Schizophrenia is a chronic, severe, and disabling brain disease. Approximately 1 percent of the population develops schizophrenia during their lifetime. More than 2 million Americans suffer from the illness in a given year. Although schizophrenia affects men and women with equal frequency, the disorder often appears earlier in men, usually in the late teens or early twenties, than in women, who are generally affected in the twenties to early thirties. People with schizophrenia often suffer terrifying symptoms such as hearing internal voices not heard by others, or believing that other people are reading their minds, controlling their thoughts, or plotting to harm them. These symptoms may leave them fearful and withdrawn. Their speech and behavior can be so disorganized that they may be incomprehensible or frightening to others. Available treatments can relieve many symptoms, but most people with schizophrenia continue to suffer some symptoms throughout their lives; it has been estimated that no more than one in five individuals recovers completely.
This is a time of hope for people with schizophrenia and their families. Research is gradually leading to new and safer medications and unraveling the complex causes of the disease. Scientists are using many approaches from the study of molecular genetics to the study of populations to learn about schizophrenia. Methods of imaging the brain structure and function hold the promise of new insights into the disorder.
Schizophrenia as An Illness: Schizophrenia is found all over the world. The severity of the symptoms and long-lasting, chronic pattern of schizophrenia often cause a high degree of disability. Medications and other treatments for schizophrenia, when used regularly and as prescribed, can help reduce and control the distressing symptoms of the illness. However, some people are not greatly helped by available treatments or may prematurely discontinue treatment because of unpleasant side effects or other reasons. Even when treatment is effective, persisting consequences of the illness, lost opportunities, stigma, residual symptoms, and medication side effects may be very troubling.
The first signs of schizophrenia often appear as confusing, or even shocking, changes in behavior. Coping with the symptoms of schizophrenia can be especially difficult for family members who remember how involved or vivacious a person was before they became ill. The sudden onset of severe psychotic symptoms is referred to as an acute phase of schizophrenia. Psychosis a common condition in schizophrenia, is a state of mental impairment marked by hallucinations, which are disturbances of sensory perception, and/or delusions, which are false yet strongly held personal beliefs that result from an inability to separate real from unreal experiences. Less obvious symptoms, such as social isolation or withdrawal, or unusual speech, thinking, or behavior, may precede, be seen along with, or follow the psychotic symptoms.
Some people have only one such psychotic episode; others have many episodes during a lifetime, but lead relatively normal lives during the interim periods. However, the individual with chronic schizophrenia or a continuous or recurring pattern of illness often does not fully recover normal functioning and typically requires long-term treatment, generally including medication, to control the symptoms.
There is no known single cause of schizophrenia. Many diseases, such as heart disease, result from interplay of genetic, behavioral, and other factors; and this may be the case for schizophrenia as well. Scientists do not yet understand all of the factors necessary to produce schizophrenia, but all the tools of modern biomedical research are being used to search for genes, critical moments in brain development, and other factors that may lead to the illness.
Types of Schizophrenia:
Paranoid schizophrenia - These persons are very suspicious of others and often have grand schemes of persecution at the root of their behavior. Hallucinations and more frequently delusions are a prominent and common part of the illness.
Disorganized schizophrenia (Hebephrenic Schizophrenia) - In this case the person is verbally incoherent and may have moods and emotions that are not appropriate to the situation. Hallucinations are not usually present.
Catatonic schizophrenia - In this case, the person is extremely withdrawn, negative and isolated, and has marked psychomotor disturbances.
Residual schizophrenia - In this case the person is not currently suffering from delusions, hallucinations, or disorganized speech and behavior, but lacks motivation and interest in day-to-day living.
Schizoaffective disorder - These people have symptoms of schizophrenia as well as mood disorder such as major depression, bipolar mania, or mixed mania.
Undifferentiated Schizophrenia - Conditions meeting the general diagnostic criteria for schizophrenia but not conforming to any of the above subtypes, or exhibiting the features of more than one of them without a clear predominance of a particular set of diagnostic characteristics.
Schizophrenia is classified as a psychotic disorder. People with schizophrenia have symptoms of psychosis, an abnormal state of consciousness in which the higher functions of the mind are disrupted. In psychosis, some combination of a person's perceptions, thought processes, beliefs, and emotions appear to become disconnected from reality. These symptoms may come and go, and the person may seem normal at times.
Most of the symptoms of schizophrenia are symptoms of psychosis, but it is possible to have psychotic symptoms without having schizophrenia. Symptoms of schizophrenia are categorized as one of three types: positive (psychotic) symptoms, negative symptoms, and cognitive symptoms.
Positive Symptoms of Schizophrenia: Positive symptoms of schizophrenia are behaviors and experiences that the ill person has that healthy people do not. Positive symptoms are also referred to as psychotic symptoms, although the word psychotic is used in many other ways as well. Positive symptoms include:
Delusions: Delusions are false beliefs that don't make sense in the context of a person's culture. Although everyone has wrong beliefs from time to time, psychotic delusions also have an abnormal obsessive quality. People with psychotic delusions can't be convinced that their beliefs aren't real.
Hallucinations: Hallucinations are false sensory experiences that have no basis in the external world. Psychotic hallucinations occur when the person is fully awake and not under the influence of alcohol or illicit drugs. Auditory hallucinations (hearing voices) and visual hallucinations (seeing things) are the most common, but a person can hallucinate a touch (for example, bugs crawling on the skin), taste or smell.
Disorganized speech: Also known as loose association. In psychotically disorganized speech, words are not linked together based on the normal rules of language, but are strung together based on sounds, rhyme, puns, or free associations. Although everyone makes speech errors, especially when they're tired or stressed, psychotically disorganized speech is obviously abnormal, and is difficult or impossible to understand.
Disorganized or catatonic behavior: Psychotically disorganized behaviors are not goal-directed, and don't make sense in context. For example, taking one's clothes off to take a bath is sensible. Taking one's clothes off on a public bus is an example of a disorganized behavior. Laughing at inappropriate times or for no reason is a disorganized behavior. Adopting strange postures or freezing are catatonic behaviors.
Negative Symptoms of Schizophrenia: Negative symptoms of schizophrenia describe normal traits that are absent or reduced in the person who is ill. Negative symptoms include:
Flattened affect: Patients with flattened affect appear very emotionless, or have a very limited range of emotions. They show little response to emotional or disturbing situations or images.
Anhedonia: Patients may fail to experience or express pleasure in things that they once found enjoyable.
Cognitive Symptoms of Schizophrenia: Cognitive symptoms of schizophrenia have to do with the way a person thinks. Although cognitive symptoms are not used to diagnose schizophrenia, some are fairly common with the illness
Difficulty maintaining attention: The inability to maintain focused attention makes people with schizophrenia seem spacey or “out of it.”
Memory problems: Schizophrenia often effects working memory, which is the kind of memory you use to keep things in your head for active processing, like the digits of a phone number you're about to dial.
Difficulty planning and structuring activities: Caused by reduced executive control. Executive control is the mental process that allows us to identify the steps needed to complete a task and then execute them in a proper order. Executive control also allows us to suppress our response to distractions in order to get something done.
Lack of insight: People with schizophrenia have a specific cognitive blindspot that prevents them from understanding that they are ill. This means that loved ones and caregivers should remain as vigilant as possible to help the patient maintain the routines of treatment in order to control symptoms.
Causes and Risk factors:
The causes of schizophrenia are not fully known. However, it appears that schizophrenia usually results from a complex interaction between genetic and environmental factors.
Genetic causes of schizophrenia: Schizophrenia has a strong hereditary component. Individuals with a first-degree relative (parent or sibling) who has schizophrenia have a 10 percent chance of developing the disorder, as opposed to the 1 percent chance of the general population. But schizophrenia is only influenced by genetics, not determined by it. While schizophrenia runs in families, about 60% of schizophrenics have no family members with the disorder. Furthermore, individuals who are genetically predisposed to schizophrenia don't always develop the disease, which shows that biology is not destiny.
Environmental causes of schizophrenia: Twin and adoption studies suggest that inherited genes make a person vulnerable to schizophrenia and then environmental factors act on this vulnerability to trigger the disorder. As for the environmental factors involved, more and more research is pointing to stress, either during pregnancy or at a later stage of development. High levels of stress are believed to trigger schizophrenia by increasing the body's production of the hormone cortisol.
Research points to several stress-inducing environmental factors that may be involved in schizophrenia, including:
1. Prenatal exposure to a viral infection.
2. Low oxygen levels during birth (from prolonged labor or premature birth).
3. Exposure to a virus during infancy.
4. Early parental loss or separation.
5. Physical or sexual abuse in childhood.
6. Brain chemical imbalances.
7. There is evidence that chemical imbalances in certain neurotransmitters, proteins, and amino acids play a role in causing schizophrenia.
Dopamine — Dopamine is the primary brain chemical implicated in schizophrenia. The dopamine hypothesis suggests that an excess of dopamine in the brain contributes to schizophrenia.
Glutamate — Glutamate is another important neurotransmitter implicated in schizophrenia. Studies show an underactivity of glutamate in schizophrenic patients. This supports the dopamine hypothesis, since dopamine receptors inhibit the release of glutamate.
Abnormal brain structure: In addition to abnormal brain chemistry, abnormalities in brain structure may also play a role in schizophrenia. Enlarged brain ventricles are seen in some schizophrenics, indicating a deficit in the volume of brain tissue. There is also evidence of abnormally low activity in the frontal lobe, the area of the brain responsible for planning, reasoning, and decision-making. Some studies also suggest that abnormalities in the temporal lobes, hippocampus, and amygdala are connected to schizophrenia's positive symptoms. But despite the evidence of brain abnormalities, it is highly unlikely that schizophrenia is the result of any one problem in any one region of the brain.
When the signs and symptoms of schizophrenia are ignored or improperly treated, the effects can be devastating both to the individual with the disorder and those around him or her. Some of the possible effects of schizophrenia are:
Relationship problems - Relationships suffer significantly because people with schizophrenia often withdraw and isolate themselves. Paranoia can also cause a person with schizophrenia to be suspicious of friends and family.
Disruption to normal daily activities - Schizophrenia causes significant disruptions to daily functioning, both because of social difficulties and because everyday tasks become hard, if not impossible to do. A person's delusions, hallucinations, and disorganized thoughts typically prevent him or her from doing normal things like bathing, eating, or running errands.
Alcohol and drug abuse - Schizophrenics frequently develop problems with alcohol or drugs, which are often used in an attempt to self-medicate, or relieve symptoms. In addition, they may also be heavy smokers, a complicating situation as cigarette smoke can interfere with the effectiveness of medications prescribed for the disorder.
Increased suicide risk - People with schizophrenia have a high risk of attempting suicide. Any suicidal talk, threats, or gestures should be taken very seriously. People with schizophrenia are especially likely to commit suicide during psychotic episodes, during periods of depression, and in the first six months after they've started treatment.
Diagnosing schizophrenia can be quite difficult and sometimes its symptoms can be confused with other medical conditions. Symptoms of schizophrenia are quite similar to those caused by brain injury or surgery, drug abuse, chronic Vitamin B12 deficiency, or tuberculosis. There is no physical test that can prove that you have schizophrenia.
Instead, a diagnosis is made based upon your symptoms, family history, and emotional history. In some cases, it may be difficult to diagnose a first episode of schizophrenia. In this case, a doctor may have to track a case over a period of time to establish a pattern of the signs of schizophrenia.
Though there is no cure for schizophrenia, a wide variety of treatment options are available to sufferers with the disorder. Schizophrenia treatment is now quite effective in most cases, and can suppress symptoms and prevent relapse in the majority of schizophrenics. However, treatments are ongoing and usually lifelong.
Antipsychotics: The most common medical treatment for schizophrenia is the use of antipsychotic medication. 70% of people using medications for schizophrenia improve, and medicine can also cut the relapse rate for the disorder by half, reducing it to 40%. Classic schizophrenia medication includes Thorazine, Fluanxol, and Haloperidol. These medications are effective in treating the positive symptoms of schizophrenia. Newer "atypical" medications include Risperdal, Clozaril, and Aripiprazole. These medications are recommended for first-line treatment and are excellent at reducing negative symptoms.
Antidepressants: Antidepressants are recommended for those suffering from schizoaffective disorder. Antidepressants can successfully reduce the symptoms of depression in these patients.
Psychotherapy: Psychotherapy of some type is highly recommended for people suffering from schizophrenia. By adding behavioral treatments for schizophrenia to a medical treatment regimen, the rate of relapse is further reduced, to only 25%. A variety of types of psychotherapy are available to schizophrenics. Cognitive therapy, psychoeducation, and family therapy can all help schizophrenics deal with their symptoms and learn to operate in society. Social skills training is of great importance, in order to teach the patient specific ways to manage themselves in social situations.
Alternative Treatments: Alternative treatments for schizophrenia are available, although they are never recommended without first seeking medical treatment. They are most effective when paired with antipsychotics and administered under doctor supervision. In particular, dietary supplements have proven to have dramatic effects on the symptoms of schizophrenia.
Glycine Supplements: Glycine, an amino acid, is shown to help alleviate negative symptoms in schizophrenics by up to 24%.
Omega-3 Fatty Acids: Found in fish oils, Omega-3 fatty acids high in EPA can help to reduce positive and negative symptoms associated with schizophrenia.
Antioxidants: The antioxidants Vitamin E, Vitamin C, and Alpha Lipoic Acid show a 5 to 10% improvement in symptoms of the disorder.
Medicine and medications:
Stelazine: This medication is used to treat schizophrenia. It may also be used for the short-term treatment of anxiety. For anxiety, it is generally used when other medications cannot be taken. Trifluoperazine can help stabilize the symptoms of schizophrenia and improve mood, making it easier to function in everyday life. Trifluoperazine is part of a class of drugs called phenothiazines. It works by affecting the balance of certain chemicals in the brain.
Haldol Oral: Haloperidol is used to treat certain mental/mood disorders (e.g., schizophrenia, schizoaffective disorders). This medicine helps you to think more clearly, feel less nervous, and take part in everyday life. It can also help prevent suicide in people who are likely to harm themselves. It also reduces aggression and the desire to hurt others. It can decrease negative thoughts and hallucinations.
Trilafon Oral: This medication is used to treat certain mental/mood disorders (e.g., schizophrenia, manic phase of bipolar disorder, schizoaffective disorder). This medicine helps you to think more clearly, feel less nervous, and take part in everyday life. It can reduce aggressive behavior and the desire to hurt yourself/others. It may also help to decrease hallucinations (e.g., hearing/seeing things that are not there). Perphenazine is a psychiatric medication (antipsychotic-type) that works by helping to restore the balance of certain natural substances (e.g., dopamine) in the brain.
Thorazine Oral: Chlorpromazine is used to treat symptoms of certain types of mental or emotional conditions. It is also used to control hiccups, reduce anxiety and treat nausea and vomiting.
Risperdal Oral: Risperidone is used to treat certain mental/mood disorders (schizophrenia, manic phase of bipolar disorder, irritability associated with autistic disorder). This medication can help you to think clearly and function in daily life.
Abilify Oral: Aripiprazole is used to treat certain mental/mood disorders (e.g., bipolar disorder, schizophrenia). Aripiprazole is known as an antipsychotic drug (atypical type). It works by helping to restore the balance of certain natural chemicals in the brain (neurotransmitters).
Geodon Oral: This medication is used to treat certain mental/mood disorders (schizophrenia or manic/mixed episodes associated with bipolar disorder). It may be used after other medications have not been effective. Ziprasidone is a psychiatric medication (anti-psychotic type) that works by helping to restore the balance of certain natural substances (neurotransmitters) in the brain.
Clozaril Oral: This medication is used to treat certain mental/mood disorders (schizophrenia, schizoaffective disorders). Clozapine is a psychiatric medication (anti-psychotic type) that works by helping to restore the balance of certain natural substances (neurotransmitters) in the brain.
Seroquel Oral: This medication is used with or without other medications to treat certain mental/mood conditions (e.g., bipolar disorder, schizophrenia). Quetiapine is known as an anti-psychotic drug (atypical type). It works by helping to restore the balance of certain natural chemicals (neurotransmitters) in the brain.
Navane Oral: This medication is used to treat a certain mental/mood disorder (schizophrenia). Thiothixene can improve the symptoms of schizophrenia, making it easier to function in everyday life. It belongs to a class of drugs known as antipsychotics. It works by affecting the balance of certain chemicals in the brain.
Zyprexa Oral: This medication is used to treat certain mental/mood conditions (schizophrenia, bipolar mania). It works by helping to restore the balance of certain natural chemicals in the brain (neurotransmitters).
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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