What Is Schizophrenia?
Schizophrenia is a serious mental illness characterized by an inability to distinguish reality from fantasy. People with schizophrenia must take antipsychotic medications to reduce symptom severity. Although an exact cause of schizophrenia has yet to be determined, psychiatrists and neuroscientists believe that excess dopamine in the brain from the misfiring of neurons responsible for regulating dopamine produces psychotic features of schizophrenia.
Schizophrenia is more prevalent in men than in women. Typically, the onset of schizophrenia occurs in late adolescence to early adulthood or later in life (late 30s to 40s). Some researchers think that, due to the timing of schizophrenia, the disease may also correlate to disturbances in hormonal regulation involving estrogen and testosterone.
Schizophrenia is not curable. It is a chronic mental disorder requiring lifetime medication, psychological counseling and support from social services, family members and friends. Fortunately, new research is aiding in understanding the causes of schizophrenia, and schizophrenia treatment has advanced significantly, so people with schizophrenia can lead more normal lives.
A diagnosis of undifferentiated schizophrenia means a psychiatrist recognizes signs of schizophrenia in a patient, but these signs don’t fit into a particular schizophrenia subtype. Undifferentiated schizophrenia is often difficult to diagnose and may require extensive testing to rule out an organic disorder (brain tumor or abscess) or severe depression with psychotic features.
Disorganized (Hebephrenic) Schizophrenia
The onset of disorganized schizophrenia often occurs in adolescence, with teens exhibiting flat or inappropriate emotions, disorganized speech and behavior and anhedonia (inability to find pleasure in any activity). Teenagers with disorganized schizophrenia don’t harbor delusions or hallucinate. However, they do have bizarre behaviors, such as repeating words or sentences, shifting rapidly between topics when talking and inventing words that are meaningless to others.
Unlike general delusions involving beliefs comparable to some popular conspiracy theories, paranoid delusions are focused on the self. Individuals with paranoid schizophrenia believe they are being targeted, influenced or spied on by neighbors, the government, extraterrestrials, family members or even inanimate objects. Living with paranoid schizophrenia is possible, but patients need to take medication as prescribed and see counselors regularly. In some cases, paranoid delusions may compel people to engage in actions harmful to themselves and others.
A classic sign of catatonic schizophrenia is a person’s reluctance to change the positioning of their arms, legs, head and other parts of the body. Someone with catatonic schizophrenia may extend an arm out in front of them, place the other arm over their head and remain in that position for hours. They will resist changing, or they may allow themselves to be manually moved only to return to their previous position immediately. Some catatonic schizophrenic patients occasionally engage in repetitive behavior, such as clapping, rotating their arms or moving their fingers the same way over and over again.
To be diagnosed with residual schizophrenia, patients need to have a history of negative schizophrenic symptoms with infrequent events presenting positive schizophrenia symptoms. Individuals with residual schizophrenia may go years without hallucinating or having delusions.
Positive Symptoms of Schizophrenia
Positive signs of schizophrenia are what most people think of when they characterize someone with schizophrenia: hallucinating visually and audibly, delusional thinking, disorganized thinking and presenting agitated or repetitive body movements. At the extreme end of active schizophrenia, people hear voices, see things other people do not see, use odd words and phrases and, in general, have little to no contact with reality.
Negative Symptoms of Schizophrenia
Negative symptoms involve the emotional presentation of schizophrenia. They include:
- Exhibiting a flat effect: Facial expressions are nonexistent while speech sounds monotonous and almost robotic.
- Anhedonia: Patients feel no pleasure in previously enjoyable activities and generally don’t want to participate in any social or solo activities.
- Extreme isolation: People with schizophrenia are so overwhelmed by their hallucinations and delusions they speak little or not at all if someone attempts to engage them in conversation.
Since negative schizophrenic symptoms resemble severe clinical depression, some patients may be misdiagnosed initially with major depression until they begin exhibiting positive symptoms of schizophrenia.
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Living with Schizophrenia: Treatment Choices
Medication for regulating dopamine levels in the brain and relieving symptoms of schizophrenia are either “typical” or “atypical.”Typical antipsychotics are meant to control positive symptoms like delusions, hallucinations and disorganized thinking. Typical antipsychotics prescribed to people with schizophrenia include:
Developed over 50 years ago to treat psychosis, typical antipsychotics are also prescribed to reduce symptoms of bipolar disorder, post-traumatic stress disorder and postpartum psychosis.
Atypical antipsychotic medication treats both negative and positive symptoms of schizophrenia. They represent newer drugs that have fewer side effects than typical antipsychotic medications. Popular schizophrenia medication prescribed today include:
- Aripiprazole (Abilify)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
- Risperidone (Risperdal)
Cariprazine, one of the newer atypical antipsychotic drugs, seems to target dopamine receptors in the brain more effectively than older medications. Specifically, cariprazine is a dopamine receptor antagonist, or a drug that prevents receptors from releasing too much dopamine into the brain. In addition, cariprazine has a small but significant affinity with serotonin receptors that may help people with schizophrenia stabilize their mood and improve cognitive processes.
The Importance of Taking Medication for Schizophrenia
People diagnosed with schizophrenia can live normal lives as long as they take their medications as prescribed. Antipsychotic medications are critical to preventing a relapse of schizophrenic symptoms. Unfortunately, many people who take their medications faithfully think they don’t have to take them anymore after dopamine levels stabilize and their symptoms subside. Positive and negative symptoms of schizophrenia will return within a few weeks of not taking prescribed antipsychotic medication.
Another reason why people with schizophrenia stop taking their medication is the side effects of these drugs. Common side effects experienced when taking either atypical or typical antipsychotic medications include:
- Drowsiness and fatigue
- Nausea and vomiting
- Dry mouth
- Muscle tremors, muscle stiffness or muscle rigidity
A person taking medication for schizophrenia should never stop taking it without consulting their psychiatrist. Because there’s a wide variety of medications available to treat schizophrenia, psychiatrists can work with their patients to find a drug that works better for them. In some cases, patients may need to take several medications to reduce both symptoms of schizophrenia and side effects. Remember, today’s advanced treatments for schizophrenia spell “HOPE” for everyone diagnosed with schizophrenia.
Psychotherapy for Schizophrenia
After medication has stopped delusional thinking and hallucinations, people with schizophrenia often experience varying degrees of cognitive decline, such as problems with attention memory, processing complex information and solving problems. Cognitive remediation therapy helps strengthen a person’s overall cognitive skills by using mental and compensatory exercises such as checklists, daily pill boxes and repeating tasks to encode the process in their long-term memory. Cognitive training software is also available to prevent cognitive decline associated with schizophrenia.
Individual psychotherapy/skills counseling commonly involves a cognitive behavioral therapy approach combined with life skills therapy to help patients gain a better understanding of their symptoms. Many people with schizophrenia who take their medication as prescribed continue having difficulty with managing relationships, relating to people empathetically and challenging unusual beliefs that persist simply because of the impact these beliefs made on them before treatment.
The Promise of Neurostimulation to Relieve Negative Symptoms of Schizophrenia
A June 2018 article in Neuroscience and Biobehavioral Reviews discusses the promise of noninvasive prefrontal neurostimulation using repetitive transcranial direct current stimulation and transcranial magnetic stimulation to improve negative symptoms of schizophrenia. This could mean people with specific subtypes of schizophrenia may not need to take medication in the future if they are not affected by positive symptoms. FHE Health’s Neuro Rehab program is a leader in qEEG mapping, neurostimulation as well as NeruoFeedback.
Research into the biopsychosocial and genetic underpinnings of schizophrenia is consistently leading to more effective treatment methods as neuroscientists continue learning about this complex mental illness. A diagnosis of schizophrenia should not be thought of as a life sentence but as a life changer brimming with hope, optimism and expectations for enjoying a full, rich life.