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Schizophrenia

What is Schizophrenia?

Schizophrenia is a serious mental health disorder in which people experience significant challenges with determining what is real and not real, thinking clearly, relating to others, managing emotions, and daily functioning.

Schizophrenia is characterized by difficulty with thinking clearly, managing emotions, decision-making, and social interactions. Symptoms of schizophrenia encompass cognitive, behavioral, and emotional challenges. These include delusions, hallucinations, disorganized speech, catatonic or disorganized behavior, and negative symptoms (deficits in emotional expression, diminished motivation, etc.). A significant disturbance in the level of functioning (in major areas such as work, interpersonal relationships, or self-care) is also seen in schizophrenia.

While schizophrenia can be a severe mental illness, there is hope for improving quality of life for not only those with the disorder but their loved ones as well.

Who is diagnosed with Schizophrenia?

Schizophrenia affects roughly 1% of the population.  Risk of schizophrenia among first degree relatives is about 10%.  Men often develop the illness earlier in life between late teens and mid twenties.  Women are more common to develop the illness in their 30s. Diagnosis in adolescence is rare. The course of the illness usually is one of relapsing and remitting disease.  Individuals with schizophrenia will usually manifest periods of relative wellness mixed with periods of exacerbations of symptoms (even if engaged in adequate treatment).  The majority of people suffering from schizophrenia have gradually worsening disease course with each exacerbation of psychosis. People with schizophrenia typically have co-occurring mental disorders, predominantly PTSD and substance use disorders.  They also struggle to have adequately meaningful social and occupational capacities.  This often leads to more isolation and poverty.

Symptoms of Schizophrenia

According to the DSM-5, symptoms include:

Presence of two (or more) of the following, for a significant portion of a 1 month period:

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Grossly disorganized or catatonic behavior
  • Negative symptoms

(*must include at least delusions, hallucinations or disorganized speech)

  • The level of functioning is markedly lower than functioning prior to onset in work, interpersonal relationships, or self-care, and lasts for a significant portion of time since symptoms began
  • Continuous signs of the disturbance last for at least 6 months. The 6 month period must include at least 1 month of symptoms related to delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior (less if successfully treated) and may include negative symptoms, or a weakened form of the previously listed symptoms (e.g. odd beliefs, unusual perceptual experiences.
  • Schizoaffective disorder and depressive or bipolar disorder have been ruled out, and the disturbance is not attributable to physiological effects of a substance

What Causes Schizophrenia?

Like many other mental health conditions, the exact cause of schizophrenia is not completely known or understood. Schizophrenia does not have one single cause. Rather, as with many diseases, it is likely that a combination of genetic and environmental factors contribute to its development.

Genetic/Physiological

Genetics strongly contribute as risk factors for developing schizophrenia. Having close relatives with schizophrenia increases the likelihood of developing the disorder. Children of a parent with schizophrenia have a 10 percent chance of developing the disorder. An identical twin of someone with schizophrenia has a 40-65 percent chance of developing the disorder. To date, several genes have been associated with an increased risk, but no single gene causes schizophrenia. Research shows higher rates of genetic mutations affecting brain development in people with schizophrenia. Pregnancy, birth complications, and greater paternal age are also associated with an increased risk for developing schizophrenia. Additional prenatal and perinatal difficulties, such as stress, infection, malnutrition, maternal diabetes, and other medical conditions, may contribute to the development of schizophrenia

Environmental

Environmental circumstances have also been linked to schizophrenia. Factors such as birth season are associated with the disorder. Schizophrenia and related disorders are found in higher numbers among some minority ethnic groups and children who grow up in urban environments.

Risk of Violence and Suicide with Schizophrenia

The risk of violence among persons with schizophrenia is believed to be correlated to the degree they may suffer from delusional thinking.  This is more of a risk among untreated individuals than treated ones.  Risk of suicide among those suffering from schizophrenia is about 10-15% while about ½ make an attempt at one point.  The most common cause of death, however is heart disease.

Treatment for Schizophrenia

Schizophrenia is a serious and long-term mental health disorder. 5-6% of people with schizophrenia die by suicide every year, with 20% attempting suicide, and many others have thoughts about killing themselves. Suicidal risk remains high across the lifespan for males and females with schizophrenia. Early intervention is important for managing symptoms and creating best treatment outcomes. A combination of medication and psychotherapy seems to be the best treatment option available for bipolar disorder.

Medication

Medication is considered first-line treatment for schizophrenia and other thought-related disorders. Symptoms of schizophrenia reflect a combination of symptoms related to thought disorders, mood disorders, and anxiety disorders. Because of this, managing schizophrenia with medication typically includes a mix of antipsychotics, antidepressants, and anxiolytics. A major obstacle in treating schizophrenia is that many individuals stop taking their prescribed medication, particularly because of harsh side effects. Compliance with medication is critical for successful treatment.

Psychotherapy

Psychotherapy is also an integral component of treatment for schizophrenia. Medication ideally manages the more significant symptoms such as delusions and hallucinations. Therapy provides a safe and non-judgmental space to discuss distressing thoughts and feelings. Psychotherapy also teaches crucial social skills, setting limits, reality testing, offers support, and helps individuals stay compliant with their medication regimen. Family therapy is also very helpful in educating loved ones about schizophrenia and offering support.

If you or someone you know is experiencing symptoms of schizophrenia, please contact your primary care physician or a mental health professional for help today.

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