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Schizophrenia
Definition
Schizophrenia is a mental disorder that makes it hard to:
- Tell the difference between what is real and not real
- Think clearly
- Have normal emotional responses
- Act normally in social situations
Alternative Names
Childhood-onset schizophrenia
Causes
Schizophrenia is a complex illness. Mental health experts are not sure what causes it. However, genes may play a role.
- Certain events may trigger schizophrenia in people who are at risk for it because of their genes.
- You are more likely to develop schizophrenia if you have a family member with the disease.
Schizophrenia affects both men and women equally. It usually begins in the teen years or young adulthood, but it may begin later in life. It tends to begin later in women, and is more mild.
Childhood-onset schizophrenia begins after age 5. Childhood schizophrenia is rare and can be hard to tell apart from other developmental problems in childhood, such as autism.
Symptoms
Schizophrenia symptoms usually develop slowly over months or years. Sometimes you may have many symptoms, and at other times you may only have a few symptoms.
People with any type of schizophrenia may have trouble keeping friends and working. They may also have problems with anxiety, depression, and suicidal thoughts or behaviors.
At first, you may have the following symptoms:
- Irritable or tense feeling
- Trouble concentrating
- Trouble sleeping
As the illness continues, you may have problems with thinking, emotions, and behavior, including:
- Bizarre behaviors
- Hearing or seeing things that are not there (hallucinations)
- Isolation
- Lack of emotion (flat affect)
- Problems paying attention
- Strongly held beliefs that are not real (delusions)
- Thoughts that "jump" between different topics (“loose associations”)
Symptoms depend on the type of schizophrenia you have.
Paranoid schizophrenia symptoms may include:
- Anxiety
- Anger or arguing
- False beliefs that others are trying to harm you or your loved ones
Disorganized schizophrenia symptoms may include:
- Childlike behavior
- Problems thinking and explaining your ideas clearly
- Showing little emotion
Catatonic schizophrenia symptoms may include:
- Grimacing or other odd expressions on the face
- Lack of activity
- Rigid muscles and posture
- Not responding much to other people
Undifferentiated schizophrenia may include symptoms of more than one other type of schizophrenia.
Exams and Tests
There are no medical tests to diagnose schizophrenia. A psychiatrist should examine you to make the diagnosis. The diagnosis is made based on an interview of you and your family members.
The health care provider will ask questions about:
- How long the symptoms have lasted
- How the ability to function has changed
- Developmental background
- Genetic and family history
- How well medications have worked
Brain scans (such as CT or MRI) and blood tests may help rule out other conditions that have similar symptoms.
Treatment
During an episode of schizophrenia, you may need to stay in the hospital for safety reasons.
MEDICATIONS
Antipsychotic medications are the most effective treatment for schizophrenia. They change the balance of chemicals in the brain and can help control symptoms.
These medications are usually helpful, but they can cause side effects. Many side effects can be managed, and they should not prevent you from seeking treatment for this serious condition.
Common side effects from antipsychotics may include:
- Dizziness
- Feelings of restlessness or "jitters"
- Sleepiness (sedation)
- Slowed movements
- Tremor
- Weight gain
Long-term use of antipsychotic medications may increase your risk for a movement disorder called tardive dyskinesia. This condition causes repeated movements that you cannot control, especially around the mouth. Call your health care provider right away if you think you may have this condition.
When schizophrenia does not improve with several antipsychotics, the medication clozapine can be helpful. Clozapine is the most effective medication for reducing schizophrenia symptoms, but it also tends to cause more side effects than other antipsychotics.
Schizophrenia is a life-long illness. Most people with this condition need to stay on antipsychotic medication for life.
SUPPORT PROGRAMS AND THERAPIES
Supportive therapy may be helpful for many people with schizophrenia. Behavioral techniques, such as social skills training, can be used to improve social and work functioning. Job training and relationship-building classes are important.
Family members of a person with schizophrenia should be educated about the disease and offered support. Programs that offer outreach and community support services can help people who lack family and social support.
Family members and caregivers are often encouraged to help people with schizophrenia stay with their treatment.
It is important that the person with schizophrenia learns how to:
- Take medications correctly and manage side effects
- Notice the early signs of a relapse and what to do if symptoms return
- Cope with symptoms that occur even while taking medication (a therapist can help)
- Manage money
- Use public transportation
Outlook (Prognosis)
The outlook with schizophrenia is hard to predict. Most of the time, symptoms improve with medication. However, some people may have trouble functioning and are at risk for repeated episodes, especially during the early stages of the illness.
People with schizophrenia may need housing, job training, and other community support programs. People with the most severe forms of this disorder may not be able to live alone. They may need to live in group homes or other long-term, structured residences.
Symptoms will return if you do not take your medication.
Possible Complications
Having schizophrenia increases your risk for:
- Developing a problem with alcohol or drugs: This is called a substance abuse problem. Using alcohol or other drugs increases the chances your symptoms will return.
- Physical illness: People with schizophrenia may become physically sick, because of an inactive lifestyle and side effects from medication. A physical illness may not be detected because of poor access to medical care and difficulties talking to health care providers.
- Suicide
When to Contact a Medical Professional
Call your health care provider if:
- Voices are telling you to hurt yourself or others.
- You feel the urge to hurt yourself or others.
- You are feeling hopeless or overwhelmed.
- You are seeing things that aren't really there.
- You feel you cannot leave the house.
- You are unable to care for yourself.
Prevention
There is no known way to prevent schizophrenia.
You can prevent symptoms by taking your medication exactly as your doctor told you to. Symptoms will return if you stop taking your medication.
Always talk to your doctor if you are thinking about changing or stopping your medications. See your doctor or therapist regularly.
References
Freudenreich O, Weiss AP, Goff DC. Psychosis and schizophrenia. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 28.
Lyness JM. Psychiatric disorders in medical practice. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 404.
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
