Schizophrenia Guide

The following guide is designed to be a primer for individuals seeking information about schizophrenia, its symptoms, diagnosis, treatments, and how people can cope with it.

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The following guide is designed to be a primer for individuals seeking information about Schizophrenia. We have tried to be as objective as possible in presenting the most accurate information available, but it is the responsibility of each individual to conduct their own research beyond this guide. If there is information that we have missed out or are as yet unaware of, please let us know by emailing contact@junomedical.com.

What is schizophrenia?

The word “schizophrenia” derives from the Greek “skhizein” (to split) and “phrēn” (mind) and indicates a long-term mental disorder that involves cognitive, behavioural, and emotional dysfunctions.

How many types of schizophrenia are there?

Schizophrenia is typically characterized by a withdrawal from reality and personal relationships, as well as disturbances in a person’s movement. There are 3 main types of schizophrenia that can be identified:

  • Catatonic schizophrenia: as in a catatonic stupor, people affected exhibit a dramatic decrease in movement or even immobility, and resistance to change, e.g. by keeping the same position or not talking for long periods of time.

  • Paranoid schizophrenia: this is the most common type of schizophrenia and is characterized by delusions of persecution, where the subjects believe they are victims of a conspiracy. Other symptoms include having visual hallucinations and hearing voices.

  • Hebephrenic schizophrenia: also known as disorganized schizophrenia, this subtype involves incoherent, illogical thoughts and behaviours, and emotional blunting.

What are the causes and who is at greater risk of developing schizophrenia?

According to the World Health Organization (WHO), schizophrenia affects 21 million people worldwide. Research has identified a combination of genetic, biological, and environmental factors that may cause schizophrenia.

Genetics

While genetic research related to schizophrenia is ongoing, it is not possible to predict who will develop the disease by using genetic information; in fact, scientists believe that different genes contribute to a higher risk of schizophrenia but that no single gene is the prime cause to develop the disease by itself.

Nevertheless, having one or more relatives with schizophrenia increases the chance of developing the disease: chances are 10% higher if it’s a parent, a sister, or a brother, and 40% if both parents have it. Chances are greatest—up to 50%—if an identical twin has the disorder.

Still, there are people who developed schizophrenia when nobody in the family had it. In these cases, gene changes or other complementary factors may have made the condition more likely.

Environment

Scientists think that many environmental factors may be involved in the development of schizophrenia.

Exposure to viral infections, illnesses, or malnutrition before birth (especially during the first 6 months of pregnancy) are believed to increase the risk of developing schizophrenia later in life.

Brain chemistry and structure

Research has identified that an imbalance in the chemical reactions of the brain involving neurotransmitters - chemicals that facilitate the communication between brain cells - may play a role in schizophrenia.

Brain images of people affected by schizophrenia also showed a few differences compared to those of people who were not affected by the disorder: the main differences involved larger ventricles and less gray matter in people diagnosed with schizophrenia.

What are the symptoms?

Symptoms of schizophrenia usually start between ages 16 and 30 and can be divided into positive, negative, and cognitive ones.

Positive symptoms

Positive symptoms refer to an excess or distortion of normal functions.

Hallucinations: hallucinations can involve all 5 senses (hearing, sight, taste, smell, and touch). Hearing voices is the most common type of hallucination in schizophrenia. People with the disorder hear voices that talk to them about their behaviour, give them commands or threaten them or others.

Delusions: delusions involve having a distorted image of what is happening in the reality. Delusions can be persecutory, where people believe that others are trying to harm them or plotting against them, and delusions of reference, where people think that the environment is directly related to them, e.g. they believe they receive special messages through the TV or the radio.

Disorganized speech and behaviour: the person shows incoherent speech that impairs effective communication as well as difficulties in completing basic day-to-day activities. It also includes bizarre or inappropriate behaviour.

Negative symptoms

Negative symptoms refer to a decrease in socialization, motivation, emotional responsiveness, and movement.

Apathy: the person shows lower interest in activities that used to be part of his or her everyday life, such as work, studies, or sport. Personal hygiene and appearance may also suffer noticeably.

Lack of emotion: patients show diminished affective responsiveness or display inappropriate reaction - or no reaction at all - to either good or bad news. People with schizophrenia may also show anhedonia, which defines an inability to experience pleasure.

Poor social functioning: the person avoids contacts with other people and prefers to spend time alone and isolated.

Cognitive symptoms

Cognitive symptoms involve difficulties with memory and concentration.

Disorganized thoughts: schizophrenia sufferers may demonstrate disorganized thinking and difficulties in expressing thoughts or integrating feelings and behaviour.

Difficulty concentrating: the person displays attention deficit and the inability to gather and process information and make decision out of it.

Poor memory: the person will have trouble keeping recently learned information and use it to carry out a task.

How is schizophrenia diagnosed?

Despite recent advances in research, there is no screening or test that can absolutely diagnose schizophrenia. Doctors typically come to the diagnosis by observing the symptoms.

Below the most commonly used criteria to diagnose schizophrenia:

Presence of symptoms. Verifying whether two or more symptoms have been occurring for the least 30 days. Symptoms include hallucinations, delusions, disorganized speech and behaviour, and negative symptoms.

Behavioural changes. Doctors may also consider if people have had a significant change in terms of behaviour with other people (relatives or friends), at school, or when taking care of themselves. The person should show behavioural changes for at least six months. This period of time should include at least 30 days of active-phase symptoms (positive or negative symptoms).

Exclusion of other diagnoses. Doctors rule out any other medical illness, medication or substance abuse that may be the cause of behavioural changes.

Diagnostic interview. In order to confirm the diagnosis, a psychiatrist may carry out a diagnostic interview with the patient. The goal of this interview is to assess the hallucinations and the thoughts the patient is having. Questions may include, “Have you ever heard people talking when nobody else was around you? What do they talk about?”, “Have you ever felt like your actions are controlled by something external?”, “Have you ever felt like someone is spying upon you?”.

How is schizophrenia treated?

Schizophrenia may require lifelong treatment and it is typically guided by an experienced psychiatrist. Treatment may include:

Medications

Antipsychotic medications are the most common drugs prescribed. Although antipsychotic medications do not cure the illness, they are proven to be effective in controlling symptoms by affecting the brain neurotransmitter dopamine.

Higher doses may be necessary during the acute phase. The dose may be adjusted later on during the maintenance phase. Doctors may try different doses and drug combinations according to each individual case before achieving the right result.

Therapy

Psychotherapy: the patient will learn how to manage everyday life by understanding how the illness is affecting him or her and how to tell the difference between what is real and unreal. The sessions will teach the patient how to deal with thoughts and behaviours. Psychotherapy can also involve family members and friends.

Social skills training: patients will find help in improving their communication and social interactions.

Family therapy: this therapy helps family members or friends of the patient deal with the mental disorder. Understanding and knowing the psychosis is a fundamental step towards a successful improvement of the patient’s health conditions.

Hospitalization

When symptoms are severe, hospitalization may be necessary to ensure a protected and monitored environment with trained professionals.

Electroconvulsive Therapy

Electroconvulsive Therapy (ECT) may be an option for adults who do not respond to drug therapy. It is often effective for catatonia - a state of motor immobility - delusions, hallucinations, and disorganized thinking.

Can people with schizophrenia heal?

While there is still no cure that can absolutely heal schizophrenia, there are treatments that have proven to be effective in treating the condition.

Considering recovery a combination of disappearance of symptoms, integrated life in the community, and positive social interactions, a great percentage of people with the disorder have shown significant improvements.

According to the World Fellowship for Schizophrenia and Allied Disorders, the course of schizophrenia can be divided into 2 prognoses—one 10 years after the diagnosis and one 30 years after the diagnosis. Research suggested the following results over these periods of time:

10 Years Later

  • 25% completely recovered
  • 25% much improved, relatively independent
  • 25% improved but requiring extensive support network
  • 15% hospitalized, unimproved
  • 10% dead (mostly suicide)

After 30 years

  • 25% completely recovered
  • 35% much improved, relatively independent
  • 15% improved but requiring extensive support network
  • 10% hospitalized, unimproved
  • 15% dead (mostly suicide)

What does living with schizophrenia mean?

Despite the fact that there is still no cure for schizophrenia, individuals with the disorder can get effective treatments that may allow them to enjoy productive, independent, and fulfilling lives.

Although sometimes difficult, accepting the illness is crucial. Schizophrenia often requires lifelong treatment and medications. Coming to terms with the fact that treatment and psychological support may be necessary long term is crucial to ensure a successful recovery.

Many individuals experience side effects when taking medications, such as skin rash, blurred vision, dizziness, or menstrual problems. These symptoms usually disappear after a few days, so it is important not to stop taking the prescribed drugs. Committing to following medication regimes or going to therapy may take time but it is very important to achieve positive results.

There are many blogs and articles on the Internet of people with the disorder. We strongly encourage you to read them to get a first-hand, personal overview of what it feels like to live with schizophrenia and how they cope with the disease.

How can I help someone I know with schizophrenia?

If you think a family member or a friend is showing symptoms of schizophrenia, the first thing to do is calling your family doctor. Although most family doctors will not be able to make a diagnostic interview as they do not have the necessary training and experience to deal with these cases, they should be able to give you a first support and refer you to a consultant psychiatrist. It is important not to procrastinate a visit to the doctor as the earlier the disease is diagnosed, the better it is treated.

In order to get a first overview of the status of the patient, the doctor may ask you if the person has shown one or more of these symptoms:

Withdrawal: the person is refusing social activities and the company of friends and family, and has progressively lost interest in his or her work or studies.

Bizarre ideas: the person has shown delusions of persecution, such as being followed, or being watched by aliens.

Risky behaviours: the person has attempted to harm him or herself or others, or has lost all inhibitions.

Emotional response: emotional reactions are either very weak or nonexistent.

Family and friends are often the core support to people with schizophrenia. They play a major role in helping the patient on a day-to-day basis. The first step to effectively help a person with schizophrenia is getting as much information as possible about the illness and how it affects people. At the same time, it is important that family and friends understand how they can ensure their support is effective.

Below some suggestions that may help:

Create a stable environment: it is important to use a calm tone and simple words when speaking to a person with the disorder. Agitated or loud conversions should be avoided when the person is present. It is also useful to create a few rules to establish a day-to-day activity routine, such as for personal hygiene, meals, or outdoor activities.

Be encouraging: when talking to the person with schizophrenia, family members or friends alike should avoid criticism and sound like they are imposing actions on their loved one. They should be encouraging rather than patronizing.

Understand the symptoms: when dealing with hallucinations, it is important to remember that patients feel they are real and therefore not to challenge them. In these cases, family members and friends can rather show understanding and tell the person that they do not see things the same way.

Listen actively and empathize: schizophrenia and its symptoms should not be taken for granted. It is paramount to listen closely to any complaint the person expresses. Fears and concerns should not be overlooked or denied as they might be indicators that something goes wrong. Moreover, it is important to communicate in a way patients feel their loved ones are on their side. Accepting the person and the disorder will help patients accept themselves and their disease.

Ensure ongoing compliance with treatment: many people with schizophrenia may refuse to take their medications or go for follow-up treatment. Family and friends can play a major role in these cases to ensure that patients follow the prescribed treatment and have a successful recovery.

The percentage of people who recover from the disease is encouraging, but it is also important to consider that in some cases symptoms may get worse, despite the great effort people put into making the person feel better. Even if this may be a difficult situation, it is advisable to stay strong and look for help from a specialist for further support.

I know someone with schizophrenia. How can I cope with this situation?

Having support from families and friends is pivotal to ensure treatment is successful. Nevertheless, living or knowing a person with schizophrenia may take a toll on the life of those who support them. In these cases, it is important that all people involved take good care of themselves. Below some suggestions that may be useful:

Take time off. Enjoying some free time helps face the situation better. This time can be used for hobbies, to see friends, or do sport.

Keep up your social life. Taking care of a loved one may take most of the day. Still, it is important to keep social life active and stay in touch with friends, partners, and family. Family and friends may be a safety net during the darkest days.

Eat healthy and work out. Working out reduces physical stress. Eating healthy food also helps maintain peace of mind. When it feels it is hard to be patient, going outside to have a walk may help.

Join a support group. Support groups are a great way to know people who may face the same situation. Here people give or receive advice, share their own experiences, and feel accepted.

Who can I reach out to for help or more information?

North America

USA

American Psychiatric Association (APA) https://www.psychiatry.org/
NAMI (National Alliance on Mental Illness) http://www.nami.org/
National Institute of Mental Health https://www.nimh.nih.gov/health/publications/schizophrenia-booklet/
National Mental Health Association http://www.nmha.org/about-us
Schizophrenia and Related Disorders Alliance of America (SARDAA) http://www.sardaa.org/
World Fellowship for Schizophrenia and Allied Disorders http://www.world-schizophrenia.org/disorders/schizophrenia.html

Canada

Schizophrenia Society of Canada http://www.schizophrenia.ca/

Europe

European Federation of Associations of Families of People with Mental Illness http://www.eufami.org/
European Psychiatric Association http://www.europsy.net/
European Scientific Association on Schizophrenia and other Psychoses http://www.esasnet.eu/

UK

CMHT (Local Community Mental Health Team) https://www.ocduk.org/cmht
National Schizophrenia Fellowship (RETHINK) https://www.rethink.org/

Asia

Institute of Mental Health https://www.imh.com.sg/
Schizophrenias Research Foundation http://scarfindia.org/

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