What Is Schizophrenia?
Schizophrenia is a serious mental illness that affects 300,000
Canadians. Although it affects men and women with equal frequency,
schizophrenia most often appears in men in their late teens or early
twenties, while it appears in women in their late twenties or early
thirties. Finding the causes for schizophrenia proves to be difficult as
the cause and course of the illness is unique for each person.
Interfering with a person's ability to think clearly, manage
emotions, make decisions and relate to others, schizophrenia impairs a
person's ability to function to their potential when it is not treated.
Unfortunately, no single, simple course of schizophrenia treatment
exists. Research has linked schizophrenia to a multitude of possible
causes, including aspects of brain chemistry and structure, as well as
environmental causes.
Psychosis (psyche = mind, osis = illness) is
defined as the experience of loss of contact with reality and usually
involves hallucinations and delusions. Psychosis is a common symptom of
schizophrenia. Learn more about psychosis, including first episodes, to gain more insight into this condition, including early intervention options.
Diagnosing Schizophrenia
There is no single laboratory or brain imaging test for
schizophrenia. Schizophrenia treatment professionals must rule out
multiple factors such as brain tumors and other medical conditions (as
well as other psychiatric diagnoses such as bipolar disorder). At the
same time, they must identify different kinds of symptoms that manifest
in specific ways over certain periods of time. To make matters more
complicated, the person in need of mental health help and treatment may
be in such distress that they have a hard time communicating. It often
takes a decade for people to be properly diagnosed with schizophrenia. A
health care provider who evaluates the symptoms and the course of a
person's illness over six months or more can help ensure a correct
diagnosis.
Since scientific knowledge is changing all the time, the
diagnostic criteria may change as well. Schizophrenia has been
categorized in several subtypes such as paranoid, catatonic,
disorganized and undifferentiated, but these divisions may be phased out
in favor of a syndrome model that includes multiple dimensions.
The Diagnostic and Statistical Manual of Mental Disorders (DSM),
the book health care professionals use to diagnose mental illness,
provides a set of common standards. The DSM often gets revised as new
research develops, and a fifth edition is due out in 2013. Find out more
about the DSM at www.dsm5.org.
The current DSM IV lists the following as schizophrenia
classification guidelines in patients if two or more occur persistently.
However, delusions or hallucinations alone can often be enough to lead
to a diagnosis of schizophrenia.
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized or catatonic behavior
- Negative symptoms
Health care providers also look for social/occupational dysfunction in one or more areas:
- Work or school
- Interpersonal relations
- Self care
Health care providers look for duration of these symptoms in this pattern:
- Persist for at least six months
- Include symptoms from the symptoms above for at least one month -
May include periods of prodromal (early signs) or residual symptoms or
only symptoms from the social bullet section or two or more symptoms
from the first section of bullets, with less intensity.
Health care providers make sure the following are not present:
- Sustained mood disorder symptoms during the episode
- The direct effects of substance use
- An underlying medical condition
- A pervasive developmental disorder (such as autism) unless prominent delusions or hallucinations are present.
According to current research, it is extremely important to
identify schizophrenia as early as possible. Studies show that catching
schizophrenia early can increase the chances of managing the illness and
mental health recovery. If identified and treated early on,
schizophrenia can be managed fairly well and the chances of subsequent
psychotic episodes are greatly reduced. The DSM 5 manual of the American
Psychiatric Association is at this time considering whether to include a
diagnosis for early onset of symptoms consistent with this line of
thinking.
The Symptoms of Schizophrenia
As you can see from the DSM criteria, no single symptom positively
identifies schizophrenia. On top of that, an individual's symptoms can
change over time. The symptoms of schizophrenia are generally divided
into three categories: positive, negative and cognitive symptoms.
Positive symptoms are also known as "psychotic" symptoms because
the person has lost touch with reality in certain ways. The term
"positive symptoms" refers to mental experiences that are "added on" to a
person's usual experience—typically these are hallucinations and
delusions.
- Hallucinations cause a person to hear voices inside or outside their heads or, less commonly, see things that do not exist.
- Delusions occur when someone believes ideas
that are clearly false, such as that people are reading their thoughts
or that they can control other people's minds.
Negative symptoms do not refer to negative
thinking, but rather reflect symptoms that indicate reduction of a
capacity, such as motivation. Negative symptoms often include emotional
flatness or lack of expressiveness, an inability to start and follow
through with activities, speech that is brief and lacks content and a
lack of pleasure or interest in life. Difficulties with social cues and
relationships are common. These symptoms challenge rehabilitation
efforts, as work and school goals require motivation as well as social
function. Negative symptoms can also be confused with clinical
depression.
Cognitive symptoms pertain to thinking processes.
People living with schizophrenia often struggle with executive
functioning (prioritizing tasks), memory and organizing thoughts.
Cognitive function is involved in many tasks of daily living—especially
in work or school settings. A common cognitive deficit associated with
this condition is anosognosia or "lack of insight"—when someone is not
aware of having an illness. This difficulty in understanding is based in
the brain—it is not a choice or psychological denial—and can make
treating or working with people who live with schizophrenia much more
challenging. I Am Not Sick, I Don't Need Help, a book by Xavier Amador,
Ph.D., is a great resource for dealing with this challe
