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symptoms may leave them fearful and withdrawn.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’s 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.
Making A Diagnosis
It is important to rule out other illnesses, as sometimes people
suffer severe mental symptoms or even psychosis due to
undetected underlying medical conditions. For this reason, a
medical history should be taken and a physical examination and
laboratory tests should be done to rule out other possible
causes of the symptoms before concluding that a person has
schizophrenia. In addition, since commonly abused drugs may
cause symptoms resembling schizophrenia, blood or urine samples
from the person can be tested at hospitals or physicians’
offices for the presence of these drugs.
At times, it is difficult to tell one mental disorder from
another. For instance, some people with symptoms of
schizophrenia exhibit prolonged extremes of elated or depressed
mood, and it is important to determine whether such a patient
has schizophrenia or actually has a manic-depressive (or
bipolar) disorder or major depressive disorder. Persons whose
symptoms cannot be clearly categorized are sometimes diagnosed
as having a “schizoaffective disorder.”
Can Children Have Schizophrenia?
Children over the age of five can develop schizophrenia, but it
is very rare before adolescence. Although some people who later
develop schizophrenia may have seemed different from other
children at an early age, the psychotic symptoms of
schizophrenia - hallucinations and delusions - are extremely
uncommon before adolescence.
The World of People With Schizophrenia
Distorted Perceptions of Reality People with schizophrenia may
have perceptions of reality that are strikingly different from
the reality seen and shared by others around them. Living in a
world distorted by hallucinations and delusions, individuals
with schizophrenia may feel frightened, anxious, and confused.
In part because of the unusual realities they experience, people
with schizophrenia may behave very differently at various times.
Sometimes they may seem distant, detached, or preoccupied and
may even sit as rigidly as a stone, not moving for hours or
uttering a sound. Other times they may move about constantly -
always occupied, appearing wide-awake, vigilant, and alert.
Hallucinations and Illusions Hallucinations and illusions are
disturbances of perception that are common in people suffering
from schizophrenia. Hallucinations are perceptions that occur
without connection to an appropriate source. Although
hallucinations can occur in any sensory form - auditory (sound),
visual (sight), tactile (touch), gustatory (taste), and
olfactory (smell) - hearing voices that other people do not hear
is the most common type of hallucination in schizophrenia.
Voices may describe the patient’s activities, carry on a
conversation, warn of impending dangers, or even issue orders to
the individual. Illusions, on the other hand, occur when a
sensory stimulus is present but is incorrectly interpreted by
the individual.
Delusions Delusions are false personal beliefs that are not
subject to reason or contradictory evidence and are not
explained by a person’s usual cultural concepts. Delusions may
take on different themes. For example, patients suffering from
paranoid-type symptoms - roughly one-third of people with
schizophrenia - often have delusions of persecution, or false
and irrational beliefs that they are being cheated, harassed,
poisoned, or conspired against. These patients may believe that
they, or a member of the family or someone close to them, are
the focus of this persecution. In addition, delusions of
grandeur, in which a person may believe he or she is a famous or
important figure, may occur in schizophrenia. Sometimes the
delusions experienced by people with schizophrenia are quite
bizarre; for instance, believing that a neighbor is controlling
their behavior with magnetic waves; that people on television
are directing special messages to them; or that their thoughts
are being broadcast aloud to others.
Substance Abuse Substance abuse is a common concern of the
family and friends of people with schizophrenia. Since some
people who abuse drugs may show symptoms similar to those of
schizophrenia, people with schizophrenia may be mistaken for
people “high on drugs.” While most researchers do not believe
that substance abuse causes schizophrenia, people who have
schizophrenia often abuse alcohol and/or drugs, and may have
particularly bad reactions to certain drugs. Substance abuse can
reduce the effectiveness of treatment for schizophrenia.
Stimulants (such as amphetamines or cocaine) may cause major
problems for patients with schizophrenia, as may PCP or
marijuana. In fact, some people experience a worsening of their
schizophrenic symptoms when they are taking such drugs.
Substance abuse also reduces the likelihood that patients will
follow the treatment plans recommended by their doctors.
Schizophrenia and Nicotine The most common form of substance
use disorder in people with schizophrenia is nicotine dependence
due to smoking. While the prevalence of smoking in the U.S.
population is about 25 to 30 percent, the prevalence among
people with schizophrenia is approximately three times as high.
Research has shown that the relationship between smoking and
schizophrenia is complex. Although people with schizophrenia may
smoke to self medicate their symptoms, smoking has been found to
interfere with the response to antipsychotic drugs. Several
studies have found that schizophrenia patients who smoke need
higher doses of antipsychotic medication. Quitting smoking may
be especially difficult for people with schizophrenia, because
the symptoms of nicotine withdrawal may cause a temporary
worsening of schizophrenia symptoms. However, smoking cessation
strategies that include nicotine replacement methods may be
effective. Doctors should carefully monitor medication dosage
and response when patients with schizophrenia either start or
stop smoking.
Disordered Thinking Schizophrenia often affects a person’s
ability to “think straight.” Thoughts may come and go rapidly;
the person may not be able to concentrate on one thought for
very long and may be easily distracted, unable to focus
attention.
People with schizophrenia may not be able to sort out what is
relevant and what is not relevant to a situation. The person may
be unable to connect thoughts into logical sequences, with
thoughts becoming disorganized and fragmented. This lack of
logical continuity of thought, termed “thought disorder,” can
make conversation very difficult and may contribute to social
isolation. If people cannot make sense of what an individual is
saying, they are likely to become uncomfortable and tend to
leave that person alone.
Emotional Expression People with schizophrenia often show
“blunted” or “flat” affect. This refers to a severe reduction in
emotional expressiveness. A person with schizophrenia may not
show the signs of normal emotion, perhaps may speak in a
monotonous voice, have diminished facial expressions, and appear
extremely apathetic. The person may withdraw socially, avoiding
contact with others; and when forced to interact, he or she may
have nothing to say, reflecting “impoverished thought.”
Motivation can be greatly decreased, as can interest in or
enjoyment of life. In some severe cases, a person can spend
entire days doing nothing at all, even neglecting basic hygiene.
These problems with emotional expression and motivation, which
may be extremely troubling to family members and friends, are
symptoms of schizophrenia - not character flaws or personal
weaknesses.
Normal Versus Abnormal At times, normal individuals may feel,
think, or act in ways that resemble schizophrenia. Normal people
may sometimes be unable to “think straight.” They may become
extremely anxious, for example, when speaking in front of groups
and may feel confused, be unable to pull their thoughts
together, and forget what they had intended to say. This is not
schizophrenia. At the same time, people with schizophrenia do
not always act abnormally. Indeed, some people with the illness
can appear completely normal and be perfectly responsible, even
while they experience hallucinations or delusions. An
individual’s behavior may change over time, becoming bizarre if
medication is stopped and returning closer to normal when
receiving appropriate treatment.