2) social and / or occupational impairment isn’t required for a diagnosis in the former (although it may occur).
Because schizophrenia is generally regarded as a life-long disorder, ongoing treatment is often required. In many cases, the first psychotic episode leads to hospitalization – for safety as well as stabilization. Future hospitalizations are often necessary if the patient stops taking medication and becomes severely symptomatic.
Medication is often the primary treatment for schizophrenia. Antipsychotic medications, such as Risperdal or Zyprexa, help to alleviate or reduce psychotic symptoms and improve the person’s ability to function. Many individuals with schizophrenia must take medication on an ongoing basis in order to thwart future psychotic episodes.
Unfortunately, antipsychotic medications often have undesirable side effects. This leads some individuals to stop their medication (against their doctor’s advice) because they hate the way it makes them feel. Of course, when the medication is working and the patient starts feeling good, he may also stop taking it because he believes it’s no longer necessary. It’s not uncommon for individuals with schizophrenia to end up back in the hospital not long after they discontinued their meds.
Medication doesn’t always work. When it does, its effectiveness may be limited or minimal. However, it’s considered necessary by many mental health professionals if a patient wishes to keep psychotic episodes at bay or at least significantly reduce their severity when they do occur.
Treatment for schizophrenia may also include any combination of the following:
- Education (for the patient as well as those close to him)
- Individual, couples, and / or family therapy
- Group therapy
- Day treatment (in which the patient goes to treatment for several hours each day and returns home in the evening)
- Vocational training
- Life skills training
- Support groups
Because schizophrenia is such a challenging disorder, it often triggers the development of other disorders or life choices that compound the issue. For example, many people with schizophrenia become depressed due to the stress of the disorder. While self-harm may occur due to command auditory hallucinations, it may also occur – in the form of a suicide attempt – as the result of depression and feelings of hopelessness.
Substance abuse is also a fairly common problem for individuals with schizophrenia. Many individuals turn to alcohol or drugs to quiet the voices and alleviate other symptoms – or to simply escape from the pain and stress caused by living with a serious, chronic disorder.
Homelessness is another dilemma for many individuals with schizophrenia. Many fall through the cracks of the mental health system and end up on the streets. Family members may try to help, but the challenges of the disorder can take a significant toll. Issues like substance abuse or an unwillingness to take medication as prescribed can lead to alienation from family. Without a strong support system or sufficient resources, an individual with schizophrenia will have an especially hard time navigating the system and end up not getting the treatment they need.
Sadly, there is still no cure for schizophrenia. Research has led to significant progress, and new medications are constantly being developed. While there is very little in life that is more frightening than parents discovering that their precious child, teen, or young adult has schizophrenia, hope should not be lost. As mentioned previously, with proper treatment, many individuals with this difficult disorder are able to lead fulfilling lives. And as science moves forward, we may yet discover a cure for – or a far better and more effective way of treating – this dreaded mental illness.