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What is schizophrenia?
Schizophrenia is a chronic, severe, and disabling brain
disorder that has been recognized throughout recorded history.
It affects about 1 percent of Americans.
People with schizophrenia may hear voices other people don't
hear or they may believe that others are reading their minds,
controlling their thoughts, or plotting to harm them. These
experiences are terrifying and can cause fearfulness, withdrawal,
or extreme agitation. People with schizophrenia may not make
sense when they talk, may sit for hours without moving or
talking much, or may seem perfectly fine until they talk
about what they are really thinking. Because many people
with schizophrenia have difficulty holding a job or caring
for themselves, the burden on their families and society
is significant as well.
Available treatments can relieve many of the disorder's
symptoms, but most people who have schizophrenia must cope
with some residual symptoms as long as they live. Nevertheless,
this is a time of hope for people with schizophrenia and
their families. Many people with the disorder now lead rewarding
and meaningful lives in their communities. Researchers are
developing more effective medications and using new research
tools to understand the causes of schizophrenia and to find
ways to prevent and treat it.
What are the symptoms of schizophrenia?
The symptoms of schizophrenia fall into three broad categories:
- Positive symptoms are unusual thoughts
or perceptions, including hallucinations, delusions, thought
disorder, and disorders of movement.
- Negative symptoms represent a loss or
a decrease in the ability to initiate plans, speak, express
emotion, or find pleasure in everyday life. These symptoms
are harder to recognize as part of the disorder and can
be mistaken for laziness or depression.
- Cognitive symptoms (or cognitive deficits)
are problems with attention, certain types of memory, and
the executive functions that allow us to plan and organize.
Cognitive deficits can also be difficult to recognize as
part of the disorder but are the most disabling in terms
of leading a normal life.
Positive symptoms
Positive symptoms are easy-to-spot behaviors not seen in
healthy people and usually involve a loss of contact with
reality. They include hallucinations, delusions, thought
disorder, and disorders of movement. Positive symptoms can
come and go. Sometimes they are severe and at other times
hardly noticeable, depending on whether the individual is
receiving treatment.
Hallucinations. A hallucination is something a
person sees, hears, smells, or feels that no one else can
see, hear, smell, or feel. "Voices" are the most common type
of hallucination in schizophrenia. Many people with the disorder
hear voices that may comment on their behavior, order them
to do things, warn them of impending danger, or talk to each
other (usually about the patient). They may hear these voices
for a long time before family and friends notice that something
is wrong. Other types of hallucinations include seeing people
or objects that are not there, smelling odors that no one
else detects (although this can also be a symptom of certain
brain tumors), and feeling things like invisible fingers
touching their bodies when no one is near.
Delusions. Delusions are false personal beliefs
that are not part of the person's culture and do not change,
even when other people present proof that the beliefs are
not true or logical. People with schizophrenia can have delusions
that are quite bizarre, such as believing that neighbors
can control their behavior with magnetic waves, people on
television are directing special messages to them, or radio
stations are broadcasting their thoughts aloud to others.
They may also have delusions of grandeur and think they are
famous historical figures. People with paranoid schizophrenia
can believe that others are deliberately cheating, harassing,
poisoning, spying upon, or plotting against them or the people
they care about. These beliefs are called delusions of persecution.
Thought Disorder. People with schizophrenia often
have unusual thought processes. One dramatic form is disorganized
thinking, in which the person has difficulty organizing his
or her thoughts or connecting them logically. Speech may
be garbled or hard to understand. Another form is "thought
blocking," in which the person stops abruptly in the middle
of a thought. When asked why, the person may say that it
felt as if the thought had been taken out of his or her head.
Finally, the individual might make up unintelligible words,
or "neologisms."
Disorders of Movement. People with schizophrenia
can be clumsy and uncoordinated. They may also exhibit involuntary
movements and may grimace or exhibit unusual mannerisms.
They may repeat certain motions over and over or, in extreme
cases, may become catatonic. Catatonia is a state of immobility
and unresponsiveness. It was more common when treatment for
schizophrenia was not available; fortunately, it is now rare.
Negative symptoms
The term "negative symptoms" refers to reductions in normal
emotional and behavioral states. These include the following:
- flat affect (immobile facial expression, monotonous voice),
- lack of pleasure in everyday life,
- diminished ability to initiate and sustain planned activity,
and
- speaking infrequently, even when forced to interact.
People with schizophrenia often neglect basic hygiene and
need help with everyday activities. Because it is not as
obvious that negative symptoms are part of a psychiatric
illness, people with schizophrenia are often perceived as
lazy and unwilling to better their lives.
Cognitive symptoms
Cognitive symptoms are subtle and are often detected only
when neuropsychological tests are performed. They include
the following:
- poor "executive functioning" (the ability to absorb and
interpret information and make decisions based on that
information),
- inability to sustain attention, and
- problems with "working memory" (the ability to keep recently
learned information in mind and use it right away)
Cognitive impairments often interfere with the patient's
ability to lead a normal life and earn a living. They can
cause great emotional distress.
When does it start and who gets it?
Psychotic symptoms (such as hallucinations and delusions)
usually emerge in men in their late teens and early 20s and
in women in their mid-20s to early 30s. They seldom occur
after age 45 and only rarely before puberty, although cases
of schizophrenia in children as young as 5 have been reported.
In adolescents, the first signs can include a change of friends,
a drop in grades, sleep problems, and irritability. Because
many normal adolescents exhibit these behaviors as well,
a diagnosis can be difficult to make at this stage. In young
people who go on to develop the disease, this is called the "prodromal" period.
Research has shown that schizophrenia affects men and women
equally and occurs at similar rates in all ethnic groups
around the world.
Are people with schizophrenia violent?
People with schizophrenia are not especially prone to violence
and often prefer to be left alone. Studies show that if people
have no record of criminal violence before they develop schizophrenia
and are not substance abusers, they are unlikely to commit
crimes after they become ill. Most violent crimes are not
committed by people with schizophrenia, and most people with
schizophrenia do not commit violent crimes. Substance abuse
always increases violent behavior, regardless of the presence
of schizophrenia (see sidebar). If someone with paranoid
schizophrenia becomes violent, the violence is most often
directed at family members and takes place at home.
What about suicide?
People with schizophrenia attempt suicide much more often
than people in the general population. About 10 percent
(especially young adult males) succeed. It is hard to predict
which people with schizophrenia are prone to suicide, so
if someone talks about or tries to commit suicide, professional
help should be sought right away.
What causes schizophrenia?
Like many other illnesses, schizophrenia is believed to
result from a combination of environmental and genetic factors.
All the tools of modern science are being used to search
for the causes of this disorder.
Can schizophrenia be inherited?
Scientists have long known that schizophrenia runs in families.
It occurs in 1 percent of the general population but is seen
in 10 percent of people with a first-degree relative (a parent,
brother, or sister) with the disorder. People who have second-degree
relatives (aunts, uncles, grandparents, or cousins) with
the disease also develop schizophrenia more often than the
general population. The identical twin of a person with schizophrenia
is most at risk, with a 40 to 65 percent chance of developing
the disorder.
Our genes are located on 23 pairs of chromosomes that are
found in each cell. We inherit two copies of each gene, one
from each parent. Several of these genes are thought to be
associated with an increased risk of schizophrenia, but scientists
believe that each gene has a very small effect and is not
responsible for causing the disease by itself. It is still
not possible to predict who will develop the disease by looking
at genetic material.
Although there is a genetic risk for schizophrenia, it is
not likely that genes alone are sufficient to cause the disorder.
Interactions between genes and the environment are thought
to be necessary for schizophrenia to develop. Many environmental
factors have been suggested as risk factors, such as exposure
to viruses or malnutrition in the womb, problems during birth,
and psychosocial factors, like stressful environmental conditions.
To read the rest of this article from the National Institute
for Mental Health, please click here: http://www.nimh.nih.gov/publicat/schizoph.cfm
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