Mental Health


Lesson 8

What is schizophrenia

Schizophrenia is a severe mental illness that affects the way sufferers perceive and interpret the world about them. They may have delusions about what is going on, sometimes thinking that well-disposed relatives, or even complete strangers, are plotting to harm them.

They may experience hallucinations, hearing or seeing things that are not there. As a result they may lose all contact with reality, in many cases, there may be some deterioration of personality.

Despite what many people seem to think, schizophrenia is not 'split personality' of the Jekyll and Hyde type. It is the most common psychotic illness, affecting approximately 1 % of the population.

Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.

Symptoms of schizophrenia usually start between ages 16 and 30. In rare cases, children have schizophrenia too.

The symptoms of schizophrenia fall into three categories: positive, negative, and cognitive.

Positive symptoms: “Positive” symptoms are psychotic behaviors not generally seen in healthy people. People with positive symptoms may “lose touch” with some aspects of reality. Symptoms include:

  • Hallucinations
  • Delusions
  • Thought disorders (unusual or dysfunctional ways of thinking)
  • Movement disorders (agitated body movements)

Negative symptoms: “Negative” symptoms are associated with disruptions to normal emotions and behaviors.

Symptoms include:

  • “Flat affect” (reduced expression of emotions via facial expression or voice tone)
  • Reduced feelings of pleasure in everyday life
  • Difficulty beginning and sustaining activities
  • Reduced speaking

Cognitive symptoms: For some patients, the cognitive symptoms of schizophrenia are subtle, but for others, they are more severe and patients may notice changes in their memory or other aspects of thinking.

Symptoms include:

  • Poor “executive functioning” (the ability to understand information and use it to make decisions)
  • Trouble focusing or paying attention
  • Problems with “working memory” (the ability to use information immediately after learning it)

There types of schizophrenic disorder could be seen as: 

Disorganized: Character­ized by disorganized personality, strange behaviour, and increasing withdrawal from reality. (Negative symptoms)

Paranoid: In this type, delusions, often of persecution, predominate. Sufferers often have hallucinations, thought disorders and some personality disintegration. (Positive symptoms)

Catatonia: Strange, repetitive movements, such as rocking, or rigid posturing, predominate. (Positive symptoms)

Some people have only one episode, while others experience many during a lifetime, although they may lead fairly normal lives between times.

What causes schizophrenia

The predisposition to schizophrenia may be due to an enzyme defect, a biochemical or neurologi­cal abnormality, or other factors. A person who is predisposed to develop the disease may also be vulnerable to certain environmental factors that can trigger it.

The condition is known to run in families, with close relatives of schizo­phrenic patients more likely to develop it than those not related to sufferers.

Schizophrenia usually appears during early adulthood, or even adolescence.

Neuroscientists also think that interactions between genes and aspects of the individual’s environment are necessary for schizophrenia to develop.

Environmental factors may involve:

  • Exposure to viruses
  • Recreational drugs
  • Malnutrition before birth
  • Problems during birth
  • Psychosocial factors

Different brain chemistry and structure: Scientists think that an imbalance in the complex, interrelated chemical reactions of the brain involving the neurotransmitters (substances that brain cells use to communicate with each other) dopamine and glutamate, and possibly others, plays a role in schizophrenia.

Some experts also think problems during brain development before birth may lead to faulty connections. The brain also undergoes major changes during puberty, and these changes could trigger psychotic symptoms in people who are vulnerable due to genetics or brain differences.

How is schizophrenia diagnosed and treated

A thorough medical history and physical examination are carried out to exclude other possi­ble causes for the symp­toms. Other conditions with similar symptoms need to be excluded. These include illnesses where there is a major disturbance of mood (depression or mania).

Sometimes there is a mixture of mood symp­toms and schizophrenic symptoms and the doctor may then diagnose a schizoaffective disorder.

Once schizophrenia has been diagnosed, treatment may include several approaches.

These include:

Antipsychotic medica­tions: These reduce the psychotic symptoms of schizophrenia and usually allow the person to func­tion more effectively.

However, medications do not cure schizophrenia or guarantee that there will be no further episodes.

Psychotherapy: This can help people with schizo­phrenia understand and cope with their illness and learn to sort out the real from the unreal. Family therapy may also be advised.

Group therapy: In this, the focus is on learning from the experiences of others and correcting dis­tortions and inappropriate behaviour through feed­back from other sufferers.

Coordinated specialty care (CSC)

This treatment model integrates medication, psychosocial therapies, case management, family involvement, and supported education and employment services, all aimed at reducing symptoms and improving quality of life.

The NIMH Recovery After an Initial Schizophrenia Episode (RAISE) research project seeks to fundamentally change the trajectory and prognosis of schizophrenia through coordinated specialty care treatment in the earliest stages of the disorder. 

RAISE is designed to reduce the likelihood of long-term disability that people with schizophrenia often experience and help them lead productive, independent lives.

Hospitalization: A few people may require long-term hospital care, but a short stay is more common. This can provide relief from stressful situations in a protective atmosphere, allowing restarting or adjustment of medication, and reduced pressure on the family.

Many benefits from partial hospitalization, either day care or night care. Others respond to outpatient treatment or living in a half-way house to bridge the gap between 24-hour hospitalization and independent living.

Schizophrenia often develops during the critical years when learning work skills and starting a career, so suffer­ers may lack the ability to find and perform a job.

Psychosocial treatments focus on helping people who are not acutely psychotic and include social and vocational training. This may involve learning problem-solving and self-care as well as job training and voca­tional counselling.

Self-help groups are also becoming more com­mon. Members are usually ex-patients, or relatives of people with schizophre­nia, and offer continuing mutual support.

When should I see my doctor

If someone in your family exhibits bizarre behaviour, seems unable to think straight, and seems out of touch with reality, consult your doctor, who may arrange for them to see a specialist or be hospital­ized for observation.

What is the outlook for sufferers

About 25% of patients with schizophrenia re­cover completely, and do not have another attack. Many others improve in time with treatment. 

The more obvious symptoms can nearly always be con­trolled. However, many people with schizophrenia usually require long-term treatment, including medi­cation. 

Some sufferers may never be able to live totally independently.

Here are some things you can do to help

  • Get them treatment and encourage them to stay in treatment
  • Remember that their beliefs or hallucinations seem very real to them
  • Tell them that you acknowledge that everyone has the right to see things their own way
  • Be respectful, supportive, and kind without tolerating dangerous or inappropriate behavior
  • Check to see if there are any support groups in your area

Is schizophrenia dangerous

Usually not. Some acutely disturbed people may become violent, but such outbursts are infrequent when the person is taking anti-psychotic medication

Most violent crimes are not committed by schizophrenics, but there are ex­ceptions.

Those suffering from paranoid delusions, or who believe they are being commanded by an outside force to commit certain acts, may indeed be dangerous.