Schizophrenia

Schizophrenia is a chronic, severe and disabling brain disorder in which people interpret reality abnormally. Schizophrenia may result in a combination of hallucinations, delusions and disordered thinking and behavior.

Although the causes of schizophrenia are not known, researchers believe that a combination of genetics and environment contributes to the development of the disease.

Though treatment helps relieve many symptoms of schizophrenia and many schizophrenics can lead rewarding and meaningful lives, most people who have the disorder cope with symptoms throughout their lives.

In men, schizophrenia symptoms typically start in the teens or 20s in men, and the 20s or early 30s in women. It's uncommon for children to be diagnosed with schizophrenia and rare for those older than 45. Signs and symptoms of schizophrenia, which are sometimes attributable to other mental disorders, generally are divided into three categories — positive, negative and cognitive.

Positive symptoms reflect an excess or distortion of normal functions, and can include:

• Delusions
• Hallucinations
• Difficulty speaking and organizing thoughts, resulting in stopping speech midsentence or putting together meaningless words
• Disorganized behavior, ranging from childlike silliness to unpredictable agitation

Negative symptoms refer to a diminishment or absence of characteristics of normal function. They may appear with or without positive symptoms. They include:

• Loss of interest in everyday activities
• Appearing to lack emotion
• Reduced ability to plan or carry out activities
• Neglect of personal hygiene
• Social withdrawal
• Loss of motivation

Cognitive symptoms involve problems with thought processes. These symptoms may be the most disabling in schizophrenia because they interfere with the ability to perform routine daily tasks. They include:

• Problems with making sense of information
• Difficulty paying attention
• Memory problems

Treatment

Schizophrenia is a chronic condition that requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep and basic hygiene.

A psychiatrist experienced in treating schizophrenia usually guides treatment. The treatment team also may include psychologists, social workers and psychiatric nurses and possibly a case manager to coordinate care. The full-team approach may be available in clinics with expertise in schizophrenia treatment.

Medications are the cornerstone of schizophrenia treatment. But because medications for schizophrenia can cause serious but rare side effects, patients may be reluctant to take them.

Antipsychotic medications are the most commonly prescribed to treat schizophrenia. They're thought to control symptoms by affecting the brain neurotransmitters dopamine and serotonin. A person's willingness to cooperate with treatment may affect medication choice. Someone who is uncooperative may need to be given injections instead of taking a pill.

It can take several weeks after first starting a medication to notice an improvement in symptoms. In general, the goal of treatment with antipsychotic medications is to effectively control signs and symptoms at the lowest possible dosage. The psychiatrist may try different medications, different dosages or combinations over time to achieve the desired result.

Although medications are the cornerstone of schizophrenia treatment, once psychosis recedes, psychosocial treatments that focus on improving communication and social interactions, reducing stress and finding and keeping jobs also are important.

With appropriate treatment, most people with schizophrenia can manage their condition.

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