CONDITIONS

What Is Schizophrenia

Schizophrenia is a mental illness that affects a person’s ability to think clearly, process emotions, and make decisions. Schizophrenic activity in the brain can cause irrational thoughts and behaviors, delusions, extreme paranoia, and changes in personality.

Schizophrenia is a long-term illness, and unfortunately there is no one known cure, or universal treatment plan. Because schizophrenia can present itself in different ways in different people, treatment plans typically vary from person to person.

According to SARDDA (Schizophrenia and Related Disorders Alliance of America), an estimated 3.5 million Americans are affected by Schizophrenia, and only about 50% of those affected seek and receive proper treatment. Each year, it is estimated that Schizophrenia-related economic costs total between $32.5 and $65 billion dollars.

What Causes Schizophrenia

Researchers are not sure what exactly causes Schizophrenia, though the following theories have been suggested by researchers:

  • Genetic predisposition. Scientists are investigating several genes with potential links to the development of schizophrenia, including the neuregulin-1 gene, OLIG2 gene, and the COMT gene. 1% of the general population has schizophrenia, but the incidence rises to 10% for a person that has a first degree relative (like a mother, father, brother, sister) who has the disease.
  • Environmental triggers. In people with a genetic predisposition to the disease, certain environmental triggers, including stressful and traumatic life events, can trigger schizophrenic symptoms.
  • Brain structure abnormalities. Many studies have shown physical differences in the brains of schizophrenic individuals
  • Neurotransmitter malfunction. The specific connection between neurotransmitter functioning and the development of schizophrenia is unknown, though it is known that dopamine and glutamate chemical levels play a critical role in the chemical communication within the brain and are often found in imbalanced levels in schizophrenic individuals. 

Risk Factors For Schizophrenia

The following factors can affect your risk of developing Schizophrenia:

  • Age. Though schizophrenia can develop at any age, it most commonly diagnosed between the ages of 15 and 30 and is rarely diagnosed after the age of 45.
  • Environmental Factors. The precise role of environmental factors in the development of schizophrenia is unclear, though it is though that exposure to certain viruses, traumatic episodes during youth, and in utero exposure to toxins can increase the risk of developing schizophrenia.
  • Family History. A child with a Schizophrenic parent has a 10% risk of developing the disease, as compared to the approximate 1% risk for the general population.
  • Gender. Though schizophrenia affects both men and women equally, men are more likely to develop the disease at an earlier age.
  • Homelessness. It is estimated that rates of schizophrenia are astronomically higher in the homeless population in comparison to the general public. Some studies report that up to 50% of the homeless population experiences Schizophrenic symptoms. 

Diagnosing Schizophrenia

If your primary care physician suggests you may have schizophrenia, he or she will most likely refer you to a psychiatrist for an official diagnosis. A psychiatrist will be able to make a Schizophrenia diagnosis based on the diagnostic criteria listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition).

The DSM 5 lists the following diagnostic criteria for schizophrenia:

The patient must experience at least two of the following symptoms over the course of six months, with at least one month of persistently active symptoms. The symptoms must also cause significant disturbance to occupational or personal functioning:

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Disorganized or catatonic behavior and movements
  • Negative symptoms (diminished emotional expression, lack of motivation)

Another interesting possible warning sign for schizophrenia is excessive smoking of cigarettes. The incidence of smoking is extremely high in schizophrenic patients: 80% to 90%, versus 25% to 30% of the general population. Various studies have demonstrated that the use of tobacco transiently restores the schizophrenic patient’s cognitive and sensory deficits. Smoking cessation also appears to exacerbate the symptoms of the disease.

Symptoms of Schizophrenia

The following symptoms may be early warning signs of schizophrenia:

  • Changes in speech patterns
  • Irrational thoughts or behaviors
  • Diminished emotional expression
  • Depression
  • Changes in sleep patterns
  • Inability to focus
  • Irritability
  • Social withdrawal
  • Diminished personal hygiene

Prognosis

The prognosis for Schizophrenia varies from patient to patient. According to SARDAA (Schizophrenia and Related Disorders Alliance of America) 25% of Schizophrenia patients undergoing treatment make a full recovery, 50% see an improvement in symptoms over a 10 year period, and 25% do not see any improvement in symptoms.

Living With Schizophrenia

Schizophrenia can be disruptive to both your personal and occupational life. The following tips can help you manage your symptoms and make life with Schizophrenia easier:

  • Acknowledge your disease. In cases of serious mental illness such as Schizophrenia, acknowledging that you have a disease is a critical part in the healing process. Being aware of your condition can help you better understand your own actions and emotions.
  • Educate yourself. Read up on schizophrenia as a disease. Learning about your condition can help your better interpret symptoms and choose treatment options.
  • Take your medication as prescribed by your doctor. Talking an improper dosage or stopping medications before you’re supposed to can cause a symptom relapse.
  • If you feel you need to change treatments, talk to your doctor. Just because you should take medication as prescribed doesn’t mean you shouldn’t have a say in your own treatment. If you aren’t happy with your treatment method, talk to your doctor before you make any changes to your medication regimen.
  • Take it day by day. Know that you will have good days and bad days, and that symptoms may come and go. Anticipating ups and downs can help you be more prepared to deal with physical and emotional changes. 

Screening

Schizophrenia itself may not be specifically screened for by primary care physicians, but many of its early warning signs and symptoms are covered by general mental health screening questionnaires. Specific screening tools are also available to help mental health professionals gather information from patients in order to make a diagnosis. Yale University Medical School developed the PRIME screening test in order to help doctor detect schizophrenic symptoms in patients before the symptoms result in full psychosis.

The PRIME screening test includes the following statements, to which patients respond with answers ranging from “definitely disagree” to “definitely agree”:

  • I think that I have felt that there are odd or unusual things going on that I can’t explain.
  • I think that I might be able to predict the future.
  • I may have felt that there could possibly be something interrupting or controlling my thoughts, feelings, or actions.
  • I have had the experience of doing something differently because of my superstitions.
  • Think that I may get confused at times whether something I experience or perceive may be real or may be just part of my imagination or dreams.
  • I have thought that it might be possible that other people can read my mind, or that I can read other’s minds.
  • I wonder if people may be planning to hurt me or even may be about to hurt me.
  • I believe that I have special natural or supernatural gifts beyond my talents and natural strengths.
  • I think I might feel like my mind is “playing tricks” on me.
  • I have had the experience of hearing faint or clear sounds of people or a person mumbling or talking when there is no one near me
  • I think that I may hear my own thoughts being said out loud.
  • I have been concerned that I might be “going crazy.”

Medication And Treatment

Most treatment plans for schizophrenia involve a combination of medication and psychosocial therapies.

The following categories of medications may be used to treat schizophrenia:

Antipsychotic drugs, which are particularly effective at treating hallucinations and delusions. Popular antipsychotic drugs include:

  • Olanzapine (Zyprexa)
  • Clozapine (Clozaril)
  • Quetiapine (Seroquel)
  • Fluphenazine (Prolixin)
  • Perphenazine (Trilafon)
  • Risperidone (Risperdal)
  • Haloperidol (Haldol)
  • Chlorpromazine (Thorazine)
  • Aripiprazole (Abilify)

 Common side effects of antipsychotic medications include:

  • Drowsiness
  • Weight gain
  • Dry mouth
  • Muscle spasms
  •  Skin rashes and sensitivity to the sun
  • Agranulocytosis (lose of white blood cells which prevent the body from fighting infections.  Seen mostly in the use of clozapine.

Anti-depressants drugs, which may be helpful in treating negative symptoms of schizophrenia (including diminished emotional expression and lack of motivation). The type of anti-depressant used depends on the patient and the other forms of medication being taken.

Anti-anxiety drugs,which can be helpful in reducing the duration of a psychosis episode and decreasing overall nervousness and anxiety levels. Popular anti-anxiety drugs include:

  • Alprazolam
  • Clonazepam
  • Diazepam
  • Lorazepam

Therapy options for schizophrenia patients include:

  • Cognitive Behavioral Therapy, which reduces the likelihood of schizophrenic relapses and behaviors by examining an individual’s, thoughts, feelings, and behaviors.
  • Support groups. Support groups can help individuals suffering from schizophrenia build social skills and create a sense of community.  For more information on where to find a schizophrenic support group, visit National Alliance on Mental Illness

Complementary and Alternative Treatment

The following alternative and complementary therapies may be helpful in treating symptoms of schizophrenia:

Mind/body therapies including yoga, meditation and tai chi. These practices can help develop consciousness about one’s thought patterns and reduce overall stress levels.

Dietary supplements/vitamins. A limited number of studies have found that the following supplements may be effective in regulating emotions and reducing anxiety:

  • Omega-3 fatty acids
  • Glycine
  • Tryptophan
  • Ginkgo biloba
  • Vitamin C
  • B-Complex vitamins

Diet. Some studies suggest that eliminating certain foods, including highly processed foods, caffeine, and foods high in sugar, can help regulate overall mood.

When To Contact A Doctor

Contact a doctor if you are experiencing any of the following symptoms:

  • Changes in speech patterns
  • Irrational thoughts or behaviors
  • Diminished emotional expression
  • Depression
  • Changes in sleep patterns
  • Inability to focus
  •  Irritability
  • Social withdrawal
  • Diminished personal hygiene

If you have thoughts of suicide, call the National Suicide Prevention Lifeline immediately at 1-800-273-8255.

Questions For A Doctor

If you receive a schizophrenia diagnosis, you may want to ask your doctor questions about your conditions. Sample questions include:

  •  How long is my condition likely to lapse?
  • What treatments are available?
  • What can I do to prevent relapses?
  • How can I detect relapse symptoms before they worsen?
  • What types of therapies are available?
  • How will my condition limit my activity level?