What is schizophrenia?
Schizophrenia is a chronic, severe mental disorder which is one of the most disabling mental conditions. Schizophrenia affects the person’s perception of reality, thoughts, emotions, actions and their interaction with others. Patients often have difficulty maintaining relationships and performing at work or school. This is a lifelong disease with no cure but can be controlled with appropriate medical treatment and psychological therapy.
Schizophrenia involves psychosis characterized by hallucinations (seeing things which are not there), delusions (altered perception) and changes in personality and behavior. The patients are unable to distinguish between reality and their imagination. Patients eventually tend to lose touch with reality. They may become a danger to themselves or others.
The severity of schizophrenia varies in patients. Some patients have only one psychotic episode, whereas others have many recurring psychotic episodes. Some patients tend to have repeated cycles of psychotic episodes and periods of remission (asymptomatic periods) during which they can lead normal lives. Others show very little improvement between psychotic episodes.
What are the five types of schizophrenia?
There are five classical subtypes of schizophrenia
Paranoid schizophrenia is one of the most common forms of schizophrenia.
- Delusions: These are false and sometimes unrealistic beliefs that the person refuses to stop believing despite providing proof. For example, believing they are God or that aliens are reading their minds, etc.
- Hallucinations: These involve having unreal sensations. The common hallucinations experienced are auditory hallucinations (hearing voices), visual hallucinations (seeing things) and tactile hallucinations (feeling sensations on the skin). Other rare hallucinations are smelling strange odors or having a strange taste in the mouth.
- Disorganized speech: Speaking sentences that don’t make sense, difficulty in communicating or holding conversations and shifting quickly from one thought to the next without logic.
- Difficulty focusing and comprehending.
- Behavioral problems: Decreased impulse control and irritability or mood swings.
In this subtype of schizophrenia, the patient doesn’t have hallucinations or delusions. They present with disorganized behavior and speech. This can include
- Slow movements
- Difficulty making decisions
- Writing excessively but without meaning
- Repeating movements or gestures, like pacing or walking in circles
- Having problems making sense of everyday sights, sounds and feelings
- Disorganized speech
- Disorganized thinking
- Inappropriate emotional response
The individual displays behaviors that apply to more than one subtype of schizophrenia. For example, an individual who not only has catatonia but also delusions or hallucinations with disorganized speech.
In this subtype, a person has an existing diagnosis of schizophrenia, but no longer has any major symptoms of the disorder and the symptoms are of lesser intensity.
Residual schizophrenia usually includes more “negative” symptoms (absence of normal behavior in people with schizophrenia), such as
- Lack of emotion or a limited range of emotions
- Withdrawal and isolation from family, friends and social activities
- Speaking less
- Lack of motivation
- Loss of pleasure or interest in life
- Poor hygiene and grooming habits
Although catatonic schizophrenia is a subtype of schizophrenia, catatonia is seen in various psychiatric and general medical conditions. It presents with
- Mimicking behavior
- Remaining in a fixed position for a long time
What are the first symptoms of schizophrenia?
The initial symptoms are usually only subtle behavioral changes that may go unnoticed, especially in teens. They include
- Changes in school or work performance
- Social withdrawal
- Irritability and mood swings
- Difficulty focusing
- Difficulty sleeping
How is schizophrenia diagnosed?
The doctor performs a complete medical and psychiatric evaluation. Complete blood analysis and brain imaging studies are performed to rule out other medical conditions, substance-induced psychosis or structural abnormalities in the brain.
For a person to be diagnosed with schizophrenia, they should have at least two of these symptoms for at least six months which negatively affect their work or social life and can’t be explained by any other condition
- Disorganized speech
- Disorganized or catatonic behavior
- Negative symptoms
One of the symptoms has to be
- Disorganized speech
How is schizophrenia treated?
With early diagnosis, proper treatment and psychosocial therapy, most people with schizophrenia can lead productive and fulfilling lives. Treatment for schizophrenia may include
- Medication: Medications don’t cure schizophrenia, but they can help relieve the most troubling symptoms. Medications include:
- Older (first-generation) antipsychotics such as chlorpromazine (Thorazine), haloperidol (Haldol), etc.
- Newer (atypical or second-generation) antipsychotics such as risperidone (Risperidal), iloperidone (Fanapat), clozapine (Clozaril), etc. Clozapine is used to treat schizophrenia that is resistant to other treatments.
- Psychosocial therapy: Psychosocial therapy can help with behavioral, social and occupational problems.
- Hospitalization: Hospitalization may be indicated in patients with the following
- Severe symptoms
- Risk of harm to others
- Suicidal tendencies
- Inability to care for themselves
- Electroconvulsive therapy (ECT): Electrodes are attached to the patient's scalp and small electric shocks are administered to the brain under anesthesia. ECT may help when medications are no longer effective.
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American Psychiatric Association