Understanding Schizophrenia Syracuse NY
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Psychiatry, Child & Adolescent Psychiatry
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The 2002 Academy Award winner for Best Picture, A Beautiful Mind, brought schizophrenia into the public eye, depicting the true story of the progression of the illness in a brilliant Nobel prize winner. As the film illustrated, schizophrenia makes It difficult for a person to distinguish between what is real and unreal, to think clearly, and to behave in socially acceptable ways. These obstacles can have a severe impact on one’s work, relationships, and day-to-day functioning. But as A Beautiful Mind also showed, with treatment and support, a person with schizophrenia can still lead a productive life.
What is schizophrenia?
One Man’s Story
Daniel is 21-years-old. Six months ago, he was doing well in college and holding down a part-time job in the stockroom of a local electronics store. But then he began to change, becoming increasingly paranoid and acting out in bizarre ways. First, he became convinced that his professors were “out to get him” since they didn’t appreciate his confusing, off-topic classroom rants. Then he told his roommate that the other students were “in on the conspiracy.” Soon after, he dropped out of school.
From there, things just got worse. Daniel stopped bathing, shaving, and washing his clothes. At work, he became convinced that his boss was watching him through surveillance bugs planted in the store’s television sets. Then he started hearing voices telling him to find the bugs and deactivate them. Things came to a head when he acted on the voices, smashing several TVs and screaming that he wasn’t going to put up with the “illegal spying” any more. His frightened boss called the police, and Daniel was hospitalized.
Schizophrenia is a brain disorder that affects the way a person acts, thinks, and sees the world. People with schizophrenia have an altered perception of reality, often a significant loss of contact with reality. They may see or hear things that don’t exist, speak in strange or confusing ways, believe that others are trying to harm them, or feel like they’re being constantly watched. With such a blurred line between the real and the imaginary, schizophrenia makes it difficult—even frightening—to negotiate the activities of daily life. In response, people with schizophrenia may withdraw from the outside world or act out in confusion and fear.
Most cases of schizophrenia appear in the late teens or early adulthood. For men, the average age of onset is 25. For women, typical onset is around the age of 30. However, schizophrenia can appear for the first time in middle age or even later. In rare cases, schizophrenia can even affect young children and adolescents, although the symptoms are slightly different. In general, the earlier schizophrenia develops, the more severe it is. Schizophrenia also tends to be more severe in men than in women.
Although schizophrenia is a chronic disorder, there is help available. With support, medication, and therapy, many people with schizophrenia are able to function independently and live satisfying lives. However, the outlook is best when schizophrenia is diagnosed and treated right away. If you spot the signs and symptoms of schizophrenia and seek help without delay, you or your loved one can take advantage of the many treatments available and improve the chances of recovery.
Common Misconceptions about Schizophrenia
MYTH: Schizophrenia refers to a "split personality" or multiple personalities.
FACT: Multiple personality disorder is a different and much less common disorder than schizophrenia. People with schizophrenia do not have split personalities. Rather, they are “split off” from reality.
MYTH: Schizophrenia is a rare condition.
FACT: Schizophrenia is not rare; the lifetime risk of developing schizophrenia is widely accepted to be around 1 in 100.
MYTH: People with schizophrenia are dangerous.
FACT: Although the delusional thoughts and hallucinations of schizophrenia sometimes lead to violent behavior, most people with schizophrenia are neither violent nor a danger to others.
MYTH: People with schizophrenia can’t be helped.
FACT: While long-term treatment may be required, the outlook for schizophrenia is not hopeless. When treated properly, many people with schizophrenia are able to enjoy life and function within their families and communities.
Early schizophrenia warning signs
In some people, schizophrenia appears suddenly and without warning. But for most, it comes on slowly, with subtle warning signs and a gradual decline in functioning long before the first severe episode. Many friends and family members of people with schizophrenia report knowing early on that something was wrong with their loved one, they just didn’t know what.
In this early phase, people with schizophrenia often seem eccentric, unmotivated, emotionless, and reclusive. They isolate themselves, start neglecting their appearance, say peculiar things, and show a general indifference to life. They may abandon hobbies and activities, and their performance at work or school deteriorates.
The most common early warning signs of schizophrenia include:
While these warning signs can result from a number of problems—not just schizophrenia—they are cause for concern. When out-of-the-ordinary behavior is causing problems in your life or the life of a loved one, seek medical advice. If schizophrenia or another mental problem is the cause, treatment will help.
Signs and symptoms of schizophrenia
There are five types of symptoms characteristic of schizophrenia: delusions, hallucinations, disorganized speech, disorganized behavior, and the so-called “negative” symptoms. However, the signs and symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all symptoms. The symptoms of schizophrenia may also change over time.
A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of patients. Often, these delusions involve illogical or bizarre ideas or fantasies. Common schizophrenic delusions include:
Hallucinations are sounds or other sensations experienced as real when they exist only in the person's mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia. Visual hallucinations are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.
Schizophrenic hallucinations are usually meaningful to the person experiencing them. Many times, the voices are those of someone they know. Most commonly, the voices are critical, vulgar, or abusive. Hallucinations also tend to be worse when the person is alone.
Fragmented thinking is characteristic of schizophrenia. Externally, it can be observed in the way a person speaks. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. They may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.
Common signs of disorganized speech in schizophrenia include:
Schizophrenia disrupts goal-directed activity, causing impairments in a person’s ability to take care of him or herself, work, and interact with others. Disorganized behavior appears as:
The negative symptoms of schizophrenia refer to the absence of normal behaviors found in healthy individuals. Important negative symptoms of schizophrenia include:
“Positive” Symptoms of Schizophrenia
In contrast to the negative symptoms of schizophrenia, which refer to normal behaviors that are absent, positive symptoms refer to abnormal behaviors that are present. Delusions, hallucinations, disorganized speech, and disorganized behavior are all positive symptoms of schizophrenia.
Types of schizophrenia
There are three major subtypes of schizophrenia, each classified by their most prominent symptom: paranoid schizophrenia, disorganized schizophrenia, and catatonic schizophrenia.
Signs and symptoms of paranoid schizophrenia
The defining feature of paranoid schizophrenia is absurd or suspicious ideas and beliefs. These ideas typically revolve around a coherent, organized theme or “story” that remains consistent over time. Delusions of persecution are the most frequent theme, however delusions of grandeur are also common.
People with paranoid schizophrenia show a history of increasing paranoia and difficulties in their relationships. They tend to function better than individuals with other schizophrenic subtypes. In contrast, their thinking and behavior is less disordered and their long-term prognosis is better.
Signs and symptoms of disorganized schizophrenia
Disorganized schizophrenia generally appears at an earlier age than other types of schizophrenia. Its onset is gradual, rather than abrupt, with the person gradually retreating into his or her fantasies. The distinguishing characteristics of this subtype are disorganized speech, disorganized behavior, and blunted or inappropriate emotions. People with disorganized schizophrenia also have trouble taking care of themselves, and may be unable to perform simple tasks such as bathing or feeding themselves.
The symptoms of disorganized schizophrenia include:
People with disorganized schizophrenia sometimes suffer from hallucinations and delusions, but unlike the paranoid subtype, their fantasies aren’t consistent or organized.
Signs and symptoms of catatonic schizophrenia
The hallmark of catanoic schizophrenia is a disturbance in movement: either a decrease in motor activity, reflecting a stuporous state, or an increase in motor activity, reflecting an excited state.
People with catatonic schizophrenia can be highly suggestible. They may automatically obey commands, imitate the actions of others, or mimic what others say.
Causes of schizophrenia
The causes of schizophrenia are not fully known. However, it appears that schizophrenia usually results from a complex interaction between genetic and environmental factors.
Genetic causes of schizophrenia
Schizophrenia has a strong hereditary component. Individuals with a first-degree relative (parent or sibling) who has schizophrenia have a 10 percent chance of developing the disorder, as opposed to the 1 percent chance of the general population. But schizophrenia is only influenced by genetics, not determined by it. While schizophrenia runs in families, about 60% of schizophrenics have no family members with the disorder. Furthermore, individuals who are genetically predisposed to schizophrenia don’t always develop the disease, which shows that biology is not destiny.
Environmental causes of schizophrenia
Twin and adoption studies suggest that inherited genes make a person vulnerable to schizophrenia and then environmental factors act on this vulnerability to trigger the disorder. As for the environmental factors involved, more and more research is pointing to stress, either during pregnancy or at a later stage of development. High levels of stress are believed to trigger schizophrenia by increasing the body’s production of the hormone cortisol.
Research points to several stress-inducing environmental factors that may be involved in schizophrenia, including:
Brain chemical imbalances
There is evidence that chemical imbalances in certain neurotransmitters, proteins, and amino acids play a role in causing schizophrenia.
Abnormal brain structure
In addition to abnormal brain chemistry, abnormalities in brain structure may also play a role in schizophrenia. Enlarged brain ventricles are seen in some schizophrenics, indicating a deficit in the volume of brain tissue. There is also evidence of abnormally low activity in the frontal lobe, the area of the brain responsible for planning, reasoning, and decision-making. Some studies also suggest that abnormalities in the temporal lobes, hippocampus, and amygdala are connected to schizophrenia’s positive symptoms. But despite the evidence of brain abnormalities, it is highly unlikely that schizophrenia is the result of any one problem in any one region of the brain.
Effects of schizophrenia
When the signs and symptoms of schizophrenia are ignored or improperly treated, the effects can be devastating both to the individual with the disorder and those around him or her. Some of the possible effects of schizophrenia are:
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