Schizophrenia

Overview

Schizophrenia is a mental disorder characterised by a general dissociation from reality, delusions and hallucinations. While the term refers to a single condition, in clinical psychology, schizophrenia comprises a spectrum of mental conditions. These include the following:

• Schizotypal personality disorders
• Delusional disorders
• Brief psychosis or psychotic disorders
• Schizophreniform disorders
• Schizoaffective disorders

Typically, schizophrenia begins to manifest at different ages based on biological gender. Males tend to demonstrate symptoms between 15 to 25 years of age, while, in females, the clinical markers start showing up between the ages of 25 to 35.

In addition, male and female patients usually experience the effects differently. For example, delusions seem to be more common among females, while males are more affected by a loss of cognitive ability and rational thinking.

In the case of children, schizophrenia is rare but possible. If it develops, the disorder tends to be significantly more severe. As such, the early onset of the condition is vastly more challenging to treat.

Types of Schizophrenia:

There are various types of schizophrenia.

Paranoid schizophrenia: This is the most common type. It may emerge later in life than in other forms. Hallucinations and/or delusions are among the symptoms, but your speech and emotions may remain unaffected.

Hebephrenic schizophrenia: This is also known as 'disorganised schizophrenia', usually appearing between the ages of 15 and 25. Symptoms include disorganized behaviours and thoughts, as well as short-lived delusions and hallucinations. You may have disorganized speech patterns, and others may struggle to understand you.

People with disorganized schizophrenia frequently display little or no emotion in their facial expressions, voice tone, or mannerisms.

Catatonic schizophrenia: This is the most uncommon schizophrenia diagnosis, distinguished by unusual, limited, and sudden movements. You may frequently switch between being very active and very still. You may not say much, but mimic other people's speech and movement.

Undifferentiated schizophrenia: Your diagnosis may include symptoms of paranoid, hebephrenic, or catatonic schizophrenia, but it does not clearly fit into one of these categories.

Residual schizophrenia: If you have a history of psychosis but only experience negative symptoms (such as slow movement, poor memory, lack of concentration, and poor hygiene), you could be diagnosed with residual schizophrenia.

Simple schizophrenia: Negative symptoms (such as slow movement, poor memory, lack of concentration, and poor hygiene) are most noticeable early on and worsen, while positive symptoms (such as hallucinations, delusions, and disorganized thinking) are uncommon.

Cenesthopathy schizophrenia: Cenesthopathic schizophrenia patients experience unusual bodily sensations.

Schizophrenia with no specific diagnosis: Symptoms meet the general criteria for a diagnosis but do not fall into any of the above categories.

Symptoms:

Schizophrenia is a mental disorder that affects how a person thinks, feels, and behaves. It can cause various symptoms, such as:

• Hallucinations: Seeing, hearing, smelling, or feeling unreal things, such as voices, lights, or insects.
• Delusions: Having false beliefs that are not based on reality, such as being persecuted, famous, or controlled by others.
• Disorganized thinking and speech: Having trouble forming coherent thoughts and sentences, or speaking in a difficult way to understand or follow.
• Abnormal motor behaviour: Acting in a strange or unpredictable way, such as being agitated, catatonic, or silly.
• Negative symptoms: Having reduced or lack of normal functions, such as emotion, motivation, or social interaction.

Schizophrenia is a complex and chronic condition that requires professional treatment and support. If you or someone you know is experiencing any of these symptoms, please seek help from a doctor or counsellor as soon as possible.

Causes:

Schizophrenia is a complex mental disorder that has no single cause. A combination of factors, such as genetics, brain chemistry, brain structure, pregnancy and birth complications, and environmental triggers, influences it. Some of these factors are explained below:

• Genetics: Schizophrenia tends to run in families, but no specific gene is responsible. It is more likely that different combinations of genes make people more vulnerable to the condition.
• Brain chemistry: Schizophrenia may be related to the abnormal functioning of neurotransmitters, which are chemicals that carry messages between brain cells. In particular, dopamine and glutamate may play a role in schizophrenia.
• Brain structure: Studies have shown that people with schizophrenia have subtle differences in the structure of their brains, such as shrinkage or circuitry dysfunction. These changes may affect how the brain processes information.
• Pregnancy and birth complications: Research has shown that people who develop schizophrenia are more likely to have experienced complications before and during their birth, such as low birth weight, premature labour, or lack of oxygen. These factors may have a subtle effect on brain development.
• Environmental triggers: Stressful or traumatic life events, such as bereavement, divorce, abuse, or drug use, may trigger schizophrenia in people who are already at risk. These events may affect how the brain responds to stress and emotions.

Schizophrenia is a treatable condition that requires professional help and support. Medication, psychotherapy, and psychosocial interventions can help reduce the symptoms and improve the quality of life of people with schizophrenia. If you or someone you know is experiencing any signs of schizophrenia, please seek help from a doctor or counsellor as soon as possible.

Risk factors:

A risk factor is a condition that, while not causing the disease, is associated with it. A high cholesterol level (hypercholesterolemia) is one risk factor for a heart attack. It does not imply that it will cause a heart attack because not everyone with high cholesterol will have one, and not all heart attack victims have high cholesterol. However, it increases the risk of having a heart attack.

As a result, several risk factors for developing schizophrenia have been identified, though they do not directly cause it. Environmental factors include obstetric complications, substance abuse, and certain viruses. The genetic aspect is the most important, accounting for 80% of its presence. A family is more likely to present a case of schizophrenia if another family member has already been diagnosed with the disease. The risk increases proportionately to the degree of kinship with the affected family member. Genetics play a significant role in this disease (around 80%), but it is not limited to a single gene.

According to recent theories, the presence of a number of mutated genes predisposes an individual to develop schizophrenia. In other words, more than one gene must be mutated to develop the disease, just as it is with other complex medical complaints like diabetes. This inheritance increases the risk of developing schizophrenia if certain environmental factors cause the onset of clinical symptoms.

Possible Complications:

While there are no visible physical effects, leaving schizophrenia untreated can cause severe mental degradation and pose a risk to the patient and others around them. Typically, undiagnosed or untreated cases of schizophrenia can lead to the following:

• Suicidal Tendencies

Due to the condition's drastic impact on a patient's mental faculties and cognitive abilities, most schizophrenic patients tend to develop suicidal thoughts. If left unaddressed through clinical counselling, this can worsen, causing an individual to attempt suicide.

• Anxiety Disorders & Other Related Conditions

Medical experts have observed a correlation between schizophrenia and other mental disorders, such as Obsessive-Compulsive Disorder (OCD) or other anxiety-related conditions. This is primarily due to schizophrenia causing severe delusional and behavioural dysfunction. When left untreated, schizophrenic patients will experience more pronounced effects concerning these mentioned symptoms.

• Social Liabilities & Victimization

While there is a general misconception of schizophrenic patients being violent, it is, in fact, the opposite. Usually, people suffering from the disorder have little to no association with their immediate surroundings.
This can cause them to behave in a manner perceived as unnatural or dangerous. Consequently, this can make them a target in public settings, often leading to violence and physical altercations.

• Drug & Alcohol Abuse

It is not uncommon for people with schizophrenia to become overly dependent on recreational drugs and alcohol. This is partly due to patients experiencing immense paranoia, social anxiety and mental stress. However, such behavioural patterns only worsen the condition's effects, impairing their mental faculties.

• Severe Social & Occupational Dysfunction

In almost all cases, schizophrenic patients will experience some form of dysfunctionality in their personal and professional lives. However, leaving the condition unmanaged or untreated can make the situation even worse.
For example, schizophrenia negatively impacts a person’s ability to have relatively normal social relationships. However, medications and psychotherapy can prove to be effective in mitigating this specific concern.

Prevention:

There is no guaranteed way to prevent schizophrenia, but sticking to the treatment plan can help prevent relapses or worsening symptoms. Furthermore, researchers hope that learning more about risk factors for schizophrenia will lead to earlier detection and treatment.
 

When To Consult A Doctor?

1. Upon Manifestation of Symptoms

The initial clinical signs of schizophrenia are general paranoia, social withdrawal and mental and cognitive impairment alongside a muted emotional display. As such, if a person starts deviating significantly from their past behavioural patterns while demonstrating any of the mentioned symptoms, it may indicate schizophrenia or other related mental disorders. However, it is critical not to make assumptions and visit a clinical psychologist for a proper diagnosis.

2. Active Psychotic Break

The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists five primary markers for schizophrenia. These include delusional behaviour, hallucinations, incoherent or disorganised speech, unusual movements and gestures and negative symptoms (absence of normal standard behavioural patterns). An active psychotic break refers to the manifestation of at least two of the mentioned clinical signs.

3. Regular Counselling

General counselling is immensely helpful in dealing with daily emotional stressors and other related anxiety. However, a meaningful discussion around persistent mental stress or existing conditions can help pinpoint specific indicators for the disorder. In addition, a cursory visit to a clinical psychologist can help assess the probability of a person developing schizophrenia if the condition runs in the family.

Diagnosis:

Clinical Diagnosis Based on the DSM-5

According to the DSM-5, diagnosing schizophrenia requires three specific conditions to be met. First, at least two of the five primary symptoms must be present. Second, the symptoms must persist for at least a month. The related effects must also be present for at least six months. Finally, the individual in question must have faced some form of occupational or social dysfunction, meaning their professional or personal life was affected due to the associated symptoms. Only when all three of these requirements are met can a clinical psychologist render a confirmed diagnosis for the condition.

Additional/Supplementary Tests

There are no other medical or diagnostic tests for schizophrenia. However, healthcare providers may conduct a few clinical examinations to rule out the possibility of the symptoms being caused by another condition. These include the following:

• Imaging Tests

Medical professionals may rely on a Magnetic Resonance Imaging (MRI) or a Computerized Tomography (CT) scan to rule out issues such as strokes, traumatic brain injuries or tumours.

• Urine, Blood & Cerebrospinal Fluid Tests

These types of clinical examinations primarily look for elevations or general alterations in bodily fluids to eliminate the possibility of the symptoms being caused by infection, poisoning or internal biological toxicity.

• Electroencephalogram (ECG)

Used for assessing brain activity, an ECG can help determine if a specific neurological disorder, like epilepsy, is the causal factor for the manifested symptoms.

Treatment:

Schizophrenia is not curable. However, the condition’s related effects and symptoms can be managed effectively through various treatment options. Unlike other mental disorders, schizophrenia requires a combination of clinical remedies. As such, these include the following:

• Typical/First-Generation Antipsychotics

These medications affect how the patient's brain uses dopamine, a biological chemical that facilitates cell communication. Some examples are haloperidol, loxapine and fluphenazine.

• Atypical/Second-Generation Antipsychotics

These drugs inhibit serotonin and dopamine usage in the brain. One such example is Clozapine, which is particularly effective in mitigating the symptoms of schizophrenia.

Nonetheless, most atypical antipsychotics have prominent side effects and are only ever prescribed when other medications do not work. In addition, consistent blood monitoring may be necessary to avoid serious complications related to these drugs.

• Psychotherapy

Cognitive behavioural therapy can help schizophrenic patients better manage the condition. Long-term counselling alongside such methods is also helpful in enabling people to deal with the associated anxiety, paranoia or depression. In addition, consistent psychotherapy helps patients with treatment adherence. In most cases of schizophrenia, affected individuals do not recognise or understand that they suffer from the disorder. Thus, these therapeutic methods increase the probability of patients continuing their treatment.

• Electroconvulsive Therapy (ECT)

Medication or psychotherapy may not be effective in more severe cases. In such instances, the patient may be at risk of harming themselves or others around them. Clinical psychologists will usually recommend ECT for such patients.

The procedure involves the application of an electric current to the scalp, which stimulates specific parts of the brain. That stimulation causes a minor seizure, alleviating some of the condition's related symptoms. ECT is highly effective for schizophrenic patients with suicidal tendencies.

Additional Information

Difference Between Schizophrenia and Psychosis

There are some strong connections between psychosis and schizophrenia. However, there are also specific distinctions between the two. In clinical terms, psychosis is a group of symptoms characterised by a disassociation from reality and a person's immediate surroundings. As such, psychosis may be a clinical marker in schizophrenic patients. Conversely, schizophrenia includes a broad spectrum of related disorders, all of which may have psychosis as part of their symptoms.

Underlying Cause of Schizophrenia

Certain factors have been linked to increasing a person's risk of developing schizophrenia. These include the following:

• Genetic history
• Environmental stressors and triggers
• Congenital disabilities and developmental issues
• Excessive usage of recreational drugs
• Chemical imbalances in the brain

Regardless, medical research still has not conclusively identified the causal factor behind the condition. This compounds the issues related to a general lack of understanding of the disorder's effects, complications and risks.

Is Schizophrenia A Lifelong Condition?

Schizophrenia is incurable and lasts the entirety of a person's life. However, the treatment can alleviate the associated symptoms for some time. But the condition may return at any given time. That is why medical experts do not consider a patient to have recovered from the disorder even if they stop demonstrating the symptoms or clinical markers.

Instead, they are considered to be 'in remission'. This is why, it is necessary, if not mandatory, for affected individuals to continue with their treatment and medications even if they have stopped experiencing related signs such as hallucinations and delusions.