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Mental Health Conditions: Understanding Schizophrenia

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Mental Health Conditions: Understanding Schizophrenia

Schizophrenia is a mental health condition that affects a person's ability to function socially in a typical way. People with this condition may hear voices or experience paranoid or delusional thoughts, such as believing that their minds are being read or controlled. Experiences like these can cause social withdrawal, fearfulness or agitation to a severe level.

People with schizophrenia may have difficulty conveying information when they talk, may sit for hours without talking or moving, or may seem completely fine until they talk about what they're thinking. To learn more about how this condition affects people, review this basic information about what schizophrenia is, how it's diagnosed and how mental health professionals treat it.

What Is Schizophrenia?

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The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) — a handbook that contains diagnostic criteria to help professionals recognize mental health disorders — defines the term "schizophrenia" as a spectrum of disorders that include a combination of delusions, hallucinations and other disorganized behaviors. To be diagnosed with schizophrenia, the DSM-5 requires that a person experiences at least two of the following behaviors (including at least one of the first three) consistently over a month-long period:

Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Negative symptoms such as a lack of speech or diminished emotional expression

Schizophrenia is a chronic disorder that a professional can only diagnose after six months of observation. People who experience an episode of acute psychosis aren't automatically diagnosed with schizophrenia, and someone can exhibit one or more symptoms of schizophrenia without actually having the disorder. Another diagnostic requirement is that someone must also exhibit the symptoms of schizophrenia when free from the influence of outside factors, including alcohol and drugs.

Three primary types of symptoms are associated with schizophrenia:

Positive symptoms: This refers to perceptions or thoughts such as delusions, mirages, voices, scents, disorganized behavior and movement disorders.
Negative symptoms: These include a loss of or decrease in the ability to speak, express emotion, initiate plans (lack of "goal-directed behavior") or find pleasure in everyday life. Patients with schizophrenia may lose their ability to perform basic hygiene activities as well. These symptoms may appear months or even years before the positive symptoms of schizophrenia do.
Cognitive symptoms: These include trouble paying attention, memory issues and a decreased ability to manage executive functions (such as organizing and planning). These are much harder symptoms to recognize and can often be mistaken for laziness. They can also be difficult to recognize as part of the disorder but can be some of the most disabling symptoms.

Schizophrenia Causes and Risk Factors

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Although the cause of this condition isn't completely clear, schizophrenia likely results from a combination of genetic and environmental factors. Schizophrenia has been known to run in twins and close relatives, but not all cases run in families. Studies suggest that this disorder may be the result of differences in a person's brain's chemical balance, which includes the neurotransmitters serotonin, dopamine and glutamate.

Schizophrenia may develop during childhood or adulthood, and it affects people of all genders equally. Although childhood-onset schizophrenia can start as early as age 5, this is quite rare. The symptoms of autism and other childhood developmental disabilities are similar to those of schizophrenia; therefore childhood-onset schizophrenia is difficult to diagnose.

What are better understood are the risk factors for a poor response to schizophrenia treatment. These include drug or substance abuse and alcoholism. Smoking and nicotine use, along with caffeine use, may also reduce the efficacy of the antipsychotic drugs that are the backbone of schizophrenia treatment.

Schizophrenia Tests, Diagnosis and Treatment

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There are no specific medical tests for diagnosing schizophrenia. Instead, professionals diagnose it following a focused psychiatric evaluation and documentation of symptoms and their duration, as defined by the DSM-5. A psychiatrist will examine the patient and discuss any signs or abnormalities the patient's family members may have noticed. Although there are no medical tests for diagnosing schizophrenia, brain imaging and blood tests may be used to rule out other disorders or medical conditions that could cause similar symptoms.

Current treatments for schizophrenia focus on eliminating the symptoms of the disease rather than preventing or curing the disorder. Antipsychotic drugs such as clozapine are the mainstay of schizophrenia treatment. A patient may need to take multiple antipsychotic drugs for long-term symptom management. Non-pharmacologic treatments, such as cognitive behavioral therapy, are also useful for assisting with social adjustment. Self-help groups and family counseling may be beneficial, too.

The antipsychotic drugs that are common in the treatment of schizophrenia have several metabolic side effects. These include:

Sleepiness
Weight gain
Increased risk of diabetes or high cholesterol
Body tremors
Sluggish movement
Restlessness
Cardiac rhythm changes that can predispose a patient to arrhythmia (irregular heartbeat)
Significant reduction in white blood cells, which increases the patient's risk of infection
Tardive dyskinesia, which describes involuntary movements and twitches

Schizophrenia Health Outcomes

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Despite notable advancements in pharmacologic and non-pharmacologic therapies, the overall outcomes for patients with schizophrenia are inconsistent. Schizophrenia drug therapy needs to remain ongoing. That's because relapse is common if the patient stops taking their medication, which is often called "non-compliance." This is common in patients with schizophrenia, with non-compliance rates of up to 74%.

Non-compliance often happens because of drug side effects, symptoms not improving or the patient's denial of their illness. Insight into the symptoms, course, treatment and outcomes of schizophrenia is critical for achieving lasting treatment and is a key factor in preventing relapse and treatment non-compliance.

People with schizophrenia are expected to live 10 to 15 years less than the general population. This is likely due to the consequences of untreated symptoms, which include poor hygiene, substance abuse and an increased likelihood of ignoring other health conditions that require treatment.

If it's not properly diagnosed and treated, schizophrenia can lead to numerous complications, including:

Substance abuse: A person with untreated or poorly managed schizophrenia may turn to substance abuse for symptom management or coping. However, substance abuse is known to exacerbate the symptoms of schizophrenia. It can also decrease the effectiveness of treatment for someone living with schizophrenia.
Physical illness: Refusing proper treatment and care for schizophrenia may cause someone who has the condition to refuse medical care. This can lead to potential health problems and physical illness.
Suicide: If not diagnosed and treated, schizophrenia can lead to suicide. Substance abuse further increases this risk.

Resource Links:

https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t22/

https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024791/

Patel KR, Cherian J, Gohil K, Atkinson D. "Schizophrenia: Overview and Treatment Options" P.T. 2014;39(9):638-45