SCHIZOPHRENIA

DEFINITION

Schizophrenia (pronounced skit-suh-FREH-nee-uh) is a psychotic disorder or group of psychotic disorders that cause a patient to lose touch with reality. It is marked by severely impaired reasoning and emotional instability and can cause violent behavior.

Schizophrenic patients are often unable to make sense of the signals they receive from the world around them. They imagine objects and events to be very different from what they really are. If untreated, most people with schizophrenia gradually withdraw from the outside world.

Exactly what schizophrenia is has been the source of considerable disagreement among psychiatrists (doctors who deal with mental disorders). There is some thought that the disease psychiatrists call schizophrenia is actually a number of different conditions classified under a single heading.

DESCRIPTION

Schizophrenia is a serious mental disorder that affects millions of people worldwide. By some estimates, 1 percent of the world's population may be schizophrenic. People diagnosed with schizophrenia make up about half of all patients in psychiatric hospitals and may occupy as many as one quarter of the world's hospital beds.

Schizophrenia can affect people of any age, race, sex, social class, level of education, or ethnic background. Slightly more men than women develop the condition. Most patients are diagnosed in their late teens or early twenties, but the disorder can appear at any time in a person's life. Schizophrenia is rarely diagnosed in children, though it has been reported in children as young as five years of age.

Psychiatrists today recognize five subtypes of schizophrenia.

Paranoid Schizophrenia

Patients diagnosed with paranoid schizophrenia tend to suffer from delusions and hallucinations. A delusion is a belief about the world that is not consistent with the facts. For instance, a patient may believe he or she is someone other than who he or she really is. A patient suffering from a paranoid delusion may believe, unrealistically, that someone intends to do the patient harm.

Hallucinations often take the form of hearing imaginary voices and a patient may believe that he or she is receiving messages from a supernatural or unknown source.

Although people with paranoid schizophrenia have relatively normal emotions and cognitive (thinking) functions, compared to those who suffer other forms of schizophrenia, their delusions and hallucinations, put them at high risk for violent or suicidal behavior.

Disorganized Schizophrenia

Patients with disorganized schizophrenia have confused, disorganized patterns of speech, thought, and behavior. They may act silly or withdraw from the world around them. At one time, disorganized schizophrenia was called hebephrenia (pronounced HEE-buh-FREN-ee-uh).

Catatonic Schizophrenia

Catatonic schizophrenia is characterized by abnormal types of posture and movement. A patient may stand or walk in peculiar patterns, may repeat certain motions over and over again, or become rigid and unmoving for long periods of time.

Undifferentiated Schizophrenia

This category is reserved for patients who show some symptoms of schizophrenia but do not fit into any of the three categories described above.

Residual Schizophrenia

Patients in this category have had at least one schizophrenic episode but no longer display the most severe symptoms of the first three types of schizophrenia.

CAUSES

People have argued for centuries about the causes of mental illnesses such as schizophrenia. Historically, people with these afflictions have been defined as "mad" or "insane" or were believed to be possessed by evil spirits. Those suffering from mental illness were often beaten, tortured, or locked up in special facilities.

For much of the twentieth century, scientists thought that stressful or traumatic conditions in a person's life could cause mental disorders. Psychiatrists believed that a neglected or abused child, for example, ran a higher risk of developing some mental disorders.

This theory is now less popular with scientists, who generally agree that the disease is biological and not caused by life experiences. There are, however, several competing theories as to what does cause the illness.

Heredity

Research shows that the condition tends to run in families. A person with schizophrenic relatives is ten times as likely to develop schizophrenia as someone who has no history of the disease in the family.

Viral Infection

Some researchers have argued that schizophrenia is caused by a virus that attacks the brain. The virus is thought to attack the part of the brain that interprets messages from the senses. Damage to this part of the brain may account for a person's delusions and hallucinations.

Chemical Imbalance

A popular theory is that schizophrenia is caused by an imbalance of neurotransmitters in the brain. Neurotransmitters (pronounced NOOR-oh-TRANZ-mit-urz) are chemicals that carry electrical messages between nerve cells. Too much of a neurotransmitter, or too little, may account for various mental disorders, including schizophrenia.

There is still no consensus (agreement) as to which, if any, of these theories is correct, or whether the disease is caused by a combination of factors.

SYMPTOMS

Because schizophrenia's cause is unknown, the disease is defined by a set of symptoms. Most patients have some, but not all, of these symptoms. The most common symptoms are delusions and hallucinations, which may include hearing imaginary voices.

Another common symptom is called insertion or withdrawal of thought. This term refers to the patient's belief that someone or something can put thoughts in the patient's head or take them out. For example, some patients believe that God, the FBI, or alien beings talk to them and tell them how to behave.

Disorganized thinking and behavior are also characteristic of schizophrenia. A patient may have trouble completing a sentence, thinking through an idea, or answering a question clearly. He or she may also have trouble carrying out routine tasks such as tying shoe laces, washing, or getting dressed.

Those suffering from schizophrenia may exhibit other abnormal behavior. For example a patient may show no emotions, or be unable to speak, or may avoid taking any action at all.

DIAGNOSIS

There are currently no laboratory tests by which schizophrenia can be diagnosed. Some imaging techniques, such as computed tomography (CT) scans, which use X rays to create a picture of internal organs, can be helpful in showing abnormal structures in the brain. CT scans are also sometimes called computerized axial tomography (CAT) scans. For the most part, however, doctors must observe a patient's behavior to decide if he or she is schizophrenic.

The first step in this process is to rule out other physical and mental disorders. Some diseases and disorders of the brain cause symptoms similar to those of schizophrenia. Encephalitis (see encephalitis entry), or brain fever, is one such disease. Encephalitis is caused by a virus and must be treated very differently from schizophrenia.

Psychiatrists also try to distinguish various types of mental disorders from each other. While many disorders have symptoms similar to those of schizophrenia, they may require quite different treatments.

Psychiatrists usually rely on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) in diagnosing a mental disorder. DSMIV is a standard reference book that lists all recognized mental disorders. It also lists the basis on which each disorder is diagnosed. The standards used for diagnosing schizophrenia are as follows:

• A patient must have two or more of the following symptoms during a one-month period: delusions, hallucinations, disorganized speech, disorganized behavior, or lack of normal behaviors (such as the ability to speak).
• The patient shows a decline in social, personal, or occupational functions, including the ability to care for him or herself.
• The disturbed behavior must last for at least six months.
• Other physical and mental problems must be ruled out as causes of the abnormal behavior.

TREATMENT

The treatment for schizophrenia depends in part on the stage of the patient's condition.

Hospitalization

In the early stages, hospitalization may be necessary. Hospitalization prevents patients from doing harm to themselves or others. Hospitalization often lasts until treatment with medications begins.

Medication

The primary form of treatment for schizophrenia is medication. Drugs are now available to control many of the symptoms of the disorder. Between 60 to 70 percent of patients with schizophrenia respond to drug treatment.

In the early stages of the disorder, patients may be given regular doses of medicine. The drugs may be swallowed or given by injections. As the patient improves, drugs may be given in depot doses, a form of medication that works in the system for two to four weeks. Depot doses are used because patients often forget to take their medication. Most people with schizophrenia will need to stay on medication throughout their lives.

The most successful medications used in the treatment of schizophrenia are neurotransmitter antagonists. An antagonist is a chemical that acts against some substance in the body.

Researchers now believe that schizophrenia may be caused when the brain produces too much neurotransmitter. Neurotransmitters are chemicals that carry electrical messages between nerve cells. Too much neurotransmitter can cause brain cells to remain active far longer than they would normally. Neurotransmitter antagonists fight off the excess neurotransmitters, helping the brain cells relax and behave more normally.

Psychotherapy

At one time doctors thought that counseling could help cure schizophrenia, by helping patients understand the events in their history that led to the disorder. That view is no longer as popular because most researchers think schizophrenia is a biological problem rather than a problem caused by early upbringing or life events.

Still, some forms of psychotherapy can help schizophrenic patients. Behavior therapy, example, can teach patients to cope with daily activities and may improve the way they interact with other people.

The primary form of treatment for schizophrenia is medication. Drugs are now available to control many of the symptoms of the disorder. (Reproduced by permission of

AP/Wide World Photos

)

Family therapy

Family members can also benefit from some forms of therapy. For instance, parents may feel that they are somehow responsible for a child's schizophrenia. Professional therapists can help all family members better understand the mental disorder. They can also outline ways in which family members can provide support for the patient. Family therapy may also focus on improving the family's ability to communicate with each other and solve mutual problems brought about by the disease.

PROGNOSIS

The prognosis for schizophrenia is related to the age at which a patient first develops symptoms. The earlier the condition appears, the more permanent the damage is likely to be. Patients who develop the condition later in life have a better chance for leading relatively symptom-free lives.

PREVENTION

There is currently no way to prevent the development of schizophrenia.

FOR MORE INFORMATION

Books

Mueser, Kim Tornval. Coping With Schizophrenia: A Guide for Families. Oakland, CA: New Harbinger Publications, 1994.

Torrey, E. Fuller. Surviving Schizophrenia: A Manual for Families Consumers and Providers, 3rd edition. New York: Harperperennial Library, 1995.

Tsuang, Ming T., et al. Schizophrenia: The Facts, 2nd edition. New York: Oxford University Press, 1997.

Periodicals

Winerip, Michael. "Schizophrenia's Most Zealous Foe." New York Times Magazine (February 22, 1998): 26–29.

Web sites

"Ask NOAH About: Mental Health." NOAH: New York Online Access to Health. [Online] http://www.noah.cuny.edu/mentalhealth/mental.html#Schizophrenia (accessed on October 31, 1999).