Schizophrenia – Symptoms, Causes, Types and Treatment

Schizophrenia is a severe psychological ailment. In this, people often interpret reality abnormally. Patients diagnosed with schizophrenia are prone to hallucinations and unrealistic illusions.

Schizophrenia is one of the most challenging disorders not only for patients but for caregivers as well.

What is Schizophrenia?

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.

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.

Types of Schizophrenia

• Paranoid Schizophrenia – The patients have symptoms like delusions and hallucinations.
• Catatonic Schizophrenia – The patients rarely react to any stimuli and possess odd body movements.
• Hebephrenic Schizophrenia – The patients have disorganized behavior. This is why it is also known as disorganized schizophrenia.
• Residual Schizophrenia – The patients have a poor attention span, are easily withdrawn emotionally, and are mentally disorganized.
• Undifferentiated Schizophrenia – The patients show several symptoms that it becomes hard to identify what is bothering them and may not fit in any other category. Hence they are categorized as undifferentiated schizophrenia.

What are the Major Symptoms of Schizophrenia?

Schizophrenia is a neurological disorder that triggers several problems in an individual. The significant impact of schizophrenia is the erratic changes in thinking power, human behavior, and frequent change in emotions. Signs and symptoms may vary, but the common ones are:

A few behaviors that are early signs 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 behavior
• 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

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

• Delusions – People diagnosed with schizophrenia are delusional, having false beliefs. Delusions are the most common symptom, occurring in over 90% of the patients. Often, they have a constant fear of getting mistreated or harmed by others.
• Hallucinations – The patients diagnosed with schizophrenia sometimes hallucinate, i.e., see, hear, smell, or feel objects that are not present. These patients experience certain things that are unintelligible to others.
• Disorganized Thinking – Effective communication becomes challenging and decreases, and the patients are more likely to stay quiet or answer partially. When pursued, their responses are different and irrational because of the disorganized thinking caused by the neurological disorder.
• Abnormal Behavior – The patients respond to the situations indifferently, which is observed as abnormal behavior. It can include inappropriate postures, resistance in understanding, lack of response, or unusual movement.

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.

Some symptoms to look for in teenagers include:

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

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

When is the Right Time to Visit a Doctor?

People symptomatic of schizophrenia are likely to be unaware of situations, as they are delusional, frightened, and confused. If you observe or feel the person is getting isolated, acting suicidal, or showing unusual behavior, it is time to seek medical attention.

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What are the Causes Behind Schizophrenia?

It is not known what causes schizophrenia. However, experts believe that a combination of brain chemistry, genetics and environment contribute to the development of this disorder.

Problems with some naturally occurring brain chemicals, such as neurotransmitters called glutamate and dopamine, cam contribute to schizophrenia. Neuroimaging studies reveal differences in central nervous system and the brain structure of people with schizophrenia.

The exact causes are still unknown. However, some major elements that can trigger schizophrenia are:

• Genetics
• Structural and chemical changes in the brain
• Pregnancy
• Birth complications
• Premature labor
• Childhood trauma or Post traumatic stress disorder
• Psychological and environmental factors
• Societal factors
• Developmental Factors

Risk Factors Associated with Schizophrenia

• Family history of schizophrenia
• Exposure to viruses, toxins, drugs, or severe infection that affects the brain
• Taking mind-altering drugs [psychoactive or psychotropic drugs)
• Pregnancy and birth complications
• Disorders of the immune system
• Childhood trauma

How to Diagnose Schizophrenia?

Based on the symptoms, doctors conduct several examinations to look for neurological patterns in the brain. Steps for diagnosis include:

• Physical Examination: It is done to rule out the other problems with the same symptoms.
• Screening Tests: MRI and CT scan are conducted to rule out other causes, and alcohol and drug test screening is done.
• Psychiatric Examination: A mental health test is done, where a doctor asks about changing moods, hallucinations, substance abuse, and potential suicidal threats.
• Diagnostic criteria for schizophrenia: A mental health professional or a doctor may make use of the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

What is the Treatment Plan for Schizophrenia?

The patients diagnosed with schizophrenia require lifelong treatment, even if symptoms have reduced. Using psychological therapy and medications can help the patients to manage the condition.

Medications

Antipsychotic medications help control the symptoms that severely affect the dopamine level. However, these medications have serious side effects on the patients; this is why most of them avoid taking any. Second gerenation antipsychotic medication like the following have less side effects:

• Aripiprazole
• Asenapine
• Brexpiprazole
• Cariprazine
• Clozapine
• Ziprasidone

Other medicines may also help, like antidepressants or anti-anxiety drugs. It can take several weeks to notice an improvement in symptoms.

Psychotherapy

• Social skills training: This helps the patient improve their communication skills. Social interactions and the capability of engaging in the day to day activities are also enhanced.
• Individual therapy: Recognizing early symptoms of relapse and learning to manage stress can help manage Schizophrenia. Psychotherapy can help normalize thought patterns.
• Family therapy: Education and support are given to the members of a family that is dealing with a Schizophrenia patient.
• Vocational rehabilitation and supported employment: In this, Schizophrenia patients are assisted in preparing for, finding, and keeping a job.

Hospitalization

Sometimes the symptoms and complications worsen, so it becomes important to hospitalize the patient to ensure  safety, nutritious diet, and sufficient sleep.

Electroconvulsive therapy

Sometimes adults do not respond to the medications and other treatments, so electroconvulsive therapy is conducted to treat them.

Recovery & Rehabilitation

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.

Complications if Schizophrenia is not Treated

• Anxiety disorders
• Suicidal attempts
• Depression
• Substance abuse
• Aggressive behavior
• Social isolation
• Obsessive-compulsive disorders

What are the Preventive Measures for Schizophrenia?

There is no solution for preventing schizophrenia. However, if diagnosed and treated, early symptoms can be controlled. Still, there is ongoing research on this disease to understand and check if there is any possible way for early diagnosis of the same. This will immensely help in creating better treatment.

What are the other conditions related to Schizophrenia?

There are a few other related conditions to Schizophrenia:

• Delusional disorder: In this condition, a person holds false beliefs that might persist for a month. These beliefs can be ‘wild’ things that are possible but do not occur. Such delusions can cause problems at home or office and even lead to legal troubles.
• Brief psychotic disorder: When a person experiences a brief episode of psychotic behavior, it is a brief psychotic disorder. Such episodes might last from a day to a month. After such a brief episode, the person returns to normal. This condition involves symptoms like delusions, hallucinations, disorganized speech, and grossly disorganized behavior. It can happen to any person. It is twice as common in females than in men.
• Schizophreniform disorder: This is very similar to Schizophrenia, but the symptoms are less severe and last for a short time. The symptoms last for at least a month and less than six months. The disorder has certain symptoms, which are present for a certain time in that one-month. These symptoms include:

• Hallucinations
• Delusions
• Disorganized behavior
• Negative symptoms
• Disorganized speech

• Schizoaffective disorder: Major mood swings are a part of schizoaffective disorder. People have both bipolar disorder and Schizophrenia at the same time. There are different phases or time divisions between the symptoms of both; it is one-third as common as Schizophrenia. It can begin in early adulthood.

What are the Myths Associated with Schizophrenia?

The complexity and lack of knowledge about schizophrenia explain why there are several myths and misconceptions about the disorder.

Schizophrenia hampers the person’s ability to react or understand the normal life patterns. With limited access to information, taboos exist about the disease. We have listed some points that will help to clear the misconceptions

Suffers from Split Personality

The most common symptoms of this disorder are delusions and hallucinations, making people believe that the patients have split personality(dissociative identity disorder). Split personality is different from schizophrenia .The fact is, due to the symptoms, the patients normally hear or see unrealistic objects that contradict their ability to differentiate between reality and imagination.

Becomes Violent

Another myth is that schizophrenic patients become violent and dangerous. The patients with schizophrenia feel isolated and socially withdrawn, and mostly they become a victim of their thoughts. The fact they are dangerous to others  or violent is untrue.

The Patient Cannot Work

With proper medication and regular therapy, the patients can work quite well in a calm environment. It has been seen that when the patients are provided with proper treatment, they tend to be more efficient than anticipated.

Sudden Changes in Personality keep happening

Each patient with schizophrenia reacts differently. Sometimes the patients might find particular objects triggering. It is important to keep them away from any triggering event that can negatively impact their wellbeing. Proper medication and regular therapy can help them to handle such situations in a better way.

Long-term Hospitalizations are needed

Some patients get hospitalized, but it happens when the disorder becomes extreme, requiring long-term care. When proper treatment and out-patient care is given to the patient, the need for getting them hospitalized subsides.

It is only a genetic cause

If your family members are diagnosed with schizophrenia, then you too are at risk. But risk factors other than genes can trigger this disorder; and it is also not that if someone in the family has schizophrenia , you also will necessarily get it .

Conclusion

The signs and symptoms of schizophrenia can be a challenge to cope with ,  for any individual but with the right treatment and constant care, it can be managed. Schizophrenia occurs in episodes and with the right care and help, you can learn to identify the periodz of remission and try to limit the frequency of episodes occurring in the future.

Several people have been seen to manage the disorder and work functionally with proper support, treatment, and therapy.

Frequently Asked Questions (FAQs)

How can you notice the symptoms?

When you see a sudden change in behavior, speech, or actions, you need to go for a consultation. Mostly if you have a family history of schizophrenia, you need to take immediate action after observing unusual symptoms like isolation, abnormal  thought patterns, concentration problems, and movement disorders.

What kind of treatment is required if it is diagnosed late?

Schizophrenia needs life-long treatment. So even if diagnosed early, you need to pay  close  attention and therapy; the same applies if diagnosed late. However, it depends on how the patient is reacting to the disorder, based on which the doctor will provide you with therapy and oral medications.

Will there be aggressive side-effects with the medication?

The patients can have  mood swings, dizziness, restlessness, constipation, nausea, low blood pressure, seizures, and blurred vision.

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.