Schizophrenia

Schizophrenia is a mental illness. It may cause disturbed or disorganized thinking, speech, or behavior. People with schizophrenia have problems functioning in one or more areas of life: work, school, home, or relationships. People with schizophrenia are at increased risk for suicide, certain chronic physical illnesses, and unhealthy behaviors, such as smoking and drug use.

People who have family members with schizophrenia are at higher risk of developing the illness. Schizophrenia affects men and women equally but usually appears at an earlier age (teenage or early adult years) in men.

SYMPTOMS

The earliest symptoms are often subtle (prodrome) and may go unnoticed until the illness becomes more severe (first-break psychosis). Symptoms of schizophrenia may be continuous or may come and go in severity. Episodes often are triggered by major life events, such as family stress, college, military service, marriage, pregnancy or child birth, divorce, or loss of a loved one. People with schizophrenia may see, hear, or feel things that do not exist (hallucinations). They may have false beliefs in spite of obvious proof to the contrary (delusions). Sometimes speech is incoherent or behavior is odd or withdrawn.

DIAGNOSIS

Schizophrenia is diagnosed through an assessment by your caregiver. Your caregiver will ask questions about your thoughts, behavior, mood, and ability to function in daily life. Your caregiver may ask questions about your medical history and use of alcohol or drugs, including prescription medication. Your caregiver may also order blood tests and imaging exams. Certain medical conditions and substances can cause symptoms that resemble schizophrenia. Your caregiver may refer you to a mental health specialist for evaluation. There are three major criterion for a diagnosis of schizophrenia:

  • Two or more of the following five symptoms are present for a month or longer:

  • Delusions. Often the delusions are that you are being attacked, harassed, cheated, persecuted or conspired against (persecutory delusions).

  • Hallucinations.  

  • Disorganized speech that does not make sense to others.

  • Grossly disorganized (confused or unfocused) behavior or extremely overactive or underactive motor activity (catatonia).

  • Negative symptoms such as bland or blunted emotions (flat affect), loss of will power (avolition), and withdrawal from social contacts (social isolation).

  • Level of functioning in one or more major areas of life (work, school, relationships, or self-care) is markedly below the level of functioning before the onset of illness.  

  • There are continuous signs of illness (either mild symptoms or decreased level of functioning) for at least 6 months or longer.

TREATMENT

Schizophrenia is a long-term illness. It is best controlled with continuous treatment rather than treatment only when symptoms occur. The following treatments are used to manage schizophrenia:

  • Medication—Medication is the most effective and important form of treatment for schizophrenia. Antipsychotic medications are usually prescribed to help manage schizophrenia. Other types of medication may be added to relieve any symptoms that may occur despite the use of antipsychotic medications.

  • Counseling or talk therapy—Individual, group, or family counseling may be helpful in providing education, support, and guidance. Many people with schizophrenia also benefit from social skills and job skills (vocational) training.

A combination of medication and counseling is best for managing the disorder over time. A procedure in which electricity is applied to the brain through the scalp (electroconvulsive therapy) may be used to treat catatonic schizophrenia or schizophrenia in people who cannot take or do not respond to medication and counseling.