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Schizophrenia

Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may appear as if they have lost touch with reality, causing great distress to the individual, their relatives and friends. If untreated, the symptoms of schizophrenia can be persistent and disabling. However, effective treatments are available. When given in a timely, coordinated and sustainable manner, treatment can help affected individuals attend school or work, achieve independence, and enjoy personal relationships.

Onset and symptoms

Schizophrenia is usually diagnosed in the late teens to early 1930s and is more likely to occur in men (late adolescence - early 20s) than women (early 20s - early 30s). A diagnosis of schizophrenia often follows the first episode of psychosis, when individuals first show symptoms of schizophrenia. Gradual changes in thinking, mood, and social functioning often begin before the first episode of psychosis, usually in mid-adolescence. Schizophrenia can occur in younger children, but it rarely occurs before late adolescence.

The symptoms of schizophrenia generally fall into the following three categories:

Psychotic symptoms include altered perceptions (eg, changes in vision, hearing, smell, touch, and taste), abnormal thinking, and strange behavior. People with psychotic symptoms can lose a shared sense of reality and experience themselves and the world in a distorted way. In particular, individuals typically experience:

  • Hallucinations, such as hearing voices or seeing things that are not there
  • Delusions, which are firmly held beliefs unsupported by objective facts (eg, Paranoia - irrational fears that others are "out to get you" or to believe that the television, radio, or Internet is broadcasting special messages that will only respond. require)
  • Thought disturbance, including unusual thinking or disorganized speech

Negative symptoms include loss of motivation, disinterest or lack of pleasure in daily activities, social withdrawal, difficulty showing emotions, and difficulty functioning normally. In particular, individuals typically have:

  • Decreased motivation and difficulty in planning, starting and maintaining activities
  • Decreased feelings of pleasure in everyday life
  • "Flat affect", or reduced expression of emotions through facial expression or voice
  • Speak less

Cognitive symptoms include problems with attention, concentration, and memory. For some individuals, the cognitive symptoms of schizophrenia are subtle, but for others they are more prominent and interfere with activities such as following conversations, learning new things, or remembering appointments. In particular, individuals typically experience:

  • Difficulty in processing information to make decisions
  • Problems using information immediately after learning it
  • Problems focusing or paying attention

Risk factors

Several factors contribute to the risk of developing schizophrenia.

Genetics: Schizophrenia sometimes runs in families. However, it's important to know that just because someone in a family has schizophrenia doesn't mean other members of the family will have it too. Genetic studies strongly suggest that many different genes increase the risk of developing schizophrenia, but no gene causes the condition itself. It is not yet possible to use genetic information to predict who will develop schizophrenia.

Environment: Scientists believe that interactions between genetic risk and aspects of a person's environment may play a role in the development of schizophrenia. Environmental factors that may play a role include living in poverty, a stressful environment, and exposure to viruses or nutritional problems before birth.

Brain structure and function: Scientists think that differences in brain structure, function and brain functioninteractions between chemical messengers (called neurotransmitters) can contribute to the development of schizophrenia. For example, differences in the volumes of specific components of the brain, in the way brain regions are connected and interact, and in neurotransmitters, such as dopamine, are found in people with schizophrenia. Differences in brain connections and circuits seen in people with schizophrenia can start to develop before birth. Brain changes that occur during puberty can cause psychotic episodes in people who are vulnerable because of genetics, environmental exposure, or the types of brain differences mentioned above.

Treatments and Therapies

The causes of schizophrenia are complex and not fully understood, so current treatments focus on managing symptoms and solving problems related to daily functioning. Treatments include:

Antipsychotic Medication

Antipsychotic medications can help reduce the intensity and frequency of psychotic symptoms. They are usually taken in pill or liquid form on a daily basis. Some antipsychotics are given as an injection once or twice a month, which some people say is more convenient than daily oral doses. Patients whose symptoms do not improve with standard antipsychotics are usually given clozapine. People treated with clozapine should undergo routine blood tests to detect a potentially dangerous side effect occurring in 1-2% of patients.

Many people who take antipsychotics have side effects such as weight gain, dry mouth, restlessness, and drowsiness when they start taking these drugs. Some of these side effects go away over time, but others can persist, so some people may consider stopping their antipsychotic medications. Stopping medication suddenly can be dangerous and can make schizophrenia symptoms worse. People should not stop taking antipsychotic medications without first talking to a health care provider.

Shared decision-making between doctors and patients is the recommended strategy for determining the best type of medication or drug combination and the correct dose. The United States Food and Drug Administration (FDA) website provides the latest information on warnings, patient medication guides, or newly approved medications.

Psychosocial treatments

Cognitive behavioral therapy, behavioral skills training, supervised work, and cognitive recovery interventions can help address the negative and cognitive symptoms of schizophrenia. A combination of these therapies and antipsychotic medications is common. Psychosocial treatments can be helpful in teaching and improving coping skills to address the day-to-day challenges of schizophrenia. They can help people pursue their life goals, such as going to school, working, or establishing relationships. People who participate in regular psychosocial treatment are less likely to relapse or be admitted to hospital. For more information on psychosocial treatments, see the Psychotherapies webpage on the NIMH website.

Family education and support

Educational programs for family members, significant others, and friends provide instruction on schizophrenia symptoms and treatments, as well as strategies for helping the person with the disease. Increasing the understanding of key supporters of psychotic symptoms, treatment options, and the course of recovery can reduce their suffering, enhance coping and empowerment, and enhance their ability to provide effective help. Family-based services can be provided on an individual basis or through multi-family workshops and support groups. For more information on family-related services in your area, visit the Family Education and Support Groups page on the National Alliance on Mental Illness website.

Coordinated special care

Coordinated specialist care (CSC) is a general term used to describe restorative treatment programs for people with a first episode of psychosis, an early stage of schizophrenia. A team of health professionals and specialists provides CSC, which provides psychotherapy, medication management, case management, employment and support.

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