Shcizophrania
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symptoms may leave them fearful and withdrawn.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 schizohphrenia
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.
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.
Are People With Schizophrenia Likely To Be Violent?
News and entertainment media tend to link mental illness and
criminal violence; however, studies indicate that except for
those persons with a record of criminal violence before becoming
ill , and those with substance abuse or alcohol problems, people
with Schizophrenia are not especially prone to violence.
Most individuals with schizophrenia are not violent; more
typically, they are withdrawn and prefer to be left alone. Most
violent crimes are not committed by persons with schizophrenia,
and most persons with schizophrenia do not commit violent
crimes.
Substance abuse significantly raises the rate of violence in
people with schizophrenia but also in people who do not have any
mental illness. People with paranoid and psychotic symptoms,
which can become worse if medications are discontinued, may also
be at higher risk for violent behavior. When violence does
occur, it is most frequently targeted at family members and
friends, and more often takes place at home.
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 interferes 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.
What About Suicide?
Suicide is a serious danger in people who have schizophrenia. If
an individual tries to commit suicide or threatens to do so,
professional help should be sought immediately. People with
schizophrenia have a higher rate of suicide than the general
population. Approximately 10 percent of people with
schizophrenia (especially younger adult males) commit suicide.
Unfortunately, the prediction of suicide in people with
schizophrenia can be especially difficult.