Schizophrenia

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Schizophrenia Overview
Schizophrenia Causes
Schizophrenia Symptoms
When to Seek Medical Care
Exams and Tests
Schizophrenia Treatment
Self-Care at Home
Medical Treatment
Medications
Other Therapy
Next Steps
Follow-up
Prevention
Outlook
Support Groups and Counseling
For More Information
Web Links
Synonyms and Keywords
Authors and Editors
Related schizophrenia articles:
Schizophrenia - on WebMD
Schizophrenia - on MedicineNet

Schizophrenia Overview
Schizophrenia is a chronic, severe, and disabling mental illness. It affects men and women with equal
frequency. People suffering from schizophrenia may have the following symptoms:

Delusions, false personal beliefs held with conviction in spite of reason or evidence to the contrary,
not explained by that person's cultural context

Hallucinations, perceptions (can be sound, sight, touch, smell, or taste) that occur in the absence of
an actual external stimulus (Auditory hallucinations, those of voice or other sounds, are the most
common type of hallucinations in schizophrenia.)
Disorganized thoughts and behaviors
Disorganized speech
Catatonic behavior, in which the affected person's body may be rigid and the person may be
unresponsive
The term schizophrenia is Greek in origin, and in the Greek meant "split mind." This is not an accurate
medical term. In Western culture, some people have come to believe that schizophrenia refers to a splitpersonality disorder. These are two very different disorders, and people with schizophrenia do not have
separate personalities.
Schizophrenia and other mental health disorders have fairly strict criteria for diagnosis. Time of onset as well
as length and characteristics of symptoms are all factors. The active symptoms of schizophrenia must be
present at least 6 months, or only 1 month if treated.

 Who is affected?

Estimates of how many people are diagnosed with this disorder vary. The illness affects
about 1% of the population. More than 2 million Americans suffer from schizophrenia at
any given time, and 100,000-200,000 people are newly diagnosed every year. Fifty
percent of people in hospital psychiatric care have schizophrenia.

Schizophrenia is usually diagnosed in people aged 17-35 years. The illness appears
earlier in men (in the late teens or early twenties) than in women (who are affected in the
twenties to early thirties). Many of them are disabled. They may not be able to hold
down jobs or even perform tasks as simple as conversations. Some may be so
incapacitated that they are unable to do activities most people take for granted, such as
showering or preparing a meal. Many are homeless. Some recover enough to live a life
relatively free from assistance.

Schizophrenia Causes
The causes of schizophrenia are not known. However, an interplay of genetic, biological, environmental, and
psychological factors are thought to be involved. We do not yet understand all the causes and other
issues involved, but current research is making steady progress towards elucidating and defining causes of
schizophrenia.
In biological models of schizophrenia, genetic (familial) predisposition, infectious agents, allergies, and
disturbances in metabolism have all been investigated.
Schizophrenia is known to run in families. Thus, the risk of illness in an identical twin of a person with
schizophrenia is 40-50%. A child of a parent suffering from schizophrenia has a 10% chance of developing
the illness. The risk of schizophrenia in the general population is about 1%.
The current concept is that multiple genes are involved in the development of schizophrenia and that factors
such as prenatal (intrauterine), perinatal, and nonspecific stressors are involved in creating a disposition or
vulnerability to develop the illness. Neurotransmitters (chemicals allowing the communication between nerve
cells) have also been implicated in the development of schizophrenia. The list of neurotransmitters under
scrutiny is long, but special attention has been given to dopamine, serotonin, and glutamate.
Also, recent studies have identified subtle changes in brain structure and function, indicating that, at least in
part, schizophrenia could be a disorder of the development of the brain.
It is important for doctors to investigate all reasonable medical causes for any acute change in someones
mental health or behavior. Sometimes a medical condition that might be treated easily, if diagnosed, is
responsible for symptoms that resemble those of schizophrenia

Schizophrenia Symptoms
Usually with schizophrenia, the person's inner world and behavior change notably. Behavior changes might
include the following:

Social withdrawal

Depersonalization (intense anxiety and a feeling of being unreal)

Loss of appetite
Loss of hygiene
Delusions

 Hallucinations (eg, hearing things not actually present)

The sense of being controlled by outside forces
A person with schizophrenia may not have any outward appearance of being ill. In other cases, the illness
may be more apparent, causing bizarre behaviors. For example, a person with schizophrenia may wear
aluminum foil in the belief that it will stop one's thoughts from being broadcasted and protect against
malicious waves entering the brain.
People with schizophrenia vary widely in their behavior as they struggle with an illness beyond their control.
In active stages, those affected may ramble in illogical sentences or react with uncontrolled anger or
violence to a perceived threat. People with schizophrenia may also experience relatively passive phases of
the illness in which they seem to lack personality, movement, and emotion (also called a flat affect). People
with schizophrenia may alternate in these extremes. Their behavior may or may not be predictable.
In order to better understand schizophrenia, the concept of clusters of symptoms is often used. Thus, people
with schizophrenia can experience symptoms that may be grouped under the following categories:

Positive symptoms - Hearing voices, suspiciousness, feeling under constant surveillance,

delusions, or making up words without a meaning (neologisms).

Negative (or deficit) symptoms - Social withdrawal, difficulty in expressing emotions (in extreme
cases called blunted affect), difficulty in taking care of themselves, inability to feel pleasure (These
symptoms cause severe impairment and are often mistaken for laziness.)
Cognitive symptoms - Difficulties attending to and processing of information, in understanding the
environment, and in remembering simple tasks
Affective (or mood) symptoms - Most notably depression, accounting for a very high rate of
attempted suicide in people suffering from schizophrenia
Helpful definitions in understanding schizophrenia include the following:

Psychosis: Psychosis is defined as being out of touch with reality. During this phase, one can
experience delusions or prominent hallucinations. People with psychoses are not aware that what
they are experiencing or some of the things that they believe are not real. Psychosis is a prominent
feature of schizophrenia but is not unique to this illness.

Schizoid: This term is often used to describe a personality disorder characterized by almost

complete lack of interest in social relationships and a restricted range of expression of emotions in
interpersonal settings, making a person with this disorder appear cold and aloof.
Schizotypal: This term defines a more severe personality disorder characterized by acute
discomfort with close relationships as well as disturbances of perception and bizarre behaviors,
making people with schizophrenia seem odd and eccentric because of unusual mannerisms.
Hallucinations: A person with schizophrenia may have strong sensations of objects or events that
are real only to him or her. These may be in the form of things that they believe strongly that they
see, hear, smell, taste, or touch. Hallucinations have no outside source, and are sometimes
described as "the person's mind playing tricks" on him or her.
Illusion: An illusion is a mistaken perception for which there is an actual external stimulus. For
example, a visual illusion might be seeing a shadow and misinterpreting it as a person. The words
"illusion" and "hallucination" are sometimes confused with each other.
Delusion: A person with a delusion has a strong belief about something despite evidence that the
belief is false. For instance, a person may listen to a radio and believe the radio is giving a coded
message about an impending extraterrestrial invasion. All of the other people who listen to the
same radio program would hear, for example, a feature story about road repair work taking place in
the area.

Types of schizophrenia are as follows:

Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations but relatively

normal intellectual functioning and expression of affect. The delusions can often be about being
persecuted unfairly or being some other person who is famous. People with paranoid-type
schizophrenia can exhibit anger, aloofness, anxiety, and argumentativeness.

Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or

difficult to understand, and flattening or inappropriate emotions. People with disorganized-type
schizophrenia may laugh at the changing color of a traffic light or at something not closely related
to what they are saying or doing. Their disorganized behavior may disrupt normal activities, such as
showering, dressing, and preparing meals.
Catatonic-type schizophrenia is characterized by disturbances of movement. People with catatonictype schizophrenia may keep themselves completely immobile or move all over the place. They
may not say anything for hours, or they may repeat anything you say or do senselessly. Either
way, the behavior is putting these people at high risk because it impairs their ability to take care of
themselves.
Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the
above types but not enough of any one of them to define it as another particular type of
schizophrenia.
Residual-type schizophrenia is characterized by a past history of at least one episode of
schizophrenia, but the person currently has no positive symptoms (delusions, hallucinations,
disorganized speech or behavior). It may represent a transition between a full-blown episode and
complete remission, or it may continue for years without any further psychotic episodes.

When to Seek Medical Care

If someone who has been diagnosed with schizophrenia has any behavior change that might indicate
treatment is not working, it is best to call the doctor. If the family, friends, or guardians of a person with
schizophrenia believe symptoms are increasing, a doctor should be called as well. Do not overlook the
possibility of another medical problem in addition to the schizophrenia.

On a general level, anyone with an acute change in mental status (a noticeable change in
behavior), whether diagnosed with schizophrenia or not, should be taken to a hospital or a
physician for evaluation. The behavior change may indicate a readily treatable medical illness that,
if not treated early, can cause permanent physical damage.

Someone with schizophrenia should be taken to the hospital if medical illness is suspected. People
with schizophrenia may or may not be able to communicate their symptoms in the same way as
someone who does not have schizophrenia. This situation requires a doctor for diagnosis and
treatment. Moreover, medical illness can aggravate schizophrenia.
Take your loved one with schizophrenia immediately to the hospital and/or call "911;" if he or she is in
danger of self-harm or harming others. People with schizophrenia are much more likely than the general
population to commit suicide.

A quick way to assess whether someone is suicidal or homicidal is to ask the questions: "Do you
want to hurt or kill yourself?" "Do you want to hurt or kill anyone?" "Are you hearing any voices?"
and "What are the voices telling you?" People will tell you what is on their mind and should be
taken seriously when they verbalize these thoughts.

Many families fear abusing the emergency medical system when these and similar issues arise. However, if
you have any doubts, go to the emergency department. Don't worry about whether the visit should be made.
If, afterward, the health concern is found not to be an emergency problem, then everyone is relieved.
Likewise, if a medical emergency is found, you have made the right decision. The medical professionals can
reassure you that you made the right decision in the face of unknown medical questions about someone
elses health

Exams and Tests

To diagnose schizophrenia, one has first to rule out any medical illness that may be the actual cause of the
behavioral changes. Once medical causes have been looked for and not found, a psychotic illness such as
schizophrenia could be considered. The diagnosis will best be made by a licensed mental health
professional (preferably a psychiatrist) who can evaluate the patient and carefully sort through a variety of
mental illnesses that might look alike at the initial examination.

The doctor will examine someone in whom schizophrenia is suspected either in an office or in the
emergency department. The doctor's role is to ensure that the patient doesn't have any medical
problems. The doctor takes the patient's history and performs a physical examination. Laboratory
and other tests, sometimes including a computerized tomography (CT) scan of the brain, are
performed. Physical findings can relate to the symptoms associated with schizophrenia or to the
medications the person may be taking.

People with schizophrenia can exhibit a mild confusion or clumsiness.

Subtle minor physical features, such as highly arched palate or wide or narrow set eyes,
have been described, but none of these findings alone allow the physician to make the
diagnosis.

Most symptoms found are related to movement (motor symptoms). Some of these can be
side effects of prescribed medications. Medications may, for example, cause dry mouth,
constipation, drowsiness, stiffness on one side of the neck or jaw, restlessness, tremors of
the hands and feet, and slurred speech.

Tardive dyskinesia is one of the most serious side effects of medications used to treat
schizophrenia. It is usually seen in older people and involves facial twitching, jerking and
twisting of the limbs or trunk of the body, or both. It is a less common side effect with the
newer generation of medications used to treat schizophrenia. It does not always go away,
even when the medicine that caused it is discontinued.

A rare, but life-threatening complication resulting from the use of neuroleptic

(antipsychotic, tranquilizing) medications is neuroleptic malignant syndrome (NMS). It
involves extreme muscle rigidity, sweatiness, salivation, and fever. If this is suspected, it
should be treated as an emergency.

Generally, results are normal in schizophrenia for the lab tests and imaging studies available to
most doctors. If the person has a particular behavior as part of their mental disorder, such as
drinking too much water, then this might show as a metabolic abnormality in the person's laboratory
results. Some medications can trigger a decreased immune response, reflected by a low number of
white blood cells in the blood. Likewise, in people with NMS, metabolism may be abnormal.

Family members or friends of the person with schizophrenia can help by giving the doctor
a detailed history and information about the patient, including behavioral changes, previous level of

social functioning, history of mental illness in the family, past medical and psychiatric problems,
medications, and allergies (to foods and medications), as well as the person's previous physicians
and psychiatrists. A history of hospitalizations is also helpful so that old records at these facilities
might be obtained and reviewed.

Schizophrenia Treatment
Self-Care at Home
Home care for a person with schizophrenia depends on how ill the person is and on the family or guardian's
ability to care for the person. The ability to care for a person with schizophrenia is tied closely to time,
emotional strength, and financial reserves.
In spite of these possible barriers, basic issues to address with people with schizophrenia, include the
following:

First, ensure that your loved one is taking prescribed medications. One of the most common
reasons that people with schizophrenia relapse into a new episode is that they quit taking
medication. Family members might see much improvement and mistakenly assume medications
may no longer be needed. That is a disastrous assumption. A later psychotic outbreak will likely
happen.

The family should provide a caring, safe environment that allows for as much freedom of action as
is appropriate at the time. Any hostility in the environment should be reduced or eliminated.
Likewise, any criticism should be reduced.

Medical Treatment
This is a time of hope for people with schizophrenia as well as for their families. New and safer medications
are constantly being discovered, thus making it possible not only to treat symptoms otherwise resistant to
treatment (such as negative or cognitive symptoms), but to considerably diminish the side-effect burden and
to improve the quality and enjoyment of life.
In patients experiencing acutely psychotic episodes in which they are obviously a danger to themselves and
others, due to either suicidal or homicidal ideation, or inability to take care of their basic needs,
hospitalization and antipsychotic medications are the treatments of choice. Hospitalization is essential

Medications
Antipsychotic medications are proven effective in treating acute psychosis and reducing the risk of future
psychotic episodes. The treatment of schizophrenia thus has two main phases: an acute phase, when
higher doses might be necessary in order to treat psychotic symptoms, followed by a maintenance phase,
which could be life-long. During the maintenance phase, dosage is gradually reduced to the minimum
required to prevent further episodes. If symptoms reappear on a lower dosage, a temporary increase in
dosage may help prevent a relapse.
Even with continued treatment, some patients experience relapses. By far, though, the highest relapse rates
are seen when medication is discontinued.
The large majority of patients experience substantial improvement when treated with antipsychotic agents.
Some patients, however, do not respond to medications, and a few may seem not to need them.

Since it is difficult to predict which patients will fall into what groups, it is essential to have long-term followup, so that the treatment can be adjusted and any problems addressed promptly.
Antipsychotic medications are the cornerstone in the management of schizophrenia. They have been
available since the mid-1950s, and although antipsychotics do not cure the illness, they greatly reduce the
symptoms and allow the patient to function better, have better quality of life, and enjoy an improved outlook.
The choice and dosage of medication is individualized and is best done by a physician who is well trained
and experienced in treating severe mental illness.
The first antipsychotic was discovered by accident and then used for schizophrenia. This was
chlorpromazine (Thorazine), which was soon followed by medications such as haloperidol (Haldol),
fluphenazine (Prolixin), thiothixene (Navane), trifluoperazine (Stelazine), perphenazine (Trilafon), and
thioridazine (Mellaril). These medications have become known as "neuroleptics" because, although effective
in treating positive symptoms (ie, acute symptoms such as hallucinations, delusions, thought disorder, loose
associations, ambivalence, or emotional lability), they cause side effects, many of which affect the
neurologic (nervous) system. These older medications are not as effective against symptoms such as
decreased motivation and lack of emotional expressiveness.
Since 1989, a new class of antipsychotics (atypical antipsychotics) has been introduced. At clinically
effective doses, no (or very few) of these neurological side effects, which often affect the
extrapyramidal nerve tracts (which control such things as muscular rigidity, painful spasms, restlessness, or
tremors) are observed.
The first of the new class, clozapine (Clozaril) is the only agent that has been shown to be effective where
other antipsychotics have failed. Its use is not associated with extrapyramidal side effects, but it does
produce other side effects, including possible decrease in the number of white cells, so the blood needs to
be monitored every week during the first 6 months of treatment and then every 2 weeks to catch this side
effect early if it occurs.
Other atypical antipsychotics include risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel),
ziprasidone (Geodon), and aripiprazole (Abilify). The use of these medications has allowed successful
treatment and release back to their homes and the community for many people suffering from
schizophrenia.
Although more effective and better tolerated, the use of these agents is also associated with side effects,
and current medical practice is developing better ways of understanding these effects, identifying people at
risk, and monitoring for the emergence of complications.
Most of these medications take 2-4 weeks to take effect. Patience is required if the dose needs to be
adjusted, the specific medication changed, and another medication added. In order to be able to determine
whether an antipsychotic is effective or not, it should be tried for at least 6-8 weeks (or even longer with
clozapine).
Because the risk of relapse of illness is higher when antipsychotic medications are taken irregularly or
discontinued, it is important that people with schizophrenia follow a treatment plan developed in
collaboration with their doctors and with their families. The treatment plan will involve taking the prescribed
medication in the correct amount and at the times recommended, attending follow-up appointments, and
following other treatment recommendations.
People with schizophrenia often do not believe that they are ill or that they need treatment. Other possible
things that may interfere with the treatment plan include side effects from medications, substance abuse,
negative attitudes towards treatment from families and friends, or even unrealistic expectations. When
present, these issues need to be acknowledged and addressed for the treatment to be successful

Other Therapy

Psychosocial treatments
In spite of successful antipsychotic treatment, many patients with schizophrenia have difficulty with
motivation, activities of daily living, relationships, and communication skills. Also, since the illness typically
begins during the years critical to education and professional training, these patients lack social and work
skills and experience. In these cases, the psychosocial treatments help most, and many useful treatment
approaches have been developed to assist people suffering from schizophrenia.

Individual psychotherapy: This involves regular sessions between just the patient and a therapist
focused on past or current problems, thoughts, feelings, or relationships. Thus, via contact with a
trained professional, people with schizophrenia become able to understand more about the illness,
to learn about themselves and to better handle the problems of their daily lives. They become
better able to differentiate between what is real and, by contrast, what is not and can acquire
beneficial problem-solving skills.

Rehabilitation: Rehabilitation may include job and vocational counseling, problem solving, social
skills training, and education in money management. Thus, patients learn skills required for
successful reintegration into their community following discharge from the hospital.
Family education: Research has consistently shown that people with schizophrenia who have
involved families fare better than those who battle the condition alone. Insofar as possible, all family
members should be involved in the care of your loved one.
Self-help groups: Outside support for family members of those with schizophrenia is necessary and
desirable. The National Alliance for the Mentally Ill (NAMI) is an in-depth resource. This outreach
organization offers information on all treatments for schizophrenia, including home care