Schizophrenia is a serious mental disorder in which people lose the ability to interpret reality in a normal way. It is a disorder that affects a person’s ability to think, feel and behave normally. Schizophrenia usually results in a combination of delusions, hallucinations, and mental disorientation that impairs thinking and behavior, this affects day to day functioning, and can be disabling.
Schizophrenia is named from the Greek words ‘schizein’ and ‘phren’ which mean ‘to split’ and ‘mind’, respectively. The early definition of schizophrenia literally translated to ‘the fragmentation of psychological functioning’. Hence, for schizophrenics, ‘the personality loses its unity’.
Schizophrenia is a psychotic disorder. This means that it is a disorder relating to the mind.
Schizophrenia is marked by the following symptoms:
Positive Symptoms of Schizophrenia:
Positive symptoms are highly exaggerated perceptions, ideas, or actions. The person has trouble differentiating what’s real from what isn’t. “Positive” here means the presence (rather than absence) of symptoms. They can include:
Delusions are erroneous beliefs. These beliefs are often misinterpreted. Schizophrenic individuals experience delusions which vary in terms of content, these are:
Thought broadcasting (“My private thoughts are being transmitted to others”).
Thought insertion (“Someone is planting thoughts in my head”) and,
Thought withdrawal (“The CBI is robbing me of my thoughts”).
Delusions occur in the ‘mind’ but hallucinations depend on the five senses. Auditory hallucinations are most common. It involves hearing voices not belonging to the individual. Threatening voices as well as two or more voices ‘talking’ to each other are common.
Disorganized thinking for schizophrenics can have many forms like:
This is marked by problems when it comes to goal-directed behavior, manner of dressing, and catatonic behaviors. In this case, a schizophrenic individual may find it difficult to complete activities like bathing and dressing properly in order to go to school or to work, and may display agitated behavior even when no environmental triggers are present.
In terms of catatonic or disorganised behaviors, a schizophrenic individual may display any or all of the following:
Negative Symptoms of Schizophrenia:
Negative symptoms refer to an absence or lack of normal mental function involving thinking, perception and behavior. You might notice:
unresponsive, coupled with poor eye contact and reduced bodily language.
fluency and productivity. (It is different from unwillingness to speak which requires a different clinical intervention altogether).
The associated negative symptoms for schizophrenia are:
The other associated features of schizophrenia are:
with his or her thoughts
symptoms are severe
In order for schizophrenia to be diagnosed, an individual must meet certain requirements of symptoms as set by DSM – 5. The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) is the result of effort by hundreds of international experts in all aspects of mental health for more than 10 years.
There are five sets of criterions that need to be considered:
Criterion A. An individual must meet two of the five criterions set forth, and at least
one of the first three:
Criterion B. There must be a deterioration in the individual from a previous level of functioning in areas of life such as self-care, social relations, and work.
Criterion C. Schizophrenic tendencies must be experienced by the individual for at least six months. Such duration should include a manifestation of the symptoms listed
in Criterion A.
Criterion D. There must be a manifestation of a full manic or depressive syndrome in the individual as defined by Criteria A and B of the major manic or depressive episode.
Criterion E. The disorder must have been active before the age of 45.
Criterion F. The symptoms must not be due to mental retardation or any organic
In sum, the diagnosis of schizophrenia involves two things:
➔ First is that the symptoms displayed must not be indicative of other mental disorders; and
➔ Second, that the symptoms should not result from substance abuse, a medical condition or medication. For the former, other mental disorders must be ruled out before the finalization of the diagnosis.
CAUSES OF SCHIZOPHRENIA
Let’s take a look at the risks and the triggers that lead to the manifestation of schizophrenic symptoms.
research on identical twins.
Research data suggests the following incidence rates:
Though there are other risk factors and triggers that need to be considered before a diagnosis is deemed final.
Studies are indicative of differences in the brain structure of those who are diagnosed with schizophrenia, although these differences are subtle. Overall, the findings have led to the contention that schizophrenia may partly be a brain development disorder.
Pregnancy and Complications at Birth
➔ The risk factors discussed above only show some of the possible causes of schizophrenia.
➔ They cannot be considered as sole determinants in building a person’s disorder history. They should also not become the single-handed basis for planning treatment.
➔ It is best to consult with a psychological professional for proper intervention if one suspects having schizophrenia.
‘Triggers’ represent the precursors to the development of schizophrenic symptoms and do not directly cause schizophrenia.
Emotionally-charged events usually cause high levels of stress. These include death and consequent bereavement, the loss of a home or a job, the end of a marriage or a relationship, and different forms of abuse such as physical, emotional, and sexual.
Drug Misuse and Abuse
Schizophrenia requires lifelong intervention even when its symptoms have ceased to manifest. There is no cure for schizophrenia, though there are various types of interventions designed to help manage its symptoms.
These are medical and psychosocial therapy.
On top of these, hospitalization may also be required to ensure that the affected individual gets proper nutrition and enough sleep. Hospitalization ensures
safety of the individual, especially when the symptoms are severe and may be necessary in order to prevent the individual from neglecting physical hygiene.
Antipsychotic drugs are the most commonly used medications in managing
schizophrenic symptoms. Problems in the brain’s neurotransmitters can lead to the manifestation of schizophrenic symptoms, antipsychotic medications are administered in order to balance neurotransmitter levels, especially dopamine.
A psychiatrist may try multiple antipsychotic drugs, and possibly a combination of them in order to determine which works best for a patient. At times, antipsychotic drugs
can also be combined with other types of drugs such as anti-anxiety medication, or
These medicines have side effects so it’s important that an individual discusses
what these are with the psychiatrist. Also, not all patients are always willing to take pills, some may prefer injections as the mode of administration.
Psychosocial (psychological and social) interventions should be implemented along with medical treatment. The following are the types of interventions that may be implemented once the schizophrenic symptoms have subsided:
This helps the person to spot early warning signs of schizophrenic symptom relapse and also helps to realign the person’s thought processes with objective reality. Learning how to spot signs of a relapse shall help the individual to manage themselves until professional help becomes available. It also helps to normalize an individual’s thought processes, enabling them to recognize what’s real and what’s not.
Also known as CBT, it is aimed at changing an individual’s thoughts and behavior. Delusions and hallucinations cause irrational thoughts. An individual can be taught how to manage such delusional and hallucinatory thoughts by undergoing CBT. It includes being aware of the triggers and how to respond in order to minimize their effects.
Also known as CET and ‘cognitive remediation’, this approach teaches individuals how to better identify social triggers that lead to psychotic episodes. Upon identifying triggers, the individuals are taught how to reorganize their thought processes, attention and memory. This therapy integrates computer-based training into the overall procedure.
Immediate family of a schizophrenic patient also needs support, and as such, the importance of going through family therapy cannot be understated. Some of the things that will be discussed during the therapy include coping strategies,
information about the disorder, strategies for dealing with a schizophrenic person, and also learning how to prevent emotional breakdowns. Family members should be aware that they partly play a role towards an affected member’s road to effective recovery. They must learn how to properly relate with a schizophrenic person.
Upon being diagnosed with schizophrenia a person will notice changes in the way he or she relates to the people around them, as well as how they deal with the day to day demands of life. Though a small number of schizophrenics fully recover and get reintegrated into the society, it’s not usually the case for most. As schizophrenic symptoms are recurring, affected individuals need to learn to make adjustments in order to apply themselves adequately socially. They’ll be an active player in their daily routines by doing so.
Affected persons may find it difficult to keep their regular jobs because of the nature of the symptoms of schizophrenia. Which will be even more likely in case their jobs are stressful and demanding. There’s no telling about the recurrence and severity of an individual’s symptoms, this may cause issues that can affect their employment. For these very reasons it is better if schizophrenic individuals work in jobs that are fit to their circumstances and their condition. Thus, the goal of vocational training and rehabilitation is to prepare them for the prospect of employment, finding employment, and staying in such employment. It’s also useful for individuals with schizophrenia to reach out to their communities.
This is especially true if their communities offer support programs for people affected by schizophrenia.
‘Comorbidity’ is the ‘simultaneous presence’ or ‘co-occurrence’ of two or more chronic disorders in the same individual. Some schizophrenic symptoms are similar to other psychotic disorders due to which there’s a high chance of comorbidity. This means that
a schizophrenic individual can develop other mental disorders, or that other mental disorders can lead to schizophrenia.
Based on research findings, the following disorders may coexist with
➔ The underlying concepts related to comorbidity are experiences, symptoms and habits.
➔ Other mental disorders have similar features, just like Schizophrenia, thereby sharing similar symptoms. It’s important for this reason to arrive at a definite diagnosis by performing different types of tests.
➔ An individual’s experiences also play a role in comorbidity. For example, an individual diagnosed with PTSD can develop a heightened sense of awareness or hypervigilance perceiving pending danger even when such danger isn’t really present. Such Hypervigilance, if it becomes severe, can cause delusions and hallucinations in a person.
➔ Habits too can spur comorbidity. Research for Schizophrenia has found that those who develop the disorder often had a history of substance abuse.
Why Comorbidity Matters
Knowledge about comorbidity matters due to the following reasons:
when the diagnosis is a mental disorder.
found that people having comorbid mental disorders respond poorly to treatment, the course of their disorder even worsened over time. Thus it can give clinical
insights as to how treatment should be structured for such people.
Living with a Schizophrenic
Remember the following points if you are a family member of someone who has been diagnosed with schizophrenia:
You should not compare your loved one’s progress with that of others. See if there’s something that you can do to help your loved one. Always consult with the doctor first for validation when doing something out of the recommended treatment plan.
emotions in schizophrenics are caused by their symptoms. It will be normal for you to react, but remember that reacting is different from responding.
When your family member has a psychotic episode, remember to not:
Doing so will give him or her a sense of control.
Instead, aim to:
You can also lessen the likelihood of a relapse through the following:
Communicating with a Schizophrenic
The external environment is often overwhelming for a schizophrenic. Effective communication is key to ‘calming’ them down. This is a skill that you will have to learn when you talk to a person with schizophrenia (or with any mental disorder).
Three elements of good communication are:
Knowing when to talk
Knowing what to talk about
Knowing how to talk