Schizophrenia is a chronic mental illness that requires life long treatment. It is in fact a group of brain disorders in which ‘reality is interpreted abnormally’. It usually strikes around late adolescence or early adulthood affecting men and women of all races, cultures and classes.
People who suffer from schizophrenia suffer hallucinations and delusions, and their thought process becomes disorderly. This word comes from the Greek roots ‘schizo’ meaning split and ‘phrene’ meaning mind. The term ‘schizophrenia’ was coined by the Swiss psychiatrist Eugen Bleuler in 1908 to describe the disorderly and fragmented thinking of people with this disorder. It must not be confused with split personalities or multiple personality disorder.
 Symptoms of Schizophrenia
The symptoms of schizophrenia are commonly divided into positive symptoms, negative symptoms and cognitive symptoms.
- Positive symptoms: The positive symptoms of schizophrenia are those that involve a loss of contact with reality. Sufferers experience unusual thoughts and perceptions which include hallucinations, which mean that they may sense things that are not real. Commonly, schizophrenics hear imaginary voices or see imaginary people. They may also have delusions – false beliefs that do not change even when others around present proof that the belief cannot be logical or true. Thought disorders are another positive symptom. Schizophrenics have difficulty organising their thoughts in a logical manner. Often their thoughts are blocked (thought blocking) where they abruptly stop speaking, as if the thought was pulled out of their heads. Speech is also garbled and they jumble together meaningless words – this is sometimes called ‘word salad’. Movement disorders are not uncommon. People with schizophrenia are often uncoordinated and clumsy; they may exhibit involuntary movements or repeat certain movements over and over. In extreme cases, the person may become catatonic- which is a state of immobility and unresponsiveness.
- Negative symptoms:The negative symptoms of schizophrenia indicate the decrease of behavioural abilities and emotion. These may include an immobile facial expression or monotonous voice. People with schizophrenia may show a lack of interest and pleasure in everyday life. They may lack motivation to plan and execute planned activities. They may withdraw socially and speak only when forced to do so. They may appear to lack emotion and neglect personal hygiene.
- Cognitive symptoms: Cognitive symptoms are those that affect the ability to plan and organise, importantly affect the memory and attention. The cognitive symptoms are the most debilitating symptoms and cause sufferers a great deal of distress. The cognitive symptoms cause problems with memory. They may affect the person’s ability to pay attention and also affects their ability to understand and make sense of information.
 Types of schizophrenia
Based on the predominance of the symptoms, schizophrenia is commonly classified into the following types:
- Paranoid-type schizophrenia:Paranoid-type schizophrenics predominantly suffer from delusions and hallucinations. They often have a sense that they are being watched, followed or persecuted. Often their cognitive functions remain relatively intact, but they exhibit anger, aloofness and anxiety.
- Disorganised-type schizophrenia:As the name suggests, disorganised type schizophrenics have disorganised thoughts and speech, inappropriate behaviour and display of emotion. This type of schizophrenia affects normal daily activities such as eating, speaking and hygiene. Sufferers may exhibit moodiness, poor concentration, confusion and strange ideas.
- Catatonic schizophrenia:Catatonic schizophrenia affects a person’s motor abilities. Catatonic schizophrenia can take a rare and severe form where patients can stay unmoved for hours or move all over the place. They may not speak for long periods or senselessly repeat words. People with catatonic schizophrenia are unable to care for themselves.
- Residual type schizophrenia:This is where a person has been diagnosed with schizophrenia, but no longer has prominent symptoms such as hallucinations and delusions. This may be because the person is in transition between episodes of schizophrenia or this may represent remission.
- Undifferentiated-type schizophrenia:Undifferentiated schizophrenic clearly have this disorder, but do not display enough of any one type of symptoms to classify them under another type.
 Causes of Schizophrenia
Medical scientists have not been able to pin point the exact causes for schizophrenia. Researchers believe that a combination of genetic and environmental factors maybe responsible for this disease. It is also believed that a chemical imbalance affecting the neurotransmitters in the brain may be responsible.
Put simply, our brain has billions of nerve cells that have branches that send and receive messages from each other. The ends of these nerve cells release chemicals called neurotransmitters that carry the message from the end of one nerve to the other. It is believed that in people with schizophrenia, something goes wrong with this communication system because of problems with the neurotransmitters, particularly dopamine and glutamate. This is a promising area of research to learn more about schizophrenia.
With the help of neuroimaging studies, the schizophrenic brain has been shown to look a little different form healthy brains. These differences are small – overall grey matter is lower in people with schizophrenia, some areas of the brain have more or less metabolic activity, the fluid filled cavities at the centre of the brain called ventricles are larger in people with schizophrenia. However, more research is required to fully understand the significance of these differences.
 Is schizophrenia genetic?
Research has shown that schizophrenia does have strong genetic links – scientists have observed that schizophrenia has a tendency to run in families. Schizophrenia is seen in 10% of people with a first degree relative (parent or sibling) with the disorder. People with second degree relatives (aunts and uncles, grandparents, cousins) develop schizophrenia more often than the general population. The most at risk is the identical twin of a person with schizophrenia, where the risk of developing the disease is 40 to 65%.
Schizophrenia and violence Studies show that if a person does not have a record or history of violence prior to developing schizophrenia, and are not substance abusers, they are unlikely to commit crimes after they develop the illness. Therefore, schizophrenics are not particularly prone to violence and most actually prefer to be left alone. Paranoid schizophrenics may sometimes exhibit violent behaviour with family members at home.
 Schizophrenia and drug abuse
People who have schizophrenia have a greater tendency to abuse drugs and alcohol than the normal population. Drugs and alcohol can interfere with the prescribed treatment for schizophrenia and can aggravate symptoms; also, schizophrenics who are abusing substances such as drugs and alcohol are less likely to follow their treatment plan.
Schizophrenics are addicted to nicotine at three times the rate of the general population. Nicotine has been found to interfere with antipsychotic medication according to several studies. However, quitting nicotine may be harder for people with schizophrenia since the withdrawal symptoms they experience may make their symptoms worse.
 Schizophrenia and suicide
People with schizophrenia attempt suicide more often than the general population, and about 10% of them succeed in their attempts (especially young adult males). In case a person with schizophrenia, talks about or attempts suicide, it is important to seek medical help immediately.
 Treatment of Schizophrenia
Since there is no cure for schizophrenia and because it affects so many areas of a person’s life, treatment for schizophrenia revolves around managing the symptoms and providing a support system. The treatment usually involves medication as well as psychosocial treatments.
Psychiatrists most commonly prescribe antipsychotic medications for schizophrenia. These medications can have serious side effects, which is why many people are reluctant to take them and stay with their treatment plan. The antipsychotic medications are of two types:
- Conventional antipsychotic medication: These medications are usually prescribed to control the positive symptoms of schizophrenia. There are a number of different types and brands of conventional antipsychotic medications. The medications often have severe neurological side effects including the possibility of involuntary jerking movements or tardive dyskinesia.
- Atypical or new generation antipsychotic medication: These are newer antipsychotic drugs that are used to control both positive and negative symptoms of schizophrenia. It can take several weeks after first starting a medication to see some improvement. A psychiatrist may recommend one or a combination of medications, depending on the response of the patient. Certain medications may also increase the risks of weight gain, high cholesterol, diabetes and high blood pressure.
The treatment of schizophrenia is a long term process. It is extremely important that a psychiatrist prescribe, and continually monitor the use and changes in medication, even when the symptoms of schizophrenia appear to have reduced.
Psychosocial treatments also play an important role in living with schizophrenia. Individual therapy helps people cope with the disease and the daily challenges it brings with it. It also helps schizophrenics’ helps deal with communication and relationships, the stigma associated with schizophrenia and sticking with the treatment plan. Family therapy educates and supports families dealing with schizophrenia. The understanding and support of family members can help in recognising stressful situations, monitoring symptoms and helping with the treatment plan. Family therapy also helps all members cope with stress and conflict.
 See Also
- What is schizophrenia?
- Schizophrenia: Treatment and drugs
- schizophrenia: violence, drugs and suicide
- Symptoms of schizophrenia