Schizophrenia Health Article

Definition

Schizophrenia is the most chronic and disabling of the severe mental disorders, associated with abnormalities of brainstructure and function, disorganized speech and behavior, delusions, and hallucinations. It is sometimes called a psychotic disorder or a psychosis.

Description

People diagnosed with schizophrenia do not always have the same set of symptoms; in addition, a given patient's symptoms may change over time. Since the nineteenth century, doctors have recognized different subtypes of the disorder, but no single classification system has gained universal acceptance. Some psychiatrists prefer to speak of schizophrenia as a group or family of disorders ("the schizophrenias") rather than as a single entity. A standard professional reference, The Diagnostic and Statistical Manual of Mental Disorders(also known as the DSM-IV-TR)acknowledges that its present classification of subtypes is not fully satisfactory for either clinical or research purposes, and states that "alternative subtyping schemes are being actively investigated."

The symptoms of schizophrenia can appear at any time after age six or seven, although onset during adolescence and early adult life is the most common pattern. There are a few case studies in the medical literature of schizophrenia in children younger than five, but they are extremely rare. Schizophrenia that appears after age 45 is considered late-onset schizophrenia. About 1%–2% of cases are diagnosed in patients over 80.

The onset of symptoms in schizophrenia may be either abrupt (sudden) or insidious (gradual). Often, however, it goes undetected for about two to three years after the onset of diagnosable symptoms, because the symptoms occur in the context of a previous history of cognitive and behavioral problems. The patient may have had panic attacks, social phobia, or substance abuse problems, any of which can complicate the process of diagnosis. In most cases, however, the patient's first psychotic episode is preceded by a prodromal (warning) phase, with a variety of behaviors that may include angry outbursts, withdrawal from social activities, loss of attention to personal hygiene and grooming, anhedonia (loss of one's capacity for enjoyment), and other unusual behaviors. The psychotic episode itself is typically characterized by delusions, which are false but strongly held beliefs that result from the patient's inability to separate real from unreal events; and hallucinations, which are disturbances of sense perception. Hallucinations can affect any of the senses, although the most common form of hallucination in schizophrenia is auditory ("hearing voices"). Autobiographical accounts by people who have recovered from schizophrenia indicate that these hallucinations are experienced as frightening and confusing. Patients often find it difficult to concentrate on work, studies, or formerly pleasurable activities because of the constant "static" or "buzz" of hallucinated voices.

There is no "typical" pattern or course of the disorder following the first acute episode. The patient may never have a second psychotic episode; others have occasional episodes over the course of their lives but can lead fairly normal lives otherwise. About 70% of patients diagnosed with schizophrenia have a second psychotic breakdown within five to seven years after the first one.

Some patients remain chronically ill; of these, some remain at a fairly stable level while others grow steadily worse and become severely disabled.

About 20% of patients with schizophrenia recover the full level of functioning that they had before the onset of the disorder, according to NIMH statistics; but the remaining 80% have problems reintegrating into mainstream society. These patients are often underachievers in school and in the workplace, and they usually have difficulty forming healthy relationships with others. The majority (60%–70%) of patients with schizophrenia do not marry or have children, and most have very few friends or social contacts. The impact of these social difficulties as well as the stresscaused by the symptoms themselves is reflected in the high suiciderate among patients with schizophrenia. About 10% commit suicide within the first 10 years after their diagnosis— a rate 20 times higher than that of the general population.