Schizophrenia Health Article

Definition

Schizophrenia is a mental disorder. It difficult for a person to tell the difference between real and unreal experiences, to think logically, to have normal emotional responses to others, and to behave normally in social situations.

Causes, incidence, and risk factors

Schizophrenia is a complex and puzzling illness. Even the experts in the field are not exactly sure what causes it. Some doctors think that the brain may not be able to process information correctly.

Genetic factors appear to play a role, as people who have family members with schizophrenia may be more likely to get the disease themselves. Some researchers believe that events in a person's environment may trigger schizophrenia. For example, problems during intrauterine development (infection) and birth may increase the risk for developing schizophrenia later in life.

Psychological and social factors may also play some role in its development. However, the level of social and familial support appears to influence the course of illness and may be protective against relapse.

There are 5 recognized types of schizophrenia: catatonic, paranoid, disorganized, undifferentiated, and residual. Features of schizophrenia include its typical onset before the age of 45, continuous presence of symptoms for 6 months or more, and deterioration from a prior level of social and occupational functioning.

People with schizophrenia may show a variety of symptoms. Usually the illness develops slowly over months or even years. At first, the symptoms may not be noticed. For example, people may feel tense, may have trouble sleeping, or have trouble concentrating. They become isolated and withdrawn, and they do not make or keep friends. As the illness progresses, psychotic symptoms develop:

• Delusions - false beliefs or thoughts with no basis in reality
• Hallucinations - hearing, seeing, or feeling things that are not there
• Disordered thinking - thoughts "jump" between completely unrelated topics (the person may talk nonsense)
• Catatonic behavior - bizarre motor behavior marked by a decrease in reactivity to the environment, or hyperactivity that is unrelated to stimulus
• Flat affect - an appearance or mood that shows no emotion

No single characteristic is present in all types of schizophrenia. The risk factors include a family history of schizophrenia. Schizophrenia is thought to affect about 1% of the population worldwide.

Schizophrenia appears to occur in equal rates among men and women, but women have a later onset. For this reason, males tend to account for more than half of patients in services with high proportions of young adults. Although the onset of schizophrenia is typically in young adulthood, cases of the disorder with a late onset (over 45 years) are known.

Childhood-onset schizophrenia begins after the age of 5 and, in most cases, after relatively normal development. Childhood schizophrenia is rare and can be difficult to differentiate from other pervasive developmental disorders of childhood, such as autism.

Symptoms

Catatonic type:

• Motor disturbances
• Stupor
• Negativism
• Rigidity
• Agitation
• Inability to take care of personal needs
• Decreased sensitivity to painful stimulus

Paranoid type:

• Delusional thoughts of persecution or of a grandiose nature
• Anxiety
• Anger
• Violence
• Argumentativeness

Disorganized type:

• Incoherence (not understandable)
• Regressive behavior
• Flat affect
• Delusions
• Hallucinations
• Inappropriate laughter
• Repetitive mannerisms
• Social withdrawal

Undifferentiated type: Patient may have symptoms of more than one subtype of schizophrenia.

Residual type: Prominent symptoms of the illness have abated, but some features - such as hallucinations and flat affect - may remain.

Signs and tests

Because other diseases can also cause symptoms of psychosis, psychiatrists should make the final diagnosis. The diagnosis is made based on a thorough psychiatric interview of the person and family members. As yet, there are no defining medical tests for schizophrenia. The following factors may suggest a schizophrenia diagnosis, but do not confirm it:

• Developmental background
• Genetic and family history
• Changes from level of functioning prior to illness
• Course of illness and duration of symptoms
• Response to pharmacological therapy

CT scans of the head and other imaging techniques may identify some changes associated with schizophrenia in the research literature and may rule out other neurophysiological disorders.