What is Schizophrenia?

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by RI Editors

This research essay is part of our Peculiar Minds series.

Bad TripFrom the National Institute of Mental Health:

Schizophrenia is a chronic, severe, and disabling brain disorder that has affected people throughout history. About 1 percent of Americans have this biological illness. People with the disorder may hear voices other people don’t hear. They may believe other people are reading their minds, controlling their thoughts, or plotting to harm them. This can terrify people with the disorder and make them withdrawn or extremely agitated. People with schizophrenia may not make sense when they talk. They may sit for hours without moving or talking. Sometimes people with schizophrenia seem perfectly fine until they talk about what they are really thinking.

Symptoms

Hallucinations are things a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel. Voices are the most common type of hallucination in schizophrenia. The voices may talk to the person about his or her behavior, order the person to do things, or warn the person of danger. Sometimes the voices talk to each other. Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects, and feeling things like invisible fingers touching their bodies when no one is near.

Delusions are false beliefs that are not part of the person’s culture and do not change. The person believes delusions even after other people prove that the beliefs are not true or logical. People with schizophrenia can have delusions that seem bizarre, such as believing that neighbors can control their behavior with magnetic waves. They may also believe that people on television are directing special messages to them, or that radio stations are broadcasting their thoughts aloud to others. Sometimes they believe they are someone else, such as a famous historical figure. They may have paranoid delusions and believe that others are trying to harm them, such as by cheating, harassing, poisoning, spying on, or plotting against them or the people they care about. 

Thought disorders are unusual or dysfunctional ways of thinking. One form of thought disorder is called “disorganized thinking,” causing trouble organizing thoughts or connecting them logically. Sufferers may talk in a garbled way that is hard to understand. Another form is called “thought blocking.” This is when a person stops speaking abruptly in the middle of a thought. When asked why he or she stopped talking, the person may say that it felt as if the thought had been taken out of his or her head. Finally, a person with a thought disorder might make up meaningless words, or neologisms.

Movement disorders may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other extreme, a person may become catatonic, not moving or responding to others. Catatonia is rare today, but it was more common when treatment for schizophrenia was not available.

Negative symptoms are associated with disruptions to normal emotions and behaviors. These symptoms are harder to recognize as part of the disorder and can be mistaken for depression or other conditions. These symptoms include the following:

  • Flat affect (a person’s face does not move or he or she talks in a dull or monotonous voice)
  • Lack of pleasure in everyday life
  • Lack of ability to begin and sustain planned activities
  • Speaking little, even when forced to interact

People with negative symptoms need help with everyday tasks. They often neglect basic personal hygiene. This may make them seem lazy or unwilling to help themselves, but the problems are symptoms caused by the schizophrenia.

Cognitive symptoms are subtle. Like negative symptoms, cognitive symptoms may be difficult to recognize as part of the disorder. Often, they are detected only when other tests are performed. Cognitive symptoms include the following:

  • Poor executive functioning (the ability to understand information and use it to make decisions)
  • Trouble focusing or paying attention
  • Problems with working memory (the ability to use information immediately after learning it)

Onset

Schizophrenia affects men and women equally. It occurs at similar rates in all ethnic groups around the world. Symptoms such as hallucinations and delusions usually start between ages 16 and 30. Men tend to experience symptoms a little earlier than women. Most of the time, people do not get schizophrenia after age 45. Schizophrenia rarely occurs in children, but awareness of childhood-onset schizophrenia is increasing.

It can be difficult to diagnose schizophrenia in teens. This is because the first signs can include a change of friends, a drop in grades, sleep problems, and irritability — behaviors that are common among teens. A combination of factors can predict schizophrenia in up to 80 percent of youth who are at high risk of developing the illness. These factors include isolating oneself and withdrawing from others, an increase in unusual thoughts and suspicions, and a family history of psychosis. In young people who develop the disorder, this stage of the disorder is called the prodromal period.

Myths

People with schizophrenia are not usually violent. In fact, most violent crimes are not committed by people with schizophrenia. However, some symptoms are associated with violence, such as delusions of persecution. Substance abuse may also increase the chance a person will become violent. If a person with schizophrenia becomes violent, the violence is usually directed at family members and tends to take place at home.

People with the illness attempt suicide much more often than others. About 10 percent (especially young adult males) die by suicide. It is hard to predict which people with schizophrenia are prone to suicide.

Causes

Genes and environment. Scientists have long known that schizophrenia runs in families. The illness occurs in 1 percent of the general population, but it occurs in 10 percent of people who have a first-degree relative with the disorder, such as a parent, brother, or sister. People who have second-degree relatives (aunts, uncles, grandparents, or cousins) with the disease also develop schizophrenia more often than the general population. The risk is highest for an identical twin of a person with schizophrenia. He or she has a 40 to 65 percent chance of developing the disorder.

In addition, it probably takes more than genes to cause the disorder. Scientists think interactions between genes and the environment are necessary for schizophrenia to develop. Many environmental factors may be involved, such as exposure to viruses or malnutrition before birth, problems during birth, and other not yet known psychosocial factors.

Different brain chemistry and structure. Scientists think that an imbalance in the complex, interrelated chemical reactions of the brain involving the neurotransmitters dopamine and glutamate, and possibly others, plays a role in schizophrenia. Neurotransmitters are substances that allow brain cells to communicate with each other.

Also, in small ways the brains of people with schizophrenia look different than those of healthy people. For example, fluid-filled cavities at the center of the brain, called ventricles, are larger in some people with schizophrenia. The brains of people with the illness also tend to have less gray matter, and some areas of the brain may have less or more activity.

Studies of brain tissue after death also have revealed differences in the brains of people with schizophrenia. Scientists found small changes in the distribution or characteristics of brain cells that likely occurred before birth. Some experts think problems during brain development before birth may lead to faulty connections. The problem may not show up in a person until puberty. The brain undergoes major changes during puberty, and these changes could trigger psychotic symptoms.

Editor’s Note: There are great success stories. Recently Elyn R. Saks, professor at USC Gould School of Law, told her story for the New York Times

 

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photo by: fdecomite

One Response to What is Schizophrenia?

  1. templegoer says:

    The article you linked is amazing. It has strengthened my resolve to look for the ‘wellness within the illness’. I have recently discovered that I have an aunt with schizophrenia, and this may go some way to explaining some eccentricities within our family. It also confirms my instinctual need for time out and to control the stimuli around me and my children. We need to affirm respect for difference, both family and community can be very normative and exclude difference. This article shows us how we can include and make possible a more integrated existence that better serves us all.

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