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Schizophrenia is a mental illness characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests as hallucinations (such as hearing voices), paranoid or bizarre delusions (false ideas), disordered thoughts, and problems with feelings, behaviour and motivation and it is accompanied by significant social or occupational dysfunction. In many people symptoms recur or persist long-term, but in some people there may be one episode of symptoms that lasts a few weeks. Treatment includes medication, psychotherapy and social support.

What is schizophrenia and who gets it?

Schizophrenia is a serious mental health condition that causes disordered ideas, beliefs and experiences. In a sense, people with schizophrenia lose touch with reality and do not know which thoughts and experiences are true and real, and which are not.

Some people have wrong ideas about schizophrenia. For instance, it has nothing to do with a split personality. Despite the etymology of the term from the Greek roots skhizein (σχίζειν, "to split") and phrēn, phren- (φρήν, φρεν-; "mind"), schizophrenia does not imply a "split mind" and it is not the same as dissociative identity disorder—also known as "multiple personality disorder" or "split personality"—a condition with which it is often confused in public perception. Also, the vast majority of people with schizophrenia are not violent.

Schizophrenia develops in about 1 in 100 people. The onset of symptoms typically occurs in young adulthood, with a global lifetime prevalence of about 0.3–0.7%. It can occur in men and women. The most common ages for it first to develop are 15-25 in men and 25-35 in women.

child depression
“ There Is A Thin Line Between Genius And Insanity"
The faces of schizophrenia
Mathmetician John Nash, author Jack Kerouac, Fleetwood Mac guitarist Peter Gre

What are the symptoms of schizophrenia?

There are many possible symptoms. They are often classed into positive and negative. Positive symptoms are those that show abnormal mental functions. Negative symptoms are those that show the absence of a mental function that should normally be present.

Positive symptoms include the following

  • Delusions These are false beliefs that a person has, and most people from the same culture would agree that they are wrong. Even when the wrongness of the belief is explained, a person with schizophrenia is convinced that they are true. For example, a person with schizophrenia may believe that neighbours are spying on them with cameras in every room, or a famous person is in love with them, or that people are plotting to kill them, or there is a conspiracy about them. These are only a few examples and delusions can be about anything.

  • Hallucinations This means hearing, seeing, feeling, smelling, or tasting things that are not real. Hearing voices is the most common. Some people with schizophrenia hear voices that provide a running commentary on their actions, argue with them, or repeat their thoughts. The voices often say things that are rude, aggressive, unpleasant, or give orders that must be followed. Some people with schizophrenia appear to talk to themselves as they respond to the voices. People with schizophrenia believe that the hallucinations are real.

  • Disordered thoughts Thoughts may become jumbled or blocked. Thought and speech may not follow a normal logical pattern.

Negative symptoms include the following

  • Lack of motivation Everything seems an effort. For example, tasks may not be finished, concentration is poor, losing interest in social activities, and often wanting to be alone.

  • Few spontaneous movements.

  • Facial expressions do not change much and the voice may sound monotonous.

  • Changed feelings Emotions may become flat. Sometimes the emotions may be odd such as laughing at something sad. Other strange behaviours sometimes occur.

Negative symptoms can make some people neglect themselves, can also lead to difficulty with education. For families and carers, the negative symptoms are often the most difficult to deal with. Persistent negative symptoms tend to be the main cause of long-term disability.

Families may only realise with hindsight that the behaviour of a relative has been gradually changing. Recognising these changes can be particularly difficult if the illness develops during the teenage years when it is normal for some changes in behaviour to occur.

Other symptoms

  • Difficulty planning.
  • Memory problems.
  • Obsessive-compulsive symptoms.

How is the diagnosis made?

Diagnosis is based on observed behavior and the patient's reported experiences.

Not all symptoms are present in all cases. Different forms of schizophrenia occur depending upon the main symptoms that develop.

Symptoma in schizophrenia may develop quickly over a few weeks or so. Family and friends in such cases may recognise that the person has a mental health problem. However sometimes symptoms develop slowly over months and the person may gradually become withdrawn, lose friends, jobs, etc, before the condition is recognised.

What is the cause of schizophrenia?

The exact cause is not known. It is thought that the balance of certain brain chemicals (neurotransmitters) is altered. Hereditary factors are thought to be important. For example, a close family member of someone with schizophrenia has a 1 in 10 chance of also developing the condition. A child born to a mother and father who both have schizophrenia has a 1 in 2 chance of developing it. However, other factors may to be needed to trigger the condition in people who are genetically prone to it. For example:

  • Stress such as relationship problems, financial difficulties, social isolation, bereavement, etc.

  • A lack of oxygen at the time of birth that may damage a part of the brain.

  • Illegal or street drugs may trigger the condition in some people. For example, those who use cannabis heavily are more likely to develop schizophrenia than nonusers.

What are the treatments for schizophrenia?

The primary treatment of schizophrenia is antipsychotic medications, often in combination with psychological and social supports. Hospitalization may occur for severe episodes either voluntarily or (if mental health legislation allows it) involuntarily. Long-term hospitalization is uncommon.

Antipsychotic medication

The main drugs used to treat schizophrenia are called antipsychotics. Antipsychotic medication is used to relieve the symptoms. Antipsychotic drugs tend to work best to ease positive symptoms. Antipsychotic drugs are also used to prevent recurring episodes of symptoms (relapses). Therefore, antipsychotic medication is usually taken on a long-term basis.There are various different antipsychotic drugs, and different ones may be used in different circumstances.

There are some differences between the various antipsychotic drugs. Therefore, one may be better for an individual than another. For example, some are more sedating than others. A psychiatrist is the best person to advise on which to use in each case. Sometimes, if one does not work so well, a different one is tried and may work well.

A good response to antipsychotic medication occurs in about 7 in 10 cases. However, symptoms may take 2-4 weeks to ease after starting medication, and it can take several weeks for full improvement. Even when symptoms ease, antipsychotic medication is normally continued long-term. This aims to prevent:

  • Relapses.
  • To limit the number and severity of relapses.

However, if you only have one episode of symptoms that clears completely with treatment, one option is to try coming off medication after 1-2 years. Your psychiatrist will be the best person to advise.

    Depot injections of an antipsychotic drug

    In some cases, an injection of a long-acting antipsychotic drug is used once symptoms have eased. The drug from a depot injection is slowly released into the body and is given every 2-4 weeks. This aims to prevent relapses. The main advantage of depot injections is that you do not have to remember to take tablets every day.

    What about side-effects from antipsychotic drugs?
    Side-effects can sometimes be troublesome. There is often a fine balance between easing symptoms and having to put up with some side-effects from treatment. The different antipsychotic drugs can have different types of side-effects. Also, sometimes one drug causes side-effects in some people and not in others. Therefore, it is not unusual to try two or more different drugs before one is found that is best suited to an individual.

    The following are the main side-effects that sometimes occur. Common side-effects include:

    • Dry mouth
    • Blurred vision
    • Flushing and constipation

    . These side effects may ease off when you get used to the drug.

    Other side effects

    • Drowsiness (sedation) is also common but may be an indication that the dose is too high. A reduced dose may be an option.

    • Some people develop weight gain. This appears to be a particular problem with the atypical antipsychotics, notably clozapine and olanzapine.

    • Movement disorders may develop in some cases. These include:
      • Parkinsonism For example, tremor and muscle stiffness

      • Restlessness of the legs.

      • Abnormal movements of the face and body.

      • Tardive dyskinesia (TD) - which is a movement disorder that can occur if you take antipsychotics for several years. It causes rhythmical movements. These are usually lip-smacking and tongue-rotating movements, although it can affect the arms and legs too.

    Atypical antipsychotic drugs are thought to be less likely to cause movement disorder side-effects than typical antipsychotic drugs. This reduced incidence of movement disorder is the main reason why an atypical antipsychotic drug is often used first-line. Atypical antipsychotic do, however, have their own risks. In particular, the risk of weight gain. If side-effects occur, then other drugs may be used to counteract them.


    Cognitive behavioural therapy (CBT)

    CBT and other psychotherapy treatments are not alternatives to drug treatment. They are used in some cases in addition to medication. CBT reduces the chance of being admitted or readmitted to hospital, can reduce symptom severity and can improve social functioning.

    Family intervention

    This may be offered and consists of therapy sessions for relatives of patients with schizophrenia. It has been found to reduce hospital admissions and the severity of symptoms after treatment.

Social and community support

This is very important. Families, friends and local support groups can also be major sources of help.

Encouraging physical health

It is quite common for people with schizophrenia not to look after themselves so well. Such things as smoking, lack of exercise, obesity, and an unhealthy diet are more common than average in people with schizophrenia. Weight gain may be a side-effect of antipsychotic drugs. All of these factors may lead to an increased chance of developing heart disease and diabetes in later life.

Therefore, as with everyone else in the population, people with schizophrenia are encouraged to adopt a healthy lifestyle - not to smoke, to take regular exercise, to eat healthily, etc.

What is the prognosis?

  • In most cases there are recurring episodes of symptoms (relapses). The frequency and duration of each relapse can vary. Some people recover completely between relapses. Some people improve between relapses but never recover fully. Treatment often prevents relapses, or limits their number and severity.

  • In some cases, there is only one episode of symptoms that lasts a few weeks or so. This is followed by a complete recovery, or substantial improvement without any further relapses.

  • Some people with schizophrenia are not helped much by treatment and need long-term dependent care.

  • Depression is a common complication of schizophrenia.

  • It is thought that up to a third of people with schizophrenia abuse alcohol and/or illegal drugs. Helping or treating such people can be difficult.

  • About 1 in 10 people with schizophrenia commit suicide.

The outlook is thought to be better if:

  • Treatment is started soon after symptoms begin.

  • Symptoms develop quickly over several weeks rather than slowly over several months.

  • The main symptoms are positive symptoms rather than negative symptoms.

  • The condition develops in a relatively older person (aged over 25).

  • Symptoms ease well with medication.

  • Treatment is taken as advised.

  • There is good family and social support which reduces anxiety and stress.

  • Abuse of illegal drugs or alcohol does not occur.

Newer drugs and better psychological treatments have improved the outlook of schizophrenia.