survival8: Understanding Schizophrenia

Understanding Schizophrenia

(Self-portrait of a person with schizophrenia, representing that individual's perception of the distorted experience of reality in the disorder)

The word "Schizophrenia" was coined by Paul Eugen Bleuler (30 April 1857 – 15 July 1939), it is derived from two Greek words "skhizein" meaning "to split" and "phren" meaning "mind".

Few definitions of this word:
A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation. (Google Dictionary)

Schizophrenia is a mental disorder characterized by abnormal social behavior and failure to understand what is real. Common symptoms include false beliefs, unclear or confused thinking, hearing voices that others do not hear, reduced social engagement and emotional expression, and a lack of motivation. People with schizophrenia often have additional mental health problems such as anxiety disorders, major depressive illness, or substance-use disorders. Symptoms typically come on gradually, begin in young adulthood, and last a long time. (Wikipedia)

Confusing, yeah, let me start over...

Schizo means to split, phrenia in this case refers to the mind even though schizophrenia can be interpreted to mean splitting of the mind, it does not refer to the split personality like some media sources might portray. Rather schizophrenia describes scattered or fragmented pattern of thinking.

Schizophrenia is actually a syndrome meaning there are all sorts of symptoms that might be associated with it and different patients might experience different symptoms. Although symptoms can be broadly categorized under three major areas: positive symptoms, negative symptoms and cognitive symptoms.

Alright, taking a step back, most human symptoms from any illness are extreme version of a normal physiological process for example everyone has a heartbeat, right, tachycardia is a fast heartbeat. In the same way, everyone has a normal body temperature but during a fever, that temperature is higher.

In schizophrenia, patients have positive symptoms, which aren't positive is the sense that they are helpful but positive in the sense they are some new feature that does not have a normal or physiologic counterpart.

These are psychotic symptoms such as delusions, hallucinations, disorganized speech and disorganized or catatonic behavior; none of which occur physiologically.

Delusions are false beliefs that the person might feel very strongly about so much so that they will not change their mind even if you gave them evidence against it. There are all sorts of different delusions like for example a delusion of control where somebody thinks that some outside source or person or thing is controlling their actions.

There can be delusions of reference where someone might think that insignificant remarks are directed at them, like a newscaster is speaking directly to them through the TV.

Hallucinations are a second type of positive symptoms and there can be any kind of sensation that is not actually there, including visual but also including auditory sensations like hearing voices or commands.

A third type is disorganized speech, an example being something like a word salad which seems just like a random jumbling of the words or phrases like "pencil, dog, hat, coffee, blue!"

Disorganized behavior, on the other hand, could be like an exhibit of bizarre or silly behavior that is out of context and does not seem to have much of a purpose, like for example, wearing multiple layers of jackets on a hot summer day. Also sometimes, there may be behavior that is described as catatonic, which has to do with their movements, postures and responsiveness. So like, they might be super resistant to moving or being an unresponsive stupor.

Negative symptoms are when there is reduction or removal of normal processes. In addition, this is like a decrease in emotions that they can express or a loss in interest in things that they once found interesting.

One type of negative symptom is called flat affect where they do not respond with an emotional reaction, which would seem inappropriate. Like if they saw something very unexpected like a small monkey playing in the living room, they might simply sit and watch idly as if nothing was happening.

Another type is alogia or poverty of speech, which a lack of content in their speech so like if somebody asked them "Do you have any children?", they might respond with "Yes.", instead of "yeah, one boy and two girls".

A third type of negative symptom is avolition, which is the decrease in motivation to complete certain goals so some of them might stay at home for a long period of time without trying to reach out the friends or find work.

Cognitive symptoms are like not being able to remember things, learn new things or understand other things easily. These symptoms are more subtle though, they are more difficult to notice and might only be detected if there are really specific tests for them. Example would be somebody not being able to keep track of several things at once, like a phone number and an address.

People with schizophrenia seem to cycle through three phases, typically in order. During the prodromal phase, patients might become withdrawn and spend most of their time alone and a lot of times, it seems similar to other mental disorders like depression or anxiety disorder. During the active phase, patients experience more severe symptoms like delusions, hallucinations, disorganized speech, disorganized behavior or catatonic behavior. Following an active phase, patients are often enter into a residual phase where they might exhibit cognitive symptoms like not being able to concentrate or becoming withdrawn again as with the prodromal phase.

For an official diagnosis of schizophrenia (DSM-V), patients need to be diagnosed with two of the following:

1. Delusions

2. Hallucinations

3. Disorganized speech

4. Disorganized / catatonic behavior

5. Negative symptoms

Also, at least one of them has to be one of these:

1. Delusions

2. Hallucinations

3. Disorganized speech

So basically, they could not have just disorganized behavior and negative symptoms. Even though some patients might have cognitive symptoms as well, they are not specifically needed for diagnosis. Also though for a diagnosis, signs of these disturbances must be ongoing for at least 6 months, meaning that they are likely in one phase or another for a period of 6 months but there must be at least one month of “active” phase symptoms.

Finally, those symptoms cannot be attributed to another condition, like substance abuse.

Now that we have diagnosed it, why does it even happen in the first place? What causes schizophrenia? Well, researchers do not really know, since it seems that signs and symptoms of schizophrenia are pretty unique to humans, or at least they are hard to imagine or notice in animal models like mice or rats (“Is this rat delusional?”). One clue is that that majority of anti-psychotic medication that improves schizophrenia symptoms blocks the dopamine receptors “D2” which reduces dopamine levels in neurons. This thing suggests may be schizophrenia has something to do with the increased levels of dopamine. These medications are though neither universally nor completely effective and do not work for everyone with schizophrenia which adds to the confusion that there is probably more to the story than just the D2 receptors. Interestingly, one of the most effective anti-psychotic drugs is a weak D2 antagonist (blocker) so just seems that other neurotransmitter systems norepinephrine, serotonin and GABA are probably involved.

Twin studies have shown to support the genetic basis as well, even though there have not been any specific genes conclusively linked to schizophrenia yet.

In addition, environmental factors like early/prenatal exposure to infections, and certain autoimmune disorders like celiac disease have been linked with schizophrenia.

Finally, an important set of clues involve the epidemiology, schizophrenia seems to happen slightly more in men than in women with onset in the mid-twenties for men but late twenties for women and a clinical signs for schizophrenia are often less severe. Some studies suggest differences might be due to estrogen regulation of dopamine systems. There however does not seem to be any difference among the race.

Now treating schizophrenia can be really tricky and anti-psychotic medications are often used but it is super important to combine the efforts of several explanations/disciplines and health professionals including professionals in therapy and counseling, medicine, and psychopharmacology. Anti-psychotics can be very effective at reducing symptoms but they often come with a lot of additional considerations to keep in mind like cost and potential for unwanted side effects like tolerance, dependency or withdrawal.

Final word, schizophrenia is not curable but treatable and could last life long. It is a serious mental illness that is diagnosed to 3.2 million people in the population every year. About 0.3–0.7% of people are affected by schizophrenia during their lifetimes. In 2013, there were an estimated 23.6 million cases globally. About 20% of people do well, and a few recover completely.