What to Know About Schizophrenia—a Chronic, Misunderstood Mental Illness
Symptoms can be severe, and no one really knows what causes them.
Schizophrenia is a serious mental illness that alters how a person feels, what they see, and how they behave. It’s a chronic condition, and there's no cure for it. However, many people with schizophrenia are able to become fully or partially free from its symptoms and live full lives with the condition.
Schizophrenia is not as common as some other mental health issues. In fact, it’s estimated that less than 1% of Americans have schizophrenia, according to the National Institute of Mental Health (NIMH). But knowledge is power—so here's what everyone should know about schizophrenia.
There are two kinds of schizophrenia symptoms, called positive symptoms and negative symptoms, Gregory Sayer, MD, faculty psychiatrist at NYU Langone Health, tells Health. "Positive" symptoms are those that mentally healthy people don’t normally exhibit. They usually center around losing touch with reality.
“The positive ones are psychosis-related, like hallucinating, delusional thinking, and disorganized thinking,” Dr. Sayer says. “The thought process of a person with schizophrenia is disorganized. They don't go from one topic to the next in a logical or reasonable way. They're on one topic one moment and jump to a completely random thing the next.” They may also exhibit abnormal body movements.
"Negative" symptoms on the other hand are those that disrupt healthy behaviors or emotions. “For negative symptoms, people with schizophrenia can sometimes become withdrawn, interact less, be less expressive emotionally, and not really partake in many activities,” Dr. Sayer says. “Over time, there can also be impairments with their cognition, concentration, focus, and decision-making, and all of this can make it harder for them to care for themselves.”
Symptoms aren’t always stable; they may change and fluctuate in severity. Typically, schizophrenia symptoms show up between the ages of 16 and 30, according to the NIMH. The condition often starts in the late teens for men and the early 20s for women, Dr. Sayer adds.
The exact cause of schizophrenia hasn't been discovered yet, however, there are certain risk factors that make people more likely to develop it.
Schizophrenia can sometimes run in families. If you have a family history of the mental disorder, you're at a higher risk of developing it yourself. Scientists haven't, however, been able to identify the particular genes linked to it.
Certain environmental factors like malnutrition in the womb, complications during a person’s birth, and being exposed to certain viruses are thought to contribute (in addition to genetics) to a person’s risk of developing schizophrenia. Research suggests that some psychosocial factors like childhood abuse and growing up in a stressful and judgmental home may also increase a person’s risk of schizophrenia.
Certain imbalances in chemicals in the brain may play a role in developing schizophrenia. Experts think the neurotransmitter dopamine in particular is likely involved, Dr. Sayer says, and medications that block this brain chemical are often used to reduced schizophrenia symptoms (more on that later).
Other research suggests that brain changes during adolescence and early adulthood may also be linked to schizophrenia.
If you notice any of the symptoms of schizophrenia in yourself or a loved one, talk to a doctor or mental health professional.
“Just because someone has psychotic symptoms doesn't necessarily mean it's schizophrenia,” Dr. Sayer says. “People can have psychotic symptoms for other reasons. They would need to be evaluated to see if it's caused by a different disorder, a brain tumor, an infection, alcohol or drug use, or something else entirely.”
Doctors and mental health experts diagnose schizophrenia by performing physical examinations and medical tests to rule out those other causes of a person’s symptoms (like a tumor), as well as psychiatric evaluations of a person's thoughts and behaviors.
Previously, the Diagnostic and Statistical Manual of Mental Disorders, which lays out specific criteria for diagnosing mental health conditions, listed different classifications of schizophrenia. However, no such categories exist anymore. “In the most recent edition of the DSM, they don't break it down into different subtypes, they just call everything schizophrenia,” Dr. Sayer explains, due to "limited diagnostic stability, low reliability, and poor validity," according to the DSM.
Without a cure, schizophrenia treatment is focused on managing symptoms. This usually involves medication and therapy.
“Antipsychotic medications are dopamine receptor blockers, which can help with the psychotic symptoms of schizophrenia,” Dr. Sayer says. These prescription meds are usually taken orally every day, but they can also sometimes be administered as injections. They can have some side effects, so you’ll want to discuss with your doctor before starting one.
Doctors sometimes also prescribe antidepressants or anti-anxiety medications to manage schizophrenia symptoms.
Psychosocial treatments are also often helpful, particularly after finding a medication that works, according to the NIMH. That might include psychotherapy or social skills and vocational training, Dr. Sayer says. “There are classes of cognitive behavioral therapy that can help with delusions and hallucinations and help someone with schizophrenia function normally. Some people will join programs where they socialize with other people and can get [a] job so that they continue to function in society.”
During times when symptoms are severe, a person with schizophrenia may need to be hospitalized for their own safety and well-being. Learning psychosocial coping skills can help keep people out of the hospital and prevent relapse.
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