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Schizophrenia Overview

In-depth overview of schizophrenia including symptoms, causes, treatments of schizophrenia. Also resources for schizophrenia patients and family members.

What is Schizophrenia

One of the most stigmatized and debilitating mental illnesses is Schizophrenia. Though it has a specific set of symptoms, Schizophrenia varies in its severity from individual to individual, and even within any one afflicted individual from one time period to another.

The symptoms of schizophrenia generally can be controlled with treatment and, in more than 50 percent of individuals given access to continuous schizophrenia treatment and rehabilitation over many years, recovery is often possible. Though researchers and mental health professionals don't know what causes schizophrenia, they have developed treatments that allow most persons with schizophrenia to work, live with their families and enjoy friends. But like those with diabetes, people with schizophrenia probably will be under medical care for the rest of their lives.

Symptoms of Schizophrenia

Generally, schizophrenia begins during adolescence or young adulthood. The symptoms of schizophrenia appear gradually and family and friends may not notice them as the illness takes initial hold. Often, the young man or woman feels tense, can't concentrate or sleep, and withdraws socially. But at some point, loved ones realize the patient's personality has changed. Work performance, appearance and social relationships may begin to deteriorate.

As the illness progresses, the symptoms often become more bizarre. The patient develops peculiar behavior, begins talking in nonsense, and has unusual perceptions. This is the beginning of psychosis. Psychiatrists diagnose schizophrenia when a patient has had active symptoms of the illness (such as a psychotic episode) for at least two weeks, with other symptoms lasting six months. In many cases, patients experience psychotic symptoms for many months before seeking help. Schizophrenia seems to worsen and become better in cycles known as relapse and remission, respectively. At times, people suffering from schizophrenia appear relatively normal. However, during the acute or psychotic phase, people with schizophrenia cannot think logically and may lose all sense of who they and others are. They suffer from delusions, hallucinations or disordered thinking and speech.


 

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Positive and Negative Symptoms of Schizophrenia

Delusions and hallucinations are referred to as "positive symptoms" of schizophrenia

In-depth overview of schizophrenia including symptoms, causes, treatments of schizophrenia. Also resources for schizophrenia patients and family members.Delusions are thoughts that are fragmented, bizarre and have no basis in reality. For example, people suffering from schizophrenia might believe that someone is spying on or planning to harm them or that someone can "hear" their thoughts, insert thoughts into their minds, or control their feelings, actions or impulses. Patients might believe they are Jesus, or that they have unusual powers and abilities.

People suffering from schizophrenia also have hallucinations. The most common hallucination in schizophrenia is hearing voices that comment on the patient's behavior, insult the patient or give commands. Visual hallucinations, such as seeing nonexistent things and tactile hallucinations, such as a burning or itching sensation, also can occur.

Patients also suffer disordered thinking in which the associations among their thoughts are very loose. They may shift from one topic to another completely unrelated topic without realizing they are making no logical sense. They may substitute sounds or rhymes for words or make up their own words, which have no meaning to others.

These symptoms don't mean people with schizophrenia are completely out of touch with reality. They know, for example, that people eat three times a day, sleep at night and use the streets for driving vehicles. For that reason, their behavior may appear quite normal much of the time.

However, their illness does severely distort their ability to know whether an event or situation they perceive is real. A person with schizophrenia waiting for a green light at a crosswalk doesn't know how to react when he hears a voice say, "You really smell bad." Is that a real voice, spoken by the jogger standing next to him, or is it only in his head? Is it real or a hallucination when he sees blood pouring from the side of the person next to him in a college classroom? This uncertainty adds to the terror already created by the distorted perceptions.

Psychotic symptoms of schizophrenia may lessen--a period during which doctors say the patient is in the residual stage or remission. Other symptoms, such as social withdrawal, inappropriate or blunted emotions, and extreme apathy, may continue during both these periods of remission and periods when psychosis returns--a period called relapse, and may persist for years. People with schizophrenia who are in remission still may not be mentally able to bathe or dress appropriately. They may speak in a monotone and report that they have no emotions at all. They appear to others as strange, disconcerting people who have odd speech habits and who live socially marginal lives.

Cognitive deficits include impairment in attention, processing speed, working memory, abstract thinking, problem solving, and understanding social interactions. The patient's thinking may be inflexible, and the ability to problem solve, understand the viewpoints of other people, and learn from experience may be diminished.

There are many types of schizophrenia. For example, a person whose symptoms are most often colored by feelings of persecution is said to have "paranoid schizophrenia;" a person who is often incoherent but has no delusions is said to have "disorganized schizophrenia." Even more disabling than the delusions and hallucinations are the symptoms of "negative" or "deficit" schizophrenia. Negative or deficit schizophrenia refers to the lack or absence of initiative, motivation, social interest, enjoyment and emotional responsiveness. Because schizophrenia can vary from person to person in intensity, severity and frequency of both psychotic and residual symptoms, many scientists use the word "schizophrenia" to describe a spectrum of illnesses that range from relatively mild to severe. Others think of schizophrenia as a group of related disorders, much as "cancer" describes many different but related illnesses.

Schizophrenia and Violence

Schizophrenia is a relatively modest risk factor for violent behavior. Threats of violence and minor aggressive outbursts are far more common than seriously dangerous behavior. Patients more likely to engage in significant violence include those with substance abuse, persecutory delusions, or command hallucinations and those who do not take their prescribed drugs. Very rarely, a severely depressed, isolated, paranoid person attacks or murders someone whom he perceives as the single source of his difficulties (eg, an authority, a celebrity, his spouse). Patients with schizophrenia may present in an emergency setting with threats of violence to obtain food, shelter, or needed care.

Some Numbers

Approximately 2.2 million American adults have schizophrenia. About 24 million people worldwide suffer from schizophrenia; meaning about 150 of every 100,000 persons will develop schizophrenia. Schizophrenia affects men and women equally, however its onset in women is typically five years later than with men. Though it is a relatively rare illness, its early age of onset and the lifelong disability, emotional and financial devastation it brings to its victims and their families make schizophrenia one of the most catastrophic mental illnesses. Schizophrenia fills more hospital beds than almost any other illness, and Federal figures reflect the cost of schizophrenia to be from $30 billion to $48 billion in direct medical costs, lost productivity and Social Security pensions. According to the World Health Organization, more than 50% of persons worldwide with schizophrenia are not receiving appropriate care.

continue: Causes of Schizophrenia

Last Updated: 29 March 2017
Reviewed by Harry Croft, MD

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