Schizophrenia affects an estimated 1 in 100 Canadians and their families. There isn’t yet widespread agreement on the cause of schizophrenia. While there is no cure, there are effective treatments. Many people living with schizophrenia manage symptoms, and enjoy a full life, with the help of treatment.
What is schizophrenia?
Schizophrenia is a serious medical condition that affects the brain.
Schizophrenia is a serious medical condition that affects the brain. It is a psychotic disorder in which the person with schizophrenia experiences a loss of contact with reality. This makes it very hard for them to distinguish between what is real and what is not.
Some people with schizophrenia communicate using scattered speech and random strings of sentences. Other times they speak quite clearly. This can make it difficult to understand them and to communicate with them. Without help, the person affected can find holding a job – and functioning in society – extremely difficult. A specialist is needed to make a diagnosis of schizophrenia because there are no diagnostic tests.
People living with schizophrenia can lead rewarding and meaningful lives.
There are treatments which can relieve many of the disorder's symptoms. Most people who have schizophrenia need support to learn how to cope with at least some aspect of their mental or physical health. With support and help, people living with schizophrenia can lead rewarding and meaningful lives.
Medications cannot alleviate all the symptoms but they can help. Researchers are developing more effective medications. They are also using new research tools to understand the causes of schizophrenia and to find ways to prevent and treat it.
Symptoms of schizophrenia
Symptoms don’t appear overnight, or develop at the same age for everyone.
The development of schizophrenia is a slow process. Symptoms don’t appear overnight, or develop at the same age for everyone. Symptoms usually surface in early adulthood and they may seem more puzzling than concerning. This can involve changes to thoughts, perceptions, attention span, emotions and behaviour.
Symptoms of the disorder vary greatly from person to person, and can range from mild to severe. They can also vary over time in some individuals.
- Individuals with this disorder may develop significant loss of interest or pleasure. Some people may develop odd or eccentric moods - inappropriate smiling, laughing, or silly facial expressions; depression, anxiety or anger.
- Day-night reversal: Staying up late at night and then sleeping late into the day.
- Loss of appetite: A person may lose their appetite because eating is no longer enjoyable. Or, she may refuse food as a consequence of delusional beliefs. They often exhibit unusual movements like pacing, rocking, or lazy immobility.
- Cognitive Impairment: People with schizophrenia may not be able to pay attention or concentrate. They may have poor memory, and have difficulty solving problems. However, many people with schizophrenia are unaware that anything is wrong.
Without treatment, the symptoms may be more persistent. There are times when an individual is in remission and they feel like themselves. There are also periods of relapse. During episodes of acute illness, they may experience one or all of these main conditions:
- Delusions and/or hallucinations
- Lack of motivation
- Social withdrawal
- Disruptions in thought
Delusions are false beliefs that have no basis in reality. People with schizophrenia may think, for example, that someone is spying on them, listening to their thoughts, or placing thoughts in their minds.
Hallucinations most often consist of hearing voices that comment on their own behaviour are insulting or give commands. Less often, an individual with schizophrenia may see or feel things that aren't there. Rarely, they will experience alterations in taste or smell.
Disorganized thinking makes some people with schizophrenia feel mixed up. In conversation, they may jump randomly from one unrelated topic to another. Depression and anxiety frequently accompany these feelings.
Symptoms can be divided into positive or negative symptoms. This can be confusing. It doesn’t mean there is a bright side and a downside to schizophrenia, in the way most of us would think about something that is positive (good) or negative (bad). It refers to the effect each symptom within the category has on the person living with the disorder.
Positive symptoms are abnormal thoughts and perceptions. Negative symptoms are loss, or decrease, of normal functions. As a result of these symptoms, a person with schizophrenia will often withdraw from society and everyday life.
- Disordered thinking
- Abnormal Movements (rare)
- Flat affect - nothing can elicit an emotional response; robotic. An individual may stare off into space. Their facial expressions remain blank. Theymay speak in a monotone, without the characteristic jumps in pitch that most voices do - their voice sounds almost robotic. This is all external. Their mind is still very active.
- Impaired attention. A person is unable to keep focus or concentrate.
- Avolition. This describes a lack of motivation or lack of desire to be involved with anything. A person showing this symptom may stop paying attention to personal appearance. They may be content with a very inactive lifestyle.
- Anhedonia. A person with this symptom will find it difficult to enjoy anything. They no longer find pleasure in activities they once enjoyed, or in important relationships. There is very little that makes them truly happy.
- Alogia - lack of speech. An individual with this symptom talks less and, when they do say something, it is vague, seems meaningless and may not make sense to the listener.
It can be difficult to recognize the early signs of schizophrenia, making it difficult to detect the condition.
- In the early stage, a person may experience anxiety which often leads to sleep disturbances.
- An individual may start to shut long-time friends out of their lives.
- Work or school begins to suffer and they might seem distant by co-workers or classmates.
- They may stop paying attention to personal hygiene or appearance.
- They may also have one or more episodes where they talk in ways that may be difficult for people to understand.
- Or they may start having unusual perceptions.
Types of schizophrenia
There are three classifications for schizophrenia:
- Disorganized Schizophrenia
- Catatonic Schizophrenia
- Paranoid Schizophrenia
It is characterized by significant speech impairment. Alogia – or lack of speech – is common. A person experiencing disorganized schizophrenia might talk in random stings of words, along with silliness and laughter. Their emotional state can change rapidly. Their emotions may seem dampened or flat one minute; the next they might start crying or smiling.
Catatonic schizophrenia is characterized by extreme shifts in emotions. A person experiencing catatonic schizophrenia may resist instructions from someone trying to help. They may echo what someone else is saying or make fun of any form of communication. It is hypothesized that the drug therapies hide these symptoms well because they are mostly motor based.
A person with catatonic schizophrenia may experience extreme switches in emotional states, from flat to wild excitement, and everything in between. They don't listen to instructions. They often repeat what someone else is saying - like an echo. They make fun of any form of communication. The onset of this form of schizophrenia has been found to be more dramatic than the others but it is rare. It is hypothesized that the drug therapies hide these symptoms well because they are mostly motor based.
It is characterised by extremely vivid delusions. An individual experiencing paranoid schizophrenia may believe they are being persecuted by other people. They may be paranoid about being caught by these people. Frequently, individuals believe they are under surveillance with bizarre explanations – i.e. by the Central Intelligence Agency or satellites. Along with this, they might believe they have more power, knowledge and understanding that anyone else.
They may also hear voices which threaten them or tell them what to do. There may be times they are agitated, angry, difficult to get along with and even physically violent. This can be a result of their beliefs, other people around them not believing them, or a result of instructions they believe they're receiving.
Causes of schizophrenia
While the exact causes of schizophrenia remain unknown, it is believed to be caused by a biochemical imbalance – a biological disorder of the brain. Several theories offer some insight into the possible causes and development of schizophrenia.
Many researchers are looking for genetic causes of schizophrenia that run in families. Success may become more likely as genes for complex illnesses are found.
Computer images of brain activity show clear differences between the brains of people without schizophrenia and the brains of people who have the condition. Magnetic Resonance Imaging (MRI) shows the prefrontal cortex - the part of the brain that controls thought and higher mental functions – behaves differently in people with schizophrenia. This area of the brain is believed to be responsible for many of the negative symptoms. Either the area didn’t develop normally, or it deteriorated for some unknown reason.
Computed Axial Tomography (CAT scan) shows that the fluid-filled spaces within the brain – ventricles - tend to be larger in individuals with schizophrenia than in people without the illness. This is more common in men.
The limbic system – a part of the nervous system - regulates our emotions, their structure and function, and has a lot to do with how our memories are formed. Research on the effects of schizophrenia on this area of the brain is still ongoing. There are no definitive results from studies.
Treatments doctors are using are helping researchers put together the pieces of this complex disorder. For example, some people with schizophrenia respond well when they are given medication that interferes with how the body uses dopamine - a biochemical produced in the brain that plays a major role in managing emotions. This is leading researchers to think that either an over-production of dopamine or over-sensitivity to it is a factor in the illness.
The exact causes of schizophrenia remain unknown.
A number of medications are effective in treating schizophrenia. It takes time to find the right combination for each individual. The medications used can help bring biochemical imbalances closer to normal by targeting dopamine. The drugs are complicated, and people react differently to them. There are, however, are some common drugs used in treatment that seem to work well with the majority of people living with schizophrenia.
Psychotherapy for individuals and their families is also part of the treatment process. While there is no cure for schizophrenia, effective treatment can help individuals with the disorder to feel much better and live full lives. Therapy can be critical in helping individuals and their loved ones manage the emotional aspects of the disorder and reduce stress.
Professionals, individuals and families can be helped by maintaining a positive, recovery-focused view. There are a number of therapies and "hands-on" supportive treatments, commonly called psychiatric rehabilitation. These treatments can help individuals particularly with the negative symptoms that accompany schizophrenia.
For more information:
Schizophrenia Society of Canada
Schizophrenia Society of Nova Scotia
Nova Scotia Early Psychosis Program