Schizophrenia

This is a long-term condition that affects the way a person thinks. It is characterized by feelings of paranoia, hallucinations, and delusions, and significantly impacts a person’s ability to function.

What is it?

The word schizophrenia comes from the Greek, and literally means “split mind,” which has led to the myth that people with the condition have split personalities, but they do not. Instead they suffer from delusions and hallucinations that they believe are real. There are different types of schizophrenia. The main ones are paranoid (hallucinations and delusions); catatonic (unusual movements, switching between being very active and being very still); and disorganized, which has aspects of both. Despite popular belief, individuals with schizophrenia are not always violent. They are, however, more likely to abuse alcohol and drugs, and it is these habits, combined with their condition, that can cause them to become aggressive. Schizophrenia appears to result from a combination
of physical, genetic, psychological, and environmental factors. MRI scans have identified abnormal levels of neurotransmitters dopamine and serotonin and unusual brain structure, and there might be a correlation between the condition and pregnancy or birth complications. It is also thought that excessive cannabis use in young adulthood can be a trigger.Popular theories regarding the causes of schizophrenia in the second half of the 20th century included family dysfunction theories, such as the “double bind” (when people are faced with contradictory, irreconcilable demands for courses of action), high levels of parent/ caregiver “expressed emotion” (not tolerating those with the disorder), and learning the schizophrenic role through labeling. Since then, mental health specialists have observed that hearing voices or feeling paranoid are common reactions to trauma, abuse, or deprivation. Stress can trigger acute schizophrenic episodes, and learning to recognize their onset can help with management of the condition.

Symptoms of schizophrenia

These are classified as positive or negative. Positive symptoms are psychotic additions to an individual, whereas negative symptoms can look like the withdrawal or flat emotions seen with depression. Schizophrenia is likely if a person has experienced one or more symptoms from both domains for most of the time for a month.

Positive symptoms (psychotic)

These symptoms are classed as positive because they are additions to a person’s mental state and represent new ways of thinking and behaving that only develop with the condition.

❯ Hearing voices is common, and can occur occasionally or all the time. The voices may be noisy or quiet, disturbing or negative, known or unknown, and male or female.

❯ Hallucinations involve seeing things that are not there but seem very real to the person, and are often violent and very disturbing.

❯ Feeling sensations can cause a person to be convinced that they have unpleasant creatures such as ants crawling on or under their skin.

❯ Smelling and tasting things that cannot be identified can arise, and there may be difficulty discriminating between smells and tastes.

❯ Delusions—fixed beliefs—are held despite evidence to the contrary. The person may think they are famous and/or being chased or plotted against.

❯ Feelings of being controlled by, for example, a religious or dictatorial delusionist, can overwhelm a person. The beliefs can make them act differently.

Negative symptoms (withdrawal)

These symptoms are called negative because they represent a loss of certain functions, thoughts, or behaviors that a healthy person exhibits, but that are absent in those with schizophrenia.

❯ Difficulty communicating with others can result in changed body language, a lack of eye contact, and incoherence.

❯ “Flattened” emotions result in a significantly reduced range of response. The person will take no pleasure in activities.

❯ Tiredness may result in lethargy, change in sleep patterns, staying in bed, or sitting in the same place for long periods.

❯ Absence of willpower or motivation makes it difficult or even impossible for a person to engage in normal day-to-day activity.

❯ Poor memory and concentration means that the individual is unable to plan or set goals and has difficulty keeping track of thoughts and conversations.

❯ Inability to cope with everyday tasks results in disorganization. The individual stops looking after themselves, domestically or personally.

❯ Becoming withdrawn from social and community activities can disrupt the individual’s social life.

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TREATMENT

❯ Community mental health teams such as social workers, occupational therapists, pharmacists, psychologists, and psychiatrists work together to develop ways to help a person stay stable and progress

❯ Medication in the form of antipsychotics is prescribed to reduce mostly positive symptoms, but it does not cure the condition.

❯ Cognitive behavioral therapy and the technique of reality testing can help with management of symptoms such as delusions. New developments use imagery to defuse stress that negative symptoms cause.

❯ Family therapy can improve relationships and coping skills within the family and educate anyone involved in a person’s care.

Around 1.1%
of the global adult population has schizophrenia