Schizophrenia

Overview

Schizophrenia is a disease of the brain affecting a person's thought, perceptions, emotions movement and behavior. It does not mean that a person has a "split personality". Schizophrenia affects about one in every 100 people. More than 2 million Americans have schizophrenia in a given year. The illness affects men and women with equally. In men it usually appears between ages 15 to 25, and in women, usually between ages 25 to 35. The symptoms and long lasting pattern of schizophrenia often cause a high degree of disability. It has been estimated that the financial cost of the illness in the United States exceed that of all cancers combined. 33 to 50 percent of homeless Americans are reported to have schizophrenia.

Although there is no cure, schizophrenia is highly treatable and there is much hope for patients and their families. New discoveries in treatment have led to new and safer medications with fewer side effects. 

Cause

The exact cause for schizophrenia is not known. Bad parenting or personal weakness is not the cause. Research into the cause has pointed to several possibilities. Schizophrenia does run in families and scientists studying genetic factors have found that it is likely that multiple genes are involved. It is likely, but not yet certain that there is an imbalance of the chemicals in the brain that allow communication between the nerve cells. Other researchers called Neurobiologists have found that schizophrenia may be a developmental disorder that means that neurons (brain cells) and/or their connections may not have formed properly before birth. Infection, poor nutrition, and hypoxia (not enough oxygen) during pregnancy are possible causes. Immune and viral causes of schizophrenia have also been proposed, although the research data to support these causes is weak. 

Symptoms

The symptoms of schizophrenia vary from person to person. Symptoms may appear all at once, or develop slowly over months or years and can come and go in cycles. A person who has schizophrenia may have some, all, or combination of the following mental, emotional, and/or behavior symptoms:

Distorted Perceptions of Reality
People with schizophrenia may perceive the world and reality very differently from the reality seen and shared by others around them. Because of this, they may feel frightened, anxious, and confused.

Hallucinations
Hallucinations are perceptions that are experienced by a person but are not real. They can occur in any form of the five senses including sound, sight, touch, taste, and smell. The most common type of hallucination is hearing voices that other people do not hear. The voices may say things about the person, have a conversation, warn of real or imagined dangers, or give orders to say or do something.

Delusions
Delusions are false ideas or beliefs, which do not make sense. An example could include a person who thinks that people are cheating on him, poisoning him, spying and /or are a part of a conspiracy against him. A person with delusions may believe that he or she is a famous or important person. Sometimes a person can have a belief, which is bizarre, such as believing that an alien is controlling their behavior with electronic waves, or that people on the T.V. are talking to them.

Disordered Thinking and Speech
Schizophrenia often affects a person's ability to "think straight" so their thinking and speech are confused. Thoughts may come and go quickly, there may be difficulty concentrating, and connecting thoughts logically becomes very difficult. A person may move from one topic to another not making any sense and may even make up his own words or sounds. Because of the disordered thinking a person may do poorly in school and/or may have difficulty performing in their job. He or she may also withdraw from social situations, related to difficulties in communicating with others.

Changes in Emotional Expression, Behavior, and Personality
A person with schizophrenia may show very little emotion, speak in a monotone voice, and have very little motivation. He or she may spend days doing nothing at all including not taking care of his or her hygiene and appearance. One may notice that inappropriate feelings are expressed such as the person not caring about something important. Irrational, angry, or fearful responses toward loved ones may be common and hence cause much family concern. Strange body positioning, bizarre behavior, and extreme preoccupation with religion or the occult may occur. There may also be a change in a person's sleep pattern, usually difficulty with sleeping.

When to Seek Help or Call Doctor

If you or a loved one experiences several of the symptoms described above for more than two weeks, seek help. If you or a loved one verbalizes or tries to act on suicidal or violent thoughts, seek help immediately. Emergency help may be necessary. Please see resourses listed below. 

What Happens

When it is determined that a person requires help for the symptoms listed above, sometimes hospitalization is needed. This so a thorough mental and physical exam and tests can be performed to determine what is going on and begin treatment. Approximately a third of people with schizophrenia will recover completely. Another third will have symptoms of psychosis in several episodes during their lives and have some lesser symptoms in-between these episodes. The last third will have psychotic symptoms throughout their lives. The outlook for people with schizophrenia has improved with new medications developed over the past 25 years. Although there is no cure, many people with the illness improve enough to lead independent and fulfilling lives. 

Common Concerns

Is a person more likely to become violent if they have schizophrenia?
Most people with schizophrenia are not violent and most violent crimes are not committed by people with schizophrenia. If a person had a criminal record before becoming ill or is abusing drugs or alcohol, he or she may be more prone to violence. But this is also the case in people who do not have any mental illness. If the person stops taking their medication and has symptoms of paranoia and delusions, he or she may be more prone to violence at that time.

What About Suicide?
People with schizophrenia have a higher rate of suicide than the rest of the population and so it is a serious concern. Anyone who tries to commit suicide or threatens to do so needs professional help immediately.

Does having schizophrenia mean that you cannot work, go to school or pursue your own interests?
No, as stated before, with treatment, symptoms may be lessoned or be eliminated, allowing a person to lead an independent and fulfilling life. This illness can be disabling though, with the desire to be independent and "normal" being an ongoing or intermittent struggle. 

Exam & Tests

A complete physical and mental examination will be done if you or a loved one is evaluated in a hospital. Blood tests and tests for drugs and alcohol will be done. Other tests may include a CAT scan or MRI of the brain. These are special x-rays of the brain to determine any abnormalities. An EEG test may also need to be performed and this test measures the brain waves to see if there is any seizure activity or neurological problem. 

Treatment Overview

The antipsychotic drugs are the best treatment now available for people with schizophrenia. These drugs do not cure or guarantee that there will not be any further episodes of psychosis. They can help most of the symptoms of schizophrenia most of the time. A trained mental health professional licensed to prescribe medications will need to determine the choice and dose of medication. There are two major types of antipsychotic medication, the typical or conventional antipsychotics and the new generation also known as atypical antipsychotics. A list of commonly prescribed antipsychotic medications brand and generic names is listed below.

If you would like more information about the medications above or any other medication, please click on the patient/consumer medication education web site listed below under 'resources'.

In addition to medication, treatment also includes services for recovery and rehabilitation. This may include employment, housing and case management programs. Self-help groups can provide information and much support for people with mental illness. Therapy/counseling and crisis intervention services would also be included in the treatment of schizophrenia. 

Resources on the Internet

National Alliance for the Mentally Ill (NAMI)
Phone: 1-800-950-6264 or (703) 524-7600
Internet: http://www.nami.org

National Alliance for Research on Schizophrenia and Depression (NARSAD)
Phone: 1-800-829-8289 or (516) 829-0091
Internet: http://www.narsad.org

National Institute of Mental Health (NIMH)
Phone:301-443-4513
Internet: http://www.nimh.nih.gov

National Mental Health Association (NMHA)
Phone:1-800-969-6642 or (703) 684-7722
Internet: http://www.nmha.org

National Mental Health Consumers' Self-Help Clearinghouse
Phone: 1-800-553-4539 or (215) 751-1810
Internet: http://www.mhselfhelp.org

Pharmacology Online web site:

Community Resourses and Services

Emergency Services and Hotlines:

For additional information, please call 631-444-4000.