Schizophrenia

Schizophrenia is a mental illness characterized by abnormal social behaviour and inability to understand reality. Symptoms of schizophrenia include confused thinking, hallucinations, false beliefs, lack of motivation and decreased social life. Mental health issues like anxiety and depression are common in individuals with schizophrenia. Often, schizophrenic patients are prone to substance abuse.

A person who is schizophrenic has confusing thoughts, see images of things that are not there, hear sounds which are not present in reality and lose touch with reality. It is a common disorder that can attack anyone and at any age.

Schizophrenia is a chronic mental disorder and requires lifelong treatment. A person who is schizophrenic might experience the symptoms in episodes or constantly. The causes include environmental factors as well as genetic factors. Environmental factors like being raised in a city, use of drugs like cannabis during adolescence, the presence of infections, parental age, nutrition deficit during pregnancy, etc. play a major role.

A variety of genetic factors and family history also cause schizophrenia. A few social factors like long-term unemployment and poverty also play a role in schizophrenia.

As per many statistical reports of 2017, about 1% of the general population has schizophrenia. On average, males are more prone to schizophrenia than females and they are also likely to experience symptoms more severe than females. Most patients do not recover completely. About 20% of cases that seek help are likely to do well.

Patients suffering from schizophrenia tend to have an increased chance of developing other health issues. The life expectancy of such patients is 10 – 25 years lesser than the general population. Suicide rates among these individuals are about 5% higher than the general population.

People usually misinterpret schizophrenia to split personality disorder, which is a different type of mental illness. The split personality disorder is a rare illness compared to schizophrenia, which is common.

A normal individual may show signs and symptoms of schizophrenia but he cannot be regarded as a schizophrenic patient unless such symptoms last for a minimum period of 6 months. Sometimes, it is likely for a person to experience an episode of schizophrenia due to a sudden and unacceptable change in life. However, when certain phases pass, they recover from it and would not experience such episodes again. Stress can trigger or worsen schizophrenia but studies prove that stress alone is not the cause of schizophrenia.

The causes of schizophrenia are not defined specifically. However, it is said that there could a mix of factors. They include –

• Biology of the Brain – An imbalance in the quantities of certain chemicals in the brain which is responsible for control of thinking and understanding. An imbalance between neurotransmitters like dopamine, glutamate and serotonin could also be the cause. These neurotransmitters are responsible for the passage of information between nerve cells in the brain. An imbalance in the quantity of these chemicals would alter a person’s response to stimuli, make him have a problem in processing sound, vision, taste and smell and therefore result in hallucinations and delusions.
• Developmental Factors – Improper development of connections and pathways in the brain during a baby’s development in the womb could also later lead to schizophrenia. When a pregnant mother experiences stress and have poor nutrition during pregnancy, the baby’s chance of having schizophrenia later in life increases. Increased rate of exposure to viral infections in the uterus during delivery could also be a cause.
• Genetic Make-up of a Person– Schizophrenia runs in families and tends to pass from one generation to another. Hormonal and physical changes like puberty and onset of adolescence could also be some genetic causes of schizophrenia.
• Infections and Immune Disorders – Environmental factors can make a person sick for longer periods. Having to go through severe infections and being hospitalized for longer periods could make a person more vulnerable to schizophrenia.
• Drug-induced schizophrenia – Usage of cannabis has often resulted in triggering the first episode of schizophrenia attack in many individuals. For drugs like marijuana and LSD, many cases of relapse have been reported. Certain steroids, stimulants and other prescription drugs have also been said to cause schizophrenia and psychosis. The usage of drugs and alcohol is excessive in about half of those with schizophrenia.
• Environmental Factors – Lifestyle is one of the major factors associated with the development of schizophrenia. The living environment, doing drugs in adolescence, and prenatal stressors are a few to name under environmental factors. Childhood trauma, victimization to bullying, family dysfunction, death of a parent, etc. increase the risk of schizophrenia and psychosis.

With these being the causes of schizophrenia, there are many factors that trigger the disorder or worsen symptoms. Stress is a major triggering factor. Change in social and economic status of a person could also make him prone to schizophrenia. Loss of job, development of other diseases/conditions, loss of loved ones, and other changes can also trigger schizophrenia.

Not every person with schizophrenia experiences the same signs and symptoms. Some may develop symptoms gradually while others might have an abrupt display of symptoms. Attacks of schizophrenia occur in cycles of remission and relapse.

While prominent symptoms occur much later, many individuals show early signs of schizophrenia.

A few behaviours that are early signs signaling schizophrenia include:

• Seeing images that aren’t present
• Hearing sounds that aren’t there
• Strange body positioning
• Change in personality
• Inability to sleep
• Inability to concentrate
• Extreme expression of emotions (love, anger, fear, etc.)
• No expression of emotions, blunt behaviour
• Change in appearance
• Extreme preoccupation with religion or occult
• Constant feeling of being monitored
• Nonsensical way of writing and speaking
• Poor academic and professional performance

Few or many of these symptoms are common for normal individuals but if several of these symptoms appear and last for more than 2 weeks, one should seek help.

Symptoms of schizophrenia could be categorized into two

• Positive Symptoms
• Negative Symptoms

Positive Symptoms

These are the disturbances that come as an “addition” to a person’s personality. These include:

• Delusions – a person experiencing a delusion might often feel that he is someone famous or consider himself to be God or a religious figure. They may also believe that they are being monitored or spied upon.
• Hallucinations – A person experiencing a hallucination lives far from reality. They tend to see, feel, taste, hear and smell things that do not really exist. Commonly, they hear imaginary voices commanding them.
• Disorganized Behaviour – A person may experience movements that tend to make him anxious and tensed without a reason. He may display impulsive actions and be furious without a cause.
• Disordered Speech – This includes frequent and abrupt shifting of topics while speaking, making up words and sounds, repeating words and ideas.

Negative Symptoms

These are the capabilities that are “lost” from a person’s personality.

• Social Withdrawal – A person with schizophrenia might like to refrain himself from social bonding. These people often prefer staying alone and away from the crowd.
• No expression of Emotion – Individuals may not be able to show or reciprocate emotions. It also includes a lack of enthusiasm. Normal emotional responses are absent.
• Negative symptoms often result in a poor quality of life and tend to be more burdensome than positive symptoms. A person showing negative symptoms is often tough to be brought back to normal. They also are less responsive to medication.
• In children, common symptoms of schizophrenia include decreased motor development (delay in reaching milestones), decreased intelligence, preference to playing in isolation than in a group, poor performance in academics, social anxiety, etc.

In teenagers, the condition is more difficult to recognize. Normal teen behaviour is almost close to that of schizophrenic behaviour. A schizophrenic teen is less likely to have delusions and more likely to have visual hallucinations.

Some symptoms to look for in teenagers include:

• Withdrawal from friends and family
• Poor academic performance
• Irritability
• Depressed or dull mood
• Trouble sleeping
• Lack of motivation

As there is no definite cause of schizophrenia, the risk factors cannot be accurately estimated.

Some of them include:

• A family history of schizophrenia
• Older age of the father
• Pregnancy and birth complications
• Usage of drugs during teenage and young adulthood
• Disorders of the immune system
• Childhood trauma

A mental health professional will assess the patient to evaluate the symptoms being experienced by him. There is no objective test to diagnose schizophrenia however certain tests could be ordered to rule out other illnesses and conditions. A doctor will have to exclude possible conditions like bipolar mood disorder, in order to confirm schizophrenia in a person. The doctor should also make sure that the symptoms are not a result of drug usage, medication or other medical condition.

A patient must have at least two typical symptoms from the following:

• Delusions
• Hallucinations
• Disorganized or catatonic behaviour
• Disorganized speech
• Negative symptoms lasting most of the time during the past 4 weeks
• The doctor may conduct the following examinations

Physical Examination: This is done in order to rule out other underlying health conditions before confirming a mental health disorder.

Screening: A screening procedure for alcohol and drugs is done to rule out the causes. Imaging studies like MRI or CT scan could also be ordered for.

Mental Evaluation: A mental health professional observes the appearance of the person, his mood, thoughts, delusions, hallucinations, drug use, suicidal thoughts etc. including a discussion of family and personal life.

Proper medical help and guidance from professionals can result in a better, long-term outcome for patients. No cure exists for schizophrenia. Proper treatment can help a person lead a productive and fulfilling life. People who seek medical help at an early stage of the condition improve faster and can lead a regular life.

Recovery from schizophrenia can be possible through various means which include medication and rehabilitation. While medication helps in the management of the condition, rehabilitation usually plays a major role in getting back the confidence and skills a person needs to lead a productive life in the community.

• Rehabilitation: Helps individuals recover their skills like employment, cooking, budgeting, socializing, problem solving, stress management, shopping, cleaning, etc.
• Self-help Groups: Individuals who experience mental illness provide constant support to persons with serious mental issues.
• Therapy/counseling: Includes individual and group talk therapies that help patients and family members in understanding the condition in a better way.

Apart from these, a patient is given antipsychotic medications to control the symptoms of schizophrenia. These medications reduce the biological imbalances that cause schizophrenia. Proper usage of these medicines would also keep the patient from experiencing a relapse. All anti-psychotic medications should be taken as prescribed by the doctor and not otherwise.

Typical and atypical antipsychotics are the two major types of antipsychotic medications.

Typical antipsychotics are otherwise called conventional antipsychotics. They effectively manage the positive symptoms. Some examples of such drugs are Chlorpromazine, Perphenazine, Fluphenazine, Mesoridazine, Thiothixene, etc.

Atypical or new generation antipsychotics treat both positive and negative symptoms. They come with fewer side effects. Some examples are  Aripiprazole, Asenapine, Clozapine, Olanzapine, Risperidone, Ziprasidone, circumcision etc.

Antipsychotic drugs come with mild side effects like dry mouth, drowsiness, constipation, quitting-smoking, dizziness, blurred vision, etc. These side effects often fade away in a few weeks. Severe and rare side effects include facial tics, and loss of muscle control.

There are no studies that suggest actions that could prevent or delay the onset of this condition. Some studies show that early use of medication and intervention to be beneficial for the patient. In individuals who are at high risk, cognitive behavioral therapy could reduce the risk of psychosis later on in life. Avoiding drugs and substance abuse could be one way of preventing schizophrenia. Regular exercise has also proven to have a positive effect on the physical and mental health of those with schizophrenia.

How does schizophrenia begin?

Hallucinations and delusions are the primary symptoms of schizophrenia in most cases. They are likely to show up between ages 16 to 30.

Can Schizophrenia be cured?

Schizophrenia is a chronic mental illness. Though it cannot be cured completely, it can be managed with the help of therapy and medication.

Is schizophrenia a split-personality disorder?

No. Schizophrenia is completely different from split-personality disorder.

Are people with schizophrenia dangerous?

In most cases, patients are not violent and hence are not dangerous.

What are the four types of schizophrenia?

In the past, schizophrenia had subtypes called paranoid, disorganized, catatonic, childhood and schizoaffective.

Apollo Hospitals has the best Psychiatrist in India. To find the best Psychiatrist doctors in your nearby city, visit the links below:

• Psychiatrist in Bangalore
• Psychiatrist in Chennai
• Psychiatrist in Hyderabad
• Psychiatrist in Delhi
• Psychiatrist in Mumbai
• Psychiatrist in Kolkata