Is This REALLY Happening?

Schizophrenia is the most disabling and major mental illness, affecting 1.1% of the US population. That
is 2.6 million adults, 40% of which are untreated. This brain disease is a real illness with a biological basis and
cannot be learned.
Schizophrenia distorts the way a person thinks, acts, expresses emotions, perceives reality, and reacts
to others. They often have problems functioning in society, at work, at school, and in relationships. Due to
these difficulties there are 3.9% of state prison inmates living with schizophrenia. 200,000 or the 600,00
homeless population also have schizophrenia or manic-depressive disorder, that’s one third. The disease is
life-long, and has no cure. It can only be controlled if the person has proper treatment.
Schizophrenia is considered a type of psychosis, where the individual cannot tell what is real from what
is imagined. In a sense they lose touch with reality, and this can be frightening. There are sudden shifts in
personality or behavior when they lose touch with reality, this is called a psychotic episode. Schizophrenia can
vary in severity. They can have one episode or many, and may experience decline in time between relapses
and remissions.
Symptoms usually start occurring during hormonal and physical changes, especially in males. Onset for
men is usually in late teens to early 20’s, where as women it’s a little later being early 20’s to 30’s. Onset can
start in children as little as 5 years old, but these are extremely rare cases. The first rise of symptoms before
onset of full psychosis is the prodromal period. This period can last days, weeks, or years. The changes are
subtle especially in the teen years.
- Changes in grades
- Social withdrawal
- Trouble concentrating
- Temper flares
- Difficulty sleeping
Once full psychosis appears you will see symptoms in categories of positive and negative, with also some
disorganized and cognitive symptoms.
Positive symptoms don’t mean “good”, what it means is that behavior or stimuli are added to the
norm. Some of the positive symptoms are:
- Delusions
o Strange beliefs not based in reality
 Ex: People can hear their thoughts, or aliens control their brain
- Hallucinations
o Perceiving sensations that aren’t real (visual, audio, tactile, smell, taste)
o Voices are the most common hallucination for Schizophrenics, seconded by visual
hallucinations
o Voices are usually negative comments in nature, or commands
- Catatonia
o Physically fixed in a single position for long periods of time (almost as if paralyzed or in a
coma)
Delusions and hallucinations are internal phenomena that can be discovered only by asking. Patients respond
to internal stimuli by looking around the room when no one is present, carrying on a conversation alone, or
behaving or interacting as if someone is present.
Negative symptoms in the same do not mean “bad”, they are the absence of behavior or stimuli. Some
of these symptoms include:
- Lack/Limited range of emotion
- Withdrawal from family, friends, and social activities
- Lack of energy
- Reduced speech
- Lack of motivation
- Loss of pleasure or interest in life
- Poor hygiene and grooming habits
Disorganized symptoms are shown through disorganized behavior and speech that include disturbance
in emotional expression. Some of these symptoms include:
- Nonsense words
- Subject shifting
- Inability to make decisions
- Writing excessively without meaning
- Forgetful/Losing items
- Repeating (phrases, or movement)
o Pacing/Walking in circles
Cognitive symptoms involve problems with concentration and memory that can be just as disabling as
the other symptoms. These symptoms include:
- Poor executive functioning
o Can’t understand information and use it to make decisions
- Trouble focusing
- Difficulty with working memory
o Can’t use information immediately after learning it
Although we are not 100% sure what causes schizophrenia, we do have some idea of roles that may
play into the disease.
- Genetics
- Brain Chemistry/Circuits
o Abnormal regulation of neurotransmitters (glutamate, GABBA, Dopamine)
o Trouble with glia supporting nerve cells within brain circuits
- Brain abnormality
o Abnormal brain structures or function
 Not found in all cases of schizophrenia
- Environmental factors
o Viral infection
o Extensive exposure to toxins like marijuana
o Highly stressful situations
  These environmental factors may trigger those with an inherited tendency to
develop schizophrenia
When a physician sees someone that has some of these symptoms they will first start out with a
medical history assessment. This is to see if there are any significant mental health or illness ties to family
members. Since there are no diagnostic tests to diagnose Schizophrenia the physician will then try and rule
out other diseases, illnesses, or intoxications. This will be done with blood testing, and possible brain imaging.
If there are no explainable ties to why these symptoms are happening then they will most likely be referred to
a psychiatrist or other mental health professional.
The psychiatrist will evaluate the patient using The Diagnostic and Statistical Manual IV-TR (Criterion
A). Two or more symptoms from the Criterion A must be present for a significant portion of time during a 1-6
month period. These include:
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
Only one Criterion A symptom is required if the delusions are bizarre or hallucinations consist of a single-voice
running commentary on the persons behavior or thought, or two or more voices are conversing with each
other.
The goal of treatment is to reduce symptoms and decrease chance of relapse. This is done through a
few different avenues. One major step in treatment is the right medication regimen. The first line in
medication treatment is antipsychotics. These block dopamine receptors and relieve delusions, hallucinations,
and thinking problems. There are two different types of antipsychotics. The “older” medications are classified
as first generation antipsychotics, while the “newer” medications are second generation antipsychotics.
First generation
- Chlorpromazine
- Fluphenazine
- Haloperidol
- Loxapine
- Perphenazine
- Thioridazine
- Thiothixine
- Trifluperazine
First generation antipsychotics have turned into the second line of defense over the years due to their
extreme benefits and risks weighing. They have a high incidence of EPS (extrapyramidal symptoms) which
include dyskinesia, akathisia, and parkinsonism (Parkinson like effects). The second generation antipsychotics
have been termed a little safer for use, but have their own set of issues such as metabolic syndrome.
Second Generation
- Abilify
- Clozapine
 - Latuda
- Zyprexa
- Seroquel
- Risperdal
- Geodon
Another section of treatment for Schizophrenia is CSC (Coordinated specialty care). This is geared more
toward first onset of symptoms. It combines medicine, therapy, social services, employment, and educational
interventions. Family is heavily involved in this treatment as much as possible. Psychosocial therapy is to help
with behavioral, psychological, social, and occupational problems. It manages symptoms, identifies early signs
of relapse, and helps them develop a prevention plan. Psychosocial therapy has many dynamics which
include:
- Rehabilitation
o Regain social skills and independence
- Cognitive remediation
o Strengthen attention
- Individual psychotherapy
o Helps client understand illness and cope
- Family therapy
o Helps family deal more effectively with their loved one
- Group therapy and support groups
o Continuing mutual support
If the person is critical, or a danger to self or others hospitalization may be a consideration. These inpatient
visits will help stabilize the critical condition and provide guidance to follow-up. Some alternative therapies
that are still new to scene include ECT and DBS. ECT (Electroconvulsive therapy) is conducted under general
anesthesia. This an approach where electrodes are placed on the clients scalp and shocks are delivered to the
brain. This causes controlled seizures that can improve mood and thinking over time. These treatments
usually run 2-3 times per week for several weeks. Although this isn’t the first line of treatment for
schizophrenia (more used in depressive or manic disorders) it has been know to help some cases where other
treatment was unsuccessful. DBS (deep brain stimulation) is still in study but has shown some effect on
schizophrenia. It is a neurological procedure where electrodes are surgically implanted to stimulate different
brain areas (some of which that produce neurotransmitters). This is mostly successful in treating Parkinson’s
Disease, but shows some promise in this area as well.