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People
with the disorder may hear voices other people don't hear. They may believe
other people are reading their minds, controlling their thoughts, or plotting
to harm them. This can terrify people with the illness and make them withdrawn
or extremely agitated.
People
with schizophrenia may not make sense when they talk. They may sit for hours
without moving or talking. Sometimes people with schizophrenia seem perfectly
fine until they talk about what they are really thinking.
Families
and society are affected by schizophrenia too. Many people with schizophrenia
have difficulty holding a job or caring for themselves, so they rely on others
for help.
Treatment
helps relieve many symptoms of schizophrenia, but most people who have the
disorder cope with symptoms throughout their lives. However, many people with
schizophrenia can 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. In the years to come, this
work may help prevent and better treat the illness.
Experts
think schizophrenia is caused by several factors.
Genes and environment in Schizophrenia
Scientists have long known that schizophrenia runs in families. The illness occurs in 1 percent of the general population, but it occurs in 10 percent of people who have a first-degree relative with the disorder, such as a parent, brother, or sister. People who have second-degree relatives (aunts, uncles, grandparents, or cousins) with the disease also develop schizophrenia more often than the general population. The risk is highest for an identical twin of a person with schizophrenia. He or she has a 40 to 65 percent chance of developing the disorder.
Other
recent studies suggest that schizophrenia may result in part when a certain
gene that is key to making important brain chemicals malfunctions. This problem
may affect the part of the brain involved in developing higher functioning
skills. Research into this gene is ongoing, so it is not yet possible to use
the genetic information to predict who will develop the disease.
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In
addition, it probably takes more than genes to cause the disorder. Scientists
think interactions between genes and the environment are necessary for
schizophrenia to develop. Many environmental factors may be involved, such as
exposure to viruses or malnutrition before birth, problems during birth, and
other not yet known psychosocial factors.
Different brain chemistry and structure
Scientists think that an imbalance in the complex, interrelated chemical reactions of the brain involving the neurotransmitters dopamine and glutamate, and possibly others, plays a role in schizophrenia. Neurotransmitters are substances that allow brain cells to communicate with each other. Scientists are learning more about brain chemistry and its link to schizophrenia.
Also,
in small ways the brains of people with schizophrenia look different than those
of healthy people. For example, fluid-filled cavities at the center of the
brain, called ventricles, are larger in some people with schizophrenia. The
brains of people with the illness also tend to have less gray matter, and some
areas of the brain may have less or more activity.
Studies
of brain tissue after death also have revealed differences in the brains of
people with schizophrenia. Scientists found small changes in the distribution
or characteristics of brain cells that likely occurred before birth. Some
experts think problems during brain development before birth may lead to faulty
connections. The problem may not show up in a person until puberty. The brain
undergoes major changes during puberty, and these changes could trigger
psychotic symptoms. Scientists have learned a lot about schizophrenia, but more
research is needed to help explain how it develops.
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Who Is At Risk?
About
1% of Americans have this illness.
Schizophrenia
affects men and women equally. It occurs at similar rates in all ethnic groups
around the world. Symptoms such as hallucinations and delusions usually start
between ages 16 and 30. Men tend to experience symptoms a little earlier than
women. Most of the time, people do not get schizophrenia after age 45.
Schizophrenia rarely occurs in children, but awareness of childhood-onset
schizophrenia is increasing.
It
can be difficult to diagnose schizophrenia in teens. This is because the first
signs can include a change of friends, a drop in grades, sleep problems, and
irritability—behaviors that are common among teens. A combination of factors
can predict schizophrenia in up to 80% of youth who are at high risk of developing
the illness. These factors include isolating oneself and withdrawing from
others, an increase in unusual thoughts and suspicions, and a family history of
psychosis. In young people who develop the disease, this stage of the disorder
is called the "prodromal" period.
Signs & Symptoms of Schizophrenia
The
symptoms of schizophrenia fall into three broad categories: positive symptoms,
negative symptoms, and cognitive symptoms.
Positive symptoms
Positive
symptoms are psychotic behaviors not seen in healthy people. People with
positive symptoms often "lose touch" with reality. These symptoms can
come and go. Sometimes they are severe and at other times hardly noticeable,
depending on whether the individual is receiving treatment. They include the
following:
Hallucinations are things 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. The voices may talk to the person about his or her behavior, order
the person to do things, or warn the person of danger. Sometimes the voices
talk to each other. People with schizophrenia may hear voices for a long time
before family and friends notice the problem.
Other
types of hallucinations include seeing people or objects that are not there,
smelling odors that no one else detects, and feeling things like invisible
fingers touching their bodies when no one is near.
Delusions are false beliefs that are not part of the person's
culture and do not change. The person believes delusions even after other
people prove that the beliefs are not true or logical. People with
schizophrenia can have delusions that seem bizarre, such as believing that
neighbors can control their behavior with magnetic waves. They may also believe
that people on television are directing special messages to them, or that radio
stations are broadcasting their thoughts aloud to others. Sometimes they
believe they are someone else, such as a famous historical figure. They may
have paranoid delusions and believe that others are trying to harm them, such
as by cheating, harassing, poisoning, spying on, or plotting against them or
the people they care about. These beliefs are called "delusions of
persecution."
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Thought
disorders are unusual or dysfunctional
ways of thinking. One form of thought disorder is called "disorganized
thinking." This is when a person has trouble organizing his or her
thoughts or connecting them logically. They may talk in a garbled way that is
hard to understand. Another form is called "thought blocking." This
is when a person stops speaking abruptly in the middle of a thought. When asked
why he or she stopped talking, the person may say that it felt as if the
thought had been taken out of his or her head. Finally, a person with a thought
disorder might make up meaningless words, or "neologisms."
Movement
disorders may appear as agitated body
movements. A person with a movement disorder may repeat certain motions over
and over. In the other extreme, a person may become catatonic. Catatonia is a
state in which a person does not move and does not respond to others. Catatonia
is rare today, but it was more common when treatment for schizophrenia was not
available.
Negative
symptoms
Negative
symptoms are associated with disruptions to normal emotions and behaviors.
These symptoms are harder to recognize as part of the disorder and can be
mistaken for depression or other conditions. These symptoms include the
following:
·
"Flat affect" (a person's
face does not move or he or she talks in a dull or monotonous voice)
·
Lack of pleasure in everyday life
·
Lack of ability to begin and sustain
planned activities
·
Speaking little, even when forced to
interact.
People
with negative symptoms need help with everyday tasks. They often neglect basic
personal hygiene. This may make them seem lazy or unwilling to help themselves,
but the problems are symptoms caused by the schizophrenia.
Cognitive
symptoms
Cognitive
symptoms are subtle. Like negative symptoms, cognitive symptoms may be
difficult to recognize as part of the disorder. Often, they are detected only
when other tests are performed. Cognitive symptoms include the following:
·
Poor "executive
functioning" (the ability to understand information and use it to make
decisions)
·
Trouble focusing or paying attention
·
Problems with "working
memory" (the ability to use information immediately after learning it).
Cognitive
symptoms often make it hard to lead a normal life and earn a living. They can
cause great emotional distress.
Treatments
Because
the causes of schizophrenia are still unknown, treatments focus on eliminating
the symptoms of the disease. Treatments include antipsychotic medications and
various psychosocial treatments.
Antipsychotic
medications
Antipsychotic
medications have been available since the mid-1950's. The older types are
called conventional or "typical" antipsychotics. Some of the more
commonly used typical medications include:
·
Chlorpromazine (Thorazine)
·
Haloperidol (Haldol)
·
Perphenazine (Etrafon, Trilafon)
·
Fluphenazine (Prolixin).
In
the 1990's, new antipsychotic medications were developed. These new medications
are called second generation, or "atypical" antipsychotics.
One
of these medications, clozapine (Clozaril) is an effective medication that
treats psychotic symptoms, hallucinations, and breaks with reality. But
clozapine can sometimes cause a serious problem called agranulocytosis, which
is a loss of the white blood cells that help a person fight infection. People
who take clozapine must get their white blood cell counts checked every week or
two. This problem and the cost of blood tests make treatment with clozapine
difficult for many people. But clozapine is potentially helpful for people who
do not respond to other antipsychotic medications.
Other
atypical antipsychotics were also developed. None cause agranulocytosis.
Examples include:
·
Risperidone (Risperdal)
·
Olanzapine (Zyprexa)
·
Quetiapine (Seroquel)
·
Ziprasidone (Geodon)
·
Aripiprazole (Abilify)
·
Paliperidone (Invega).
What
are the side effects?
Some
people have side effects when they start taking these medications. Most side
effects go away after a few days and often can be managed successfully. People
who are taking antipsychotics should not drive until they adjust to their new
medication. Side effects of many antipsychotics include:
·
Drowsiness
·
Dizziness when changing positions
·
Blurred vision
·
Rapid heartbeat
·
Sensitivity to the sun
·
Skin rashes
·
Menstrual problems for women.
Atypical
antipsychotic medications can cause major weight gain and changes in a person's
metabolism. This may increase a person's risk of getting diabetes and high
cholesterol. A person's weight, glucose levels, and lipid levels should be
monitored regularly by a doctor while taking an atypical antipsychotic
medication.
Typical
antipsychotic medications can cause side effects related to physical movement,
such as:
·
Rigidity
·
Persistent muscle spasms
·
Tremors
·
Restlessness.
Long-term
use of typical antipsychotic medications may lead to a condition called tardive
dyskinesia (TD). TD causes muscle movements a person can't control. The
movements commonly happen around the mouth. TD can range from mild to severe,
and in some people the problem cannot be cured. Sometimes people with TD
recover partially or fully after they stop taking the medication.
TD
happens to fewer people who take the atypical antipsychotics, but some people
may still get TD. People who think that they might have TD should check with
their doctor before stopping their medication.
How
are antipsychotics taken and how do people respond to them?
Antipsychotics
are usually in pill or liquid form. Some anti-psychotics are shots that are
given once or twice a month.
Symptoms
of schizophrenia, such as feeling agitated and having hallucinations, usually
go away within days. Symptoms like delusions usually go away within a few
weeks. After about six weeks, many people will see a lot of improvement.
However,
people respond in different ways to antipsychotic medications, and no one can
tell beforehand how a person will respond. Sometimes a person needs to try
several medications before finding the right one. Doctors and patients can work
together to find the best medication or medication combination, as well as the
right dose.
Some
people may have a relapse-their symptoms come back or get worse. Usually,
relapses happen when people stop taking their medication, or when they only
take it sometimes. Some people stop taking the medication because they feel
better or they may feel they don't need it anymore. But no one should stop
taking an antipsychotic medication without talking to his or her doctor. When a
doctor says it is okay to stop taking a medication, it should be gradually
tapered off, never stopped suddenly.
How
do antipsychotics interact with other medications?
Antipsychotics
can produce unpleasant or dangerous side effects when taken with certain
medications. For this reason, all doctors treating a patient need to be aware
of all the medications that person is taking. Doctors need to know about
prescription and over-the-counter medicine, vitamins, minerals, and herbal
supplements. People also need to discuss any alcohol or other drug use with
their doctor.
To
find out more about how antipsychotics work, the National Institute of Mental
Health (NIMH) funded a study called CATIE (Clinical Antipsychotic Trials of
Intervention Effectiveness). This study compared the effectiveness and side
effects of five antipsychotics used to treat people with schizophrenia. In
general, the study found that the older typical antipsychotic perphenazine
(Trilafon) worked as well as the newer, atypical medications. But because
people respond differently to different medications, it is important that
treatments be designed carefully for each person. More information about CATIE
is on the NIMH website.
Psychosocial
treatments
Psychosocial
treatments can help people with schizophrenia who are already stabilized on
antipsychotic medication. Psychosocial treatments help these patients deal with
the everyday challenges of the illness, such as difficulty with communication,
self-care, work, and forming and keeping relationships. Learning and using
coping mechanisms to address these problems allow people with schizophrenia to
socialize and attend school and work.
Patients
who receive regular psychosocial treatment also are more likely to keep taking
their medication, and they are less likely to have relapses or be hospitalized.
A therapist can help patients better understand and adjust to living with
schizophrenia. The therapist can provide education about the disorder, common
symptoms or problems patients may experience, and the importance of staying on
medications. For more information on psychosocial treatments, see the psychotherapies section on the NIMH
website.
Illness
management skills. People with schizophrenia can take
an active role in managing their own illness. Once patients learn basic facts
about schizophrenia and its treatment, they can make informed decisions about
their care. If they know how to watch for the early warning signs of relapse
and make a plan to respond, patients can learn to prevent relapses. Patients
can also use coping skills to deal with persistent symptoms.
Integrated
treatment for co-occurring substance abuse.
Substance abuse is the most common co-occurring disorder in people with
schizophrenia. But ordinary substance abuse treatment programs usually do not
address this population's special needs. When schizophrenia treatment programs
and drug treatment programs are used together, patients get better results.
Rehabilitation. Rehabilitation emphasizes social and vocational training
to help people with schizophrenia function better in their communities. Because
schizophrenia usually develops in people during the critical career-forming
years of life (ages 18 to 35), and because the disease makes normal thinking
and functioning difficult, most patients do not receive training in the skills
needed for a job.
Rehabilitation
programs can include job counseling and training, money management counseling,
help in learning to use public transportation, and opportunities to practice
communication skills. Rehabilitation programs work well when they include both
job training and specific therapy designed to improve cognitive or thinking
skills. Programs like this help patients hold jobs, remember important details,
and improve their functioning.
Family
education. People with schizophrenia are
often discharged from the hospital into the care of their families. So it is
important that family members know as much as possible about the disease. With
the help of a therapist, family members can learn coping strategies and
problem-solving skills. In this way the family can help make sure their loved
one sticks with treatment and stays on his or her medication. Families should
learn where to find outpatient and family services.
Cognitive
behavioral therapy. Cognitive behavioral therapy (CBT)
is a type of psychotherapy that focuses on thinking and behavior. CBT helps
patients with symptoms that do not go away even when they take medication. The
therapist teaches people with schizophrenia how to test the reality of their
thoughts and perceptions, how to "not listen" to their voices, and
how to manage their symptoms overall. CBT can help reduce the severity of
symptoms and reduce the risk of relapse.
Self-help
groups. Self-help groups for people with
schizophrenia and their families are becoming more common. Professional
therapists usually are not involved, but group members support and comfort each
other. People in self-help groups know that others are facing the same
problems, which can help everyone feel less isolated. The networking that takes
place in self-help groups can also prompt families to work together to advocate
for research and more hospital and community treatment programs. Also, groups
may be able to draw public attention to the discrimination many people with
mental illnesses face.
Living With
How
can you help a person with schizophrenia?
People
with schizophrenia can get help from professional case managers and caregivers
at residential or day programs. However, family members usually are a patient's
primary caregivers.
People
with schizophrenia often resist treatment. They may not think they need help
because they believe their delusions or hallucinations are real. In these
cases, family and friends may need to take action to keep their loved one safe.
Laws vary from state to state, and it can be difficult to force a person with a
mental disorder into treatment or hospitalization. But when a person becomes
dangerous to himself or herself, or to others, family members or friends may
have to call the police to take their loved one to the hospital.
Treatment
at the hospital. In the emergency room, a mental
health professional will assess the patient and determine whether a voluntary
or involuntary admission is needed. For a person to be admitted involuntarily,
the law states that the professional must witness psychotic behavior and hear
the person voice delusional thoughts. Family and friends can provide needed
information to help a mental health professional make a decision.
After
a loved one leaves the hospital.
Family and friends can help their loved ones get treatment and take their
medication once they go home. If patients stop taking their medication or stop
going to follow-up appointments, their symptoms likely will return. Sometimes
symptoms become severe for people who stop their medication and treatment. This
is dangerous, since they may become unable to care for themselves. Some people
end up on the street or in jail, where they rarely receive the kind of help
they need.
Family
and friends can also help patients set realistic goals and learn to function in
the world. Each step toward these goals should be small and taken one at a
time. The patient will need support during this time. When people with a mental
illness are pressured and criticized, they usually do not get well. Often,
their symptoms may get worse. Telling them when they are doing something right
is the best way to help them move forward.
It
can be difficult to know how to respond to someone with schizophrenia who makes
strange or clearly false statements. Remember that these beliefs or
hallucinations seem very real to the person. It is not helpful to say they are
wrong or imaginary. But going along with the delusions is not helpful, either.
Instead, calmly say that you see things differently. Tell them that you
acknowledge that everyone has the right to see things his or her own way. In
addition, it is important to understand that schizophrenia is a biological
illness. Being respectful, supportive, and kind without tolerating dangerous or
inappropriate behavior is the best way to approach people with this disorder.
Are
people with schizophrenia violent?
People
with schizophrenia are not usually violent. In fact, most violent crimes are
not committed by people with schizophrenia. However, some symptoms are
associated with violence, such as delusions of persecution. Substance abuse may
also increase the chance a person will become violent. If a person with
schizophrenia becomes violent, the violence is usually directed at family
members and tends to take place at home.
The
risk of violence among people with schizophrenia is small. But people with the
illness attempt suicide much more often than others. About 10 percent
(especially young adult males) die by suicide. It is hard to predict which
people with schizophrenia are prone to suicide. If you know someone who talks
about or attempts suicide, help him or her find professional help right away.
What
about substance abuse?
Some
people who abuse drugs show symptoms similar to those of schizophrenia.
Therefore, people with schizophrenia may be mistaken for people who are
affected by drugs. Most researchers do not believe that substance abuse causes
schizophrenia. However, people who have schizophrenia are much more likely to
have a substance or alcohol abuse problem than the general population.
Substance
abuse can make treatment for schizophrenia less effective. Some drugs, like
marijuana and stimulants such as amphetamines or cocaine, may make symptoms
worse. In fact, research has found increasing evidence of a link between
marijuana and schizophrenia symptoms. In addition, people who abuse drugs are
less likely to follow their treatment plan.
Schizophrenia
and smoking
Addiction
to nicotine is the most common form of substance abuse in people with
schizophrenia. They are addicted to nicotine at three times the rate of the
general population (75 to 90 percent vs. 25 to 30 percent).
The
relationship between smoking and schizophrenia is complex. People with
schizophrenia seem to be driven to smoke, and researchers are exploring whether
there is a biological basis for this need. In addition to its known health
hazards, several studies have found that smoking may make antipsychotic drugs
less effective.
Quitting
smoking may be very difficult for people with schizophrenia because nicotine
withdrawal may cause their psychotic symptoms to get worse for a while.
Quitting strategies that include nicotine replacement methods may be easier for
patients to handle. Doctors who treat people with schizophrenia should watch
their patients' response to antipsychotic medication carefully if the patient
decides to start or stop smoking.
The above
information was from the National Institute of Mental Health (NIMH)
website. Find this information on their
website at http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
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