Everything you need to know about Schizophrenia

Despite the fact that 1.5% of the world’s population has this illness, it’s still little understood by the general public.   Contrary to popular belief, Schizophrenia isn’t the same thing as multiple personality disorder.  But if it isn’t multiple personality disorder, then what is it?

Schizophrenia in a nutshell

If you have Schizophrenia or know somebody who does, it can be hard to grasp where the problem lies.  People with this disorder rarely have physical signs that they are sick.  Instead, they tend to have problems with their thinking.  They struggle to tell the difference between reality and non-reality.  Schizophrenia is diagnosed when someone has experienced at least one month of “psychosis” (hallucinations, delusions, and disorganized speech & behavior) and five months of negative symptoms.  Let’s break that down into English.

• Hallucinations. In formal terms, a hallucination is a sensory experience that appears to be real but isn’t.  For example, the person with psychosis might hear a voice or voices that no one else can hear.  The voices can be a women or man, or both, and sometimes it feels like multiple people are talking at once.  Sometimes voices are terrifying.  They can be loud and derogatory.  At other times it’s just the opposite.  Some Schizophrenics find their voices comforting.
• Delusions. Delusions are elaborate false belief systems that won‘t go away despite the lack of evidence to support them.  The delusion seems real to the person who has it.  There are many types of delusions. The most common is paranoia, where the sufferer believes others are trying to harm them.  Other types include religious (for example, believing in a special mission to fend the world of demons) or bizarre ones (like being convinced one’s hands are controlled by aliens).
• Disorganized speech and behavior. Sometimes the psychotic person’s conversations and actions don’t make sense. Disorganized speech means the beginning of one’s sentences doesn’t necessarily match the end of the sentences.  Disorganized behavior includes actions like giggling when not talking to anyone, repeating other people’s words or actions for no reason, or dressing oddly (like wearing three hats and three watches).
• Negative symptoms. Negative symptoms refer to the loss of an ability or characteristic.  Examples include becoming emotionally unavailable (“emotional blunting”) and losing interest in relationships, work, hobbies, and future plans. Often the individual with Schizophrenia will stop caring for their hygiene and lose interest in socializing with others.  This self-neglect isn’t caused by depression.

Keep in mind that individuals with other mental disorders can also develop psychosis, including delusional disorder, depression, manic depressive illness, Schizoaffective disorder, and others.  Talk to your doctor if you’re unsure about your diagnosis.

Judgment can be a challenge

Schizophrenics aren’t senile.  They might be better at Trivial Pursuit than anyone else in the family. Even then, sometimes their judgment can be off.  For example, a Schizophrenic might talk about taking out a mortgage on a house without understanding they need money to do so.  They might respond to a small fire in the kitchen by leaving the house and calling 911, even when there’s a fire extinguisher in view.  They might be brilliant at advanced calculus but struggle with the concept of paying for things.  For this reason, people with Schizophrenia often need monitoring and live in group homes.

Knowing so much but not enough

Many Schizophrenics I work with don’t believe they’re sick.  This is the hardest part for people to understand: even when stable with medications, when the voices and delusions are gone, when conversation makes sense and goal-oriented activity has gained them some independence, most Schizophrenics still tend to stop their meds if no one tells them to take them.

Too many causes

The chances are that Schizophrenia is more than one illness collected under a very large umbrella.  There are multiple theories about the cause.

• Doctors have noticed that Schizophrenia runs in families, suggesting it’s a genetic disease, although it does occur in people with no family history.
• From a chemical standpoint, the disorder is linked to having too much dopamine in the brain.  Dopamine is a chemical that nerve cells use to communicate with one another — excessive dopamine can cause hallucinations and delusions.  Medications for Schizophrenia decrease the level of dopamine.
• In brain scans of Schizophrenics, doctors have noticed decrease in brain size compared to those of non-Schizophrenics.  It’s unclear why this happens.
• Methamphetamine use disorder can bring about a permanent Schizophrenic-type illness, with primarily negative symptoms.  It’s thought that drugs can “jump-start” Schizophrenia in a person with a genetic tendency towards the illness.

Medications, therapy, treatment, community resources

There is no cure for Schizophrenia, but medications called antipsychotics are helpful for the hallucinations, delusions, and disorganization.  Antipsychotics are the treatment of choice.  Examples include the older antipsychotics like Haloperidol and Chlorpromazine, as well as the newer “atypical” antipsychotics like Risperidone, Olanzapine, and Aripiprazole.  Some antipsychotics are available in a  long-acting injectable formulation that is given every two weeks or longer.  That way the individual with Schizophrenia doesn’t need to remember to take his medication everyday.  Side effects vary from medication to medication.

Treatment for Schizophrenia can also include therapies like supportive talk therapy, family therapy, & psychosocial rehabilitation; social centers (places where a mentally ill person can hang out during the day); hospitalization when necessary;  and ACT team involvement.  An ACT team is an intensive community group of mental health providers, typically nurses, social workers, and a psychiatrist, who see patients in their homes. Treatment of other problems, like medical illnesses, substance abuse, and smoking, is also key.

Check out these tips for helping a loved one with Schizophrenia.