Schizophrenia is a chronic brain disorder that affects about one percent of the population. When schizophrenia is active, symptoms can include delusions, hallucinations, trouble with thinking and concentration, and lack of motivation. However, when these symptoms are treated, most people with schizophrenia will greatly improve over time. While there is no cure for schizophrenia, research is leading to new, safer treatments. Experts also are unravelling the causes of the disease by studying genetics, conducting behavioural research, and by using advanced imaging to look at the brain’s structure and function. These approaches hold the promise of new, more effective therapies.
The complexity of schizophrenia may help explain why there are misconceptions about the disease. Schizophrenia does not mean split personality or multiple-personality. Most people with schizophrenia are not dangerous or violent. They also are not homeless nor do they live in hospitals. Most people with schizophrenia live with family, in group homes or on their own. Research has shown that schizophrenia affects men and women about equally but may have an earlier onset in males. Rates are similar in all ethnic groups around the world. Schizophrenia is considered a group of disorders where causes and symptoms vary considerably between individuals.
When the disease is active, it can be characterised by episodes in which the patient is unable to distinguish between real and unreal experiences. As with any illness, the severity, duration and frequency of symptoms can vary; however, in persons with schizophrenia, the incidence of severe psychotic symptoms often decreases during a patient’s lifetime. Not taking medications as prescribed, use of alcohol or illicit drugs, and stressful situations tend to increase symptoms. Symptoms fall into several categories:
- Positive psychotic symptoms: Hallucinations, such as hearing voices, paranoid delusions and exaggerated or distorted perceptions, beliefs and behaviours.
- Negative symptoms: A loss or a decrease in the ability to initiate plans, speak, express emotion or find pleasure.
- Disorganization symptoms: Confused and disordered thinking and speech, trouble with logical thinking and sometimes bizarre behaviour or abnormal movements.
- Impaired cognition: Problems with attention, concentration, memory and declining educational performance.
Symptoms usually first appear in early adulthood. Men often experience symptoms in their early 20s and women often first show signs in their late 20s and early 30s. More subtle signs may be present earlier, including troubled relationships, poor school performance and reduced motivation. It is rarely diagnosed in children or adolescents. Before a diagnosis can be made, however, a psychiatrist should conduct a thorough medical examination to rule out substance misuse or other medical illnesses whose symptoms mimic schizophrenia.
Researchers believe that some genetic and environmental factors contribute to causation, and life stresses may play a role in the disorder’s onset and course. Since multiple factors may contribute, scientists cannot yet be specific about the exact cause in individual cases. Since the term schizophrenia embraces several different disorders, variation in a cause between cases is expected.
Recovery and Rehabilitation
Treatment can help many people with schizophrenia lead highly productive and rewarding lives. As with other chronic illnesses, some patients do extremely well while others continue to be symptomatic and need support and assistance.
After the symptoms of schizophrenia are controlled, various types of therapy can continue to help people manage the illness and improve their lives. Therapy and supports can help people learn social skills, cope with stress, identify early warning signs of relapse and prolong periods of remission. Because schizophrenia typically strikes in early adulthood, individuals with the disorder often benefit from rehabilitation to help develop life-management skills, complete vocational or educational training and hold a job. For example, supported-employment programs have been found to help persons with schizophrenia obtain self-sufficiency. These programs provide people with severe mental illness with competitive jobs in the community.
Many people living with schizophrenia receive emotional and material support from their family. Therefore, it is important that families be provided with education, assistance and support. Such assistance has been shown to help prevent relapses and improve the overall mental health of the family members as well as the person with schizophrenia.
Living With Schizophrenia
Optimism is important, and patients, family members and mental health professionals need to be mindful that many patients have a favourable course of illness, that challenges can often be addressed, and that patients have many personal strengths that can be recognised and supported.
Credit: Ranna Parekh, M.D. M.P.H., American Psychiatric Association