Schizophrenia

## Overview

Schizophrenia is a serious brain illness. People who have it may hear voices that aren't there. They may think other people are trying to hurt them. Sometimes they don't make sense when they talk. The disorder makes it hard for them to keep a job or take care of themselves.

Symptoms of schizophrenia usually start between ages 16 and 30. Men often develop symptoms at a younger age than women. People usually do not get schizophrenia after age 45. There are three types of symptoms:

* Psychotic symptoms distort a person's thinking. These include hallucinations (hearing or seeing things that are not there), delusions (beliefs that are not true), trouble organizing thoughts, and strange movements.
* "Negative" symptoms make it difficult to show emotions and to function normally. A person may seem depressed and withdrawn.
* Cognitive symptoms affect the thought process. These include trouble using information, making decisions, and paying attention.

No one is sure what causes schizophrenia. Your genes, environment, and brain chemistry may play a role.

There is no cure. Medicine can help control many of the symptoms. You may need to try different medicines to see which works best. You should stay on your medicine for as long as your doctor recommends. Additional treatments can help you deal with your illness from day to day. These include therapy, family education, rehabilitation, and skills training.

## Symptoms and Onset

Schizophrenia is typically diagnosed in the late teen years to the early thirties and tends to emerge earlier in males (late adolescence – early twenties) than females (early twenties – early thirties). A diagnosis of schizophrenia often follows the first episode of psychosis, when individuals first display symptoms of schizophrenia. Gradual changes in thinking, mood, and social functioning often begin before the first episode of psychosis, usually starting in mid-adolescence. Schizophrenia can occur in younger children, but it is rare for it to occur before late adolescence.

### Positive Symptoms

‘Positive’ symptoms are experienced in addition to reality. These may include:

Hallucinations. These include a person hearing voices, seeing things, or smelling things others can’t perceive. The hallucination is very real to the person experiencing it, and it may be very confusing for a loved one to witness. The voices in the hallucination can be critical or threatening. Voices may involve people that are known or unknown to the person hearing them.

Delusions. These are false beliefs that don’t change even when the person who holds them is presented with new ideas or facts. People who have delusions often also have problems concentrating, confused thinking, or the sense that their thoughts are blocked.

### Negative Symptoms

Negative symptoms are ones that diminish a person’s abilities. Negative symptoms often include being emotionally flat or speaking in a dull, disconnected way. People with the negative symptoms may be unable to start or follow through with activities, show little interest in life, or sustain relationships. Negative symptoms are sometimes confused with clinical depression.

The following are some examples of negative symptoms.

* Lack of motivation
* Losing interest in life and activities
* Problems concentrating
* Not wanting to leave your house
* Changes to your sleeping patterns
* Not wanting to have conversations with people
* Feeling uncomfortable with people
* Feeling that you haven’t got anything to say
* Losing your normal thoughts and feelings
* No energy

### Cognitive Issues

Cognitive issues/disorganized thinking. People with the cognitive symptoms of schizophrenia often struggle to remember things, organize their thoughts or complete tasks. Commonly, people with schizophrenia have anosognosia or “lack of insight.” This means the person is unaware that he has the illness, which can make treating or working with him much more challenging.

## Types of schizophrenia

### Paranoid schizophrenia

* Common form of schizophrenia.
* Prominent hallucinations, particularly hallucinations where you hear voices or sounds.
* Prominent delusions.
* Speech and emotions may be unaffected.

### Hebephrenic schizophrenia

* Irresponsible and unpredictable behaviour.
* Prominent disorganised thoughts.
* Problems with speech.
* Self-isolation.
* Pranks, giggling and health complaints.
* Usually diagnosed in adolescents or young adults.

### Catatonic schizophrenia

* Rarer than other types.
* Unusual movements, often switching between being very active and very still.
* You may not talk at all.

### Simple schizophrenia

* Negative symptoms are prominent early and get worse quickly.
* Positive symptoms are rare.

## Myths and misconceptions

There are some myths or mistaken beliefs about schizophrenia which come from the media. For example,

* ‘Schizophrenia means someone has a split personality’

This is not the case. The mistake may come from the fact that the name 'schizophrenia' comes from two Greek words meaning 'split' and 'mind'.

* ‘Schizophrenia causes people to be violent’

Research shows that only a small number of people with the illness may become violent. The same way as a small minority of the general public may become violent.

People with schizophrenia are far more likely to be harmed by other people than other people are to be harmed by them. But as these incidents can be shocking, the media often report them in a way which emphasises the mental health diagnosis. This can create fear and stigma in the general public.

## How to help

**Educate yourself.** Schizophrenia is a difficult mental illness to understand. So learn as much as you can. The more information you have, the better prepared you will be to deal with it.

**Be Goal-Oriented** A doctor will set up a wellness plan with your loved one that will include specific goals. If you’re not sure who to call to get treatment started, try your family doctor, who may refer you to a psychiatrist.

**Understand and validate.** When your loved one describes their hallucinations or delusions, you might feel uncertain about how to respond. It’s normal to not know what to say, but you can still validate their confusion, frustration, and fear — even when you don’t fully understand their experience. Instead of dismissing these symptoms as lies or stories, remember the things they see, hear, and believe are completely real to them.

**Stay in contact.** Your loved one might lose interest in things they used to enjoy: work or school, hobbies, and spending time with you and other loved ones. Keeping in contact provides your loved with important social and emotional support. Staying connected also gives you the opportunity to encourage them if they seem reluctant to get support or continue treatment.

**Make a crisis plan.** Once they appear, schizophrenia symptoms can come and go throughout life. Creating a plan for what to do when this happens can make it easier to manage symptoms if they return or get worse.

## Resources

https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizophrenia

https://medlineplus.gov/schizophrenia.html

https://www.nimh.nih.gov/health/topics/schizophrenia

https://www.webmd.com/schizophrenia/schizophrenia-and-family

https://www.healthline.com/health/schizophrenia/how-to-help-someone-with-schizophrenia#stay-in-touch

https://www.helpguide.org/articles/mental-disorders/helping-someone-with-schizophrenia.htm