Schizophrenia
a serious mental illness that interferes with a person's ability to think clearly, manage emotions, make decisions and relate to others.
There’s a scene in that movie A Beautiful Mind where Russell Crowe, playing mathematician John Forbes Nash Jr., has been having some really bizarre behaviors and his wife goes into his workshop to see if she can get any clues as to why. She’s been giving him his medication for schizophrenia, but unbeknownst to her, he hasn’t been taking it because of side effects. It’s not until she sneaks into his workshop that she sees how deep into his delusions he is. She’s been hearing him talking to people, and she’s familiar with his disease since this isn’t the first time he’s been lost in his alternate reality. It is the first time, though, that his other reality has endangered her child and made him lash out violently.
Schizophrenia, which affects less than 1% of the population, can make it difficult to distinguish what is real. It can be a terrifying disease, one that forces some people into the safety of total isolation. It can also lead to substance abuse as a means to self-medicate and, at its worst, suicide. Though a difficult disease to have, it is manageable, and many people with schizophrenia lead rewarding, productive lives.
What causes schizophrenia?
It is not clear what exactly causes schizophrenia, but it appears to be a result of a genetic, physical, and environmental factors. Stress may ignite symptoms in at-risk people, as will certain drugs, particularly cannabis, cocaine, LSD or amphetamines, but it is unknown why those elements affect some people and not others. Dopamine, a neurotransmitter, is believed to be a factor in schizophrenia given its link to hallucinations and delusions. Other contributors being investigated include structural damage to the brain while in utero or during birth, malnutrition, inflammation in the brain, and exposure to viruses during pregnancy.
What are the symptoms of schizophrenia?
Schizophrenia does not present itself in a predictable way. It is always present, but it doesn't always have symptoms. Symptoms can also vary in severity and duration, and it appears they present less frequently with age.
Symptoms of schizophrenia fall under three categories:
- Positive symptoms, including audible and visual hallucinations, paranoia, delusions, and exaggerated behaviors.
- Negative symptoms, such as difficulty with or inability to make plans, speak, demonstrate emotion, or experience pleasure.
- Disorganized symptoms, including unorganized thinking and speech, struggles with logical thinking, and bizarre behavior or unusual movements.
Due to the nature of schizophrenia, there are likely to be problems with maintaining focus, concentrating, and recalling information. In general, men have initial symptoms in late teens or early 20s and women show their first signs in their 20s and early 30s. Symptoms must be present for at least six months in order to meet diagnostic criteria.
How is schizophrenia treated?
The range of schizophrenia symptoms means that there is no perfect recipe for treatment. Some patients respond exceptionally well with treatment, while others may require more support and assistance, possibly to the point of institutionalization. Though there is no cure, it is important to optimistic with a schizophrenia diagnosis, as therapy, medications, and early interventions can control the disease and improve lives.
Among medications used to manage schizophrenia, antipsychotics are the most commonly prescribed. Medications like haloperidol and chlorpromazine have long been used, but they come with an increased risk of developing a movement disorder called tardive dyskinesia. Newer antipsychotics, including aripiprazole (Abilify), brexpiprazole (Rexulti), clozapine (Clozaril, Versacloz), lurasidone (Latuda), olanzapine (Zyprexa), paliperidone (Invega), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon) come with less risks of side effects. Medication compliance is a huge indicator of successful management of schizophrenia, which is why some antipsychotic drugs have been developed into longer-lasting injectable forms. These medications are given every couple of weeks or once a month and may help with compliance.
Therapy is also an important component of treatment. Individual therapy helps patients learn to cope with stress and recognize signs of relapse. Family therapy is also hugely helpful, as families often need tremendous support and continuing education in order to provide help to their loved one. There are also social skills training and vocational rehabilitation, which helps people with schizophrenia communicate more effectively and obtain and keep gainful employment.
If medications and therapy are unsuccessful, hospitalization will ensure basic needs are met. Electroconvulsive therapy (ECT) is also an option for schizophrenia that does not respond to medications and therapy.
