Schizophrenia: Definition, Symptoms, Causes

Schizophrenia alters how a person thinks, feels, and acts, making it hard for them to differentiate between reality and imagination. Individuals with schizophrenia can often become unresponsive or withdrawn, making it difficult to establish personal and professional relationships (Haycoco, 2009). Contrary to popular misconception, schizophrenia is not a split or multiple personality disorder. Most people with schizophrenia are non-violent and do not pose a danger to others (Mental Health America, 2013).

People with schizophrenia may conjure up details about people they have different feelings towards, disconnected from reality, living within their own worlds.

They can exhibit varying moods, and the disease affects individuals from different backgrounds uniquely. Studies have shown that the effects of the disease are more severe the younger the patient is, with the condition worsening over time. At first, people may appear eccentric, reclusive, irate, or emotionally upset. Over time, their appearance may become untidy, their conversations unusual, and their lives indifferent (Wilkenson, 2014). Lifelong treatment is required for people with schizophrenia to help manage symptoms and improve their quality of life (Mayo Clinic Healthy Living, 1998-2018).

The cause of schizophrenia is unclear, with theories ranging from heredity and abnormal brain chemistry to viral infections and immune disorders among others. While it is agreed that some disorders can be inherited and that people can develop the disease over time, it is unclear what specifically triggers the condition. It may lay dormant until the body undergoes hormonal or physical changes, such as during puberty or stressful situations (Mental Health America, 2013). Some individuals may have it even though no one else in their family does, and others may carry a familial history of schizophrenia without developing it themselves. While various genes increase the risk, no single gene has been identified as a definitive cause (National Institute of Mental Health, 2016).

Chemical imbalances of dopamine, glutamate, and serotonin can affect the brain's reaction to stimuli, possibly explaining why schizophrenic people may become exacerbated by bright lights and loud music (Mental Health America, 2013). Symptoms vary among individuals and can either develop slowly over time or appear abruptly. Most symptoms start to occur between the ages of 16 and 30 (National Institute of Mental Health, 2016). The disease affects perceptions, causing individuals to hear or see imaginary things, feel as though they are being watched, or speak or write unusually. They may also experience false beliefs, anger, confusion, hallucinations, reduced auditory or sensory functions, and decreased social interaction (Mental Health America, 2013). Schizophrenia affects men and women equally but tends to develop earlier in men. Men typically experience symptoms in their early 20s, and women in their late 20s to early 30s. Individuals with schizophrenia are also more likely to die at a younger age, often due to comorbidities like diabetes and heart disease (American Psychiatric Association, 2018). However, paranoia, delusions, and hallucinations are among the most common symptoms, but no single symptom confirms a diagnosis of schizophrenia (Torrey, 2013).

The American Psychiatric Association describes three categories of symptoms: positive, negative, and cognitive. Positive symptoms are those that exist or are perceived only by the person experiencing them. This can make the individual seem out of touch with reality. Such symptoms include delusions, hallucinations, strange or distorted ideas, bizarre behaviors, and altered perceptions. Concurrent behavioral changes may include withdrawal from society, suspicion, hostile temperament, an absent gaze, lack of facial expression, poor personal hygiene, and inappropriate emotional responses. Cognitive difficulties can manifest as lack of concentration, depression, forgetfulness, and insomnia (Haycoco, 2009; National Institute of Mental Health, 2016). Delusions, found in 90% of cases, are beliefs held against all evidence to the contrary. Delusions can be of persecution, control, reference, or grandeur (Wilkinson, 2014). Hallucinations are perceived as real by the individual experiencing them, but they only exist in their mind.

Auditory hallucinations occur due to misinterpretation in the patient's own mind. Amid their disorganized thoughts, they may believe they're conversing with another person (Wilkinson, 2014). Negative symptoms, on the other hand, are represented as diminished or missing traits, disrupting regular behaviors and emotions. These might include blank expressions, no eye contact, and lack of motivation or enthusiasm. These individuals might appear monotone yet ones who are aware of their surroundings (Haycoco, 2009; National Institute of Mental Health, 2016). Cognitive symptoms, both subtle and severe, often translate to changes in the person's memory. Typically, the affected individual struggles to understand information and use it to make decisions, or they may have trouble focusing or recalling recently acquired information (National Institute of Mental Health, 2016). Symptoms in teenagers are similar to adults, but can be more challenging to recognize due to their similarity to typical teenage behavior. For instance, withdrawal from friends, drop in school performance, difficulty sleeping, depressed mood, and lack of motivation contrarily, teens are less likely to have delusions but are more likely to experience hallucinations (Mayo Clinic Healthy Living, 1998-2018).

The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) defines and classifies mental disorders to optimize diagnosis, treatment, and research procedures. According to the DSM-5 criteria, a person must display symptoms associated with schizophrenia (such as delusions, hallucinations, etc.) for at least one month during supervised observation to be diagnosed with a mental disorder. If the disorder persists for more than a month, but less than six months, the patent will likely be diagnosed with schizophrenia. Meanwhile, disturbances that last for less than a month are classified as brief psychotic disorders (American Psychiatric Association, 2018).

The DSM-5 has defined five subtypes of schizophrenia in the United States. The paranoid type experiences hallucinations and delusions, but does not have disorganized behavior. The disorganized type possesses a flat affect, and unusual thought behaviors are observed. The undifferentiated type exhibits psychotic symptoms, but neither paranoia nor disorganized thought is present. The residual type manifests positive symptoms which are not severe in nature. The Catatonic type can become immobile or actively agitated without any apparent cause (Wilkenson, 2014). At present, there is no cure for schizophrenia, but with treatment, individuals can lead productive and fulfilling lives. Some forms of treatment include medication therapy and participation in rehabilitation programs. Rehabilitation can help someone regain confidence and teach them skills to lead a productive, independent life (Mental Health America, 2013). People with schizophrenia often lack an awareness that their struggles may stem from a mental disorder. Frequently, it is left to family and friends to convince the individual to seek professional help (Mayo Clinic Healthy Living, 1998-2018).

Services available:

• Case Management: Helps with access to financial services, treatment, and additional resources.
• Psychosocial Rehab: Assists with regaining employment, cooking, cleaning, socializing, and stress management skills.
• Self-Help Groups: Provide support and information to people with serious mental illness, delivered by individuals with personal experiences.
• Drop-In Centers: Sites where people can socialize and receive informal support as needed.
• Housing: Services can range from moral support to 24-hour supervised living.
• Employment: Offers assistance in finding employment or help with gaining skills to re-enter the workforce.
• Therapy: Provides "talk", individual, group, and family in order to help members have a better understanding of the illness and share their apprehensions.
• Crisis: Organizes 24-hour hotlines, after-hours counseling, behavioral center placement, and planned hospitalizations. (Mental Health America, 2013)

Medications are also used to help with symptoms of schizophrenia. They can reduce chemical imbalances. There are two major types of antipsychotic medication: Typical and Atypical. Typical medications help with "positive" symptoms, while Atypical medications help with both "positive and negative" symptoms. Typical medications include Chlorpromazine (Thorazine), Haloperidol (Haldol), Perphenazine (Trilafon), etc. Atypical medications include Aripiprazole (Abilify, Aristada), Lurasidone (Latuda), Asenapine (Saphris), etc. (Mental Health America, 2013)

Another category is known as "miscellaneous antipsychotic agents." These medications are used to treat agitation in schizophrenic people. One such example is Loxapine (Adasuve, Loxitane). As with most medications, side effects are common with all of these medications. They can range from mild such as dry mouth, blurred vision, constipation, drowsiness, and dizziness to more severe side effects such as trouble with muscle control, pacing, tremors, and facial tics. (Mental Health America, 2013) Coordinated specialty care integrates medication, psychosocial therapies, case management, family involvement, supported education, and employment services. All of these are intended to reduce symptoms and improve the quality of life. The National Institute of Mental Health, Recovery After an Initial Schizophrenic Episode (RAISE) research project seeks to change the course and projection of schizophrenia to treatment in the earliest stages. (National Institute of Mental Health, 2016)

Clinical trials look at new ways to prevent, detect, or treat schizophrenia and other conditions. Treatments can be new medications, surgical procedures, devices, or new ways of using existing treatments. The goal of the treatment is to determine if the new tests or treatments work and if they are safe. (National Institute of Mental Health, 2016) If left untreated, there can be severe problems that can affect every aspect of a person's life. Complications include suicidal thoughts or attempts, self-injury, anxiety, obsessive-compulsive disorder, depression, drug or alcohol abuse, inability to hold a job or go to school, legal and financial problems, as well as health and medical issues. (Mayo Clinic Healthy Living, 1998-2018) Schizophrenia causes people to suffer from other disorders such as obesity, sedentary life, smoking, drug, and alcohol abuse. These additional factors can cause physical, mental, and psychological disabilities. People can live and function as long as the conditions are managed. Many people have fought this disorder and lived successful lives.

• Dr. John Forbes Nash Jr., who won the Nobel Prize for economics, suffered from schizophrenia. His life was the inspiration for the movie, "A Beautiful Mind".
• Peter Green, one of the founding members of Fleetwood Mac, suffered from schizophrenia. He spent time in and out of hospitals, but he managed to control his disorder over time.
• Lionel Aldridge, a two-time Super Bowl champion from the Green Bay Packers, developed schizophrenia after he retired.
• Brian Wilson, a member of the Beach Boys and a Grammy-winning singer, developed schizophrenia. The list goes on and on, but all these people overcame this obstacle and lived their lives to the fullest. (Wilkenson, 2014)

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