Schizophrenia: Meaning, Symptoms, Types and Treatment



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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 between 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 make 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 the 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: is 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: is characterized by symptoms of schizophrenia and an additional major mood disorder, such as depression or bipolar disorder.

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

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

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


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 schizophrenia 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 are of three types:

  1. Physical symptoms which include:
    • Change in personal habits: When the symptoms of schizophrenia begin to affect a person, usually the person slips in areas of personal grooming and dressing. They are not concerned about their appearance and also personal hygiene. This occurs due to their confused mindset which makes it very difficult for them to even focus and perform and perform a simple routine task, such as combing their hair or brushing their teeth.
    • Psychomotor Issues: Patients suffering from schizophrenia may encounter psychomotor problems such as clumsiness, and repetitive actions such as frequently pacing in a particular space. In extreme cases, the patient remains in a rigid motionless posture for an extended period of time.
  2. Mental symptoms which include:
    • Hallucinations: Patients may start seeing, hearing, smelling or feeling something which actually does not exist. The most common among these is hearing voices that talk about them or tell them something. 
    • Delusions: The patient shows tremendous belief in false ideas which are completely out of touch with reality. These may include grandiose delusions of being a great religious figure, or a movie star, or having superpowers. Delusions also include being constantly paranoid because they the patients think someone is trying to kill them.
  3.  Behavioural symptoms include:
    • Disorganized Thought, Speech, and Irrational Behavior: Confused or disordered thinking is very common among the schizophrenia patients. Their thoughts are jumbled up and disconnected. This affects their ability to connect and communicate with other people coherently. It also affects their behaviour as they struggle to even perform their routine tasks such as, brush their teeth or take a bath.

The negative symptoms are of three types:

  1. Physical symptoms which include:
    • Sexual Problems: Patients suffering from schizophrenia experience a significant reduction, or at times the total absence of libido (sex drive). The men especially may experience problems having an erection. While both men and women can have problems achieving an orgasm. 
    • Lethargy: People with schizophrenia may show a complete lack of energy and not perform any kind of major physic
    • activity (including bathing). They may engage only in light physical activity. They may spend most of their time in bed or watching T.V.
  2. Mental symptoms which include:
    • Indecisiveness:  Due to their conflicted thoughts and emotions, patients suffering from schizophrenia are unable to take decisions easily. Even a simple decision of what to wear for the day can be very difficult for them.
  3. Emotional symptoms which include:
    • Depression:People suffering from schizophrenia often suffer from major depression. Therefore, it can be easily misleading and the person may be labelled to be simply depressive. especially if it is a teenager, it is easy to dismiss this symptom as a 'teenage phase'.

    • Social Withdrawal: Since people suffering from schizophrenia are often in a state of inner confusion they tend to withdraw from society at large. They feel calmer when they are with themselves. Besides, they are so absorbed in their own thoughts and feelings, that they lose interest in others. In the beginning, this can also be mistaken for introvertedness.

    • Apathy: People suffering from schizophrenia can become very emotionless. Not only will they not express any emotions, but, at times it seems as if they lose the ability to feel any emotions. They may even display incongruous emotions such as laughing at sad news or appearing to be unhappy when hearing good news. This makes them seem insensitive.

    • Suicidal Tendencies: People suffering from schizophrenia are at a high risk of suicidal behaviour. Especially people with schizophrenia who are single, separated, unemployed, or living alone are known to attempt suicide and also, unfortunately, succeed. Suicide attempts are especially made when the patient undergoes a major depressive phase. And major depressive phases are very common among patients suffering from schizophrenia.

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 behaviour (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 an 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, behavioural 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 of 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 prioritizing the tasks. Therefore, practicing 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. In fact, 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 dietician 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 the schizophrenia treatment. Consult your doctor if you have an addiction problem.

What is the treatment for schizophrenia?

Medical Treatment

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 ?

Patient Experiences

Jude Joseph
Extremely Satisfied With Schizophrenia Treatment
My sister R Ananda Kumari is a schizophrenic for the last 20 years we had consulted with many repute psyhciatrics in Bangalore and few months at NIMHANS too......i got details about MANASA. From google search and got an appointment with Dr.Dharmendra and our first consultation was in the year 2012 my sister was counselled and treatment was given with phase manner and few times was admitted in manasa under guidance of Dr.Dharmendra To conclude by April 2013 she has improved and interacts as a normal person does her day to day work by self and the she consumes her tablets reguraly Today she is fine and she travels alone to Day care centre at MPA and comes home all by herself and hence we really thank and recommend to other to visit Dr.Dharmendra. Sir we as a family thank you again on behalf of kumari for the care,counselling and treatment provided and even the staff and Management of MANASA who were very helpful during her stay in the hospital. Currently she visits as a out patient for review once in four month....... ...Read Less
Doctor in this story :Dr. M.S Dharmendra
Neuropysciatric Hospital
Chetan
Great Improvement After Schizophrenia Treatment
I feel much better now. Was never agreeing for meds initially, wasted so much time because of that. But I am better and understand what is schizophrenia and why i used to have those voices and fears. Dr.Shyam is undoubtedly best psychiatrist in town....Read Less
Doctor in this story :Dr. Shyam Mithiya
Dr. Shyam Mithiya's Psychiatry and Sex Clinic
Jyotsna Nair
Better Mental State After Schizophrenia Treatment
She is a very good doctor and is very supportive. She has been counselting my sister who has schizophrenia for the past 6 yrs.now my sister is at a much better mental state....Read Less
Doctor in this story :Dr. Kavita Sagarkar
Beautiful Mind Clinic

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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