Schizophrenia

Answer 1

Definition

Schizophrenia is a mental disorder that makes it difficult to tell the difference between real and unreal experiences, to think logically, to have normal emotional responses, and to behave normally in social situations.

Causes, incidence, and risk factors

Schizophrenia is a complex illness. Even experts in the field are not sure what causes it.

Genetic factors appear to play a role. People who have family members with schizophrenia may be more likely to get the illness themselves.

Some researchers believe that environmental events may trigger schizophrenia in people who are already genetically at risk for the disorder. For example, infection during development in the mother's womb or stressful psychological experiences may increase the risk for developing schizophrenia later in life. Social and family support appears to improve the illness.

Schizophrenia affects about 1% of people worldwide. It occurs equally among men and women, but in women it tends to begin later and be milder. For this reason, males tend to account for more than half of patients in services with high numbers of young adults. Although schizophrenia usually begins in young adulthood, there are cases in which the disorder begins later (over age 45).

Childhood-onset schizophrenia begins after age 5 and, in most cases, after normal development. Childhood schizophrenia is rare and can be difficult to tell apart from other developmental disorders of childhood, such as autism.

Symptoms

Schizophrenia may have a variety of symptoms. Usually the illness develops slowly over months or years. Like other chronic illnesses, schizophrenia cycles between periods of fewer symptoms and periods of more symptoms.

At first, you may feel tense, or have trouble sleeping or concentrating. You can become isolated and withdrawn, and have trouble making or keeping friends.

As the illness continues, psychotic symptoms develop:

• Appearance or mood that shows no emotion (flat affect)
• Bizarre movements that show less of a reaction to the environment (catatonic behavior)
• False beliefs or thoughts that are not based in reality (delusions)
• Hearing, seeing, or feeling things that are not there (hallucinations)

Problems with thinking often occur:

• Problems paying attention
• Thoughts "jump" between unrelated topics (disordered thinking)

Symptoms can be different depending on the type of schizophrenia:

• Paranoid types often feel anxious, are more often angry or argumentative, and falsely believe that others are trying to harm them or their loved ones.
• Disorganized types have problems thinking and expressing their ideas clearly, often exhibit childlike behavior, and frequently show little emotion.
• Catatonic types may be in a constant state of unrest, or they may not move or be underactive. Their muscles and posture may be rigid. They may grimace or have other odd facial expressions, and they may be less responsive to others.
• Undifferentiated types may have symptoms of more than one other type of schizophrenia.
• Residual types experience some symptoms, but not as many as those who are in a full-blown episode of schizophrenia.

People with any type of schizophrenia may have difficulty keeping friends and working. They may also have problems with anxiety, depression, and suicidal thoughts or behaviors.

Signs and tests

A psychiatrist should perform an evaluation to make the diagnosis. The diagnosis is made based on a thorough interview of the person and family members.

No medical tests for schizophrenia exist. The following factors may suggest a schizophrenia diagnosis, but do not confirm it:

• Course of illness and how long symptoms have lasted
• Changes from level of function before illness
• Developmental background
• Genetic and family history
• Response to medication

CT scans of the head and other imaging techniques may find some changes that occur with schizophrenia and may rule out other disorders.

Treatment

During an episode of schizophrenia, you may need to stay in the hospital for safety reasons, and to receive basic needs such as food, rest, and hygiene.

MEDICATIONS

Antipsychotic medications are the most effective treatment for schizophrenia. They change the balance of chemicals in the brain and can help control the symptoms of the illness.

These medications are helpful, but they can have side effects. However, many of these side effects can be addressed, and should not prevent people from seeking treatment for this serious condition.

Common side effects from antipsychotics may include:

• Sleepiness (sedation) or dizziness
• Weight gain and increased chance of Diabetes and high cholesterol

Less common side effects include:

• Feelings of restlessness or "jitters"
• Problems of movement and gait
• Muscle contractions or spasms
• Tremor

Long-term risks of antipsychotic medications include a movement disorder called tardive dyskinesia. In this condition, people develop movements that they cannot control, especially around the mouth. Anyone who believes they are having this problem should check with their doctor right away.

For people who try and do not improve with several antipsychotics, the medication clozapine can be helpful. Clozapine is the most effective medication for reducing schizophrenia symptoms, but it also tends to cause more side effects than other antipsychotics.

Because schizophrenia is a chronic illness, most people with this condition need to stay on antipsychotic medication for life.

SUPPORT PROGRAMS AND THERAPIES

Supportive and problem-focused forms of therapy may be helpful for many people. Behavioral techniques, such as social skills training, can be used during therapy or at home to improve function socially and at work.

Family treatments that combine support and education about schizophrenia (psychoeducation) appear to help families cope and reduce the odds of symptoms returning. Programs that emphasize outreach and community support services can help people who lack family and social support.

Important skills for a person with schizophrenia include:

• Learning to take medications correctly and how to manage side effects
• Learning to watch for early signs of a relapse and knowing how to react when they occur
• Coping with symptoms that are present even while taking medications. A therapist can help persons with schizophrenia test the reality of thoughts and perceptions.
• Learning life skills, such as job training, money management, use of public transportation, relationship building, and practical communication

Family members and caregivers are often encouraged to help people with schizophrenia stick to their treatment.

Expectations (prognosis)

The outlook for a person with schizophrenia is difficult to predict. Most people with schizophrenia find that their symptoms improve with medication, and some can get good control of their symptoms over time. However, others have functional disability and are at risk for repeated episodes, especially during the early stages of the illness.

To live in the community, people with schizophrenia may need supported housing, work rehabilitation, and other community support programs. People with the most severe forms of this disorder may be too disabled to live alone, and may need group homes or other long-term, structured places to live. Some people with milder forms of schizophrenia are able to have satisfying relationships and work experiences.

Complications

• People with schizophrenia have a high risk of developing a substance abuse problem. Use of alcohol or other drugs increases the risk of relapse, and should be treated by a professional.
• Physical illness is common among people with schizophrenia due to an inactive lifestyle and side effects from medication. Physical illness may not be detected because of poor access to medical care and difficulties talking to health care providers.
• Not taking medication will often cause symptoms to return.

Calling your health care provider

Call your health care provider if:

• Voices are telling you to hurt yourself or others.
• You feel the urge to hurt yourself or others.
• You are feeling hopeless and overwhelmed.
• You are seeing things that aren't really there.
• You feel like you cannot leave the house.
• You are unable to care for yourself.

Prevention

There is no known way to prevent schizophrenia.

If you do have the condition, the best ways to prevent symptoms from coming back are to take the medication your doctor prescribed, and see your doctor or therapist regularly. Always talk to your doctor if you are thinking about changing or stopping your medications.

References

Leucht S, Corves C, Arbter D, Engel RR, Li C, Davis JM. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet. 2009;373:31-41. Epub 2008 Dec 6.

Freudenreich O, Weiss AP, Goff DC. Psychosis and schizophrenia. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 28.

Answer 2

Definition

Schizophrenia is a complex mental disorder that makes it difficult to:

• Tell the difference between real and unreal experiences
• Think logically
• Have normal emotional responses,
• Behave normally in social situations

Alternative Names

Childhood-onset schizophrenia

Causes, incidence, and risk factors

Schizophrenia is a complex illness. Mental health experts are not sure what causes it. However, genetic factors appear to play a role.

• Certain environmental events may trigger schizophrenia in people who are genetically at risk for it.
• You are more likely to develop schizophrenia if you have a family member with the disease.

Schizophrenia affects both men and women equally. It usually begins in the teen years or young adulthood, but may begin later in life. It tends to begin later in women, and is more mild.

Childhood-onset schizophrenia begins after age 5. Childhood schizophrenia is rare and can be difficult to tell apart from other developmental disorders of childhood, such as autism.

Symptoms

Schizophrenia symptoms usually develop slowly over months or years. Sometimes you may have many symptoms, and at other times you may only have a few.

People with any type of schizophrenia may have difficulty keeping friends and working. They may also have problems with anxiety, depression, and suicidal thoughts or behaviors.

At first, you may have the following symptoms:

• Irritable or tense feeling
• Difficulty sleeping
• Difficulty concentrating

As the illness continues, problems with thinking, emotions and behavior develop, including:

• Lack of emotion (flat affect)
• Strongly held beliefs that are not based in reality (delusions)
• Hearing or seeing things that are not there (hallucinations)
• Problems paying attention
• Thoughts "jump" between unrelated topics ( “loose associations”)
• Bizarre behaviors
• Social isolation

Symptoms can vary, depending on the type of schizophrenia you have.

Paranoid schizophrenia symptoms may include:

• Anxious
• Angry or argumentative
• False believes that others are trying to harm you or your loved ones.

Disorganized schizophrenia symptoms may include:

• Problems with thinking and expressing ideas clearly
• Childlike behavior
• Showing little emotion

Catatonic schizophrenia symptoms may include:

• Lack of activity
• Muscles and posture may be rigid
• Grimaces or other odd expressions on the face
• Does not respond much to other people

Undifferentiated schizophrenia symptoms may include symptoms of more than one other type of schizophrenia.

People with residual schizophrenia have some symptoms, but not as many as those who are in a full-blown episode of schizophrenia.

Signs and tests

There are no medical tests to diagnose schizophrenia. A psychiatrist should examine the patient to make the diagnosis. The diagnosis is made based on a thorough interview of the person and family members. The doctor will ask questions about:

• How long the symptoms have lasted
• How the person's ability to function has changed
• Developmental background
• Genetic and family history
• How well medications have worked

Brain scans (such as CT or MRI) and blood tests may help to rule out other disorders that have similar symptoms to schizophrenia.

Treatment

During an episode of schizophrenia, you may need to stay in the hospital for safety reasons.

MEDICATIONS

Antipsychotic medications are the most effective treatment for schizophrenia. They change the balance of chemicals in the brain and can help control symptoms/

These medications are usually helpful, but they can cause side effects. Many of these side effects can be improved, and should not prevent people from seeking treatment for this serious condition.

Common side effects from antipsychotics may include:

• Sleepiness (sedation)
• Dizziness
• Weight gain
• Increased chance of diabetes and high cholesterol
• Feelings of restlessness or "jitters"
• Slowed movements
• Tremor

Long-term use of antipsychotic medications may increase your risk for a movement disorder called tardive dyskinesia. This condition causes repeated movements that you cannot control, especially around the mouth. Call your doctor right away if you think you may have this condition.

When schizophrenia does not improve with several antipsychotics, the medication clozapine can be helpful. Clozapine is the most effective medication for reducing schizophrenia symptoms, but it also tends to cause more side effects than other antipsychotics.

Schizophrenia is a life-long illness. Most people with this condition need to stay on antipsychotic medication for life.

SUPPORT PROGRAMS AND THERAPIES

Supportive therapy may be helpful for many people with schizophrenia. Behavioral techniques, such as social skills training, can be used to improve social and work functioning. Job-training and relationship building classes are important.

Family members of a person with schizophrenia should be educated about the disease and offered support. Programs that emphasize outreach and community support services can help people who lack family and social support.

Family members and caregivers are often encouraged to help people with schizophrenia stick to their treatment.

It is important that the person with schizophrenia learns how to:

• Take medications correctly and how to manage side effects
• Notice the early signs of a relapse and what to do if symptoms return
• Cope with symptoms that occur even while taking medication. A therapist can help.
• Manage money
• Use public transportation

Expectations (prognosis)

The outlook for a person with schizophrenia is difficult to predict. Most of the time, symptoms improve with medication. However, others may have difficulty functioning and are at risk for repeated episodes, especially during the early stages of the illness.

People with schizophrenia may need supported housing, job training, and other community support programs. People with the most severe forms of this disorder may not be able to live alone. Group homes or other long-term, structured places to live may be needed.

Symptoms will return if a person with schizophrenia does not take their medication.

Complications

Having schizophrenia increases your risk for:

• Developing a problem with alcohol or drugs: This is called a substance abuse problem. Using alcohol or other drugs increases the chances your symptoms will return.
• Physical illness: People with schizophrenia may become physically sick, because of an inactive lifestyle and side effects from medication. A physical illness may not be detected because of poor access to medical care and difficulties talking to health care providers.
• Suicide

Calling your health care provider

Call your health care provider if:

• Voices are telling you to hurt yourself or others.
• You feel the urge to hurt yourself or others.
• You are feeling hopeless or overwhelmed.
• You are seeing things that aren't really there.
• You feel you cannot leave the house.
• You are unable to care for yourself.

Prevention

There is no known way to prevent schizophrenia.

Symptoms can be prevented by taking medication. You should take your medication exactly as your doctor told you to. Symptoms will return if you stop taking your medication.

Always talk to your doctor if you are thinking about changing or stopping your medications. See your doctor or therapist regularly.

References

Leucht S, Corves C, Arbter D, Engel RR, Li C, Davis JM. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet. 2009;373:31-41. Epub 2008 Dec 6.

Freudenreich O, Weiss AP, Goff DC. Psychosis and schizophrenia. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 28.

Reviewed By

Review Date: 02/07/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 3

Schizophrenia is a chronic mental disorder characterized by distortions in thinking, perception, emotions, and behavior. Symptoms can include hallucinations, delusions, disorganized thinking, and social withdrawal. Treatment usually involves a combination of medications, therapy, and support services.