Schizophrenia

Schizophrenia is a psychotic disorder that often begins in late adolescence or early adulthood. It is an illness of the brain that affects how a person perceives the world, how they think and how they behave. Individuals experiencing schizophrenia have both positive and negative symptoms. Positive symptoms include: delusions, hallucinations as well as disorganized speech and behaviour. These symptoms often alternate with negative symptoms. Common negative symptoms include: blunted affect, flattened affect, alogia, and avolition. Schizophrenia usually takes many years to develop. A person with schizophrenia will often have negative symptoms for a few years before positive symptoms develop.

Schizophrenia sometimes has a genetic component although not always. Birth trauma and fetal damage in utero also increase the risk for schizophrenia. Significant marijuana use may bring on schizophrenia in youth who are at higher risk for the illness.

Schizophrenia is equally as common in men and women. The age of onset is later in women, usually by about 10 years compared to men. Some research suggests that women, tend to have more paranoid delusions and hallucinations, while men are more disorganized and experience more negative symptoms.

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How Do You Know If Someone You Love Has Schizophrenia?

Many young people with schizophrenia will demonstrate a slow and gradual onset of the illness (often over the period of 6-9 months or more).

Early signs include:
• Social withdrawal
• Odd behaviours
• Lack of attention to personal hygiene
• Excessive preoccupation with religious or philosophical constructs
• Young people may share bizarre ideas or may complain of being persecuted by others
• They may begin abusing substances – particularly alcohol and marijuana and develop a substance abuse disorder concurrently
• Difficulty concentrating
• Flattened mood, decreased speech, lack of will

It can sometimes be difficult to distinguish the onset of schizophrenia from other mental disorders such as depression or social anxiety disorders.

Schizophrenia is diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM). For a medical professional to diagnosis someone with schizophrenia the person, must experience at least 6 months total of signs/symptoms AND at least one month of active phase symptoms (hallucinations and delusions).

The individual must also be experiencing severe dysfunction in one or more areas of daily life (social, family, interpersonal, school/work), etc.

What Are Common Types of Delusions?

Delusions are fixed false beliefs., Some of the more common types of delusions are grandiose, persecutory, religious, jealous and somatic delusions. Delusions vary by cultural context.

  • Grandiose: Delusions of inflated worth, power, knowledge, identity or special relationship to a deity or famous person
  • Persecutory: Delusions that the person is being malevolently treated in some way
  • Religious: individual's beliefs revolve around religious themes (e.g. belief that they have been selected by God to carry out his bidding)
  • Jealous: Delusions that the individual's sexual partner is being unfaithful

What Are Common Types of Hallucinations?

Hallucinations are disturbances in perceptions, such as hearing sounds or voices, smelling scents, etc) that may occur in any sensory modality in the absence of an actual sensory stimulus. You hear/smell/see something that isn’t there. People with schizophrenia frequently experience auditory hallucinations, The other types of hallucinations (such as seeing things that are not there) are much less common.

The most common type of auditory hallucinations are:

  • Audible Thoughts: the person hears their thoughts spoken out loud as they think them
  • Voices Arguing or Discussing: the patient hears 2 or more voices discussing or arguing with each other
  • Voices Commenting: the person hears one or more voices commenting on their behaviour, thoughts, speech, appearance, etc. Generally the voices are experienced as intrusive, abusive and critical.
  • Voices Commanding: the patient hears one or more voices instructing them to carry out specific demands. The voices may instruct the patient to do things they usually would not do or say things they usually would not say.

How Does Thinking Change in a Person with Schizophrenia?

Thinking will appear disorganized in both form and content. For example, the pattern of speaking may not make sense to others or what is being said may not make sense or be an expression of delusional ideas.

How Does Behaviour Change in a Person with Schizophrenia?

Behaviour can be disturbed. This can range from behaviours that are mildly socially inappropriate to very disruptive and even threatening behaviours that may be responses to hallucinations or part of a delusion. Self-grooming and self-care may also be compromised.

What are the Criteria for Diagnosis of Schizophrenia?

• Positive Symptoms (delusions, hallucinations, disorganized thinking)
• Negative Symptoms (sadness, few emotions, limited communication, withdrawal, inability to complete tasks)
• Behavioural Disturbances (range from very disruptive to threatening, self care may decline)
• Significant dysfunction in one or more areas of daily life (social, family, interpersonal, school/work, etc)
• These features must last for at least 6 months during which time there must be at least one month of positive symptoms

What Causes Schizophrenia?

Changes in key brain functions, such as thoughts, cognition, perception, emotions, and behaviour, indicate that the brain is the biological site of schizophrenia.

Schizophrenia is linked to structural and functional abnormalities in the brain. There is destruction of neural (brain) tissue (atrophy) centered in the cognitive and emotion regions and thalamus (attention region).

Individuals with schizophrenia have a hard time filtering and processing,information., Frequently, people with schizophrenia experience the,information, coming into their senses as garbled and mixed together. A variety of different neurochemical pathways are involved in schizophrenia., These include the pathways that use the chemicals dopamine and serotonin.,, The limbic system (an area of the brain involved with emotion), the thalamus (which coordinates outgoing messages), the cortex (the part of the brain that houses problem solving and complex thinking) and several other brain regions are affected.

While multiple theories have been put forth regarding the origin of schizophrenia, by far the vast majority of evidence points, a neurodevelopmental model of schizophrenia genesis. Evidence from genetic studies suggest a high degree of heritability of schizophrenia and point to a number of potential candidate genes that may be perturbed early in development leading ultimately to the development of psychotic symptoms. (Genes involved with cell migration, cell proliferation, axonal outgrowth, myelination, synaptogenesis, and apoptosis are affected in subjects with schizophrenia, pointing to either a direct, genetic effect of damage to the brain as it is developing).
 
Brain imaging studies (such as CAT scans and MRI scans) have shown changes in a number of brain regions including the pre-frontal cortex (PFC), cerebellum, hippocampus, and amygdala., There is also strong evidence that prenatal complications and viral infection during pregnancy increases the risk for schizophrenia in the offspring. Recent research findings suggest that a heavy consumption of cannabis may be associated with an increased risk of developing schizophrenia, particularly if there is a genetic predisposition to the illness.

What Can You Do?

A young person with schizophrenia will require immediate effective treatment – usually in a specialty mental health program. As a parent, friend, sibling or loved one you can become educated about the disease and its treatment, show your support to your loved one, and help your loved one get professional care.

You might want to engage in a discussion with the young person in your life, asking them some questions about how they are feeling. These questions might include:
□ Can you tell me what you are concerned about?
□ Do you feel comfortable in school? Your class?
□ Are you having any problems thinking?
□ Are you hearing or seeing things that others may not be hearing or seeing?

Early identification and effective intervention is the key to successfully treating the disorder and preventing future disability. You can aid in helping the young person by arranging a meeting with a qualified health practitioner and making sure that the young person receives a professional diagnosis and appropriate treatment plan., In many cities across Canada and elsewhere, specialized "first onset psychosis" programs are available. These generally can provide the complex treatments that are needed to fully treat the many symptoms of schizophrenia.

What Treatment Options Exist?

To reduce the impact of schizophrenia on the individual early diagnosis couple with appropriate treatment is critical.

During severe psychotic episodes individuals with schizophrenia may require hospitalization to stabilize the person and help them in developing a treatment plan. However, some individuals are able to be helped using intense outpatient treatment.

A person with schizophrenia should leave the hospital or outpatient facility with a treatment plan that will minimize symptoms and maximize quality of life. A comprehensive treatment program should include:

• Antipsychotic medication
• Education & support, for both ill individuals and families
• Social skills training
• Rehabilitation to improve activities of daily living
• Vocational and recreational support
• Cognitive therapy

Other Types of Mental Disorders and Outcomes That May Commonly Occur Alongside Schizophrenia Include:

□ Substance Use and Dependence
Suicide Risk

Resources for Teens and Families

Coping with Suicidal Thoughts
Evidence Based Medicine
Psychosis and Substance Abuse

Other Helpful Resources

□ Schizophrenia Society of Canada

□ Psychosis Sucks

□ Cannabis and Psychosis 

□ National Institute of Mental Health

□ Schizophrenia.com

□ The Road to God Knows -- this website showcases a graphic novel focusing on the life of a youth with schizophrenia

□ Nova Scotia Early Psychosis Program
□ Dealing with Psychosis - Fraser Health
□ Because Your Mind Matters

 

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