Understanding Schizophrenia: Causes, Symptoms, and Treatments
Affecting 1% of all adults globally, schizophrenia is a severe and chronic mental condition characterised by hallucinations, delusions and disorganised thoughts. Schizophrenia usually occurs between the ages of 16 and 30, with males tending to show symptoms at a slightly younger age. In some cases, the disorder develops at such a slow pace that the person is not aware of the condition for many years; however, for others, the onset of schizophrenia can be sudden, with the condition developing at a fast pace. Requiring lifelong treatment, it is crucial to have an early diagnosis in order to control symptoms and improve the long-term outlook for the person.
Causes of Schizophrenia
Research has shown that there are several factors which are involved in contributing to the onset of schizophrenia, including a combination of genetic, environmental and inherited elements such as:
Even though evidence shows that family relationships do not cause schizophrenia, people with the illness believe that various tensions in the family can trigger relapses.
The use of cannabis/recreational drugs
Studies have shown that if you have been diagnosed with schizophrenia, the use of recreational drugs may make the symptoms worse. There is some doubt, however, as to whether using recreational drugs causes schizophrenia or if those who develop schizophrenia are more likely to use recreational drugs. The use of alcohol and smoking can prevent the prescribed medication from being effective.
If a parent has been diagnosed with schizophrenia, then there is a 10% risk that a member of the family will also develop the condition. However, research has shown that it is likely to be different combinations of genes rather than one specific gene which make people more vulnerable to the condition.
Chemical imbalance in the brain
The chemicals that carry messages between brain cells are known as neurotransmitters. There is a link between neurotransmitters and schizophrenia, as changes in the level of dopamine and serotonin may be the cause of schizophrenia. Studies carried out on people with schizophrenia have shown differences in the structure of their brains, suggesting schizophrenia may, in part, be a brain disorder.
A difficult pregnancy and birth complications, such as premature labour, low birth weight or a lack of oxygen (asphyxia) during birth, are thought to be factors which may contribute to a person developing schizophrenia later in life.
Schizophrenia cannot be understood without understanding despair.— R D Laing
Symptoms of Schizophrenia
Symptoms of schizophrenia involve a range of problems with thinking (cognition), emotions or behaviour and can vary in pattern and severity depending on the individual. It should be noted that not every person will have all the symptoms, and these may change over time. Symptoms may include:
Referring to a lack of ability to function normally, the person may lose interest in everyday activities, neglect personal hygiene, or socially withdraw. Also, the person may appear to lack emotion as facial expressions do not change, eye contact is not made, and they speak in a monotone voice.
Involving seeing or hearing things that don’t exist, hallucinations can be in any of the senses; however, hearing voices is the most common. To the person with schizophrenia, the experience will be completely normal.
Occurring in most people with schizophrenia, delusions are false beliefs that are not based in reality. These can take the form of the person believing they have exceptional ability or fame, someone is in love with them, or a major catastrophe is about to happen.
Disorganised thinking (speech)
Interfering with effective communication, speech may be impaired which results in answers to questions being completely unrelated. In some instances, the person may put together meaningless words which are not understood, although this is rare and is referred to as ‘word salad’.
Abnormal motor behaviour
This type of behaviour can include excessive movement, unpredictable agitation, silliness, and resistance to instructions. As the behaviour is not focused on a goal, it is hard for the person to complete any tasks.
Types of Schizophrenia
In the past, schizophrenia was classified into different subtypes; however, mental health experts now refer to schizophrenia as a spectrum disorder, which can be categorised into the following types:
- Schizoaffective Disorder: Not as well-understood as other mental health disorders, people with the condition experience psychotic symptoms, hallucinations or delusions, combined with symptoms of a mood disorder such as bipolar or depression. People with this disorder usually need assistance and support with daily functioning.
- Paranoid Schizophrenia: The most common type of schizophrenia. People who have this condition have difficulty recognising what is real and what is not. Very often, the person will struggle in social situations because they assess others within the context of their delusions, which usually take the form of people plotting against them. As a result, they exhibit signs of acute anxiety, are suspicious, unreasonably jealous, and isolate themselves from others.
- Schizophreniform Disorder: A psychotic disorder normally lasting for less than six months, the person cannot differentiate between what is real and what is imagined. Resulting in a loss of normal living and social skills, the person often withdraws from loved ones and avoids social activities. If symptoms persist for six months or more, the diagnosis is changed to schizophrenia or, in some cases, bipolar or schizoaffective disorder.
Diagnosis of Schizophrenia
Involving a range of cognitive, behavioural and emotional symptoms, schizophrenia is difficult to diagnose and at present there are no physical or lab tests which can absolutely diagnose schizophrenia. Therefore, diagnosis is made based on clinical analysis involving the recognition of various symptoms which have a negative impact on a person’s social or occupational functioning, and includes:
- Psychiatric evaluation: Carried out by a doctor or mental health care professional, this evaluation is to check the mental status of a person. It involves observing the person’s demeanour and appearance, as well as ascertaining the thought processes of that person; delusions, hallucinations, moods, substance use, and thoughts of violence or suicide. Family and personal history will also be discussed at this evaluation.
- Tests and screenings: These tests are conducted in order to rule out those conditions which have similar symptoms, such as bipolar disorder and major depression. Tests also include screening for drugs and alcohol, as well as imaging studies such as CT or MRI scans.
- Physical exam: In order to rule out any other problems or complications which may be causing symptoms, the doctor will observe and note weight, eye movements, uncontrollable body or facial twitches, pacing, or putting the head to one side as if listening to someone speaking.
Treatments for Schizophrenia
Currently there is no cure for schizophrenia; therefore, after diagnosis it is important to start a treatment plan as soon as possible in order to improve the chances of managing the condition effectively. Treatment involves managing the person’s symptoms and is a combination of medication, psychological treatment and community support. An understanding of the person’s home life, finances and social life is just as important as checking their symptoms and physical health. Types of treatment available are:
- Cognitive Behaviour Therapy (CBT): This therapy is a talking treatment which will focus on how a person’s thoughts, beliefs and attitudes affect their feelings and behaviour. The therapist will help the person to understand their thought processes and learn coping strategies in order to deal with feelings and reactions to the symptoms they experience. This type of therapy can reduce symptoms and distress in schizophrenia as psychotic symptoms are explained in realistic terms to alleviate their distressing effect.
- Assertive Community Treatment: Based in the community, the team is made up of a psychiatrist, psychologist, nurse, and case manager. As well as making frequent contact with patients, the team monitors treatment plans, assesses psychosocial and health needs, and may also provide emotional support to families.
- Family Education: This severe mental illness can profoundly affect families; therefore, it is so important for families to be educated about the illness. Practical advice to family members can greatly reduce relapse, as well as enabling family members to support the person in the best possible way.
Antipsychotics are the main medications used to treat schizophrenia and are generally effective for treating symptoms such as hallucinations and delusions. Several antipsychotic drugs may need to be tried before finding the right one as each person will react differently to the drugs. There are other disorders which can either mimic the symptoms of schizophrenia or may accompany schizophrenia. As a result, different classes of medications may be tried—antidepressants, mood stabilisers and anti-anxiety medications—to help control agitation or anxiety.
Self-care is extremely important as it helps a person understand and overcome symptoms of schizophrenia. The following strategies can help the person promote their own self-care routine, however, making lifestyle changes can be difficult to accomplish alone. With the help and support of professionals, family and friends, the following lifestyle changes can be achieved.
- Maintain a healthy weight: Unfortunately, many of the antipsychotic drugs can slow the metabolism, resulting in weight gain which may cause obesity-related health conditions. Having a nutritious diet combined with regular exercise will not only help prevent diabetes and heart conditions but will also improve the mood of the person. Signing up for an exercise class is a great way to meet people and keep fit.
- Quit smoking and drinking: It is a fact that 50% of people with schizophrenia abuse a substance. Research has shown that those who have a substance abuse problem are much more likely to experience severe symptoms of the illness. Family and friends can help create a smoke-free and alcohol-free environment by removing cigarettes and alcohol from the home, or not using alcohol and cigarettes in their presence. Instead, spending time on healthy pursuits, along with lots of positive encouragement, will ensure they do not relapse.
- Stay connected: In order to help the person maintain their treatment plan, it is important for family members and the support team to regularly communicate. A family member will be more tuned in to the person and therefore more likely to notice subtle changes in their behaviour. This is vital as early intervention can prevent a relapse.
- Take medication: It is so important to encourage the person to follow his/her treatment plan exactly and to always take medicine as prescribed. Stopping medication suddenly for any reason can be extremely dangerous; therefore, knowing the type of medication, quantity and time to be taken is necessary for family, friends and caregivers.
- Good quality sleep: A person with schizophrenia will often suffer from too little sleep, interrupted sleep, or too much sleep. Getting into a bedtime routine where the person goes to bed at the same time every night will help to establish sleep patterns. It’s also a good idea to avoid the use of computers, phones and television for at least two hours before sleeping.
One of the most debilitating types of mental illness, schizophrenia makes it extremely difficult to make sense of what is going on. Even though schizophrenia is often characterised by hallucinations and delusions, which are common, no single symptom is essential for the diagnosis of schizophrenia.
At times unable to trust their own brain, their attempts to keep a mental perspective against all the odds are simply heroic. It is worth remembering that with the right medications, counselling and a strong support network, the ability of people with schizophrenia to live and function well in society is excellent. However, society needs to play its part in understanding this condition with its many debilitating facets, ultimately responding with kindness, patience and empathy.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
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© 2019 Lorna Lamon