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Schizophrenia
all information

Schizophrenia

Pronounced: skits-uh-FREN-ee-uh

En Español (Spanish Version)More InDepth Information on This Condition

Definition

Schizophrenia is a chronic, severe, disabling brain disorder that interferes with the way a person interprets reality. People with schizophrenia sometimes hear voices or see things that others do not, become paranoid that people are plotting against them, and experience cognitive deficits and social withdrawal. These and other symptoms make it difficult for them to have positive relationships with others. It is different from split or multiple personality disorders.

Regions of the Brain

Colored brain segments

Schizophrenia affects many different areas of the brain causing a wide range of behavioral, emotional, and intellectual symptoms.

© 2008 Nucleus Medical Art, Inc.

Causes

The cause of schizophrenia is unknown. Problems with brain structure and chemistry are thought to play a role. There also appears to be a genetic component. People with a parent or sibling with schizophrenia have a 5%-10% chance of developing the disease. This compares to a 1% chance if no relatives have schizophrenia.

Some researchers believe that environmental factors may contribute to the development of schizophrenia. They theorize that a fetal viral infection and/or difficult birth or obstetrical trauma may trigger schizophrenia in people who are predisposed.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Factors that increase your risk of schizophrenia include:

  • Having a parent or sibling with schizophrenia
  • Abnormal brain structure
  • In the northern hemisphere: being born during winter months; being born in the city
  • Oxygen deprivation during pregnancy
  • Issues at birth such as:
    • Long labor
    • Bleeding during pregnancy
    • Prematurity
    • Low birth weight
    • Maternal malnutrition
    • Infections during pregnancy
  • Loss of a parent during childhood

Men typically develop symptoms in their late teens or early twenties, while onset for women tends to occur in their twenties or thirties. In rare cases, it is seen in childhood.

Symptoms

Symptoms usually start in adolescence or early adulthood. They often appear slowly and become more disturbing and bizarre over time, or they may occur in a matter of weeks or months.

Symptoms include:

  • Hallucinations—seeing or hearing things/voices that are not there
  • Delusions—strong but false personal beliefs that are not based in reality
  • Disorganized thinking
  • Disorganized speech—lack of ability to speak in a way that makes sense or carry a conversation
  • Catatonic behavior—slow movement, repeating rhythmic gestures, pacing, walking in circles, negativism, repetitive speech
  • Emotional flatness—flat speech, lack of facial expression, and general disinterest and withdrawal
  • Paranoia—a psychosis characterized by systematized delusions of persecution or grandeur
  • Inappropriate laughter
  • Poor hygiene and self-care

Associated conditions include:

Diagnosis

Early diagnosis is extremely important. People who are diagnosed early are able to:

  • Stabilize their symptoms
  • Decrease the risk of suicide
  • Decrease alcohol and substance abuse
  • Reduce the chance of relapse and/or hospitalization

A person must have active symptoms for at least two weeks, and other symptoms for at least six months before a diagnosis can be made. The doctor will rule out other causes such as drug use, medical illness, or a different mental condition.

Treatment

Schizophrenia is not curable but it is highly treatable. Hospitalization may be required during acute episodes. Symptoms are usually controlled with antipsychotic medications.

Antipsychotic Medications

Antipsychotic medications work by blocking certain chemicals in the brain. This helps control the abnormal thinking that occurs in people with schizophrenia. Determining a medication plan can be a complicated process. Often medications or dosages need to be changed until the right balance is found. This can take months or even years. Examples of medications include:

  • Haloperidol (Haldol)
  • Thioridazine
  • Fluphenazine

Relapse is common, even for patients taking medication. Treatment compliance can be a challenge since people often stop taking their medication when they are feeling better. The side effects of traditional antipsychotics also can cause people to discontinue treatment. The most common are physical side effects such as:

  • Slow and stiff movements
  • Restlessness
  • Facial tics
  • Protruding tongue

New medications, called atypical antipsychotics, have fewer side effects, and are better tolerated over long periods of time. However, they may cause weight gain, elevated blood sugar, and elevated serum cholesterol. Examples of these medications include:

  • Aripiprazole (Abilify)
  • Clozapine (Clozaril)
  • Risperidone (Risperdal)
  • Olanzapine (Zyprexa)
  • Paliperidone (Invega)
  • Quetiapine (Seroquel)
  • Ziprasidone (Geodon)

Medications for Coexisting Conditions

Conditions often associated with schizophrenia include depression and anxiety. They may be treated with:

  • Antidepressants
  • Anxiolytic drugs
  • Lithium
  • Anticonvulsants

Electroconvulsive Therapy

Electroconvulsive therapy may be used to treat severe depression, suicidal ideation, or severe psychosis.

Supportive Therapy

Schizophrenia is a lifelong condition. It can be confusing and frightening for the person with the disease and for family members. Individual and family therapy can address:

  • Social skills
  • Vocational guidance
  • Community resources
  • Coping with family
  • Living arrangements
  • General emotional support
  • Working with the family to help them deal with the patient

Prevention

There are no guidelines for preventing schizophrenia because the cause is unknown. However, studies show that early, aggressive treatment leads to better outcomes.

RESOURCES:

American Psychiatric Association
http://www.psych.org/

National Institute of Mental Health
http://www.nimh.nih.gov/

World Fellowship for Schizophrenia and Allied Disorders
http://world-schizophrenia.org/

CANADIAN RESOURCES:

Canadian Psychiatric Association
http://www.cpa-apc.org/

Mental Health Canada
http://www.mentalhealthcanada.com/

References:

American Psychiatric Association website. Available at: http://www.psych.org.

Electroconvulsive therapy for schizophrenia. (2005 review update). Cochrane website. Available at: http://www.cochrane.org/reviews/en/ab000076.html. Accessed May 6, 2008.

McIntyre JS, Charles SC, et al. Treating schizophrenia: a quick reference guide. 2nd ed. American Psychiatric Association website. Available at: http://www.psych.org/psych_pract/treatg/quick_ref_guide/Schizophrenia_QRG.pdf. Accessed March 17, 2007.

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier Mosby; 2004.

National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/.

Schizophrenia. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/schizophrenia/DS00196. Accessed May 6, 2008.

Schizophrenia. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/publicat/schizoph.cfm. Accessed on March 17, 2007.

World Fellowship for Schizophrenia and Allied Disorders website. Available at: http://world-schizophrenia.org.



Last reviewed May 2008 by Theodor B. Rais, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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