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Schizophrenia is a serious and lifelong mental illness that affects 1% of the population worldwide. It is characterized by a disintegration of the process of thinking and of emotional responsiveness. There are striking disturbances in mental functioning. These include symptoms of disruption in the experience of reality. It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking with significant social or occupational dysfunction. Many patients with schizophrenia show signs of impoverishment in thinking, emotional experience, and social engagement. A wide range of other signs and symptoms are also observed in this illness, including disorganized thoughts and behaviors, negative mood states, and behavioral impulsivity. Schizophrenia is among the most devastating mental illness that humans can experience. Its onset is typically during adolescence or early adulthood, a period when individuals are just beginning to achieve a firm sense of self, to establish enduring relationships, and to make productive contributions.

Studies suggest that genetics, early environment, neurobiology, psychological and social processes are important contributory factors. Recreational and prescription drugs appear to cause or worsen symptoms. No single organic cause has been found. It is not clear whether the diagnosis represents a single disorder or a number of discrete syndromes.

People with schizophrenia are also likely to suffer from major depression and anxiety disorders. The lifetime occurrence of substance abuse is around 40%. Social problems, such as long-term unemployment, poverty and homelessness, are common as the disease progresses.

 

SIGNS AND SYMPTOMS

A person diagnosed with schizophrenia may experience hallucinations (most commonly hearing voices), delusions (often bizarre or persecutory in nature), and disorganized thinking and speech. The latter may range from loss of train of thought, to sentences only loosely connected in meaning, to incoherence known as word salad in severe cases. There is often an observable pattern of emotional difficulty. There may be a lack of responsiveness or motivation. Impairment in social cognition is associated with schizophrenia, as are symptoms of paranoia, and social isolation commonly occurs.

CHARACTERISTIC SYMPTOMS:

Two or more of the following, each present for much of the time during a one-month period (or less, if symptoms remitted with treatment).

DELUSIONS

Delusions are bizarre or paranoid.

HALLUCINATIONS

Hearing one voice participating in a running commentary of the patient's actions or of hearing two or more voices conversing.

DISORGANIZED SPEECH

Disorganized speech is a manifestation of a formal thought disorder. Must be severe enough to substantially impair communication.

GROSSLY DISORGANIZED BEHAVIOR

Dressing inappropriately, crying frequently or catatonic behavior.

NEGATIVE SYMPTOMS:

• Blunted affect (lack or decline in emotional response)
• Alogia (lack or decline in speech)
• Avolition (lack or decline in motivation)

SOCIAL/OCCUPATIONAL DYSFUNCTION:

There is a marked deterioration in one or more major areas of functioning such as work, interpersonal relations, or self-care.

 

TREATMENT

Management of symptoms and improving function is thought to be more achievable than a cure. Hospitalization may occur with severe episodes of schizophrenia. Long-term inpatient hospital stays are currently less common due to deinstitutionalization, although can still occur.

MEDICATION

The first line psychiatric treatment for schizophrenia is antipsychotic medication.

PSYCHOLOGICAL AND SOCIAL INTERVENTIONS

Psychotherapy is also widely recommended and used in the treatment of schizophrenia. Family therapy is beneficial. It addresses the whole family system of an individual with a diagnosis of schizophrenia.

PSYCHOEDUCATION

Information about schizophrenia, what to expect, prognosis and treatment options is very helpful.