What is Schizophrenia?

Schizophrenia is a severe and chronic mental disorder that affects approximately one percent of the population. Symptoms include losing touch with reality, disruption to normal emotions and behaviors as well as memory problems. Schizophrenia is a treatable mental disorder, but it requires lifelong management. Schizophrenia is caused by a combination of things, including genetics, environment and brain chemistry. While there is no cure for this disorder, it can be managed through medication, psychotherapy and other care services.

Types of Schizophrenia

Previously there were several schizophrenia types classified underneath the diagnosis of Schizophrenia, including:

• Paranoid Schizophrenia
• Catatonic Schizophrenia
• Schizoaffective Disorder
• Childhood Schizophrenia
• Disorganized or Hebephrenic Schizophrenic

However, in 2013 the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-V) changed the classification of these types to be included under the general diagnosis of Schizophrenia. The reason behind the elimination of these subtypes was due to the low reliability of of diagnosis of these types, as well as the fact that they did not help determine the best treatment for each patient.

Schizophrenia Symptoms

The onset of schizophrenia is typically in the late teens to early 20s for men, and in the late 20s to early 30s for women. For a diagnosis of schizophrenia, a person must show two or more of the following symptoms, each present for a significant period of time during a one-month period:

• Delusions: False or erroneous beliefs that usually involve a misinterpretation of perceptions or experiences. Someone may feel as if he’s being ridiculed, spied on or followed, or he may believe comments, song lyrics, newspaper articles or other environmental cues are directed at him
• Hallucinations: These are commonly auditory (hearing voices), but some people with schizophrenia also report seeing, smelling, touching and even tasting things that aren’t there.
• Disorganized speech, classified by incoherence or speaking about unrelated ideas
• Very disorganized or catatonic behavior, classified by a dramatic reduction in activity
• Negative symptoms, like diminished emotional expression or decreased motivation

The symptoms above can be categorized into three categories:

• Positive schizophrenia symptoms are delusions, racing thoughts or hallucinations
• Negative symptoms of schizophrenia disorder are apathy, lack of emotion and poor social functioning
• Cognitive schizophrenia symptoms are difficulty concentrating, following instruction, organizing thoughts, or memory problems. 

Early Signs of Schizophrenia

Some early signs of Schizophrenia that can be an indicator of Schizophrenia, include:

• Hearing or seeing something that isn't there
• Constant feeling of being watched
• A change in personality

If you or someone you know is experiencing any signs of Schizophrenia for an entended period of time, please reach out to a mental health provider. Baptist Health has many mental health professionals who can meet with you and determine a correct diagnosis for your symptoms.

Other symptoms of schizophrenia include:

• A markedly decreased level of functioning in one or more major areas, such as work, interpersonal relations or self-care
• Continuous signs of a behavioral disturbance persisting for at least six months, with at least one month of the symptoms mentioned above

Schizoaffective disorder and depressive or bipolar disorder with psychotic features can be ruled out if either no major depressive or manic episodes have occurred alongside symptoms or if a person’s mood episodes are only apparent while he or she is exhibiting the major symptoms of schizophrenia. Symptoms must not be attributable to the physiological effects of a substance (alcohol, drugs, medication) or another medical condition. If someone is on the autism spectrum, his or her diagnosis requires the presence of prominent delusions or hallucinations.

Diagnosis

Diagnosing schizophrenia requires a thorough physical and psychological evaluation. Your behavioral health provider will use the criteria for schizophrenia listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to determine if your symptoms indicate the condition.

Diagnostic tests include:

Physical examination: Your provider will perform a physical exam and ask questions about your health to determine if your symptoms could be linked to an underlying physical health problem, medication side effects or unhealthy behaviors (like drug use). Your provider may also order tests – like an MRI or CT scan – that help rule out conditions with similar symptoms.

Psychiatric evaluation: Your behavioral health provider will observe your appearance and demeanor and ask questions about your general thoughts, moods, delusions, hallucinations, substance use and thoughts of violence or suicide. You will likely discuss your personal and family history of these symptoms.

Causes

The cause of schizophrenia is unknown, but researchers think a combination of genetics, brain chemistry and environmental factors contributes to its development. Problems with brain chemicals, called neurotransmitters, may contribute to schizophrenia. And, imaging studies have shown differences in brain and central nervous system structures of people with schizophrenia.

Schizophrenia Risk Factors

Risk factors that could contribute to schizophrenia include:

Family history: Schizophrenia appears to have some genetic influence.

Father’s age: A child’s chance of developing schizophrenia may increase with the age of his or her father.

Increased immune system activity: Some autoimmune or inflammatory conditions appear to carry an increased risk for schizophrenia.

Pregnancy or birth complications: Malnutrition and exposure to certain pathogens or toxins may impact brain development.

Psychoactive or psychotropic drug use: Taking mind-altering drugs, especially during the teen years and young adulthood, may increase a person’s risk.

Prevention

Schizophrenia cannot be prevented. But there are some lifestyle adjustments and self-care strategies that can help you cope.

Stick to your treatment plan: Therapy, counseling and medications prescribed by your provider are the best ways to manage your symptoms.

Seek support: Joining a support group can help you connect with others facing similar issues and discuss helpful management strategies. And social services may be able to assist you with affordable housing, transportation and other daily activities.

Try relaxation and stress-management techniques: Explore yoga, gentle exercise routines, meditation and other practices that encourage muscle relaxation, deep breathing, balance and positive thought.

Prognosis

There is no known cure for schizophrenia, but treatments can reduce symptoms, decrease the likelihood that new episodes of psychosis will occur, shorten the duration of psychotic episodes and help people with schizophrenia live productive and satisfying lives.

Treatment

Most people with schizophrenia benefit from a combination of medication and psychotherapy delivered by a psychiatrist, psychologist or other behavioral health professional.

Medication
Antipsychotic medications are the most commonly prescribed drugs for schizophrenia. They’re thought to control symptoms by affecting the brain neurotransmitter dopamine. Your provider will manage your signs and symptoms at the lowest possible dose. 

Other medications also may help, such as antidepressants or anti-anxiety drugs. It can take several weeks to notice an improvement with any of these drugs. And, because medications for schizophrenia can cause serious side effects, people may be reluctant to take them. Willingness to cooperate with treatment may affect a provider’s drug choice.

Psychosocial Interventions
After symptoms subside with medication, these interventions are important for mental health maintenance. They may include:

• Psychotherapy to normalize thought patterns
• Social skills training
• Family therapy, which provides support and education
• Occupational rehabilitation and supported employment

Hospitalization
During crisis periods, people with schizophrenia may be hospitalized to prevent self-harm and ensure safety, proper nutrition, adequate sleep and basic hygiene.

Electroconvulsive Therapy
These treatments are typically reserved for people who do not respond to medication(s) and/or talk therapy.

Complications

Complications of untreated schizophrenia can include:

• Abuse of alcohol or drugs
• Anxiety disorders and obsessive-compulsive disorder (OCD)
• Depression
• Homelessness
• Inability to work or attend school
• Legal and financial problems
• Medical problems
• Overall poor health
• Self-injury
• Social isolation
• Suicidal thoughts or actions