Schizophrenia facts

Schizophrenia, also sometimes colloquially called split personality disorder, is a chronic, severe, debilitating mental illness that affects about 1% of the population, more than 2 million people in the United States alone. With the sudden onset of severe psychotic symptoms, the individual is said to be experiencing acute schizophrenia. Psychotic means out of touch with reality or unable to separate real from unreal experiences. There is no known single cause of schizophrenia. As discussed later, it appears that genetic factors produce a vulnerability to schizophrenia, with environmental factors contributing to different degrees in different individuals. There are a number of various treatments for schizophrenia. Given the complexity of schizophrenia, the major questions about this disorder (its cause or causes, prevention, and treatment) are unlikely to be resolved in the near future. The public should beware of those offering "the cure" for (or "the cause" of) schizophrenia. Schizophrenia is one of the psychotic mental disorders and is characterized by symptoms of thought, behavior, and social problems. Symptoms of schizophrenia may include delusions, hallucinations, catatonia, negative symptoms, and disorganized speech or behavior. There are five types of schizophrenia based on the kind of symptoms the person has at the time of assessment: paranoid, disorganized, catatonic, undifferentiated, and residual. Children as young as 6 years of age can be found to have all the symptoms of schizophrenia as their adult counterparts and to continue to have those symptoms into adulthood. Although the term schizophrenia has only been in used since 1911, its symptoms have been described throughout written history. Schizophrenia is considered to be the result of a complex group of genetic, psychological, and environmental factors. Health-care practitioners diagnose schizophrenia by gathering comprehensive medical, family, mental-health, and social/cultural information. The practitioner will also either perform a physical examination or request that the individual's primary-care doctor perform one. The medical examination will usually include lab tests. In addition to providing treatment that is appropriate to the diagnosis, professionals attempt to determine the presence of mental illnesses that may co-occur. People with schizophrenia are at increased risk of having a number of other mental-health conditions, committing suicide, and otherwise dying earlier than people without this disorder. Medications that have been found to be most effective in treating the positive symptoms of schizophrenia are first- and second-generation antipsychotics. Psychosocial interventions for schizophrenia include education of family members, assertive community treatment, substance-abuse treatment, social-skills training, supported employment, cognitive behavioral therapy, and weight management. Cognitive remediation, peer-to-peer treatment, and weight-management interventions remain the focus topics for research.

What is schizophrenia? Schizophrenia, also sometimes colloquially called split personality disorder, is a chronic, severe, debilitating mental illness that affects about 1% of the population, corresponding to more than 2 million people in the United States alone. Other statistics about schizophrenia include that it affects men about one and a half times more commonly than women. It is one of the psychotic mental disorders and is characterized by symptoms of thought, behavior, and social problems. The thought problems associated with schizophrenia are described as psychosis, in that the person's thinking is completely out of touch with reality at times. For example, the sufferer may hear voices or see people that are in no way present or feel like bugs are crawling on their skin when there are none. The individual with this disorder may also have disorganized speech, disorganized behavior, physically rigid or lax behavior (catatonia), significantly decreased behaviors or feelings, as well as delusions, which are ideas about themselves or others that have no basis in reality (for example, the individual might experience paranoia, in that he or she thinks others are plotting against them when they are not). What are the different types of schizophrenia? There are five types of schizophrenia, each based on the kind of symptoms the person has at the time of assessment.

Paranoid schizophrenia: The individual is preoccupied with one or more delusions or many auditory hallucinations but does not have symptoms of disorganized schizophrenia.

Disorganized schizophrenia: Prominent symptoms are disorganized speech and behavior, as well as flat or inappropriate affect. The person does not have enough symptoms to be characterized as suffering from catatonic schizophrenia.

Catatonic schizophrenia: The person with this type of schizophrenia primarily has at least two of the following symptoms: difficulty moving, resistance to moving, excessive movement, abnormal movements, and/or repeating what others say or do.

Undifferentiated schizophrenia: This is characterized by episodes of two or more of the following symptoms: delusions, hallucinations, disorganized speech or behavior, catatonic behavior or negative symptoms, but the individual does not qualify for a diagnosis of paranoid, disorganized, or catatonic type of schizophrenia.

Residual schizophrenia: While the full-blown characteristic positive symptoms of schizophrenia (those that involve an excess of normal behavior, such as delusions, paranoia, or heightened sensitivity) are absent, the sufferer has a less severe form of the disorder or has only negative symptoms (symptoms characterized by a decrease in function, such as withdrawal, disinterest, and not speaking).

What are causes of schizophrenia? Is it hereditary? One frequently asked question about schizophrenia is if it is hereditary. As with most other mental disorders, schizophrenia is not directly passed from one generation to another genetically, and there is no single cause for this illness. Rather, it is the result of a complex group of genetic, psychological, and environmental factors. Genetically, schizophrenia and bipolar disorder have much in common, in that the two disorders share a number of the same risk genes. However, the fact is that both illnesses also have some genetic factors that are unique. There are some genetic commonalities with schizophrenia and epilepsy as well. Environmentally, the risks of developing schizophrenia can even occur before birth. For example, the risk of schizophrenia is increased in individuals whose mother had one of certain infections during pregnancy. Difficult life circumstances during childhood, like the early loss of a parent, parental poverty, bullying, witnessing parental violence; being the victim of emotional, sexual, or physical abuse or of physical or emotional neglect; and insecure attachment have been associated with the development of this illness. Even factors like how well represented an ethnic group is in a neighborhood can be a risk or protective factor for developing schizophrenia. For example, some research indicates that ethnic minorities may be more at risk for developing this disorder if there are fewer members of the ethnic group to which the individual belongs in their neighborhood. What are schizophrenia symptoms and signs? According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), symptoms of schizophrenia include the following: Positive, more overtly psychotic symptoms Beliefs that have no basis in reality (delusions) Hearing, seeing, feeling, smelling, or tasting things that have no basis in reality (hallucinations) Disorganized speech Disorganized behaviors Catatonic behaviors

Negative, potentially less overtly psychotic symptoms

Inhibition of facial expressions Lack of speech Lack of motivation

How is schizophrenia diagnosed? As is true with virtually any mental-health diagnosis, there is no one test that definitively indicates that someone has schizophrenia. Therefore, health-care practitioners diagnose this disorder by gathering comprehensive medical, family, and mental-health information. Patients tend to benefit when the professional takes into account their client's entire life and background. This includes but is not limited to the person's gender, sexual orientation, cultural, religious and ethnic background, and socioeconomic status. The symptom sufferer might be asked to fill out a self-test that the professional will review if the person being evaluated is able to complete it. The practitioner will also either perform a physical examination or request that the individual's primary-care doctor perform one. The medical examination will usually include lab tests to evaluate the person's general health and to explore whether or not the individual has a medical condition that might produce psychological symptoms.

In asking questions about mental-health symptoms, mental-health professionals are often exploring if the individual suffers from hallucinations or delusions, depression and/or manic symptoms, anxiety, substance abuse, as well as some personality disorders (for example, schizotypal personality disorder) and developmental disorders (for example, autism spectrum disorders). Since some of the symptoms of schizophrenia can also occur in other mental illnesses, the mentalhealth screening is to determine if the individual suffers from schizoaffective disorder or other psychotic disorder, depressive disorder, bipolar disorder, anxiety disorder, or a substance-abuse or personality disorder. Any disorder that is associated with bizarre behavior, mood, or thinking, like borderline personality disorder or another psychotic disorder, as well as dissociative identity disorder (DID), also known as multiple personality disorder (MPD) may be particularly challenging to distinguish from schizophrenia. In order to assess the person's current emotional state, health-care providers perform a mental-status examination as well. In addition to providing treatment that is appropriate to the diagnosis, determining the presence of mental illnesses that may co-occur (be comorbid) with schizophrenia is important in improving the life of individuals with schizophrenia. For example, people with schizophrenia are at increased risk of having a substance-abuse, depressive, or anxiety disorder and of committing suicide. What are treatments for schizophrenia and the side effects of those treatments? Medications While there are a number of helpful treatments available, medication remains the cornerstone of treatment for people with schizophrenia. These medications are often referred to as antipsychotics since they help decrease the intensity of psychotic symptoms. Many health-care professionals prescribe one of these medications, sometimes in combination of one or more other psychiatric medications, in order to maximize the benefit for the person with schizophrenia. Medications that are thought to be particularly effective in treating positive symptoms of schizophrenia include olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), asenapine (Saphis), lurasidone (Latuda), and lloperidone (Fanapt). These medications are the newer group of antipsychotic medications, also called second-generation antipsychotics. They are known for having the ability to work quickly compared to many other psychiatric medications. As a group of medications, side effects that occur most often include sleepiness, dizziness, and increased appetite. Weight gain, which may be associated with higher blood sugar levels, elevated blood lipid levels, and sometimes increased levels of a hormone called prolactin, may also occur. Although older antipsychotic medications in this class like haloperidol (Haldol), perphenazine (Trilafon), and molindone (Moban) are more likely to cause muscle stiffness, shakiness, and very rarely uncoordinated muscle twitches (tardive dyskinesia) that can be permanent, health-care practitioners appropriately monitor the people they treat for these potential side effects as well. Also, more recent research regarding all antipsychotic medication seems to demonstrate that the older (first-generation) antipsychotics are just as effective as the newer ones and have no higher rate of people stopping treatment because of any side effect the medications cause. Not all medications that treat schizophrenia in adults have been approved for use in treating childhood schizophrenia. Mood-stabilizer medications like lithium (Lithobid), divalproex (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal) can be useful in treating mood swings that sometimes occur individuals who have a diagnosable mood disorder in addition to psychotic symptoms (for example, schizoaffective disorder, depression in addition to schizophrenia). These medications may take a bit longer to work compared to the antipsychotic medications. Some (for example, lithium, divalproex, and carbamazepine) require monitoring of medication blood levels, and some can be associated with birth defects when taken by pregnant women. Antidepressant medications are the primary medical treatment for the depression that can often accompany schizophrenia. Examples of antidepressants that are commonly prescribed for that purpose include serotonergic (SSRI) medications that affect serotonin levels like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro); combination serotonergic/adrenergic medications (SNRIs) like venlafaxine (Effexor) and duloxetine (Cymbalta), as well as bupropion (Wellbutrin), which is a dopaminergic (affecting dopamine levels) antidepressant medication. Despite its stigmatized history, electroconvulsive therapy (ECT) can be a viable treatment for people whose schizophrenia has inadequately responded to a number of medication trials and psychosocial interventions. When treating pregnant individuals with schizophrenia, health-care practitioners take great care to balance the need to maintain the person's more stable thoughts and behavior while minimizing the risks that medications used to treat this disorder may present. While some medications that treat schizophrenia may carry risks to the fetus in pregnancy and during breastfeeding, careful monitoring of how much medication is administered and the health of the fetus and of the mother can go a long way toward protecting the fetus from any such risks, while maximizing the chance that the fetus will grow in the healthier environment afforded by an emotionally healthy mother. Psychosocial interventions

Family psycho-education: In addition to educating family members about the symptoms, course, and treatment of schizophrenia, this form of treatment consists of providing family support, problem-solving skills, and access to care providers during times of crises. When this intervention is consistently provided for at least several months, it has been found to decrease the relapse rate for the individual with schizophrenia and improve the person's social and emotional outcomes. Also, the burden that family members experience as a result of having a loved one with schizophrenia is lessened, family members tend to be more knowledgeable about the disorder and feel more supported by the professionals involved, and family relationships are improved. Assertive community treatment (ACT): This intervention consists of members of the person's treatment team meeting with that individual on a daily basis, in community settings (for example, home, work, or other places the person with schizophrenia frequents) rather than in an office or hospital setting. The treatment team is made up of a variety of professionals. For example, a psychiatrist, nurse, case manager, employment counselor, and substance-abuse counselor often make up an ACT team. ACT tends to be successful in reducing how often people with schizophrenia are hospitalized or become homeless. Substance abuse treatment: Providing medical and psychosocial interventions that address substance abuse should be an integral part of treatment as about 50% of individuals with schizophrenia suffer from some kind of substance abuse or dependence. Social skills training: Also called illness management and recovery programming, social-skills training involves teaching clients ways to handle social situations appropriately. It often involves the person scripting (thinking through or roleplaying) situations that occur in social settings in order to prepare for those situations when they actually occur. This treatment type has been found to help people with schizophrenia resist using drugs of abuse, as well as improve their relationships with health-care professionals and with people at work. Supported employment: This intervention provides supports like a work coach (someone who periodically or consistently counsels the client in the workplace), as well as instruction on constructing a rsum, interviewing for jobs, and education and support for employers to hire individuals with chronic mental illness. Supported employment has been found to help schizophrenia sufferers secure employment, earn more money, and increase the number of hours they are able to work. Cognitive behavioral therapy (CBT): CBT is a reality-based intervention that focuses on helping a client understand and change patterns that tend to interfere with his or her ability to interact with others and otherwise function. Except for people who are actively psychotic, CBT has been found to help individuals with schizophrenia decrease symptoms and improve their ability to function socially. This intervention can be done either individually or in group sessions.