Understanding the signs, symptoms, causes and effects of schizophrenia is an important first step toward healing and recovery.
Learn about schizophrenia
Schizophrenia is a brain disorder that often begins in late adolescence, but can develop at any age, though it is rarely seen for the first time in older adults. The condition disrupts the way an individual thinks, behaves, experiences emotions, distinguishes reality from unreality, and interacts with others. Schizophrenia is a chronic condition, but is not always progressive. In fact, the symptoms of the disorder tend to lessen over the years, even without treatment. However, each individual experiences the disorder differently. Some individuals may suffer from almost constant hallucinations, while others may have periods of time when they experience predominantly “negative symptoms” (negative mood, lack of motivation, poverty of speech, slowed thought processes, social withdrawal) without the more visible “positive symptoms” (hallucinations, delusions, catatonia, paranoia). Even still, others may experience periods of normalcy when the symptoms have remitted. Often in the latter case, the psychotic episodes are more severe.
Schizophrenia is a treatable disorder. With the advent of new findings, more effective medications have been developed. While older medications tended to work on only the positive symptoms, leaving the person with negative symptoms and a poor quality of life, newer medications work on both the positive and negative symptoms.
While many may think schizophrenia doesn’t exist in childhood, this has been proven inaccurate. While rare, psychosis does appear in childhood. However, it can be difficult to distinguish from other disorders like ADHD and depression. It is also difficult to distinguish between the strong imaginative qualities of children who, for example, may have imaginary friends, and those children who are actually experiencing what may appear imaginary (e.g. seeing a child where there isn’t one).
While late onset schizophrenia does occur (characterized as occurring for the first time after the age of 45), the majority of older adults with the disorder have experienced it over their lifetime. It has been estimated that only 15% to 20% of all those with schizophrenia in late life actually experience the late onset form of the disorder.
There are some differences in schizophrenia when experienced in late life compared to when experienced in late adolescence. The rates of women diagnosed with schizophrenia in middle to late life are significantly higher than rates for men, while men are more likely to be diagnosed early in life. One theory states that it is possible that estrogen prevents the onset of schizophrenia until after menopause for those women who are predisposed to develop the disorder. Paranoia is more often found in patients with late onset, although this group also displays less severe negative symptoms, cognitive impairment, and improved prognosis compared to those with early onset schizophrenia.
The American Psychiatric Association (APA) reports that schizophrenia affects between 0.3% and 0.7% of the population. Men and women are affected by this mental health disorder in relatively equal numbers, yet the symptoms that are displayed tend to vary between the two genders. Sadly, the suicide rates among people diagnosed with schizophrenia are high, with the APA noting that between 5% and 6% of schizophrenia sufferers have died as the result of suicide. Furthermore, experts estimate that another 20% of individuals who have schizophrenia will attempt suicide at least once.
Causes and Risk Factors
Causes and risk factors for schizophrenia
Research suggests that several causes are related to the development of schizophrenia.
- Genetic: Research has demonstrated that schizophrenia has a strong genetic factor. While the prevalence rate for the condition is 1% to 1.5% in the general population, the rate for those with a first degree relative who suffers from the disorder is 10%. For identical twins, when one twin has the disorder there is a 50% likelihood that the other twin will also acquire the disorder.
There is also research that implies that individuals with schizophrenia have several unique genetic mutations which may disturb regular brain maturation.
- Environmental Factors: Environmental factors that have been linked to the development of schizophrenia include exposure to maternal depression, toxins, viruses (e.g. Rubella) prenatal malnutrition, CNS damage, hypoxia, Rh incompatibility, preeclampsia, and brain trauma during delivery.
- Physiological/Environmental Interactions: It is generally agreed that the development of schizophrenia is the result of an interaction between physiological and genetic predisposition, and the environment a person comes into contact with.
Signs and Symptoms
Signs and symptoms of schizophrenia
Symptoms generally fall into 3 general categories – Positive, Negative and Cognitive.
- Positive Symptoms – These are symptoms rarely observed in people without schizophrenia. These symptoms differ by individual, and for some they may be severe, while for others they may be minor. Almost all medications used to treat schizophrenia are effective in alleviating this category of symptoms.
- Delusions – False, irrational, or idiosyncratic beliefs. These are firmly held even when contradicted by accepted reality.
- Hallucinations– Perceptions of sensory experiences in the absence of external stimuli that the individual is convinced are real. The most common hallucination is hearing voices, but individuals with schizophrenia can experience hallucinations involving any one of their senses.
- Thought Disorders – Dysfunctional ways of thinking or linking thoughts together. They may have difficulty organizing their thoughts or linking them logically. They may speak in a garbled way that is indicative of their disordered thought processes or display thought blocking, which is when the person stops speaking in the middle of a sentence because they believe their thought has been removed from their mind. Those with this condition may also use neologisms, which are made up, meaningless words.
- Movement Disorders – This often appears as extreme agitation, with stereotyped movements and gestures, or alternates with periods of catatonia, a state in which a person fails to respond to anyone and freezes, often in unusual poses.
- Negative Symptoms-Negative symptoms refer to disturbances in feelings and behaviors. These symptoms can be harder to recognize as they can resemble depression. While it used to be difficult to help an individual with negative symptoms, newer medications have been developed that help treat these symptoms
- Flat affect – Little facial expression, speaking in a lifeless monotone
- Almost complete lack of pleasure in everyday life
- Amotivational syndrome – the inability to begin and maintain goal associated tasks
- Poverty of speech – speaking little even during a forced interaction
- Cognitive Symptoms– These symptoms can be difficult to distinguish since they are subtle. However, they are experienced as some of the individual’s most distressing symptoms, making it almost impossible to earn a living or function normally.
- Decreased comprehension of all types of information, such that they have no basis for decision making
- Difficulty focusing and attending
- Problems with working memory, preventing the ability to make use of information right after learning it
Left untreated, these symptoms make it difficult for those with schizophrenia to live on their own or support themselves. In recent years however, a number of new medications have been developed that are effective in relieving symptoms in all three categories. Additionally, psychotherapy can help individuals learn better coping skills, work on adjustment issues, and process negative beliefs, feelings, or opinions related to themselves.
Effects of schizophrenia
There are a number of effects which result from the primary symptoms of schizophrenia. These include:
- Inconsistency between emotional experience and expression
- Extreme reactions to criticism or negative judgments
- Inability to cry or express joy when feeling sad or happy
- Inappropriate laughter or crying not attached to real emotion
- Social withdrawal
- Disorganized behavior
- Speech abnormalities
- Deterioration of personal hygiene
- Bizarre or irrational comments
- Flat, expressionless gaze
- Too much sleep or insomnia
- Decreased ability to concentrate or pay attention
- Disorganized thoughts
- Strange use of words or way of speaking
Schizophrenia and co-occurring disorders
Several other mental illnesses have been known to co-occur with schizophrenia. These co-occurring disorders may include:
- Other anxiety disorders
- Panic disorder
- Social anxiety disorder
- Separation anxiety (in children)
- Selective mutism (in children)
- Major depressive disorder
- Eating disorders
- Substance abuse
- Post-traumatic stress disorder