Schizophrenia: What It Is, Symptoms, Diagnosis, and Treatment

Schizophrenia is a long-term chronic mental health issue.

Schizophrenia is a long-term chronic mental health issue. In the case of schizophrenia, symptoms may include delusions (unusual beliefs), hallucinations (seeing things that do not exist), disorganized speech, difficulty thinking, and lack of motivation. Most symptoms can significantly improve with the help of different treatment approaches. Although there is no treatment that provides a definitive cure for schizophrenia, it is possible to control symptoms and reduce relapses in most cases with the available options.

What is Schizophrenia?

Schizophrenia is a chronic mental health issue characterized by symptoms lasting at least one month, often requiring lifelong treatment. The person may appear to have no issues with functioning and behavior, except during times when they talk about delusions or act according to those delusions. Schizophrenia can be categorized into the following types based on the symptoms that arise:

• Catatonic Schizophrenia: A psychomotor state in which the person remains motionless and unresponsive for an extended period.
• Paranoid Schizophrenia: The most common type of schizophrenia. The person experiences hallucinations and delusions.
• Disorganized Schizophrenia: In this type of schizophrenia, individuals tend to show disconnected responses.
• Hebephrenic Schizophrenia: A type of schizophrenia where the individual experiences mood disorders such as depression and mania.
• Residual (Tortuous Type) Schizophrenia: A period in patients showing schizophrenia symptoms where the symptoms have diminished to almost negligible levels. Symptoms have decreased, but the person has no positive thoughts about life.
• Undifferentiated Schizophrenia: This type is accepted when the type of schizophrenia cannot be determined despite the diagnosis.

What Causes Schizophrenia?

The exact cause of schizophrenia is unknown, but it is believed to result from a combination of genetic and environmental factors. The interaction between genes and a variety of environmental factors may lead to schizophrenia. Additionally, psychosocial factors can also affect the onset and course of schizophrenia. The likelihood of men and women developing schizophrenia is equal; however, men may begin to show symptoms earlier. Symptoms of schizophrenia can start suddenly or become more pronounced over time. Although there is no known definite cause of schizophrenia, several conditions are associated with it. These include:

• Being born in winter
• Very low birth weight
• Complications during birth
• Recreational drug use
• Genetic factors
• Brain structure

How is Schizophrenia Diagnosed?

Diagnosing schizophrenia requires multiple tests and evaluations. Therefore, the individual is primarily referred to a psychiatrist for assessment of symptoms. The evaluation includes questions about current symptoms, medical history, family history, and any substance abuse issues. It may also be necessary to speak with a family member for more information about the individual's symptoms. The doctor may then conduct a physical examination and may request blood tests or brain scans to rule out underlying causes.

Doctors use various imaging techniques to ensure that symptoms suggesting schizophrenia do not arise from issues such as strokes, brain injuries, tumors, or other changes in brain structure. These techniques are typically CT or MRI scans.

Additionally, if necessary, an electroencephalogram (EEG) can be used to record and evaluate the electrical activity in the brain. Doctors can diagnose schizophrenia or related disorders by observing the symptoms or behaviors described by the individual. The identified symptoms are then compared against the criteria necessary for a schizophrenia diagnosis. To make a diagnosis, the relevant symptoms must have persisted for at least six months. The symptoms can be severe enough to cause functional difficulties in work, school, home, or social life.

What Symptoms Arise Alongside Schizophrenia?

Individuals with schizophrenia often experience persistent difficulties in cognitive skills such as memory, attention, problem-solving, and thinking abilities. Some people with schizophrenia may experience periodic worsening and improvement of symptoms throughout their lives, while others may see a gradual deterioration of symptoms over time. The severity, duration, and frequency of symptoms can vary from person to person; however, the frequency of severe psychotic symptoms typically decreases as one ages. Not adhering to prescribed medication, using alcohol or drugs, and stress can exacerbate symptoms.

Symptoms of schizophrenia can be classified into negative and positive symptoms. Negative symptoms refer to what is abnormally lacking or missing in individuals experiencing schizophrenia. These symptoms manifest as a loss of interest and motivation in life and activities, including relationships and sex, difficulties in concentration, reluctance to leave the house, and changes in sleep patterns. The phase in which the first negative symptoms are observed is called the prodromal phase of schizophrenia. Symptoms during the prodromal phase generally emerge gradually and worsen slowly. It often includes a person's increasing social withdrawal. Additionally, patients may lose interest in their appearance or personal hygiene. Negative symptoms may include:

• Impairment in emotional expression
• Speech disturbances
• Decreased desire for social contact
• Reduced motivation for daily activities

The positive symptoms of schizophrenia usually appear a few years before the first acute mood changes. Positive symptoms can include:

• Hallucinations: Hallucinations can be defined as seeing, hearing, smelling, tasting, or feeling things that are not present. The most common hallucinations are auditory, such as hearing voices.
• Psychosis: Psychosis can be described as a loss of contact with reality due to a disturbance in how the brain processes information. Psychoses are vivid and clear, resembling normal perceptions. When psychosis is severe, it can cause difficulties in performing daily life activities. Thoughts and speech can become confused due to psychotic symptoms, making it hard for others to understand the person's speech.
• Changes in behavior and thoughts: A person's behavior may become disorganized and unpredictable. Their appearance or clothing may seem unusual to others. People with schizophrenia can become inexplicably agitated, shout, or use profanity. They may believe that their thoughts are being controlled by someone else, that they do not belong to them, that they have been implanted in their minds by another person, or that someone is pulling their thoughts out of their minds.

Schizophrenia Treatment

Treatment should be conducted under the supervision of a psychiatrist but may involve a team of different mental health professionals, including a psychiatric nurse, social worker, occupational therapist, and clinical psychologist. Treatments are tailored to meet the individual needs of the patient. Schizophrenia is typically treated with a combination of medications and therapy specifically designed for each individual. Medications and cognitive behavioral therapy (CBT) are commonly preferred in treatment. Although there is currently no permanent treatment option for schizophrenia, various antipsychotic medications are effective in reducing psychotic symptoms observed during the acute phase of the illness and can also help reduce the likelihood and severity of future acute episodes. Additionally, treatment can contribute to reducing stress, supporting employment, or enhancing social skills. Individuals with schizophrenia are at a higher risk of misusing medications compared to the general population. Treatment options are discussed in more detail below.

Medications
Medication is the primary form of treatment for schizophrenia. Antipsychotic medications can reduce primary symptoms such as hallucinations and delusions. However, it may take up to six weeks for them to start showing their effects. Some individuals may experience side effects from the medication, making regular follow-up important.

Psychotherapy
Psychotherapy can help individuals understand, manage their symptoms, and learn new coping strategies. Methods such as cognitive behavioral therapy can assist individuals with schizophrenia in coping with their illness and managing their condition. Other methods that may be used in treatment include art and drama therapy, which can help individuals overcome loss of motivation and recognize their symptoms. Healthcare providers may also suggest techniques focused on different areas, such as assisting with social skills and establishing personal care routines.

Community Support
Mental health services can provide practical support for individuals with schizophrenia. A stable living environment, supportive relationships, and meaningful work or activities are essential components for recovery. Some individuals with schizophrenia may require rehabilitation and skills training to help them return to work or education.

Hospital Treatment
Some individuals with schizophrenia may need to be hospitalized from time to time. Hospitalization is preferred to help when symptoms become uncontrollable or when a person cannot manage at home.

Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is a preferred treatment option when symptoms do not improve after trying specific medications, and the person is at risk of harming themselves or others. This treatment involves using an electric current applied to the scalp to stimulate certain parts of the brain. If you are experiencing some mental health issues, do not neglect to seek support from a healthcare facility.