A severe mental illness characterized by persistent, bizarre disturbances in thought, communication, perceptions, emotions, and behavior. Schizophrenia is considered a psychosis because people with the disease become detached from reality.
Schizophrenia Symptoms And Types
The symptoms of schizophrenia fall into three groups. The so-called positive symptoms, or abnormalities not present in healthy people, include false beliefs that the person continues to hold despite evidence to the contrary (delusions) and false sensory perceptions, such as hearing voices or seeing visions that do not exist (hallucinations). Delusions commonly focus on persecution. The person believes that he or she is being spied upon, tormented, tricked, or beset by powerful outside forces. The delusions may also be grandiose, such as the belief that one has amazing magical powers. Hallucinations can affect any sense, most commonly hearing. The person hears voices that he or she perceives as coming from an outside source. The voices are often threatening or critical.
The second group, called the disorganized symptoms, includes thinking, speech, and behavior that do not make sense. People with the disease may talk senselessly. They speak in an apparently normal manner, but their words carry little or no meaning. Behavior can range from silly and childlike to extremely agitated. The individual may appear disheveled and strange (for example, wearing two overcoats on a hot day), engage in inappropriate sexual behavior such as masturbating in public, or shout and swear for no reason. In some cases, people with schizophrenia become physically rigid, holding the same pose for hours or days or moving repetitively in an unusual way (called catatonia).
The so-called negative symptoms refer to the lack of normal characteristics present. They include emotional flatness, absence of facial expression, speaking only in single words or short sentences, and a lack of pleasure in living.
Schizophrenia is classified into subtypes depending on the prominence of symptoms. For a person with paranoid schizophrenia, delusions or hallucinations, usually about persecution or grandiosity, are central. Anger, aloofness, and argumentativeness are often associated with this subtype of the disease. Disorganized schizophrenia is characterized by disordered thinking, speech, and behavior and by a lack of normal emotion. People with this form of the disease may show little emotion or laugh at inappropriate times. They have difficulty with simple, day-to-day activities such as brushing their teeth or dressing. Delusions and hallucinations are also common. In catatonic schizophrenia, motor disturbance is most prominent. Individuals immobilized by catatonia may hold a bizarre posture for hours or resist being moved; those who are hyperactive engage in frantic behavior that has no apparent purpose. Symptoms may also include resistance to all instructions, inability to talk (mutism), stupor, strange gestures or grimaces, unusual mannerisms, purposeless repetition of a word just spoken by someone else (echolalia), and repeated imitation of someone else's movements (echopraxia). Undifferentiated schizophrenia refers to disease in which no one set of symptoms is central. In residual schizophrenia, the person has experienced an episode of the disease but is not currently detached from reality.
Schizophrenia Course And Causes
In most cases, schizophrenia develops between late adolescence and the 30s. Usually the disease begins earlier in men (the early 20s) than in women (the late 20s). Symptoms may start suddenly, or they can develop gradually over an extended time. How well the individual can function depends on the disease subtype. People with paranoid schizophrenia are usually the least severely ill and those with disorganized schizophrenia, the most severely ill. Most people with schizophrenia do not marry and are socially isolated and withdrawn. The disease continues throughout life. In some cases, schizophrenia alternates between flare-ups and remissions, and in others it is chronic. Symptoms may worsen over time, or they can remain stable. About half of all people with schizophrenia have a substance abuse problem and attempt suicide.
Although the exact cause of schizophrenia remains unclear and is the subject of ongoing research, the disease clearly has an inherited component. Schizophrenia occurs at the same incidence in all racial and cultural groups throughout the world, indicating a genetic basis rather than a social one. The siblings and children of people with schizophrenia have a greater risk of developing the disease than do people from families without a history of schizophrenia. Studies of schizophrenia in twins also point to a genetic link. If one twin has the disease, the other is many times more likely to have it if he or she is an identical rather than a fraternal (nonidentical) twin. Since identical twins have exactly the same inheritance, the genetic link is clear. Research, as yet, has failed to find a single schizophrenia gene, however. Apparently the disease results from abnormalities in several genes, and environmental influences may also have some role. The fundamental mechanism of the disease is thought to be an abnormality of brain structure and chemistry.
Because schizophrenia is a severe illness that often leaves the individual incapable of functioning, hospitalization may be required to prevent harm to the person during disease episodes. Medications known as antipsychotics or neuroleptics are used to control symptoms. Usually the drugs are used continuously, since stopping medication can result in a return of symptoms. In some cases, BEHAVIOR THERAPY or PSYCHOTHERAPY can be helpful. Family therapy can help teach those close to the person with schizophrenia how to cope with the disease.