Schizophrenia is a complex mental disorder that makes it difficult to:
- Tell the difference between real and unreal experiences
- Think logically
- Have normal emotional responses,
- Behave normally in social situations
Causes, incidence, and risk factors
Schizophrenia is a complex illness. Mental health experts are not sure what causes it. However, genetic factors appear to play a role.
- Certain environmental events may trigger schizophrenia in people who are genetically at risk for it.
- You are more likely to develop schizophrenia if you have a family member with the disease.
Schizophrenia affects both men and women equally. It usually begins in the teen years or young adulthood, but may begin later in life. It tends to begin later in women, and is more mild.
Childhood-onset schizophrenia begins after age 5. Childhood schizophrenia is rare and can be difficult to tell apart from other developmental disorders of childhood, such as autism.
Schizophrenia symptoms usually develop slowly over months or years. Sometimes you may have many symptoms, and at other times you may only have a few.
People with any type of schizophrenia may have difficulty keeping friends and working. They may also have problems with anxiety, depression, and suicidal thoughts or behaviors.
At first, you may have the following symptoms:
- Irritable or tense feeling
- Difficulty sleeping
- Difficulty concentrating
As the illness continues, problems with thinking, emotions and behavior develop, including:
- Lack of emotion (flat affect)
- Strongly held beliefs that are not based in reality (delusions)
- Hearing or seeing things that are not there (hallucinations)
- Problems paying attention
- Thoughts "jump" between unrelated topics ( “loose associations”)
- Bizarre behaviors
- Social isolation
Symptoms can vary, depending on the type of schizophrenia you have.
Paranoid schizophrenia symptoms may include:
- Angry or argumentative
- False believes that others are trying to harm you or your loved ones.
Disorganized schizophrenia symptoms may include:
- Problems with thinking and expressing ideas clearly
- Childlike behavior
- Showing little emotion
Catatonic schizophrenia symptoms may include:
- Lack of activity
- Muscles and posture may be rigid
- Grimaces or other odd expressions on the face
- Does not respond much to other people
Undifferentiated schizophrenia symptoms may include symptoms of more than one other type of schizophrenia.
People with residual schizophrenia have some symptoms, but not as many as those who are in a full-blown episode of schizophrenia.
Signs and tests
There are no medical tests to diagnose schizophrenia. A psychiatrist should examine the patient to make the diagnosis. The diagnosis is made based on a thorough interview of the person and family members. The doctor will ask questions about:
- How long the symptoms have lasted
- How the person's ability to function has changed
- Developmental background
- Genetic and family history
- How well medications have worked
Brain scans (such as CT or MRI) and blood tests may help to rule out other disorders that have similar symptoms to schizophrenia.
During an episode of schizophrenia, you may need to stay in the hospital for safety reasons.
Antipsychotic medications are the most effective treatment for schizophrenia. They change the balance of chemicals in the brain and can help control symptoms/
These medications are usually helpful, but they can cause side effects. Many of these side effects can be improved, and should not prevent people from seeking treatment for this serious condition.
Common side effects from antipsychotics may include:
- Sleepiness (sedation)
- Weight gain
- Increased chance of diabetes and high cholesterol
- Feelings of restlessness or "jitters"
- Slowed movements
Long-term use of antipsychotic medications may increase your risk for a movement disorder called tardive dyskinesia. This condition causes repeated movements that you cannot control, especially around the mouth. Call your doctor right away if you think you may have this condition.
When schizophrenia does not improve with several antipsychotics, the medication clozapine can be helpful. Clozapine is the most effective medication for reducing schizophrenia symptoms, but it also tends to cause more side effects than other antipsychotics.
Schizophrenia is a life-long illness. Most people with this condition need to stay on antipsychotic medication for life.
SUPPORT PROGRAMS AND THERAPIES
Supportive therapy may be helpful for many people with schizophrenia. Behavioral techniques, such as social skills training, can be used to improve social and work functioning. Job-training and relationship building classes are important.
Family members of a person with schizophrenia should be educated about the disease and offered support. Programs that emphasize outreach and community support services can help people who lack family and social support.
Family members and caregivers are often encouraged to help people with schizophrenia stick to their treatment.
It is important that the person with schizophrenia learns how to:
- Take medications correctly and how to manage side effects
- Notice the early signs of a relapse and what to do if symptoms return
- Cope with symptoms that occur even while taking medication. A therapist can help.
- Manage money
- Use public transportation
The outlook for a person with schizophrenia is difficult to predict. Most of the time, symptoms improve with medication. However, others may have difficulty functioning and are at risk for repeated episodes, especially during the early stages of the illness.
People with schizophrenia may need supported housing, job training, and other community support programs. People with the most severe forms of this disorder may not be able to live alone. Group homes or other long-term, structured places to live may be needed.
Symptoms will return if a person with schizophrenia does not take their medication.
Having schizophrenia increases your risk for:
- Developing a problem with alcohol or drugs: This is called a substance abuse problem. Using alcohol or other drugs increases the chances your symptoms will return.
- Physical illness: People with schizophrenia may become physically sick, because of an inactive lifestyle and side effects from medication. A physical illness may not be detected because of poor access to medical care and difficulties talking to health care providers.
Calling your health care provider
Call your health care provider if:
- Voices are telling you to hurt yourself or others.
- You feel the urge to hurt yourself or others.
- You are feeling hopeless or overwhelmed.
- You are seeing things that aren't really there.
- You feel you cannot leave the house.
- You are unable to care for yourself.
There is no known way to prevent schizophrenia.
Symptoms can be prevented by taking medication. You should take your medication exactly as your doctor told you to. Symptoms will return if you stop taking your medication.
Always talk to your doctor if you are thinking about changing or stopping your medications. See your doctor or therapist regularly.
Leucht S, Corves C, Arbter D, Engel RR, Li C, Davis JM. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet. 2009;373:31-41. Epub 2008 Dec 6.
Freudenreich O, Weiss AP, Goff DC. Psychosis and schizophrenia. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 28.
Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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