What is Schizophrenia?
Schizophrenia is a mental disorder that can be diagnosed by a mental health professional. When someone has schizophrenia they might show symptoms of:
Let’s start by defining what all of these different symptoms are.
Delusions are strongly held false beliefs. People with schizophrenia often cannot be dissuaded of these delusions no matter how much evidence is presented to them. These false beliefs often center around different themes. The most common themes for delusions are persecution, grandiosity, jealousy, erotomania, and somatic. Delusions of persecution happen when the person thinks that other people are conspiring against them. An example of a grandiose delusion would be someone who thinks they are god. Delusions of jealousy often show up as people thinking their partner is cheating on them. Erotomanic delusions can be when someone thinks a celebrity is in love with them. Finally, an example of a somatic delusion could be someone thinking that there is a tapeworm living inside their body.
Hallucinations happen when someone perceives something that is not actually there. Just like with delusions, there are different types of hallucinations. These might include auditory hallucinations, visual hallucinations, or somatic hallucinations. That is hearing things, seeing things, or feeling things that are not actually there. Although all types of hallucinations have been documented in schizophrenia by far the most common are auditory hallucinations.
Disorganized speech and behavior are when someone acts and talks in a very strange way. This might show up as someone speaking in a way that seems to go off on tangents without ever making a point. Disorganized behavior can show up in a few different ways. It might be that a person with the disorder is unable to properly shower or feed themself. It could also be that their emotional responses seem inappropriate for the situation.
Negative symptoms are the absence of something you would expect in someone who does not have the disorder. This might be a little confusing, but negative symptoms are something that seems to be missing. There are many examples of this, such as showing no emotions, not moving or speaking, and no or little interest in other people.
It is important to note that in order for someone to be diagnosed with schizophrenia they must have symptoms that last for at least 6 months. Also, the symptoms must significantly impact someone’s functioning.
Types of Schizophrenia
In past versions of The Diagnostic Statistics Manual (DSM) there were different subtypes of schizophrenia. These subtypes mostly had to do with which symptoms were predominant. For example there was a subtype called paranoid schizophrenia for people who were mostly experiencing paranoid delusions.
The newest version of the DSM, the DSM-5, no longer has these subtypes. Instead it leaves the option for clinicians to give other specifiers. These include specifying if this is the first episode, if symptoms are in remission, if the person is currently having an episode (meaning they are showing symptoms), if the person has catatonic symptoms, and how severe the symptoms are.
According to the DSM-5, roughly 0.3% - 0.7% of people are diagnosed with schizophrenia at some point during their lifetime. There is some evidence to suggest that schizophrenia associated with poorer outcomes is more common in males. However, when you look at presentations that have better outcomes the disorder seems to be equally likely to occur in both sexes.
Delusions and hallucinations often emerge between the late teen years or mid 30s. It is very rare for people to start to show these symptoms before adolescents. The most common age of onset is in the mid 20s for males and late 20s for females.
There is some evidence to suggest that there is a higher risk of schizophrenia for children who grew up in urban environments. Belonging to some minority groups has also been linked to higher rates of schizophrenia. These are considered environmental risk factors.
There are also some genetic factors that have been linked to schizophrenia. As of right now there is not one gene that indicates a higher risk for the disorder. Rather, researchers have identified clusters of genes that might be associated with a higher risk for developing schizophrenia.
There also seems to be some increased risk of developing the disorder for people who had parents with a number of different issues. For example, older paternal age might be a risk factor. Also maternal stress, infection, malnutrition, or diabetes have been indicated as risk factors. It is important to note that the vast majority of people with these risk factors do not develop the disorder.
Risk of Suicide
Roughly 5% - 6% of people with schizophrenia die as a result of suicide. Additionally, about 20% of people with the disorder attempt suicide one or more times in their lifetime. The risk of suicide is especially high or young males who also have a co-occurring substance use disorder.
There are a number of schizophrenia therapy options. This might include psychotherapy, drug therapy, or case management. Although most treatment for this disorder often centers around medication, psychotherapy and case management can be integral parts of the recovery process. Within psychotherapy there are a number of different therapy techniques that might be helpful.
Cognitive Behavior Therapy (CBT) often centers around helping people rework cognitions and change behavior. This can be a particular challenge because people with schizophrenia often have delusions. Delusions are false cognitions. Generally, we do not want to reality test or challenge someone’s delusions. However, CBT asks people to rethink false cognitions. So how does this work?
Instead of outright challenging someone's thinking they might test the boundaries of the delusion. A therapist might start to test if there is any flexibility around the delusion and if there is they will start there. If there is some wiggle room they can see if someone can start to question the delusion they have. If there is little or no wiggle room they might instead work on cognitions that can be changed and on behavioral strategies.
CBT therapists might address other cognitions that might be more flexible, like negative perceptions about the disorder. They might work with someone to reframe their diagnosis. This means helping someone see how schizophrenia might make them unique or interesting rather than broken or damaged.
Humanistic Therapy can also be helpful for people who have a schizophrenia diagnosis. This type of therapy centers around positive regard and validation. In other words, making the client feel like they are heard and their feelings are valid. Sometimes people with schizophrenia feel like they are brushed aside or not taken seriously because of their disorder. Having a therapist who meets you with empathy and compassion can be exactly what is needed.
There is some debate among humanistic therapists about whether or not to validate delusions. In the past, this type of therapy has emphasized that someone’s feelings are valid and real without going along with the delusions they might be having. However, there are more clinicians recently who have decided to meet the client where they are. This might mean stepping into their world and going along with delusions. Either way, the point is to make someone feel like their feelings matter.
Psychoeducation is a technique that helps educate people about brain chemistry, symptoms, and the usual course of the disorder. This technique can be helpful both for the person with the disorder and family members. Often, learning more about a diagnosis can help people accept and understand it. Psychoeducation can benefit everyone involved by helping them see this is a disorder and not something the person can control or change on their own.
Schizophrenia Treatment Drugs
There are many medications that have been approved by the FDA to treat schizophrenia. Generally the types of drugs that are prescribed are antipsychotic medications. These seem to help curb delusions and hallucinations. There are two main types of antipsychotic medications, first-generation and second-generation.
First-generation antipsychotic medications are generally high-potency. They are very effective at reducing symptoms but people taking them may experience many unpleasant side effects. Here is a list of first-generation antipsychotic medications with the brand name and the generic name:
Second-generation antipsychotic medications were developed to help alleviate the negative symptoms of schizophrenia. These drugs were also formulated to have less side effects than their first-generation counterparts. Second-generation medications help with positive symptoms such as delusions and hallucinations but they are not always effective as first-generations medications. Here is a list of second-generation antipsychotic medications with the brand name and the generic name:
It is important to consult with a doctor when you are considering taking medication for any mental health disorder. Additionally, it is imperative to talk to a doctor before stopping or changing any medication.
Schizophrenia Treatment Centers
Treatment centers for schizophrenia will usually use an integrated approach of psychotherapy, drug treatment, and case management. Offering all of these approaches in conjunction with one another can offer the most support possible to the affected person. Many treatment centers will also offer family programming that includes psychoeducation.
Schizophrenia is considered a long-term disorder that requires long-term care. This care might start with inpatient treatment in order to help stabilize the individual. Once they are stabilized they might be moved to a step down program like a community living facility or intensive outpatient program. Providing this type of continued care offers people the best opportunity for recovery.