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SchizophreniaBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/schizophrenia/DS00196
Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and disordered thinking and behavior.
Contrary to some popular belief, schizophrenia isn't split personality or multiple personality. The word "schizophrenia" does mean "split mind," but it refers to a disruption of the usual balance of emotions and thinking.
Schizophrenia is a chronic condition, requiring lifelong treatment.
Schizophrenia symptoms also can be attributed to other mental illnesses, and no one symptom can pinpoint a diagnosis of schizophrenia. In men, schizophrenia symptoms typically start in the teens or 20s. In women, schizophrenia symptoms typically begin in the 20s or early 30s. It's uncommon for children to be diagnosed with schizophrenia and rare for those older than 45.
Signs and symptoms of schizophrenia generally are divided into three categories — positive, negative and cognitive.
In schizophrenia, positive symptoms reflect an excess or distortion of normal functions. These active, abnormal symptoms may include:
- Delusions. These beliefs are not based in reality and usually involve misinterpretation of perception or experience. They are the most common of schizophrenic symptoms.
- Hallucinations. These usually involve seeing or hearing things that don't exist, although hallucinations can be in any of the senses. Hearing voices is the most common hallucination among people with schizophrenia.
- Thought disorder. Difficulty speaking and organizing thoughts may result in stopping speech midsentence or putting together meaningless words, sometimes known as word salad.
- Disorganized behavior. This may show in a number of ways, ranging from childlike silliness to unpredictable agitation.
Negative symptoms refer to a diminishment or absence of characteristics of normal function. They may appear with or without positive symptoms. They include:
- Loss of interest in everyday activities
- Appearing to lack emotion
- Reduced ability to plan or carry out activities
- Neglect of personal hygiene
- Social withdrawal
- Loss of motivation
Cognitive symptoms involve problems with thought processes. These symptoms may be the most disabling in schizophrenia because they interfere with the ability to perform routine daily tasks. A person with schizophrenia may be born with these symptoms. They include:
- Problems with making sense of information
- Difficulty paying attention
- Memory problems
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 in teenagers are common during teen years, such as:
- Withdrawal from friends and family
- A drop in performance at school
- Trouble sleeping
Compared with schizophrenia symptoms in adults, teens may be:
- Less likely to have delusions
- More likely to have visual hallucinations
When to see a doctor
People with schizophrenia often lack awareness that their difficulties stem from a mental illness that requires medical attention. So it often falls to family or friends to get them help.
Helping someone who may have schizophrenia
If you think someone you know may have symptoms of schizophrenia, talk to him or her about your concerns. Although you can't force someone to seek professional help, you can offer encouragement and support and help your loved one find a qualified doctor or mental health provider.
If your loved one poses a danger to self or others or can't provide his or her own food, clothing or shelter, you may need to call the police or other emergency responders for help. In some cases, emergency hospitalization may be needed. Laws on involuntary commitment for mental health treatment vary by state. You can contact community mental health agencies or police departments in your area for details.
Suicidal thoughts and behavior are common among people with schizophrenia. If you suspect or know that your loved one is considering suicide, seek immediate help. Contact a doctor, mental health provider or other health care professional.
It's not known what causes schizophrenia, but researchers believe that a combination of genetics and environment contributes to development of the disease.
Problems with certain naturally occurring brain chemicals, including the neurotransmitters dopamine and glutamate, also 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 support evidence that schizophrenia is a brain disease.
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
- Exposure to viruses, toxins or malnutrition while in the womb, particularly in the first and second trimesters
- Stressful life circumstances
- Older paternal age
- Taking psychoactive drugs during adolescence and young adulthood
Left untreated, schizophrenia can result in severe emotional, behavioral and health problems, as well as legal and financial problems that affect every area of life. Complications that schizophrenia may cause or be associated with include:
- Self-destructive behavior, such as self-injury
- Abuse of alcohol, drugs or prescription medications
- Family conflicts
- Inability to work or attend school
- Health problems from antipsychotic medications
- Being a victim or perpetrator of violent crime
- Heart disease, often related to heavy smoking
Preparing for your appointment
If you're seeking help for someone with mental illness, you may start by seeing his or her family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a psychiatrist.
It's a good idea to prepare for the appointment. Here's some information to help you.
What you can do
- Write down any symptoms your loved one is experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of medications, vitamins and supplements that he or she is taking.
- Go with your loved one to the appointment. Getting the information firsthand will help you know what you're facing and what you need to do for your loved one.
- Write down questions to ask the doctor.
Preparing a list of questions will help you make the most of your time with the doctor. For schizophrenia, some basic questions to ask include:
- What is likely causing the symptoms or condition?
- Other than the most likely cause, what are other possible causes for the symptoms or condition?
- What kinds of tests are needed?
- Is this condition likely temporary or chronic?
- What's the best treatment?
- What are the alternatives to the primary approach you're suggesting?
- How can I be most helpful and supportive?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared to ask the doctor, don't hesitate to ask questions during the appointment.
What to expect from the doctor
The doctor is likely to ask you a number of questions, including:
- What are your loved one's symptoms, and when did you first notice them?
- Have symptoms been continuous or occasional?
- Has your loved one talked about suicide?
- How is your loved one functioning in daily life — is he or she eating regularly, going to work or school, bathing regularly?
- Has your loved one been diagnosed with any other medical conditions?
- What medications is your loved one currently taking?
What you can do in the meantime
If your loved one talks of suicide; isn't attending to basic needs, such as eating, bathing, and so on; or becomes violent, seek immediate help. If your loved one is violent, don't try to subdue him or her yourself. Call 911 or your local emergency number for the police.
Tests and diagnosis
When doctors suspect someone has schizophrenia, they typically ask for medical and psychiatric histories, conduct a physical exam, and run medical and psychological tests and exams. These tests and exams generally include:
- Laboratory tests. These may include a complete blood count (CBC), other blood tests that may help to rule out other conditions with similar symptoms, screening for alcohol and drugs, and imaging studies, such as an MRI or CT scan.
- Psychological evaluation. A doctor or mental health provider will check mental status by observing appearance and demeanor and asking about thoughts, moods, delusions, hallucinations, substance abuse, and potential for violence or suicide.
Diagnostic criteria for schizophrenia
To be diagnosed with schizophrenia, a person must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions.
Diagnosis of schizophrenia involves ruling out other mental health disorders and determining that symptoms aren't due to substance abuse, medication or a medical condition. In addition, a person must:
- Have at least two of the common symptoms of the disorder — delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or presence of negative symptoms for a significant amount of time during one month
- Experience significant impairment in the ability to work, attend school or perform normal daily tasks
- Have had symptoms for at least six months
There are several subtypes of schizophrenia, but not everyone easily fits into a specific category. The five most common subtypes are:
- Paranoid. Characterized by delusions and hallucinations, this type generally involves less functional impairment and offers the best hope for improvement.
- Catatonic. People with this subtype don't interact with others, get into bizarre positions, or engage in meaningless gestures or activities.
- Disorganized. Characterized by disorganized thoughts and inappropriate expressions of emotion, this type generally involves the most functional impairment and offers the least hope for improvement.
- Undifferentiated. This is the largest group of people with schizophrenia, whose dominant symptoms come from more than one subtype.
- Residual. This type is characterized by extended periods without prominent positive symptoms, but other symptoms continue.
Treatments and drugs
Schizophrenia is a chronic condition that requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep and basic hygiene.
A psychiatrist experienced in treating schizophrenia usually guides treatment. The treatment team also may include psychologists, social workers and psychiatric nurses and possibly a case manager to coordinate care. The full-team approach may be available in clinics with expertise in schizophrenia treatment.
Medications are the cornerstone of schizophrenia treatment. But because medications for schizophrenia can cause serious but rare side effects, people with schizophrenia may be reluctant to take them.
Antipsychotic medications are the most commonly prescribed to treat schizophrenia. They're thought to control symptoms by affecting the brain neurotransmitters dopamine and serotonin. A person's willingness to cooperate with treatment may affect medication choice. Someone who is uncooperative may need to be given injections instead of taking a pill. Someone who is agitated may need to be calmed initially with a benzodiazepine such as lorazepam (Ativan), which may be combined with an antipsychotic.
These newer medications are generally preferred because they pose a lower risk of debilitating side effects than do conventional medications. They include:
- Aripiprazole (Abilify)
- Clozapine (Clozaril, Fazaclo ODT)
- Olanzapine (Zyprexa)
- Paliperidone (Invega)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Ziprasidone (Geodon)
Side effects of atypical antipsychotic medications include weight gain, diabetes and high blood cholesterol.
Conventional, or typical, antipsychotics
These medications have frequent and potentially significant neurological side effects, including the possibility of developing a movement disorder (tardive dyskinesia) that may or may not be reversible. This group of medications includes:
- Haloperidol (Haldol)
These typical antipsychotics are often cheaper than newer counterparts, especially the generic versions, which can be an important consideration when long-term treatment is necessary.
It can take several weeks after first starting a medication to notice an improvement in symptoms. In general, the goal of treatment with antipsychotic medications is to effectively control signs and symptoms at the lowest possible dosage. The psychiatrist may try different medications, different dosages or combinations over time to achieve the desired result. Other medications also may be helpful, such as antidepressants or anti-anxiety medications.
Although medications are the cornerstone of schizophrenia treatment, once psychosis recedes, psychosocial treatments also are important. These may include:
- Social skills training. This focuses on improving communication and social interactions.
- Family therapy. This provides support and education to families dealing with schizophrenia.
- Vocational rehabilitation and supported employment. This focuses on helping people with schizophrenia find and keep jobs.
- Individual therapy. Learning to cope with stress and identify early warning signs of relapse can help people with schizophrenia manage their illness.
Many communities have programs to help people with schizophrenia with jobs, housing, self-help groups and crisis situations. A case manager or someone on the health care team can help find one. With appropriate treatment, most people with schizophrenia can manage their condition.
Coping and support
Coping with an illness as serious as schizophrenia can be challenging, both for the person with the condition and for friends and family. Here are some ways to cope with schizophrenia:
- Learn about schizophrenia. Education about the condition can help motivate the person with the disease to stick to the treatment plan. Education can help friends and family understand the condition and be more compassionate with the person who has it.
- Join a support group. Support groups for people with schizophrenia can help them reach out to others facing similar challenges. Support groups may also help family and friends cope.
- Stay focused on goals. Recovery from schizophrenia is an ongoing process. Keeping recovery goals in mind can help the person with schizophrenia stay motivated. Help your loved one remember to take responsibility for managing the illness and working toward goals.
- Learn relaxation and stress management. The person with the disease and loved ones may benefit from stress-reduction techniques such as meditation, yoga or tai chi.
There's no sure way to prevent schizophrenia. However, early treatment may help get symptoms under control before serious complications develop and may help improve the long-term outlook. Sticking with the treatment plan can help prevent relapses or worsening of schizophrenia symptoms. In addition, researchers hope that learning more about risk factors for schizophrenia may lead to earlier diagnosis and earlier treatment.
For people at increased risk of schizophrenia, taking proactive steps such as avoiding illegal drug use, reducing stress, getting enough sleep and starting antipsychotic medications as soon as necessary may help minimize symptoms or prevent them from worsening.
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