A brain disorder characterized by delusions, hallucinations, other disturbances in thinking and communication, and by deteriorating social functioning. “
As the illness progresses, the symptoms often become more bizarre. The patient develops peculiar behavior, begins talking in nonsense, and has unusual perceptions. This is the beginning of psychosis. Schizophrenia seems to worsen and become better in cycles known as relapse and remission, respectively. At times, people suffering from schizophrenia appear relatively normal. However, during the acute or psychotic phase, people with schizophrenia cannot think logically and may lose all sense of who they and others are. They suffer from delusions, hallucinations or disordered thinking and speech.
These symptoms don't mean people with schizophrenia are completely out of touch with reality. They know, for example, that people eat three times a day, sleep at night and use the streets for driving vehicles. For that reason, their behavior may appear quite normal much of the time.
However, their illness does severely distort their ability to know whether an event or situation they perceive is real. A person with schizophrenia waiting for a green light at a crosswalk doesn't know how to react when he hears a voice say, "You really smell bad." Is that a real voice, spoken by the jogger standing next to him, or is it only in his head? Is it real or a hallucination when he sees blood pouring from the side of the person next to him in a college classroom? This uncertainty adds to the terror already created by the distorted perceptions.
There are many types of schizophrenia. For example, a person whose symptoms are most often colored by feelings of persecution is said to have "paranoid schizophrenia;" a person who is often incoherent but has no delusions is said to have "disorganized schizophrenia." Even more disabling than the delusions and hallucinations are the symptoms of "negative" or "deficit" schizophrenia. Negative or deficit schizophrenia refersto the lack or absence of initiative, motivation, social interest, enjoyment and emotional responsiveness. Because schizophrenia can vary from person to person in intensity, severity and frequency of both psychotic and residual symptoms, many scientists use the word "schizophrenia" to describe a spectrum of illnesses that range from relatively mild to severe.
In years past, psychiatric researchers theorized that schizophrenia arose from bad parenting. A cold, distant and unfeeling mother was called "schizophrenigenic" because it was believed that such a mother could, through inadequate care, cause the symptoms of schizophrenia. This theory has been discredited today.
Most scientists now suspect that people inherit a susceptibility to the illness, which can be triggered by environmental events such as a viral infection that changes the body's chemistry, a highly stressful situation in adult life, or a combination of these.
.Like many genetically related illnesses, schizophrenia appears when the body is undergoing the hormonal and physicalchanges of adolescence. Genes govern the brain's structure and biochemistry. Because structure and biochemistry change dramatically in teen and young adult years, some researchers suggest that schizophrenia lies "dormant" during childhood. It emerges as the body and brain undergo changes during puberty.
Some scientists think genetics, autoimmune illness and viral infections combine to cause schizophrenia. Genes determine the body's immune reaction to viral infection. Instead of stopping when the infection is over, the genes tell the body's immune system to continue its attack on a specific part of the body.
The genes of people with schizophrenia may tell the immune system to attack the brain after a viral infection. This theory is supported by the discovery that the blood of people with schizophrenia contains antibodies--immune system cells--specific to the brain. Moreover, researchers in a National Institute of Mental Health study found abnormal proteins in the fluid that surrounds the brain and spinal cord in 30 percent of people with schizophrenia but in none of the mentally healthy people they studied.
Finally, some scientists suspect a viral infection during pregnancy. Many people suffering from schizophrenia were born in late winter or early spring. That timing means their mothers may have suffered from a slow virus during the winter months of their pregnancy. The virus could have infected the baby to produce pathological changes over many years after birth. Coupled with a genetic vulnerability, a virus could trigger schizophrenia.
An unsupportive home or social environment and inadequate social skills can bring on schizophrenia in those with genetic vulnerability or cause relapse in those already suffering with the disease. Psychiatrists also believe these stress factors can often be offset with "protective factors" when the person with schizophrenia receives proper maintenance doses of antipsychotic medication, and help in creating a secure network of supportive family and friends, in finding a steady and understanding place of employment, and in learning necessary social and coping skills.
Antipsychotic medications are important in reducing or eliminating the chances of relapse. One study showed that 60 to 80 percent of those who did not take medication as part of their treatment had a relapse the first year after leaving the hospital. Like virtually all other medications, antipsychotic agents have side effects. While the patient's body adjusts to the medication during the first few weeks, he or she may have to contend with dry mouth, blurred vision, constipation and drowsiness. One may also experience dizziness when standing up due to a drop in blood pressure. These side effects usually disappear after a few weeks.
Because some other side effects may be more serious and not fully reversible, a psychiatrist should closely monitor anyone taking these medications. One such side effect is called tardive dyskinesia (TD), a condition that affects 20 to 30 percent of people taking antipsychotic drugs. TD is more common among older patients.
There is also hope that the newer generations of anti-psychotic drugs now being introduced and under development will prove to be a great help to people with schizophrenia that has been resistant to treatment in the past, with fewer side effects and greater effectiveness with schizophrenia's symptoms.
Use of Clozapine is restricted, however, by an expensive medical monitoring system made necessary by the fact that the medicine can cause agranulocytosis, a blood disorder that occurs in one to two percent of patients who take it and which can prove fatal if it is not observed.
Risperidone may be safer than clozapine and have fewer of its side effects, including agranulocytosis. By ending or reducing the painful hallucinations, delusions and thought disorders, medications allow a patient to gain benefit from rehabilitation and counseling aimed at promoting the individual's functioning in society. Social skills training, which can be provided in group, family or individual sessions, is a structured and educational approach to learning social relationship and independent living skills. By using behavioral learning techniques, such as coaching, modeling and positive reinforcement, skills trainers have been successful in overcoming the cognitive deficits that interfere with rehabilitation.
Another type of learning-based treatment that has been documented to reduce relapse rates is behaviorally oriented, psycho-educational family therapy. Providing family members, including the patient, with a better understanding of schizophrenia and its treatment, while helping them to improve their communication and problem-solving skills, is becoming a standard practice in many psychiatric clinics and mental health centers
When continuing treatment and supportive care is
available in the community, with a partnership of family, patient and
professional caregivers, patients can learn to control their symptoms,
identify early warning signs of relapse, develop a relapse prevention
plan, and succeed in vocational and social rehabilitation programs. For
the vast majority of persons with schizophrenia, the future is bright
with optimism--new and more effective medications are on the horizon,
neuroscientists are learning more and more about the function of the brain
and how it goes awry in schizophrenia, and psychosocial rehabilitation
programs are increasingly successful in restoring functioning and quality
of life.
(c) Copyright 1988 American Psychiatric Association
Revised 1994