About schizophrenia

What is schizophrenia?

Schizophrenia is a chronic, severe, debilitating mental illness that affects about 1% of the population, more than 2 million people in the United States alone.

  • With the sudden onset of severe psychotic symptoms, the individual is said to be experiencing acute psychosis. Psychotic means out of touch with reality or unable to separate real from unreal experiences.
  • There is no known single cause of schizophrenia. As discussed later, it appears that genetic and other biological factors produce a vulnerability to schizophrenia, with environmental factors contributing to different degrees in different individuals.
  • There are a number of various schizophrenia treatments. Given the complexity of schizophrenia, the major questions about this disorder (its cause or causes, prevention, and treatment) are unlikely to be resolved in the near future. The public should beware of those offering "the cure" for (or "the cause" of) schizophrenia.
  • Schizophrenia is one of the psychotic mental disorders and affects an individual's thoughts, behaviors, and social functioning.
  • Symptoms of schizophrenia may include delusions, hallucinations, catatonia, negative symptoms, and disorganized speech or behavior.
  • While schizophrenia used to be divided into different types of the disorder, it is now considered to have various symptoms of one inclusive disorder.
  • Children as young as 6 years of age can be found to have all the schizophrenia symptoms as their adult counterparts and to continue to have those symptoms into adulthood.
  • Although the term schizophrenia has only been in used since 1911, its symptoms have been described throughout written history.
  • Schizophrenia is considered to be the result of a complex group of genetic, psychological, and environmental factors.
  • Health-care professionals diagnose schizophrenia by gathering comprehensive medical, family, mental-health, and social/cultural information.
  • The practitioner will also either perform a physical examination or request that the individual's primary-care doctor perform one. The medical examination will usually include lab tests.
  • In addition to providing treatment that is appropriate to the diagnosis, professionals attempt to determine the presence of mental illnesses that may co-occur.
  • People with schizophrenia are at increased risk of having a number of other mental-health conditions, committing suicide, and otherwise dying earlier than people without this disorder.
  • Medications that have been found to be most effective in treating the positive symptoms of schizophrenia are first- and second-generation antipsychotics.
  • Psychosocial interventions for schizophrenia include education of family members, assertive community treatment, substance-abuse treatment, social-skills training, supported employment, cognitive behavioral therapy, and weight management.
  • Cognitive remediation, peer-to-peer treatment, and weight-management interventions remain the focus topics for research.

What is the definition of schizophrenia?

Sometimes colloquially but inaccurately referred to as split personality disorder, schizophrenia is a chronic, severe, debilitating mental illness. It affects about 1% of the population, corresponding to more than 2 million people in the United States alone. Other statistics about schizophrenia include that it affects men about one and a half times more commonly than women. It is one of the psychotic mental disorders and is characterized by symptoms of thought, behavior, and social problems. The thought problems associated with schizophrenia are described as psychosis, in that the person's thinking is completely out of touch with reality at times. For example, the sufferer may hear voices or see people that are in no way present or feel like bugs are crawling on their skin when there are none. The individual with this disorder may also have disorganized speech, disorganized behavior, physically rigid or lax behavior (catatonia), significantly decreased behaviors or feelings, as well as delusions, which are ideas about themselves or others that have no basis in reality (for example, the individual might experience paranoia, in that he or she thinks others are plotting against them when they are not).

Given that an individual can have various predominant symptoms of schizophrenia at different times as well as at the same time, the most recent Diagnostic Manual for Mental Disorders has done away with what used to be described as five types of schizophrenia.

How common is schizophrenia in children?

Although there have been fewer studies on schizophrenia in children compared to adults, researchers are finding that children as young as 6 years old can be found to have all the symptoms of their adult counterparts and to continue to have those symptoms into adulthood.

What is the history of schizophrenia?

The term schizophrenia has only been in use since 1911. Soon before that, it was deemed a separate mental illness in 1887 by Emil Kraepelin. Despite that relatively recent history, it has been described throughout written history. Ancient Egyptian, Hindu, Chinese, Greek, and Roman writings described symptoms similar to the positive symptoms of schizophrenia. During medieval times, schizophrenia, like other illnesses, was often viewed as evidence of the sufferer being possessed by spirits or evil powers.

A number of accomplished individuals suffer from schizophrenia. The film A Beautiful Mind depicts the life of John Nash, a noted scientist, and his struggles with paranoid schizophrenia. The film The Soloist explores the challenges faced by Juilliard-trained musician Nathaniel Ayers as a result of schizophrenia. Despite those prominent portrayals of people with schizophrenia, this condition, like most mental illnesses, usually remain shrouded in secrecy and shame that goes beyond maintaining confidentiality.



What are the symptoms for schizophrenia?

Schizophrenia involves a range of problems with thinking, behavior or emotions. Signs and symptoms may vary, but usually involve delusions, Hallucinations or disorganized speech, and reflect an impaired ability to function. The effect can be disabling.

Schizophrenia symptoms generally start in the mid- to late 20s. It's uncommon for children to be diagnosed with schizophrenia. Early-onset schizophrenia occurs before age 18. Very early-onset schizophrenia in children younger than age 13 is extremely rare.

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present. Schizophrenia can be difficult to recognize in the early phases.

Early signs and symptoms

The earliest indications of childhood schizophrenia may include developmental problems, such as:

  • Language delays
  • Late or unusual crawling
  • Late walking
  • Other abnormal motor behaviors — for example, rocking or arm flapping

Some of these signs and symptoms are also common in children with pervasive developmental disorders, such as autism spectrum disorder. So ruling out these developmental disorders is one of the first steps in diagnosis.

Symptoms in teenagers

Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be more difficult to recognize in this age group. This may be in part because some of the early symptoms of schizophrenia in teenagers are common for typical development during teen years, such as:

  • Withdrawal from friends and family
  • A drop in performance at school
  • Trouble sleeping
  • Irritability or depressed mood
  • Lack of motivation
  • Strange behavior
  • Substance use

Compared with schizophrenia symptoms in adults, teens may be:

  • Less likely to have delusions
  • More likely to have visual hallucinations

Later signs and symptoms

As children with schizophrenia age, more typical signs and symptoms of the disorder begin to appear. Signs and symptoms may include:

  • Delusions. These are false beliefs that are not based in reality. For example, you think that you're being harmed or harassed; that certain gestures or comments are directed at you; that you have exceptional ability or fame; that another person is in love with you; or that a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.
  • Hallucinations. These usually involve seeing or hearing things that don't exist. Yet for the person with schizophrenia, Hallucinations have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.
  • Disorganized thinking. Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad.
  • Extremely disorganized or abnormal motor behavior. This may show in several ways, from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, which makes it hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
  • Negative symptoms. This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion ― doesn't make eye contact, doesn't change facial expressions, speaks in a monotone, or doesn't add hand or head movements that normally occur when speaking. Also, the person may have reduced ability to engage in activities, such as a loss of interest in everyday activities, social withdrawal or lack ability to experience pleasure.

Symptoms may be difficult to interpret

When childhood schizophrenia begins early in life, symptoms may build up gradually. The early signs and symptoms may be so vague that you can't recognize what's wrong, or you may attribute them to a developmental phase.

As time goes on, symptoms may become more severe and more noticeable. Eventually, your child may develop the symptoms of psychosis, including hallucinations, Delusions and difficulty organizing thoughts. As thoughts become more disorganized, there's often a "break from reality" (psychosis) frequently requiring hospitalization and treatment with medication.

When to see a doctor

It can be difficult to know how to handle vague behavioral changes in your child. You may be afraid of rushing to conclusions that label your child with a mental illness. Your child's teacher or other school staff may alert you to changes in your child's behavior.

Seek medical advice if your child:

  • Has DevelopMental delays compared with other siblings or peers
  • Has stopped meeting daily expectations, such as bathing or dressing
  • No longer wants to socialize
  • Is slipping in academic performance
  • Has strange eating rituals
  • Shows excessive suspicion of others
  • Shows a lack of emotion or shows emotions inappropriate for the situation
  • Has strange ideas and fears
  • Confuses dreams or television for reality
  • Has bizarre ideas, behavior or speech
  • Has violent or aggressive behavior or agitation

These general signs and symptoms don't necessarily mean your child has childhood schizophrenia. These could indicate a phase, another mental health disorder such as Depression or an Anxiety disorder, or a medical condition. Seek medical care as soon as possible if you have concerns about your child's behavior or development.

Suicidal thoughts and behavior

Suicidal thoughts and behavior are common among people with schizophrenia. If you have a child or teen who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with him or her. Call 911 or your local emergency number immediately. Or if you think you can do so safely, take your child to the nearest hospital emergency room.



What are the causes for schizophrenia?

It's not known what causes childhood schizophrenia, but it's thought that it develops in the same way as adult schizophrenia does. Researchers believe that a combination of genetics, brain chemistry and environment contributes to development of the disorder. It's not clear why schizophrenia starts so early in life for some and not for others.

Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren't certain about the significance of these changes, they indicate that schizophrenia is a brain disease.



What are the treatments for schizophrenia?

Given the seriousness and chronic nature of schizophrenia, home remedies are not deemed appropriate treatment for this condition. There is currently not thought to be a cure for schizophrenia, but there are a number of helpful treatments available, of which medication remains the cornerstone of treatment for people with this condition. These medications are often referred to as antipsychotics since they help decrease the intensity of psychotic symptoms. Many health-care professionals prescribe one of these medications, sometimes in combination of one or more other psychiatric medications, in order to maximize the benefit for the person with schizophrenia.

Medications that are thought to be particularly effective in treating positive symptoms of schizophrenia include olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), asenapine (Saphris), lurasidone (Latuda), and iloperidone (Fanapt). These medications are the newer group of antipsychotic medications, also called second-generation antipsychotic drugs. They are known for having the ability to work quickly compared to many other psychiatric medications. As a group of medications, side effects that occur most often include sleepiness, dizziness, and increased appetite. Weight gain, which may be associated with higher blood sugar levels, elevated blood lipid levels, and sometimes increased levels of a hormone called prolactin, may also occur. Although older antipsychotic medications in this class like haloperidol (Haldol), perphenazine (Trilafon), and molindone (Moban) are more likely to cause muscle stiffness, shakiness, and very rarely uncoordinated muscle twitches (tardive dyskinesia) that can be permanent, health-care professionals appropriately monitor the people they treat for these potential side effects as well. Also, more recent research regarding all antipsychotic medications seems to demonstrate that the older (first-generation) antipsychotics are just as effective as the newer ones, both in the management of current symptoms and prevention of future symptoms, and have no higher rate of people stopping treatment because of any side effect the medications cause. Not all medications that treat schizophrenia in adults have been approved for use in treating childhood schizophrenia.

Mood-stabilizer medications like lithium (Lithobid), divalproex (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal) can be useful in treating mood swings that sometimes occur in individuals who have a diagnosable mood disorder in addition to psychotic symptoms (for example, schizoaffective disorder, depression, in addition to schizophrenia). These medications may take a bit longer to work compared to the antipsychotic medications. Some (for example, lithium, divalproex, and carbamazepine) require monitoring of medication blood levels, and some can be associated with birth defects when taken by pregnant women.

Antidepressant medications are the primary medical treatment for the depression that can often accompany schizophrenia. Examples of antidepressants that are commonly prescribed for that purpose include serotonergic (SSRI) medications that affect serotonin levels like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro); combination serotonergic/adrenergic medications (SNRIs) like venlafaxine (Effexor) and duloxetine (Cymbalta), as well as bupropion (Wellbutrin), which is a dopaminergic (affecting dopamine levels) antidepressant medication.

Despite its stigmatized history, electroconvulsive therapy (ECT) can be a viable treatment for people whose schizophrenia has inadequately responded to a number of medication trials and psychosocial interventions.

When treating pregnant individuals with schizophrenia, health-care professionals take great care to balance the need to maintain the person's more stable thoughts and behavior while minimizing the risks that medications used to treat this disorder may present. While some medications that treat schizophrenia may carry risks to the fetus in pregnancy and during breastfeeding, careful monitoring of how much medication is administered and the health of the fetus and of the mother can go a long way toward protecting the fetus from any such risks, while maximizing the chance that the fetus will grow in the healthier environment afforded by an emotionally healthy mother.



What are the risk factors for schizophrenia?

Although the precise cause of schizophrenia isn't known, certain factors seem to increase the risk of developing or triggering schizophrenia, including:

  • Having a family history of schizophrenia
  • Increased immune system activation, such as from inflammation or autoimmune diseases
  • Older age of the father
  • Some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development
  • Taking mind-altering (psychoactive or psychoactive) drugs during teen years



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