What Is Schizophrenia?

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What Is Schizophrenia?

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When I found myself in a doctor's office a few years ago with a family member who was experiencing very unusual and challenging symptoms, the nurse practitioner took me to the hallway and said my family member had the classic symptoms of schizophrenia. I had known for a while that something similar was going on, but that was a shock. One of my first questions was, "What exactly is schizophrenia?" I soon found out the answer to that question is not simple.

Most of us have probably heard the term before and may think we have an idea as to what it is. The facts are that we probably don't really understand unless we or someone close to us has experienced this disabling brain disorder. Sometimes our first introduction to schizophrenia is from a news story or from a fictionalized movie or television show. In reality, people with schizophrenia are not usually prone to violence and prefer to be left alone, especially when receiving treatment.

There are usually extenuating circumstances if violence should occur. Quite often substance abuse is involved, or the person (in a delusional state of mind) is afraid and trying to protect himself or herself or someone else, or the person sometimes becomes suicidal. There are many more classic cases of schizophrenia we don't hear about, rather than the violent ones we do. It is very important we understand the true facts surrounding this illness, and to also minimize the stigma associated with it.

I will begin with what schizophrenia is not. It is absolutely not a split or multi-personality disorder. It is definitely not demonic possession. It is not willful behavior, and it is not caused by moral shortcomings or poor parenting. These are all very common misconceptions.

The facts regarding this illness are still being studied, and we don't know all there is to know about it. Schizophrenia interferes with a person's ability to think clearly, determine fantasy from reality, to manage emotions, relate to others and to make decisions. It is currently thought to be caused by a combination of genetic and environmental factors. In most cases, there is a family history of the disorder, and in combination with environmental risk factors such as viruses, malnutrition while in the womb, problems during birth or extremely stressful situations, a person may become vulnerable to developing the disorder.

Schizophrenia is a very common brain disorder that affects 1 to 2 percent of the general population. That is one to two people out of every hundred. Most of you probably know of someone who has this illness whether or not you realize it. While many are born with this disorder, the psychotic symptoms generally begin in late adolescence or early adulthood, and it affects all socioeconomic groups. These symptoms usually strike earlier in boys than in girls, and usually begin anywhere between the ages of 18 to 30, although there have been reports of schizophrenia as early as age 5 or as late as age 45. Prodromal symptoms, which occur in childhood and adolescence, may be diagnosed as schizophrenia later on, although it's hard to tell because they could be due to other factors.

Current theories include that the cause is a recurring dysfunction of cognitive and sensory processing. Studies show a neural disconnectivity, anatomical differences and that the neurotransmitters are out of balance, such as too much dopamine, for example. Glutamate and other brain chemicals are also suggested. Neurotransmitters are brain hormones or chemicals that allow brain cells to communicate with each other. Basic knowledge about brain chemistry and schizophrenia is growing quickly and is an encouraging area of research. The brains of people with schizophrenia are slightly different than those of healthy people. Because of some of the differences, one theory is that problems during brain development lead to faulty connections that lie dormant until puberty. The brain undergoes major changes during this time and these changes could trigger psychotic symptoms.

People with schizophrenia usually hear voices other people don't hear. They may believe that other people are reading, hearing or controlling their thoughts. They may believe others are planning or trying to hurt them. That is why these experiences are terrifying and cause considerable fear, withdrawal and agitation in the person with this disorder. People with schizophrenia may not make sense when they talk, they may sit for hours at a time focused on the voices and delusions, and they may even seem perfectly fine until they talk about what they are thinking about. They have tremendous difficulty taking care of themselves and holding down jobs.

There is a great variety of symptoms associated with schizophrenia, including what are called positive and negative symptoms, which affect language, emotion, the ability to reason, behavior and perception. While psychosis (which is defined as a mental state in which an individual experiences a distortion or a loss of contact with reality) can be associated with many illnesses, it is a large factor with regard to this disorder.

The positive symptoms are those that can be seen or heard and include hallucinations that affect all of the senses, delusions, thought disorders with regard to processing and content, unusual perceptions and unusual behaviors or movements. The positive symptoms usually involve a loss of contact with reality and are not seen in healthy people. Sometimes these symptoms are severe, and other times they are barely noticeable, depending on treatment.

The negative symptoms are those that can't be seen or heard and include an inability to initiate plans or find pleasure in everyday life, an inability to show emotions, a lack of motivation or persistence, apathy, the inability to express things they would like to say, social withdrawal, poor concentration or attention and disrupted sleep. Negative symptoms include problems with memory, organization and an inability to know social cues. People with schizophrenia have difficulty in absorbing and processing information, and an inability to make decisions based on that information. These symptoms are hugely disabling when trying to lead a normal life because they are not obviously part of a psychiatric illness. People with schizophrenia are often thought of as lazy or not wanting to better their lives, which is a huge misconception. All of this leads to much emotional distress in the patient.

Hallucinations occur in about half the people who experience psychosis. The auditory hallucinations, or voices, are the most common form, although hallucinations can involve visions and things a person smells and feels. Delusions occur in more than 90 percent of patients are a belief that appears false to others of the same background, and can be quite bizarre or grandiose. These hallucinations and delusions appear to the patients as very real, as if you or I were talking to them or threatening them. The hallucinations and delusions are almost always negative, argumentative and derogatory. Patients are not able to filter the stimulus around them. It all comes at them at a very high intensity, and they can't make it stop. It is very overwhelming, aggravating and embarrassing to them. Their experiences are like a scary movie, and the images they see are usually distorted.

Psychosis is a personal crisis, and may be biologically toxic to the brain. The longer the person is in psychosis, the harder it is to recover. Sometimes he or she won't be able to gain back what he or she has lost. While the positive symptoms can be treated fairly well, the negative symptoms are very hard to treat. Stress makes the symptoms worse; however, people can recover their lives with the right treatment.

Schizophrenia usually occurs in young people's lives at the time they are just starting to become independent. It wreaks havoc in their lives and disrupts their social and occupational plans. About 10 to 12 percent of those affected complete suicide. Others become socially isolated, unemployed and undereducated because they are not able to function without treatment. About 30 percent of the homeless population has schizophrenia. Of people with schizophrenia, 90 percent are tobacco dependent and 30 percent have a substance use disorder because of trying to self-medicate. Many are hospitalized without the ability to pay. Schizophrenia is considered to be one of the 10 most debilitating illnesses.

It is very important to seek treatment as early as possible to prevent the brain damage that can occur from prolonged psychosis. Convincing the patient he or she needs treatment can be a huge obstacle to overcome, but it can be done. There are many treatments available, and a strong family support system is also important.

While there is no cure for this illness, treatment of symptoms has greatly improved over the past 30 years. Many people do well enough to lead independent and satisfying lives. This is a positive time for schizophrenia research, with a much better understanding of genetics, neuroscience and behavior in searching for the causes and cures. While most people will probably live the rest of their lives with some of the residual symptoms, this is a time of hope for people with schizophrenia and their families.


Yamhill County Adult Mental Health Schizophrenia Workshop presented by Sally Godard, MD; Bruce Neben, LPC, PsyD; and Betty Foufos, MA.

National Institute of Mental Health http://www.nimh.nih.gov/

National Alliance on Mental Illness http://www.nami.org/