Schizophrenia: Symptoms, Complications, Diagnosis, and Treatment

What is schizophrenia?

Among the numerous challenging mental health disorders, a most chronic and disabling one is schizophrenia. Noticeably, this disorder tends to run in families and seems to be inherited.

This disorder is characterized by hallucinations, delusions, disorganized thinking, coupled with incoherency in speaking, and irrational behaviour. People with schizophrenia usually have a difficult time managing their emotions, and expressing them. They are often confused, and struggle with making decisions.

It has often been observed that people with schizophrenia withdraw from the outside world, undergo frequent bouts of depression, and are at a high risk of committing, or at least attempting suicide when they suffer from psychotic breakdowns. A psychotic breakdown occurs when the person completely loses touch with reality and the world seems to be a disconnected set of jumbled up sights, sounds, smells and tastes. Often the patients who suffer from schizophrenia describe hearing voices, which are abusive, cynical, and vulgar. These voices in their heads are either their own, or belong to people whom they know.

Schizophrenia often occurs within the ages of 16 years to 30 years. Schizophrenia rarely occurs in children, although when it does (before 12 years),  the child may suffer from symptoms such as:

  • lack of focus

  • lack of attention

  • suspiciousness

  • impaired memory

  • impaired reasoning

  • impaired speech

  • depression

  • unstable emotions

  • poor motor skills

  • poor social skills


This form of schizophrenia is known as pediatric schizophrenia or childhood-onset schizophrenia.

How does schizophrenia occur?

Schizophrenia does not suddenly begin overnight. People who suffer from schizophrenia undergo certain phases of the disorder, before they exhibit the signs of full-blown psychosis.

Phases Of Schizophrenia

The phases of schizophrenia include:

  • Prodromal phase

  • Active phase

  • Residual phase 

Prodromal phase: This is the phase when the early symptoms of schizophrenia slowly makes their appearance in the person. Symptoms such as gradual withdrawal from people around and society at large, difficulty making decisions, constant anxiety, and trouble focusing or paying attention. There may be a sudden spurt of interest in matters of religion, philosophy, and spirituality.

In certain people, though, the symptoms may suddenly stop at this point. In others they continue to advance.

The prodromal period can last for weeks or months. It should also be noted that though these symptoms are characteristic of the early stages of schizophrenia, they may also be caused by a variety of other mental ailments such. Also, if these initial symptoms occur during puberty, or in early twenties, they are often dismissed as teenage mood swings.

These early symptoms of schizophrenia can very easily be confused with other mental disorders, such as, ADHD.

Mental health professionals consider this stage to be very important, because if diagnosed early, these symptoms can be treated so that the condition never develops into full blown schizophrenia.

 

Active Phase: The active phase, also known as the acute phase of schizophrenia begins after the prodromal phase. During this phase the person experiences paranoia, states of hallucination, delusions, dysfunctional thinking patterns, irrational behaviour and confusing feelings.

This is the stage when the patient is psychotic. If left untreated, active psychotic symptoms can continue for weeks or months. The symptoms may turn acute, leading to the hospitalization of the patient for treatment, and supervision.

 

Residual phase: After the symptoms of the active phase subsides, symptoms similar to the prodromal phase begin. If the symptoms were few and not very severe during the prodromal phase, the residual phase too would follow suit. Unfortunately, more the number of breakdown episodes a person with schizophrenia experiences, the more severe the residual symptoms become. In other words, the person remains, listless, withdrawn and out of touch from reality for longer periods.

Therefore, it is highly important for a person to rigorously follow the medical treatment prescribed by the doctor, and keep a relapse at bay.

What are the subtypes of schizophrenia?

Schizophrenia is an umbrella term for a spectrum of psychotic disorders. All these disorders may share some symptoms but not all.

  • Paranoid schizophrenia: characterized by feelings of extreme suspicion and persecution that the world is out to get you. These could be interspersed with feelings of grandiosity.

  • Schizoaffective disorder: characterized by symptoms of schizophrenia and an additional major mood disorder, such as depression or bipolar disorder.

  • Catatonic schizophrenia: characterized by sudden bursts of hyperactivity followed by under activity, social withdrawal, psychomotor disturbances.  

  • Disorganized schizophrenia: characterized by disordered thoughts, confusing feelings and emotions. These may however, not be necessarily delusional.

  • Residual schizophrenia: characterized by the disappearance of delusions and hallucinations along with all the motivation and interest in life. Instead a listlessness and lethargy emerges.

What are the causes of schizophrenia?

There is no one particular cause for schizophrenia. Researchers are of the opinion that a number of factors together can trigger schizophrenia. Some of the causes are:

  • Genetics:  This disorder is seen to run in families and people are seen to inherit the tendency to develop this disorder. Presence of a combination of certain genes might make a person more prone to this disorder under stressful circumstances.

  • Drug Abuse: Some people develop schizophrenia after using certain drugs such as marijuana or cocaine. These drugs can disrupt the chemical balance in the brain and thus cause schizophrenia.


  • Birth Related Complications: Research indicates people who suffered from birth related complications are more prone to schizophrenia. The complications include:

    • premature labour

    • lack of oxygen (asphyxia) during birth

    • low birth weight

    • expectant mothers who suffer from flu or any viral disease

  • Brain Complications: Scientists believe that an imbalance of the brain chemicals can cause schizophrenia. Scientists have noted the excessive production of dopamine, glutamate, and serotonin in the brains of people with schizophrenia. These are neurotransmitters which allow nerve cells in the brain to send messages to each other. An imbalance of these chemicals affects the way a person’s brain reacts to external stimuli.

  • Stress: A stressful situation can suddenly trigger schizophrenia in someone who is already prone to it. The situations include:

    • loss of a loved one

    • unemployment

    • physical, sexual, or emotional abuse

    • divorce or separation

Who is prone to schizophrenia?

A number of risk factors can trigger schizophrenia, among them are:

  • Having an immediate relative who suffers from schizophrenia, such as a parent, a sibling, a twin raises the risk of developing schizophrenia by at least 40%.

  • It has been noticed that people living in dense urban areas are more prone to schizophrenia.

  • Babies of women who have been exposed to hunger or famine during the first three months of conception are at a high risk of developing schizophrenia. Babies of women who suffered from viral infections such as flu, during pregnancy are also at a high risk.

  • People who suffer from abuse, physical mental, sexual, and emotional, in their childhood are at a risk of suffering from schizophrenia. That is not to say that children who come from healthy, loving and supportive homes may not develop schizophrenia.

  • A family history of epilepsy is seen to be a precursor to schizophrenia in many cases, apart from other forms of neurological disorders.

  • According to some studies performed, children born of fathers who are above 50 years are at a three-fold risk of developing schizophrenia as compared to children born of fathers who are much younger.

What are the symptoms of schizophrenia? How is it diagnosed?

The symptoms of schizophrenia are twofold, positive and negative. The positive symptoms are those that are easily seen in the patient, which does not mean that they are necessarily good. The negative symptoms are those that cannot be seen.

The positive symptoms include:

The negative symptoms include:

Diagnosis

For the diagnosis, at first it would be wise to approach your family physician or a general doctor who will conduct tests and a physical exam to rule out the possibility of any medical condition, medication, and narcotics abuse which can be the cause of the symptoms. The tests can also include MRI or CT scan, apart from tests to check any form of drug or alcohol abuse.

Once the other possibilities have been ruled out, the doctor may suggest a psychiatric evaluation and refer you to a psychiatrist.
A psychiatrist evaluation includes the psychiatrist asking you about your personal, family, as well as medical history. He will ask you in detail about your thoughts, feelings, moods, any unusual experiences you may have had, such as, seeing things or people, who others are unable to see, or if you hear any voices either criticising, or abusing you, or asking you to do things.

Following the discussion, if the doctor thinks it fit, he may use the Diagnostic and Statistical Manual of Mental Disorders (DSM 4-TR or 5) scale, which is commonly used for the formal diagnosis of most psychiatric disorders.

According to the DSM 4-TR or 5 scale, to be diagnosed with schizophrenia, the patient must have experienced at least two of the following symptoms:

  • delusions

  • hallucinations

  • disorganized speech

  • disorganized or catatonic behavior (psychomotor disturbances)

  • negative symptoms (lack of speech and apathy)

The patient should have experienced the disturbing symptoms for at least 6 months, with one month of continuously active symptoms. The most significant symptoms the patient experiences must include, social withdrawal, and occupational problems, for a prolonged period of time.

Apart from DSM 4-TR or 5 scale, the doctor may also take the help of Positive and Negative Syndrome Scale (PANSS), which helps to gauge the severity of schizophrenia episode.  

Each of the positive and negative subscales in the PANSS scale, contain 7 items (P1 – P7, N1 – N7).  The General Psychopathology subscale contains 16 items with emphasis on cognition (G 1 - G16) .

Each item is scored from 1-7 based on the presence and severity of symptoms:

  • 1=absent

  • 2=minimal

  • 3=mild

  • 4=moderate

  • 5=moderate severe

  • 6=severe

  • 7=extreme

To gauge the depression level in the patient with schizophrenia the doctor may use the Calgary Depression Scale for Schizophrenia (CDSS).


Therefore, for the final diagnosis the patient will need to undergo a clinical interview, in which his affective, motor, behavioral and cognitive functions will be observed based on the questions asked by the doctor pertaining to DSM 4-TR or 5, PANSS and CDSS.

What are the complications of schizophrenia?

If left untreated, schizophrenia can result in a number of complications such as:

What are the side effects of schizophrenia drugs?

For schizophrenia usually antipsychotics are prescribed, and the dosage is constantly adjusted until the side effects become minimal. This is also achieved by sometimes changing the drug itself.

The usual side effects of the schizophrenia drugs include:

How to manage your schizophrenia ?

Schizophrenia Management

Schizophrenia can be successfully treated and managed, provided you are willing to help yourself, have a strong support network, and follow the right treatment. You can live a happy and fulfilling life, have satisfying relationships, be creative, and be a contributing member to your community no matter what the challenges you face at the moment.

You can manage schizophrenia with these few, simple guidelines:

 

  • Maintaining a Diary is Highly Therapeutic: If due to schizophrenia you hear voices, it will be highly useful for you to maintain a diary where you note down how frequently you hear these voices, how abusive or nice they are, and how do you react to the voices.

    Take your diary along with you to every appointment you have scheduled with your psychiatrist. This will enable your doctor to understand whether the medicines prescribed for you are effective or not, whether the dosage needs to be reduced or increased, or whether the prescribed medication requires a change.

    Chances are you may show a marked improvement within a few weeks of starting the anti-psychotic medicines. 

 

  • Counselling or Talk Therapy: A one-on-one counselling session can be immensely helpful for you if you suffer from schizophrenia. Sometimes it is easier to open up to a stranger instead of to family members and friends. Besides, a stranger who is not emotionally involved with you will be able to give you a better perspective, without any form of judgement, or preconceived notions, even if your thoughts, experiences and feelings sound weird or bizarre.

  • Be Active and Practice Cognitive Skills: Over a period of time schizophrenia can affect one’s cognitive skills. The patient’s dysfunctional way of thinking affects his ability to understand information and then use the information to make decisions. Apart from that, he also has trouble organizing his thoughts, focusing on any particular task, and prioritising the tasks. Therefore, practising cognitive skills on a routine basis can be of immense help.
    The cognitive skills can include :

    • maintaining a diary where the patient can note when to brush his teeth, comb his hair, and take his medication etc. He can also record his day to day experiences in the dairy.

    • learning computers and performing various tasks on computers which can be a remediation technique for problem solving skills.

    • joining art therapy classes, which can help the patient to express himself freely.

    • going for cognitive behavioural therapy.

  • Seek family and social support: This is an illness which requires emotional support, whether it be from family members or friends. The support network is vital to get the right treatment, to make sure that the treatment is working, to keep your symptoms under control and to bust your stress. Continue with your work and education, and if that is not possible, be with people who share the same interests as you, or join some classes.  
    If you do not have a family, consider joining a schizophrenia support group, or volunteer in an organization of your choice. But make sure you have social contact.

  • Manage Your Stress: Put brakes on your stress by practicing techniques such as mindfulness meditation, deep breathing, or progressive muscle relaxation. Infact, exercise is a must for you if you have schizophrenia.

  • Exercise, Exercise, Exercise: Studies show that since this illness makes people lethargic they are at a high risk of suffering from heart disease, strokes, cancer and diabetes. A good exercise regime can make a huge difference not only to your physical health but also to your mental health. You can go for yoga classes, or go for swimming, jogging, running, aerobics, dancing, and brisk walks in natural surroundings.

  • Eat Nutritious Meals: The food you eat can go a long way to influence your physical as well as mental health. Consult with your psychiatrist about your diet plan and also take the help of a nutrician if possible. Some dietary changes you can make are:

    • Take a low carbohydrate diet. Avoid sugar and caffeine intake.

    • Add foods containing fatty acids to your diet, such as omega-3 fatty acids from fatty fish, fish oil, walnuts, and flaxseeds. This will help to reduce your fatigue drastically, and balance your moods.

    • Increase your anti-oxidant levels by consuming food which contains Vitamins A, C, and E such as beans, berries, apples, plums and pecans.

    • Regularly take a multivitamin which contains niacin, Vitamin B and folic acid. This will help to maintain the chemical balance in your brain. Always take the multivitamins by first consulting with your doctor. Your doctor may also prescribe a multivitamin containing zinc, as most of the mental health disorders can result in zinc deficiency.

    • Avoid foods with gluten such as wheat, barley and rye and also bread, some cereals, soy sauce, baked goods, beer and a few other alcoholic drinks.

  • Get a Good Night’s Sleep: People with schizophrenia often have trouble sleeping. But with the medication given to you, you will need more than 8 hours of sleep. Cutting down on caffeine, practicing mindfulness meditation and exercising will help to get the much desired relaxation and sleep.

  • Avoid Narcotics, Alcohol & Smoking: Substance abuse of any kind, including smoking will hamper with the schizophrenia treatment. Consult your doctor if you have an addiction problem.

What is the treatment for schizophrenia?

Schizophrenia requires long-term treatment, and patients are advised to continue their treatment even when they become free of their symptoms, so that they can avoid a relapse.

You may be given anti-psychotics if you are diagnosed with schizophrenia, however, anti-psychotics are not a complete cure for schizophrenia. They at best reduce the psychotic symptoms such as hallucinations, delusions, paranoia, and disordered thinking. They are not helpful for treating negative symptoms such as social withdrawal, demotivation, and lack of emotional expressiveness.

The best way therefore to treat schizophrenia is to combine medicines with talk therapy or psychotherapy, family and social support, and lifestyle changes.

Psychological Therapies

A number of psychological therapies can help you immensely if you suffer from schizophrenia. These include:

  • Cognitive Behaviour Therapy

  • Individual Psychotherapy

  • Cognitive Enhancement Therapy

  • Psychosocial Support

  • Family Psychotherapy

  • Social Skills Training


Exercise

Research evidence shows that exercise will not only promote your physical well-being but also your mental well-being. 75% of schizophrenia sufferers also suffer from a range of physical health problems such as heart disease, strokes, cancer and diabetes. Damaging lifestyle habits, such as leading sedentary lifestyles, smoking, drug abuse also contribute largely to the physical illnesses of people with mental illnesses. Exercising helps to reduce stress, improve relaxation and sleep patterns and improve mood. It helps to improve the mood, elevate depression, motivation and self esteem. Exercises such as running, swimming, yoga, and weight training can help people with schizophrenia tremendously. It can help with sleep issues and people with schizophrenia often suffer from sleep issues.

Would you like to consult a doctor for Schizophrenia ?

Questions answered by trusted doctors

Verified User

Is there a permanent remedy for schizophrenia in ayurveda.what should be life style of person with schizophrenia in ayurveda

Dr. Krishna Bhat
Ayurveda, Bangalore

Its not that simple to tell treatment possibility . but if there is a chance of cure or long lasting effect its only Ayurveda wat i feel. Otherwise its just management of symptoms if u can consult wit pt definitely we can tell in details about possibilities n treatment plan

Verified User

What is the medicines dosage mostly prescribed for Schizophrenia in India? What is the treatment for patient doesn't take pill?

Dr. Sonia Malhotra
Pune, Psychiatrist

Dear sir,
Drugs used for schizophrenia have different doses and not one suit fits all. The treatment is always tailor-made to suit a patient's need.
For a patient not taking medicines, we have following options:
1. Giving medicines under direct supervision
2. Once to twice a month depot drug injections that keep releasing the drug gradually
3. Admit the patient to a mental health facility where they administer drugs orally or inject them until patient takes the drug by mouth
4. Covert medication- mixed with food etc. (Not recommended unless everything else fails, unethical according to some schools of thought!)
Pls feel free to contact me for private consultation.
Regards!

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Did you know?

It affects everyone at an equal rate

Schizophrenia affects men and women, of all ethnicities at the same rate around the world.

Schizophrenia in Men

Men tend to develop schizophrenia between 15 years -24 years of age.

Schizophrenia in Women

In women the onset of schizophrenia occurs between 25 - 34 years. Interestingly, earlier a girl starts menstruation, the longer she is protected against schizophrenia. Symptoms of schizophrenia may also develop in women who are 45 years old and in women who are in their mid-60s. These women are usually the ones who have functioned at a near-normal level until gradually the neurotransmitters in their brains begin to malfunction. Women with schizophrenia also have higher rates of suicide compared to other women.

16 years - 30 years is a crucial period

The symptoms of schizophrenia such as hallucinations and delusions usually begin between the ages of 16 years to 30 years.

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