Schizophrenia

Schizophrenia is a severe brain disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior.

People with the disorder may hear voices that other people do not hear. They may believe other people are reading their minds, controlling their thoughts, or plotting to harm them. This can terrify people with the illness and make them withdrawn or extremely agitated.

People with schizophrenia may not make sense when they talk. They may sit for hours without moving or talking. Sometimes people with schizophrenia seem perfectly fine until they talk about what they are really thinking. Many people with schizophrenia have difficulty holding a job or caring for themselves, so they rely on others for help.

Symptoms of schizophrenia usually start between ages 16 and 30. Men often develop symptoms at a younger age than women. People usually do not get schizophrenia after age 45. Approximately 1% of people in America have schizophrenia.

Schizophrenia is a chronic condition, requiring lifelong treatment. Medicines, therapy, family education, rehabilitation, and skills training play a role in many therapy plans for schizophrenia. Many people with schizophrenia lead rewarding and meaningful lives in their communities.

There are three types of symptoms in schizophrenia.

“Positive” symptoms distort a person's thinking. These include hallucinations (hearing or seeing things that are not there), delusions (beliefs that are not true), trouble organizing thoughts, and strange movements.

"Negative" symptoms make it difficult to show emotions and to function normally. A person may seem depressed and withdrawn.

Cognitive symptoms affect the thought process. These include trouble using information, making decisions, and paying attention.

Suicidal thoughts and behavior are common among people with schizophrenia. If you have a loved one who is in danger of committing suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

The exact cause of schizophrenia is unknown, but it likely involves a combination of genetics and environmental factors.

Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may also contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia.

Certain factors seem to increase the risk of developing or triggering schizophrenia, including:

• having a family history of schizophrenia
• exposure to viruses, toxins or malnutrition while in the womb, particularly in the first and second trimesters
• increased immune system activation, such as from inflammation or autoimmune diseases
• older age of the father
• taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood

When schizophrenia is suspected, doctors will conduct physical exams, runs medical and psychological tests, and obtain medical and psychiatric histories. In part, these tests can rule out other causes of the symptoms.

To be diagnosed with schizophrenia, a person must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions. A person must have at least two of the following symptoms most of the time during a one-month period, with some level of disturbance being present over six months:

• delusions
• hallucinations
• disorganized speech (indicating disorganized thinking)
• extremely disorganized behavior
• catatonic behavior, which can ranges from a coma-like daze to bizarre, hyperactive behavior
• negative symptoms, which relate to reduced ability or lack of ability to function normally

At least one of the symptoms must be delusions, hallucinations, or disorganized speech.

The person must also show a significant decrease in the ability to work, attend school, or perform normal daily tasks most of the time.

Coping with a mental disorder as serious as schizophrenia can be challenging, both for the person with the condition and for friends and family. There are several steps you can take to cope with the diagnosis.

Learn about schizophrenia. Education about the condition can help motivate the person with the disease to stick to the treatment plan. Education can help friends and family understand the condition and be more compassionate with the person who has it.

Join a support group. Support groups for people with schizophrenia can help them reach out to others facing similar challenges. Support groups may also help family and friends cope.

Stay focused on goals. Managing schizophrenia is an ongoing process. Keeping treatment goals in mind can help the person with schizophrenia stay motivated. Help your loved one remember to take responsibility for managing the illness and working toward goals.

Learn relaxation and stress management. The person with schizophrenia and loved ones may benefit from stress-reduction techniques such as meditation, yoga or tai chi.

Family and friends can also help patients set realistic goals and learn to function in the world. Each step toward these goals should be small and taken one at a time. The patient will need support during this time. When people with a mental illness are pressured and criticized, they usually do not get well. Often, their symptoms may get worse. Telling them when they are doing something right is the best way to help them move forward.

People with schizophrenia often resist treatment. They may not think they need help because they believe their delusions or hallucinations are real. In these cases, family and friends may need to take action to keep their loved one safe. Laws vary from state to state, and it can be difficult to force a person with a mental disorder into treatment or hospitalization. But when a person becomes dangerous to himself or herself, or to others, family members or friends may have to call the police to take their loved one to the hospital.

Most individuals with schizophrenia require some form of daily living support. Many communities have programs to help people with schizophrenia with jobs, housing, self-help groups and crisis situations. A case manager or someone on the treatment team can help find resources. With appropriate treatment, most people with schizophrenia can manage their condition.

The goal of treatment of schizophrenia is to reduce or eliminate the symptoms of the disease. Antipsychotic medications and psychosocial treatments are included in treatment plans. Schizophrenia requires lifelong treatment, even when symptoms have subsided.

Antipsychotic medications. Antipsychotic medications are the most commonly prescribed drugs to treat schizophrenia. They control symptoms by affecting the brain neurotransmitters dopamine and serotonin.

Newer medications are generally preferred over older medications because they pose a lower risk of serious side effects. Common antipsychotics for schizoprhenia include:

• aripiprazole (Abilify)
• asenapine (Saphris)
• clozapine (Clozaril)
• iloperidone (Fanapt)
• lurasidone (Latuda)
• olanzapine (Zyprexa)
• paliperidone (Invega)
• quetiapine (Seroquel)
• risperidone (Risperdal)
• ziprasidone (Geodon)

Psychosocial interventions. Psychological and social (psychosocial) interventions are important for long-term management of schizophrenia. These may include:

• individual therapy that teaches people to learn to cope with stress and identify early warning signs of relapse
• social skills training that focuses on improving communication and social interactions
• family therapy that provides support and education to families dealing with schizophrenia
• vocational rehabilitation and supported employment that allows people with schizophrenia to prepare for, find, and keep jobs