Schizophrenia

Schizophrenia is a chronic neuropsychiatric disorder that affects the way a person thinks, feels, behaves, and perceives the world around them. It is categorized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a psychotic disorder, which means it causes some level of disconnection from reality.

Untreated schizophrenia can cause severe, debilitating symptoms that interfere with a person’s ability to care for themselves, hold a job, live independently, and maintain relationships. If symptoms become severe enough that a person is a danger to themselves or others, they may need to be hospitalized until their condition stabilizes.  

While schizophrenia is thought to affect males and females at similar rates, psychotic symptoms tend to appear earlier in males. On average, males are most likely to receive a schizophrenia diagnosis in their late teens to early twenties. Females with schizophrenia are most often diagnosed in their late twenties to early thirties. 

Schizophrenia is rarely diagnosed in people younger than 12 or older than 40.

Early Signs of Schizophrenia

In many people with schizophrenia, the first and most obvious manifestation of the disorder is an initial episode of psychosis. In truth, schizophrenia occurs in phases: prodromal, active, and residual. In its early stages, the symptoms may be subtle and non-specific, making it difficult to know when or if an individual needs treatment and medication. 

The first stage of schizophrenia, known as the prodromal stage or the period of onset, is characterized by gradual psychological and behavioral changes. 

Symptoms of a schizophrenia prodrome can include:

• Social withdrawal and increased isolation
• Increased mood swings, anxiety, or aggression
• Significant shifts in normal routine
• Memory and concentration problems
• Decline in personal hygiene 
• Significant decline in academic or job performance
• Sleep disturbances 

It’s important to note that not everyone with schizophrenia experiences a prodromal phase. Likewise, not everyone who experiences prodromal symptoms has schizophrenia. 

Even psychotic symptoms–the hallmark of schizophrenia–do not guarantee a schizophrenia diagnosis. Psychosis can be a side effect of numerous illnesses and health conditions, including brain injuries, childbirth, substance abuse, and neurological disorders. Other mental health conditions, like bipolar disorder and severe depression, can also have psychotic features.  

If schizophrenia is present, prodromal symptoms often precede noticeable and debilitating psychotic symptoms. Negative and cognitive symptoms may also worsen. 

Psychotic (positive) symptoms of schizophrenia include:

• Hallucinations: Sensory perceptions that seem (and are believed to be) real but aren’t. Examples include hearing voices, seeing things or people who aren’t there, or feeling scratches or crawling on the skin with no external stimulus
• Delusions: Unwavering false beliefs that are strongly held despite clear evidence that the beliefs are wrong
• Disorganized speech: Speech and conversation patterns that are jumbled, incoherent, or illogical 
• Abnormal motor behavior: Unpredictable, agitated, or inappropriate motor behaviors. This can include repetitive rocking, jerking, or foot tapping, inappropriate smiling or giggling, and exaggerated or odd facial expressions and gestures.

Negative symptoms of schizophrenia include: 

• Flat affect: Minimized or absent facial expressions, muted body language, monotone speech, and lack of emotional gestures
• Lack of motivation: Decreased interest in goal-directed activities like household chores, personal hygiene, schoolwork, job responsibilities, or hobbies 
• Decreased ability to feel joy or pleasure: Numbness or lack of interest in previously enjoyable activities and hobbies
• Poverty of speech and speech content: Speaking less often, using fewer words, and providing vague or repetitious information when speaking
• Social isolation: Withdrawal from social relationships; diminished participation in social activities or engagements

Cognitive symptoms of schizophrenia include: 

• Issues with working memory and long-term memory
• Difficulty concentrating and paying attention
• Issues with processing speed (the rate at which the brain receives, interprets, and responds to information)
• Issues with reasoning, problem-solving, and decision-making
• Difficulty interpreting emotions and social cues in other people

Schizophrenia can be a confusing and frightening condition for both the person experiencing it and their loved ones. People with the disorder often don’t recognize their symptoms and behaviors as abnormal or concerning, so they may refuse treatment or medical care even when they desperately need it.

While there is no single identifiable cause of schizophrenia, there are risk factors for developing the disorder.  

These risk factors include: 

Genetics: People with a family history of schizophrenia may be more likely to develop the disorder.

Environmental factors: Stressful or dangerous life events, experiencing trauma, being abused or neglected as a child, abusing drugs, and living in poverty may increase a person’s likelihood of developing schizophrenia. Similarly, exposure to viruses or infections in the womb, lack of nutrition in infancy, and maternal stress during pregnancy may increase risk[1]. 

Brain chemistry: An imbalance of certain chemicals in the brain may be associated with a higher risk of schizophrenia

[1] Brown, Alan S. “The Environment and Susceptibility to Schizophrenia.” Progress in Neurobiology, vol. 93, no. 1, Jan. 2011, pp. 23–58, https://doi.org/10.1016/j.pneurobio.2010.09.003.

While schizophrenia can be a debilitating and frightening disorder, effective treatments and therapies are available. 

A multidisciplinary treatment approach–one that combines medication with talk therapy, psychotherapy, and psychosocial and family treatment–is thought to be the most effective method for the long-term management of schizophrenia. 

Antipsychotic medications are the first-line treatment for the psychotic symptoms of schizophrenia. These medications can lessen symptoms like hallucinations and delusions by altering the levels of certain neurotransmitters in the brain. Atypical antipsychotics (the kind that are now widely prescribed for schizophrenia) are able to block dopamine and serotonin receptors while simultaneously activating other types of receptors in the brain. As a result, atypical antipsychotics generally cause fewer severe side effects than first-generation antipsychotic medications. 

Even so, they aren’t miracle drugs. Schizophrenia is a highly complex disorder, and there isn’t a universally effective medication. Individual side effects, as well as the efficacy of the medication itself, may vary widely from person to person. It’s critical that people with schizophrenia have access to individualized care that can be tailored and adjusted according to their needs.