Home :: Schizophrenia

Information on Schizophrenia

This disorder is characterized by disturbances (for at least 6 months) in thought content and form, perception, affect, sense of self, volition, interpersonal relationships, and psychomotor behavior.

Schizophrenia affects 1% to 2% of the U.S. population and is equally prevalent in both sexes. Onset of symptoms usually occurs during adolescence or early adulthood.

The disorder produces varying degrees of impairment. Up to one-third of patients with schizophrenia have just one psychotic episode and no more. Some patients have no disability between periods of exacerbation; others need continuous institutional care. The prognosis worsens with each episode.

Causes

There is no known single cause responsible for schizophrenia. It is believed that a chemical imbalance in the brain is an inherited factor which is necessary for schizophrenia to develop. However, it is likely that many factors - genetic, behavioral, and environmental - play a role in the development of this condition.

Schizophrenia is considered to be multifactorially inherited. Multifactorial inheritance means that "many factors" are involved. The factors are usually both genetic and environmental, where a combination of genes from both parents, in addition to unknown environmental factors, produce the trait or condition. Often, one gender (either males or females) is affected more frequently than the other in multifactorial traits. There appears to be a different threshold of expression, which means that one gender is more likely to show the problem, over the other gender. Slightly more males develop schizophrenia in childhood; however, by adolescence, schizophrenia affects males and females equally.

Signs and symptoms

Schizophrenia is associated with a variety of abnormal behaviors; therefore, signs and symptoms vary widely, depending on the type and phase (prodromal, active, or residual) of the illness.

Watch for these signs and symptoms:

• ambivalence- coexisting strong positive and negative feelings, leading to emotional conflict
• apathy
• clang associations-words that rhyme or sound alike used in an illogical, non­sensical manner, for instance, "It's the rain, train, pain"
• concrete associations - inability to form or understand abstract thoughts
• delusions - false ideas or beliefs accepted as real by the patient. Delusions of grandeur, persecution, and reference (distorted belief regarding the relation between events and oneself, such as a belief that television programs address the patient on a personal level) are common in schizophrenia. Also common are feelings of being controlled, somatic illness, and depersonalization.
• echolalia - meaningless repetition of words or phrases
• echopraxia - involuntary repetition of movements observed in others
• flight of ideas-rapid succession of incomplete and unconnected ideas
• hallucinations - false sensory perceptions with no basis in reality; usually visual or auditory but may also be olfactory, gustatory, or tactile
• illusions - false sensory perceptions with some basis in reality, such as a car's backfiring mistaken for a gunshot
• loose associations - rapid shifts among unrelated ideas
• magical thinking - a belief that thoughts or wishes can control others or events
• neologisms - bizarre words that have meaning only for the patient
• poor interpersonal relationships
• regression-return to an earlier developmental stage
• thought blocking - sudden interruption in the patient's train of thought.
• withdrawal - disinterest in objects, people, or surroundings
• word salad - illogical word groupings, such as "She had a star, barn, plant."

Diagnosis

Treatment

In schizophrenia, treatment focuses on meeting the physical and psychosocial needs of the patient, based on his previous level of adjustment and his response to various interventions. Treatment may combine drug therapy, longterm psychotherapy for the patient and his family, psychosocial rehabilitation, vocational counseling, and the use of community resources.

Antipsychotic drugs or medication

The primary treatment for more than 30 years, antipsychotic drugs (also called neuroleptic drugs) appear to work by blocking postsynaptic dopamine receptors. These drugs reduce the incidence of psychotic symptoms, such as hallucinations and delusions, and relieve anxiety and agitation.

Other psychiatric drugs, such as antidepressants and anxiolytics, may control associated signs and symptoms.

Certain antipsychotic drugs are associated with numerous adverse reactions, some of which are irreversible. Most experts agree that patients who are withdrawn, isolated, or apathetic show little improvement after antipsychotic drug treatment.

High-potency antipsychotics include fluphenazine, haloperidol, thiothixene, and trifluoperazine. Loxapine, molindone, and perphenazine are intermediate in potency, and chlorpromazine and thioridazine are low-potency agents.

Haloperidol decanoate, fluphenazine decanoate, and fluphenazine enanthate are depot formulations that are implanted I.M. once or twice a week to once a month; this method allows gradual release of the drug. A new antipsychotic, risperidone, also is reported to be effective.

Clozapine, which differs chemically from other antipsychotic drugs, may be prescribed for severely ill patients who fail to respond to standard treatment. This agent effectively controls a wider range of psychotic signs and symptoms without the usual adverse effects. However, clozapine can cause drowsiness, sedation, excessive salivation, tachycardia, dizziness, and seizures, as well as agranulocytosis.

A potentially fatal blood disorder, agranulocytosis is characterized by a low white blood cell count and pronounced neutropenia. Routine blood monitoring is essential to detect the estimated 1% to 2% of all patients taking clozapine who develop agranulocytosis. If caught in the early stages, this disorder is reversible.

Psychotherapy

Clinicians disagree about the effectiveness of psychotherapy in treating schizophrenia. Some consider it a useful adjunct to drug therapy.

Others suggest that psychosocial rehabilitation, education, and social skills training are more effective for chronic schizophrenia. In addition to improving understanding of the disorder, these methods teach the patient and his family coping strategies, effective communication techniques, and social skills.

Because schizophrenia typically disrupts the family, family therapy may be helpful to reduce guilt and disappointment as well as improve acceptance of the patient and his bizarre behavior.

Prevention

The best way to prevent relapses is to continue to take the prescribed medication. Because side effects are one of the most important reasons why people with schizophrenia stop taking their medication, it is very important to find the medication that controls symptoms without causing side effects. Always talk to your doctor about any adjustments in your medications, or your wish to discontinue them