Schizophrenia Disorder

Schizophrenia Disorder

Schizophrenia Disorder

Schizophrenia is a chronic and severe mental illness characterized by relapsing episodes of psychosis which involve significant alterations in perception, thoughts, mood, and behavior.

Prevalence

Approximately 0.3 to 0.7% of the general population is affected by schizophrenia. The onset of this condition is often gradual, and it typically occurs in the early to mid-twenties in males and in the late twenties in females. Schizophrenia is more common in males than it is in females.

Symptoms of Schizophrenia Disorder:

The symptoms of schizophrenia fall into three categories: positive, negative, and cognitive, and no single symptom can be evidence of schizophrenia — each person will have their own unique mix.

The symptoms might show up slowly or suddenly. Symptoms usually last for more than one month and severely affect a person’s ability to function. Mood disorder symptoms are common during a small portion of the illness.


Positive symptoms include

  • Delusions which are often paranoid and persecutory in nature
  • Hallucinations – usually in the form of defamatory auditory voices and refer to the patient in the third person — like “Look at him,” “Isn’t he a fool,” etc.
  • Disorganized thoughts and speech – include:

    • Passivity – “Thoughts are being taken out of my head.”
    • Insertion – “Someone is putting thoughts into my head.”
    • Broadcasting – “People are overhearing my thoughts.”

Negative symptoms include:

  • Emotional blunting – limited range and expression of emotions
  • Alogia – poverty of speech
  • Anhedonia – an inability to experience pleasure
  • Avolition – lack of motivation
  • Apathy
  • Self-neglect
  • Social withdrawal

Cognitive symptoms may be social or non-social, and they might persist even when the other symptoms are in remission. They are usually the first symptoms to be seen.

  • Social cognition involves the mental processes needed to interpret and understand the self and others in the social world, which is often impaired in people with schizophrenia.
  • Non-social cognitive symptoms of schizophrenia include difficulty focusing or paying attention and poor executive functioning — the ability to understand information and use it to make decisions. The most common symptom in people with schizophrenia is lack of insight.

Many people with schizophrenia also have anxiety or substance abuse disorders.

Diagnosis of Schizophrenia Disorder:

There are no proven lab work, brain scan, or mental health tests that can accurately diagnose schizophrenia, so diagnosis is made on the person’s observed behavior — which relies on observations made by the mental health professional, family, friends, and coworkers.

The Brief Negative Symptom Scale (BNSS) can be used to assess the presence, severity, and changes of negative symptoms.

The DSM-5 listed criteria for a diagnosis of schizophrenia are as follows:

  • Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

    1. Delusions.
    2. Hallucinations.
    3. Disorganized speech (e.g., frequent derailment or incoherence).
    4. Grossly disorganized or catatonic behavior.
    5. Negative symptoms (i.e., diminished emotional expression or avolition).
  • For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).
  • Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
  • Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
  • The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
  • If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).

The diagnosis can be further categorized according to the severity, length, and number of episodes and the type of remission — full or partial. Schizophrenia might also be diagnosed with catatonia.

Causes of Schizophrenia Disorder:

The exact causes of schizophrenia remain unknown; however, environmental and genetic factors have been implicated.

  • Environmental – being raised in an urban environment, belonging to a minority ethnic group
  • Genetic – possible predisposition to developing schizophrenia if a family member has another mood or childhood disorder
  • Health – infections, exposure to a virus, and poor nutritional intake during pregnancy, problems during birth
  • Biological – possible dysfunction in brain structure and its neural messaging network, shown by differences in brain scans compared to those of healthy individuals
  • Drug use – cannabis use during adolescence

Consequences of Schizophrenia Disorder complications:

Consequences of schizophrenia include frequent unemployment, poverty, homelessness, abuse, and discrimination. Compared to the general population, people with schizophrenia have a 5% higher suicide rate and more physical health problems, reducing life longevity by about 20 years.

If you are experiencing suicidal thoughts, you can call the Suicide Prevention Hotline and talk for free at 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255). They can also provide you with information about low-cost clinics and therapists for your depression.

Call 911 if you are seriously contemplating or vocalizing thoughts of suicide or self harm.

Treatment for Schizophrenia Disorder:

Treatment of schizophrenia includes antipsychotic medications and talking therapies. About 20% to 50% of those treated improve significantly with few to no relapses, while others continue to have acute episodes and remissions over the years and require ongoing support.

It’s especially important to treat first episode psychosis (FEP) early and over a period of 2 to 5 years as it offers better long-term results — using a customized, multi-pronged treatment approach that pulls together care from 4 to 6 mental health disciplines.

Voluntary or involuntary hospitalization may be necessary when there is a risk to self and/or others. Psychiatric and occupational rehabilitation can help to promote recovery of mental and social functioning in people with this chronic condition. Ongoing support ensures continuation of the treatment, thereby reducing the chance of relapse.

  • Psychotherapy

    • Cognitive behavioral therapy – examines, challenges, and changes thoughts, emotions, and behaviors that are unhelpful to the recovery process
    • Cognitive remediation therapy – helps improve cognitive skills
    • Family education and support – provides support, education, and relational skills for family members
    • Metacognitive training – focuses particularly on the thought processes that lead to delusions to correct them
    • Group therapy – to provide ongoing education and coping strategies to a small group of people with schizophrenia
    • Interpersonal and Social Rhythm Therapy (IPSRT) – helps establish a better daily routine that includes healthy food, regular mealtimes, exercise, sunlight, and a sleep schedule, which improves a person’s quality of life.
  • Psychosocial support – helps the person learn coping skills when in stressful situations, communication skills, social skills, conflict resolution steps, and methods of self-care.
  • Community support – drop-in mental health visits, work skills training, employment support, educational support, drop-in centers, exercise sessions, internet forums
  • Intensive case management (ICM) – Assigns a case manager to the person to help coordinate care and assist in practical ways.
  • Medications – Side effects differ between atypical and phenothiazine antipsychotics, so prescriptions are chosen based on a controlled trial and error method to see which one suits the person best. Those experiencing their first episode of psychosis are put on a low dose to avoid oversensitivity to the introduction of the new medication.

    Antipsychotics usually only affect the positive symptoms. Once-off episodes of psychosis mean long-term medication is not required.

    • Atypical antipsychotics – such as olanzapine and clozapine to block dopamine receptors or combine antagonism of dopamine and serotonin
    • Phenothiazine antipsychotics – such as thioridazine and chlorpromazine to block dopamine and serotonin receptors in the brain and depress certain hormone releases

Symptoms of Schizophrenia Disorder:

The symptoms of schizophrenia fall into three categories: positive, negative, and cognitive, and no single symptom can be evidence of schizophrenia — each person will have their own unique mix.

The symptoms might show up slowly or suddenly. Symptoms usually last for more than one month and severely affect a person’s ability to function. Mood disorder symptoms are common during a small portion of the illness.


Positive symptoms include

  • Delusions which are often paranoid and persecutory in nature
  • Hallucinations – usually in the form of defamatory auditory voices and refer to the patient in the third person — like “Look at him,” “Isn’t he a fool,” etc.
  • Disorganized thoughts and speech – include:

    • Passivity – “Thoughts are being taken out of my head.”
    • Insertion – “Someone is putting thoughts into my head.”
    • Broadcasting – “People are overhearing my thoughts.”

Negative symptoms include:

  • Emotional blunting – limited range and expression of emotions
  • Alogia – poverty of speech
  • Anhedonia – an inability to experience pleasure
  • Avolition – lack of motivation
  • Apathy
  • Self-neglect
  • Social withdrawal

Cognitive symptoms may be social or non-social, and they might persist even when the other symptoms are in remission. They are usually the first symptoms to be seen.

  • Social cognition involves the mental processes needed to interpret and understand the self and others in the social world, which is often impaired in people with schizophrenia.
  • Non-social cognitive symptoms of schizophrenia include difficulty focusing or paying attention and poor executive functioning — the ability to understand information and use it to make decisions. The most common symptom in people with schizophrenia is lack of insight.

Many people with schizophrenia also have anxiety or substance abuse disorders.

Diagnosis of Schizophrenia Disorder:

There are no proven lab work, brain scan, or mental health tests that can accurately diagnose schizophrenia, so diagnosis is made on the person’s observed behavior — which relies on observations made by the mental health professional, family, friends, and coworkers.

The Brief Negative Symptom Scale (BNSS) can be used to assess the presence, severity, and changes of negative symptoms.

The DSM-5 listed criteria for a diagnosis of schizophrenia are as follows:

  • Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

    1. Delusions.
    2. Hallucinations.
    3. Disorganized speech (e.g., frequent derailment or incoherence).
    4. Grossly disorganized or catatonic behavior.
    5. Negative symptoms (i.e., diminished emotional expression or avolition).
  • For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).
  • Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
  • Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
  • The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
  • If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).

The diagnosis can be further categorized according to the severity, length, and number of episodes and the type of remission — full or partial. Schizophrenia might also be diagnosed with catatonia.

Causes of Schizophrenia Disorder:

The exact causes of schizophrenia remain unknown; however, environmental and genetic factors have been implicated.

  • Environmental – being raised in an urban environment, belonging to a minority ethnic group
  • Genetic – possible predisposition to developing schizophrenia if a family member has another mood or childhood disorder
  • Health – infections, exposure to a virus, and poor nutritional intake during pregnancy, problems during birth
  • Biological – possible dysfunction in brain structure and its neural messaging network, shown by differences in brain scans compared to those of healthy individuals
  • Drug use – cannabis use during adolescence

Consequences of Schizophrenia Disorder:

Consequences of schizophrenia include frequent unemployment, poverty, homelessness, abuse, and discrimination. Compared to the general population, people with schizophrenia have a 5% higher suicide rate and more physical health problems, reducing life longevity by about 20 years.

If you are experiencing suicidal thoughts, you can call the Suicide Prevention Hotline and talk for free at 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255). They can also provide you with information about low-cost clinics and therapists for your depression.

Call 911 if you are seriously contemplating or vocalizing thoughts of suicide or self harm.

Treatment for Schizophrenia Disorder:

Treatment of schizophrenia includes antipsychotic medications and talking therapies. About 20% to 50% of those treated improve significantly with few to no relapses, while others continue to have acute episodes and remissions over the years and require ongoing support.

It’s especially important to treat first episode psychosis (FEP) early and over a period of 2 to 5 years as it offers better long-term results — using a customized, multi-pronged treatment approach that pulls together care from 4 to 6 mental health disciplines.

Voluntary or involuntary hospitalization may be necessary when there is a risk to self and/or others. Psychiatric and occupational rehabilitation can help to promote recovery of mental and social functioning in people with this chronic condition. Ongoing support ensures continuation of the treatment, thereby reducing the chance of relapse.

  • Psychotherapy

    • Cognitive behavioral therapy – examines, challenges, and changes thoughts, emotions, and behaviors that are unhelpful to the recovery process
    • Cognitive remediation therapy – helps improve cognitive skills
    • Family education and support – provides support, education, and relational skills for family members
    • Metacognitive training – focuses particularly on the thought processes that lead to delusions to correct them
    • Group therapy – to provide ongoing education and coping strategies to a small group of people with schizophrenia
    • Interpersonal and Social Rhythm Therapy (IPSRT) – helps establish a better daily routine that includes healthy food, regular mealtimes, exercise, sunlight, and a sleep schedule, which improves a person’s quality of life.
  • Psychosocial support – helps the person learn coping skills when in stressful situations, communication skills, social skills, conflict resolution steps, and methods of self-care.
  • Community support – drop-in mental health visits, work skills training, employment support, educational support, drop-in centers, exercise sessions, internet forums
  • Intensive case management (ICM) – Assigns a case manager to the person to help coordinate care and assist in practical ways.
  • Medications – Side effects differ between atypical and phenothiazine antipsychotics, so prescriptions are chosen based on a controlled trial and error method to see which one suits the person best. Those experiencing their first episode of psychosis are put on a low dose to avoid oversensitivity to the introduction of the new medication.

    Antipsychotics usually only affect the positive symptoms. Once-off episodes of psychosis mean long-term medication is not required.

    • Atypical antipsychotics – such as olanzapine and clozapine to block dopamine receptors or combine antagonism of dopamine and serotonin
    • Phenothiazine antipsychotics – such as thioridazine and chlorpromazine to block dopamine and serotonin receptors in the brain and depress certain hormone releases
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