Schizophrenia

Schizophrenia changes your entire world. This brain disorder affects your thoughts, emotions, perception, and the way you see the world around you. The presentation of schizophrenia varies from one person to another, but the effects can be severe if left untreated.

Medicine defines schizophrenia as a chronic, severe, and disabling brain disorder that can affect a person significantly from the very beginning. It can affect major areas of function such as school, work, interpersonal relations, and self-care. The word schizophrenia means, “split mind.” However, this is an unfortunate result of the choice of a name almost a century ago. A person with schizophrenia does not experience multiple “minds” or personalities.

Schizophrenia exhibits certain characteristics in individuals. When facing schizophrenia, you may experience some or all of the following.

• Delusions: A delusion is holding on to a strong belief in something that is clearly not real, even when shown evidence to the contrary. The most common types of delusions are:
  • Paranoid delusions – “Aliens are after me to kill me. They follow me everywhere.”
  • Grandeur delusions – “I have special powers” or “I am the president of the nation.”
• Hallucinations:  A hallucination is feeling, seeing, or hearing something is there when in reality, it is not. Common types are:
  • Auditory. “I hear the voices of my dead family members.”
  • Visual. “I can see aliens sitting beside me.”
  • Tactile. “I can feel bugs crawling all over my body.”
• Disorganized speech:  When your speech often does not make sense.
• Grossly Abnormal Psychomotor Behavior: When you become mute or assume an inappropriate posture.
• Negative symptoms: Negative symptoms refer to the lack of normal characteristics or functions. Examples include:
  • Loss of interest in everyday activities
  • Lack of emotion
  • Reduced ability to plan or carry out activities
  • Neglect of personal hygiene
  • Social withdrawal
  • Loss of motivation

Experts believe schizophrenia is caused by several factors including genetic, environmental and biochemical factors.

Genetic Factors

There is some evidence that the disorder is heavily influenced by genetics. Those with a family history of schizophrenia have a higher chance of developing the disorder.  Studies show there is 12% prevalence in a child with one parent with schizophrenia and 40% prevalence if both parents are affected.

Environmental Factors

Certain environmental factors including stressful life circumstances and taking psychoactive drugs during adolescence and young adulthood have been linked to cases of schizophrenia. 

Biochemical Factors

The most popular brain chemical malfunction hypothesis is the dopamine hypothesis.

• Dopamine Hypothesis: Dopamine is a naturally occurring brain chemical. In cases of schizophrenia, this chemical is overactive in some areas of the brain (the mesolimbic system). Experts believe this overactivity is associated with delusions/hallucinations. In another region of the brain, (the meso-cortical area), dopamine is underactive in schizophrenics. Experts believe this underactivity is associated with “negative symptoms” described above.

Schizophrenia is somewhat common; it affects approximately 1% of the general population. In men, symptoms can start earlier-typically in their teens or 20s. For women, schizophrenia symptoms often come later, in the 20s or early 30s. It is uncommon for children to be diagnosed with schizophrenia and rare for those older than 45 to be newly diagnosed with the disorder.

Schizophrenia is a chronic condition that requires lifelong treatment. Treatment involves medications combined with psychosocial therapy. There are several challenges that come with treating schizophrenia.

First, the initial challenge comes with identifying the disorder early, and then helping patients and their families understand that schizophrenia is a brain disorder that requires treatment. Educating yourself and your family has a direct correlation with healthy outcomes.

Second, initiating antipsychotic medication and maintaining a treatment schedule can be an ongoing challenge. Schizophrenia is not “cured” it is treated over the course of a lifetime. Starting treatment early creates a better outcome. Every relapse due to stopping medication can affect future responses and prognosis. Once diagnosed, it is crucial to remain medicated for life, just like in other illnesses such as diabetes and hypertension. In addition, other risk factors including drug/alcohol, stress, and medical illnesses must be well managed to achieve better outcomes.

Antipsychotic medications have played a huge role in improving the patient’s quality and functionality of life since the 1950’s. These medications used in the management of schizophrenia target the areas of the brain where the chemicals (dopamine and/or serotonin) are either overactive or underactive. By controlling these brain chemicals with medications, the symptoms of schizophrenia can be controlled.

Antipsychotic medications are classified into two categories: Typical (conventional type), and Atypical (new generation). Both are commonly used in current practice. However, atypical antipsychotics are preferred over typical antipsychotics based on some therapeutic advantages and lower neurological side effects.

No preventive treatment is known for schizophrenia. However, early detection and treatment intervention can help get symptoms well under control. Members of high-risk groups such as those with a strong family history can take proactive steps by avoiding use of illegal drugs or alcohol, and reducing stress may help minimize symptoms or prevent them from worsening.