Schizophrenia

Schizophrenia is a syndrome that involves a highly altered state of inner and outer reality that impairs the everyday functioning of the individual.  This state is apparent in the pattern of disturbed perception, thinking, emotions, speech, physical appearance and overall functioning.  It is characterized by an incongruence between different mental functions... between thought content and feelings, or between feelings and motor activity.  The types are characterized by the prominence of a significant feature.

Signs and Symptoms

• Delusions (of grandeur, persecution, reference)
• Hallucinations (auditory, visual, tactile, olfactory)
• Social and/or occupational dysfunction
• Disorganized speech (loose associations, incoherence, concreteness, echolalia)
• Disorganized or catatonic behavior
• Negative emotions (blunted, flattened, inappropriate)
• Loss of functioning in at least 2 areas of life. (work, social, occupational, personal care)
• Duration of symptoms (at least 6 months)

Types of Schizophrenia:

Paranoid Type 

• Delusions
• Hallucinations
• Show little impairment in functioning, behavior or speech.

Disorganized Type

• Incoherent speech
• Blunted or flattened affect
• Extreme social impairment
• History of premorbid functioning

Catatonic Type

• Psychomotor disturbance (catatonic stupor, rigidity, excitement, posturing)

Undifferentiated Type

• No significant feature is identified

About Schizophrenia
Schizophrenia is a serious mental illness which affects how a person thinks, feels and acts. It is a disease that makes it difficult for a person to tell the difference between real and imagined experiences, to think logically, to express normal emotional responses or to behave normally in social situations.

Schizophrenia can be draining on both the person with schizophrenia and their families. People with schizophrenia often have difficulty functioning in society, at work and in school. Family members may have to help out financially and make sure that medication is taken as prescribed.

No cure for schizophrenia has been discovered, but with proper treatment, many people with this illness can lead productive and fulfilling lives.

Schizophrenia affects about 1% of the world population. 
In the United States, about 2.5 million people have this disease.

Symptoms usually appear between the ages of 15 and 35, but often appear earlier in males than females.

Schizophrenia is NOT a "split personality."
Schizophrenia is NOT caused by bad parenting.
Schizophrenia is NOT caused by personal weakness.

What Causes Schizophrenia?
Schizophrenia is a complex and puzzling disease. There are several theories about the cause of this disease: genetics (heredity); imbalance in the brain's chemistry; complications during pregnancy and/or birth. However, it is not clear if one or all of these theories are a factor in causing the disease.

• Genetics (Heredity) Scientists recognize that the disorder tends to run in families and that a person inherits a tendency to develop the disease. Schizophrenia may be triggered by environmental events, such as viral infections or highly stressful situations or a combination of both. Similar to other genetically-related illnesses, schizophrenia appears when the body undergoes hormonal and physical changes, like those that occur during puberty in the teen and young adult years.
  
• Chemistry. Genetics help to determine how the brain uses certain chemicals. People with schizophrenia have a chemical imbalance which means they are either very sensitive to or produce too much of a brain chemical called dopamine.

  Dopamine, which is a neurotransmitter, allows nerve cells in the brain to send messages to each other. The imbalance of this chemical affects the way a person's brain reacts to stimuli--which explains why a person with schizophrenia may be overwhelmed by sensory information (loud music or bright lights) which other people can easily handle. This problem in processing different sounds, sights, smells and tastes can also lead to hallucinations or delusions.
  

• Complications during pregnancy and birth. Some researchers suspect a viral infection, improper nutrition during pregnancy, or birth complications may increase the chances of a person developing schizophrenia.

Treatment
Schizophrenia is usually a lifelong disease. Most people with this illness will probably take medication for the rest of their lives, as do patients with diabetes or high blood pressure.

Antipsychotic medications help to normalize the biochemical imbalances that cause schizophrenia. They are also important in reducing the likelihood of relapse. Like all medications, however, antipsychotic drugs should be taken only under close supervision of a psychiatrist or other physician.

There are two major types of antipsychotics, traditional and new antipsychotics.

Traditional antipsychotics effectively control the hallucinations, delusions, and confusion of schizophrenia.  Side effects are common to many medications, including those for schizophrenia. Traditional antipsychotics have side effects which may be mild, to serious; some only occurring at high doses.  Side effects for antipsychotics may cause a patient to stop taking them. However, it is important to talk with your doctor before making any changes in medication since many side effects can be controlled. Be sure to weigh the risks against the potential benefits that antipsychotic drugs can provide.

• Mild side effects: dry mouth, blurred vision, constipation, drowsiness and dizziness. These side affects usually disappear a few weeks after the person starts treatment.
• More serious side effects: trouble with muscle control, muscle spasms or cramps in the head and neck, fidgeting or pacing, tremors and shuffling of the feet (much like those affecting people with Parkinson's disease).
• Side effects due to prolonged use of traditional antipsychotic medications: facial ticks, thrusting and rolling of the tongue, lip licking, panting and grimacing.
• New antipsychotics:  New medications are effective in treating a broader range of symptoms of schizophrenia, and have fewer side effects than traditional antipsychotics.

Counseling and Rehabilitation People with schizophrenia often have a difficult time performing ordinary life skills such as cooking and personal grooming as well as communicating with others in the family and at work.

Rehabilitation can help a person regain the confidence to take care of themselves and live a fuller life. Different forms of "talk" therapy, both individual and group, can help both the patient and family members to better understand the illness and share their coping problems.

Coping Guidelines For The Family:

1. Establish a daily routine for the patient to follow.
2. Help the patient stay on the medication.
3. Keep the lines of communication open about problems or fears the patient may have.
4. Understand that caring for the patient can be emotionally and physically exhausting. Take time for yourself.
5. Keep your communications simple and brief when speaking with the patient.
6. Be patient and calm.
7. Ask for help if you need it.

References:
  American Psychiatric Association.   Let's Talk Facts Pamphlet Series
        http://www.psych.org/main.html
  Diagnostic and Statistical Manual of Mental Disorders.  Vol. IV  American 
        Psychiatric Association.  1994
  National Institute of Mental Health   
        http://www.nimh.nih.gov/about/index.cfm
  National Mental Health Association.. Information Fact Sheets   
        http://www.nmha.org/

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