Schizophrenia is characterized by a disintegration of thinking processes and emotional responsiveness. It is most commonly manifested through delusions, auditory hallucinations, disorganized thinking and speech, and paranoid delusions. It may affect social or occupational functioning depending on symptoms and severity. Symptoms generally occur in young adulthood and may be diagnosed based on a person's self-reported experiences and observed behaviors. The reliability of a schizophrenia diagnosis is generally high, however, some symptoms overlap with major depression and bipolar. The exact cause of schizophrenia is unknown, but researchers believe it is influenced by a combination of factors including genetics and environment. Schizophrenia is significantly affected by heredity and its onset is often exacerbated by environmental stressors.
Although schizophrenia is believed to be a brain-based disorder, there is currently no test or brain scan that can diagnose the condition. Some people with schizophrenia see several doctors before they are properly diagnosed. Diagnosis relies partially on self-reports, as well as the doctor's own observations of the person and their behavior. Some people may also provide insight from friends and family. Generally, a person who experiences delusions or hallucinations, disrupted relationships, difficulty functioning in everyday life, and disorganized speech or thinking will be diagnosed with schizophrenia.
Some of the oldest written documents about schizophrenia originate from Pharaonic Egypt. It is also mentioned in some ancient Greek and Roman literature. Until the 19th century, it was somewhat widely believed that people experiencing mental health problems such as schizophrenia were possessed by demons.
In 1887, German psychiatrist Emil Kraepelin described a set of symptoms we now associate with schizophrenia and used the term "dementia praecox" to classify it. He chose this name because he believed that dementia praecox was a form of dementia, primarily affecting the brain. In 1911, after Kraepelin, a Swiss psychiatrist named Eugen Bleuler coined the term schizophrenia for the symptoms Kraepelin had previously observed, realizing that this state was not quite the same as dementia. Bleuler is also credited with separating the symptoms of schizophrenia into "positive" and "negative" categories. In the 20th century, the definition and diagnostic criteria of schizophrenia was modified, and scientists have continued their efforts to understand it. Today, many researchers are closely examining genetics to understand how to better recognize, treat, and diagnose schizophrenia.
The term schizophrenia has Greek roots, combining the words schizo, which means to split, and phrene, which refers to the mind. This term references a disruption of the balance between thinking, perception, memory, and to some degree personality.
As with many other mental health issues, schizophrenia is often misunderstood. Media, pop culture, and stereotyping have all created many persisting myths about the condition. This contributes to stigmatization and discrimination of people who experience it. Some common myths about schizophrenia include:
Myth: People experiencing schizophrenia are violent and dangerous.
Truth: There are some risk factors to be aware of with schizophrenia symptoms, but there is not much difference when it comes to violent behavior and crime rates between people experiencing schizophrenia and general population. When medication is regularly taken and there is no interference with other drugs or alcohol, people experiencing schizophrenia are just as prone to violence or committing crime as anyone else.
Myth: Schizophrenia and multiple personalities are the same.
Truth: Multiple personalities refers to a condition called dissociative identity. Schizophrenia and dissociative identity are two different mental health conditions. This misconception often derives from pop culture and the word schizophrenia, which roughly translates to split mind. However, the split kin this case refers to a split from reality, not necessarily a split personality.
Myth: People with schizophrenia must be hospitalized.
Truth: Sometimes people who experience schizophrenia need hospitalization to ensure good treatment. Contrary to popular belief, however, only a small minority of people experiencing schizophrenia will require a long-term stay in a mental health facility. Most who experience this condition can live comfortably with their families or within supportive housing communities.
Schizophrenia can manifest as a broad range of symptoms with variations in severity and patterns from person to person. The symptoms of this condition can also change over time. They are commonly divided into two categories: positive and negative.
Positive symptoms represent a change in thoughts and behavior that are not part of usual functioning. They include:
- Delusion of reference (when someone interprets that an ordinary object has a special relationship with them)
- Delusion of persecution
- Delusion of control (when someone believes someone or something is trying to exercise control over them)
- Delusion of grandeur
- Disorganized speech
- Disorganized behavior
Negative symptoms of schizophrenia refer to a lack of common behaviors and emotions. Sometimes they are hard to recognize because of the similarity with other mental health conditions such as depression. These symptoms include:
- A lack of emotional expression characterized by a flat or monotonous voice, lack of eye contact, and lack of facial expression
- A lack of interest in everyday life and difficulties with motivation
- Inability to feel pleasure
- Social withdrawal
Psychotherapy is widely recommended and used in treating schizophrenia. Finding a therapist or counselor to work with can help those affected with schizophrenia to increase social skills, develop higher self-esteem, and gain insight to the mental health issues accompanying the condition. In severe episodes of schizophrenia, hospitalization may occur. This may be voluntary or involuntary based on the situation. Schizophrenia may lead to other medical issues that need to be treated.
A combination psychotherapy and psychotropic medication is one of the most recommended treatment approaches for schizophrenia. Antipsychotic medications are often used to treat symptoms of schizophrenia. These medications affect neurotransmitters such as dopamine and serotonin. There are two groups of antipsychotic medication for treating schizophrenia:
- Typical (conventional) antipsychotics: These are also referred to as first-generation antipsychotics. They have a greater potential for causing side effects than newer atypical antipsychotics. This group contains drugs such as Thorazine (chlorpromazine), Prolixin (fluphenazine), Haldol (haloperidol), and Trilafon (perphenazine).
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- Atypical antipsychotics: This class of antipsychotics typically have a lower risk of developing severe side effects. Some atypical antipscyhotics include Abilify (aripiprazole), Clozaril (clozapine), and Risperdal (risperidone).
The aim of treating schizophrenia with antipsychotics is to control symptoms with the lowest possible dosage. Sometimes psychiatrists or physicians will try various medications, dosages, and combinations of drugs to achieve the best results for the person being treated. In certain cases they may prescribe antianxiety medications or antidepressants.
The Diagnostic and Statistical Manual (DSM-IV) defines schizophrenia as a mental disorder characterized by disintegrating emotional responsiveness and thought processes. There are five different types of schizophrenia listed:
- Catatonic – involves motorological and psychological disturbances; also known as catatonia
- Disorganized – involves reality distortion (delusions and hallucinations) and psychomotor poverty (poverty of speech); also known as foldermenia
- Paranoid – thought disorder and disorganized behavior are absent but hallucinations and delusions are present
- Residual – involves low intensity positive symptoms
- Undifferentiated – psychotic symptoms are present but criteria for the above types have not been met
Over the years schizophrenia has made appearances in popular culture. For example, in the film based on a true story A Beautiful Mind, John Nash struggles with paranoid schizophrenia. While Nash was highly intelligent, people with schizophrenia are often portrayed as extremely unstable or incurable in the media. This may contribute to the stigmatizing idea that people with schizophrenia are “crazy" or dangerous.
Another interesting portrayal of schizophrenia is the movie Shutter Island, a popular psychological thriller. The story follows a man who is hospitalized on Shutter Island in an institution for criminals experiencing various debilitating mental health issues. The main character shows many positive symptoms of schizophrenia, with the dominant one being the delusion that someone on the island is trying to manipulate him.
Clean, Shaven is a movie enjoyed by fans and critics that offers an objective glimpse into the reality of a person experiencing schizophrenia The film examines symptoms such as auditory hallucinations, dissociative emotions, disconcerting images, anxiety, and paranoia. The plot follows a young father experiencing schizophrenia who is trying to get his daughter back from the family who adopted her. His portrayed fight gives valuable insight into the inner world of a person who is struggling with troubles every person can relate to, but with the additional challenge of a debilitating mental health issue.
- Jablensky, A. (2010). The diagnostic concept of schizophrenia: its history, evolution, and future prospects. Dialogues in Clinical NeuroSciences. 12(3): 271–287. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181977/
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- Schizophrenia diagnosis. (n.d.). Retrieved from http://www.webmd.com/schizophrenia/guide/schizophrenia-tests
- UNC Center for Excellence in Community Mental Health. (n.d.). Myths About Mental Illness. Retrieved from http://www.med.unc.edu/psych/cecmh/patient-client-information/patient-client-information-and-resources/clients-and-familes-resources/myths-about-mental-illness
Last updated: 07-03-2015