Schizophrenia is a mental disorder, which severely impacts the way 1% of people worldwide think, feel, and act. The term comes from the Greek, schizo meaning ‘splitting’ and phrenia meaning ‘of the mind’. Therefore schizophrenia literally can be defined as a split mind. This disorder makes it hard for a person to differentiate between real and imagined experiences. It weakens their abilities to think logically, express normal emotions, and behave properly in social situations. Schizophrenia is a serious thought disorder, which affects one’s work, family, social life and an individual’s capacity to function. It is extremely draining on the ill person, as well as the people who care for them.
In 1809 John Haslam and Philip Pinel observed first symptoms. As time went another man by the name of B. Morel came up with a term demence precoce, which he observed in little boy. But it was still not until the 1800’s when a German psychiatrist, Dr. Emil Kraepelin had actually categorized the subtypes of a single syndrome. The three subtypes were hebephrenia, catatonia, and paranoia. He was mistaken when he said that this syndrome was incurable and early onset. In the 20th century a Swiss psychiatrist Dr. Eugen Bleuler had a different idea where he explained that schizophrenia might in fact be curable and possibly manifested later on in life. He was the one that explained that schizophrenia meant split of the mind and not split of personality. His four primary symptoms included loosening of associations, ambivalence, autism, and affective disturbance (Nietzel, Speltz, McCauley, Bernstein, 1998). While Europeans used Kraepelin’s criteria, North Americans used Bleuler’s. In 1959, K. Schneider had conducted a research and classified delusions and hallucinations as primary symptoms of schizophrenia.
During the last half of the nineteenth century different subtypes of what we now call schizophrenia were described as separate diseases. Paranoid psychosis was characterized in 1868, hebephrenia in 1871, and catatonia in 1874 and were all grouped together by E. Kraepelin. This group was given the name dementia praecox. Bleuler changed the name to schizophrenia in 1911.
The differentiation of the subtypes is based exclusively on the symptoms of the illness. Paranoid schizophrenia is characterized by delusions and/or hallucinations. Hebephrenic schizophrenia has as its predominant symptoms disorganized speech, disorganized behavior, and flat or inappropriate affect. Catatonic schizophrenia is diagnosed when the outstanding features of the disease are behavioral disturbances, such as posturing, rigidity, stupor and often mutism. Also simple schizophrenia is characterized by an insidious loss of interest and initiative, withdrawal, blunting of emotions and the absence of delusions or hallucinations.
Another method of subtyping schizophrenia that has been used by researchers divides patients into those with positive symptoms, and those with negative symptoms. The term positive signifies those symptoms which are present but should be absent. Negative symptoms on the other hand, indicate symptoms which are absent but should be present. This subtype has been elaborated into type I (those with “positive” symptoms) and type II (those with “negative” symptoms) by Dr. Timothy Crow and his colleagues in London who claim that these are separate diseases. Type II is a subtype of schizophrenia that most resembles traditional brain diseases.
Some of the positive symptoms of schizophrenia include:
• Delusions- false, strong beliefs
• Hallucinations- hearing, seeing, or sensing something that is really not there
• Thought disorder- thoughts and speech are jumbled that a person thinks someone is interfering with their mind
• Loss of drive- lack of drive and motivation which is part of illness and not laziness
• Blunted emotions- ability to express emotions are lost as well as lack of response or inappropriate response
• Social withdrawal- fear with interacting with others because they may harm you in some way
• Lack of insight- their experiences with delusions and hallucinations are so real that they deny they are ill and therefore refuse treatment
Schizophrenia is more common than other genetic conditions such as Huntington’s disease or PKU. It is more common than multiple sclerosis, six times more common than diabetes and sixty times more than muscular dystrophy. Not all schizophrenics suffer same illnesses but they do show similar symptoms.
Tense and nervous 80.4
Eating less 71.7
Trouble concentrating 69.6
Trouble sleeping 67.4
Enjoy things less 65.2
Can’t remember things 63.0
Seeing friends less 59.6
Feeling laughed at 59.6
Loss of interest 56.5
More religious thinking 54.3
Feeling bad for no reason 54.3
Feeling too excited 52.2
Hearing voices/seeing things 50.0
There is no one single cause for schizophrenia. Family relationships, environment, biochemical, and genetic factors are included. Studies with twins have proved to us that genes are involved. Genes are a critical part in determining what you will inherit.
Brain activity is another important element. Devices like CAT scans, MRI’s and PET scans have allowed scientists to study the brain and its function. They found abnormalities in he brain, which reveal that schizophrenia may or may not be hereditary. Overall chemical reactions are lower but dopamine levels are higher in the left side of the brain than normal. It is pointing to some nutritional deficiencies of the neurotransmitters. Neurotransmitters enable neurons to communicate and are essential to the working part of the brain. Some of the examples are serotonin, dopamine, and acetylcholine, which maintain homeostasis. Too much or too little of these chemicals in the brain will throw off the normal function of the brain. If the proper enzymes are not responding to the overflow of these neurotransmitters, a poisonous substance will build up. It will penetrate into the blood and interfere with the other messengers of the body for proper contact. To prevent neurotransmitters from being disturbed and for proper functioning, vitamins like B12, zinc, Vitamin C, E, thiamine, and folic acid are administered. There has been evidence on reduced flow of the blood in the frontal cortex in schizophrenics vs. non- schizophrenics. Pure adrenochrome is a poisonous form of adrenaline that is left in the body and if it is not converted into leuco- adrenochrome with the help of the vitamin C, it will leave the subject anxious and tense. Adrenochrome is primarily changed into adrenolutin, another poisonous form of adrenalin and will cause changes in behavior. If adrenochrome is present there will not be enough GABA. GABA is a regulator allowing for the proper message sending between neurons. The neurons will fire without a break and the result will cause patients to be irritable.
There are visible physical changes in the brain as well. Enlarged ventricles of the brain will, in turn decrease the cortex that is adjacent brain tissue. Other research also shows difference in weight of the brain. The limbic is smaller in size, a part of the brain that is involved with feelings such as anger, joy, and sexual arousal. Family relationships show no evidence of schizophrenic onset however, patients with the disorder are sensitive to family tensions and typically associated with relapse. We also should consider the environment. Schizophrenia occurs more frequently among people in the lower social class. They live in poverty rather than luxury. They tend to have lower paying jobs, lower salaries, occupy less prestige positions in the society.
A person that is diagnosed with schizophrenia has many problems which he/she has to face that for the most part a normal person doesn’t have to worry about. Employment is an area of particular difficulty for those with the illness. Work of any kind is a practical impossibility. Homelessness is another major problem faced by schizophrenics. The breakdown of family relationships or a simple urge to isolate oneself can all lead to homelessness. SANE estimates that 40 percent of homeless people suffer mental illness of some kind; many of these are schizophrenics. Once homeless, the vicious cycle of downward social drift rapidly manifests itself. The abuse of drugs and alcohol is also very common throughout the sick people. While it is perfectly true that people in close and stable families or with caring and responsible friends do suffer these problems, they are far more pronounced among those living rough, in cities particularly.
Although many people say that schizophrenia occurs equally in men and women, that generalization neglects some important gender differences in this disease. Most striking is the earlier age of onset for men, which in the United States occurs two to three years earlier than in women. An analysis of a group of 17 or 18 year old individuals with schizophrenia will reveal four or five males for every female.
Schizophrenia is also a more serious disease in men than it is in women. Men do not respond as well to antipsychotic drugs, they require higher doses of the drugs, they have a higher relapse rate, and their long-term adjustment is not nearly as good as women’s. There are, of course, many women with schizophrenia who have had a severe course and many men who have done well, but statistics clearly show that schizophrenia occurs earlier and in more severe form in males.
The reasons for such gender differences are still unknown. It should be noted that both infantile autism and childhood schizophrenia also have a strong predominance for males, and that male fetuses generally are known to be more susceptible to environmentally caused problems such as infections. The fact that males get schizophrenia both younger and more severely, then, may simply be another reflection of Mother Nature’s dictum that in many ways men are the weaker sex. Another speculation about why schizophrenia might be more severe in males is the possibility that female sex hormones (estrogens) may exert an antipsychotic effect and be protective. It is also possible, although unlikely, that schizophrenia resembles diabetes in having two major subgroups: an early-onset, more severe variety that affects mostly men, and later-onset, less severe variety more likely to strike women.
Another facet of male-female differences in schizophrenia is the effect of the menstrual cycle on the disease in some women. Although it has not been sufficiently studied, clinicians and families have noted for many years that some women with schizophrenia have a worsening of their symptoms in the days immediately preceding their menstrual period. This is almost certainly caused by the reduction and flow of hormones during the cycle, and lends further support to theories linking male-female differences in schizophrenia to hormonal differences.
It is believed that childhood schizophrenia is simply an early version of the adult disease, although much rarer. Approximately two males are affected for every female. Only about two percent of individuals with schizophrenia have the onset of their disease in childhood although that percentage varies, depending on where one fixes the childhood-adult line. Schizophrenia beginning before age 5 is exceedingly rare and between ages 5 to 10 it increases slowly. From age 10, schizophrenia increases in incidence until age 15, when it begins its sharp upward peak as the adult disease.
The symptoms of childhood schizophrenia are very similar to those of adult schizophrenia with the predictable expectation that their content is age-related. For example, one study of young children with schizophrenia reported that the source of auditory hallucinations was frequently believed to be pet animals or toys and that “monster themes were common…. As age increased, both hallucinations and elusions tended to be more complex and elaborate.” The other distinguishing feature of childhood schizophrenia is that the affected child also often has one or more of the following: seizures, learning disabilities, mild mental retardation, neurological symptoms, hyperactivity, or other behavioral problems.
Like adult schizophrenia, childhood schizophrenia is thought to have some genetic roots, although their relative importance is unclear. It is also unknown that these children have an excess number of minor physical abnormalities and mothers’ history of having had excess pregnancy and birth complications. The fact that childhood schizophrenia is a brain disease has been demonstrated by the findings of EEG abnormalities on electroencephalographs and enlarged cerebral ventricles on MRI scans.
Childhood schizophrenia is treated with the same antipsychotic medication used for adult schizophrenia. A follow-up of ten children with this disease from fourteen to thirty-four years after its onset found them still diagnosed with schizophrenia but with relatively few delusions or hallucinations. Instead they tended to be quiet and withdrawn with poverty of thought and lack of drive. A minority of children with schizophrenia will recover can do quite well as adults, but what percentage this constitutes is uncertain. It is generally thought that the earlier the age of onset of schizophrenia, the worse the outcome is likely to be, but there are major exceptions to this rule.
Just as there is a form of schizophrenia that begins early in childhood, there is also a form that begins later in life. Late on-set schizophrenia is variously defined as beginning after the age of 40 or 45. Almost all studies of it have been done by Europeans, with little interest having been shown by American researchers.
Clinically, late-onset schizophrenia is similar to the earlier- onset variety except for having a predominance of females affected; having more schizoid and paranoid personality traits in the person before he/she becomes sick; and having more paranoid delusions and more visual, tactile, and olfactory (smell) hallucinations. Neuropsychological tests and MRI scans shows deficits similar to early- onset schizophrenia. The other way in which late- onset schizophrenia differs is in having a more chronic course and less favorable prognosis that would be expected that the later the onset of the disease, the better the prognosis is likely to be.
The most successful treatment at this point in time is medication. These medicines were discovered accidentally and now carry a large responsibility by changing the state of mind. Antipsychotic drugs are used and these drugs are available in different forms such as liquid and tablet form. Scientists are not completely sure why they work but they are known to change chemicals in the brain to slow down the activity rate. Some of the drugs prescribed include, Proxilin, Mellaril, Thorazine, Haldol, Moban, and Clocaril. Not all patients respond to the medications so the best drug is found by trial and error. Many of the medications cause side effects. They include allergic reactions, weight gain, and shakes but overall, for the most part they keep the ill ones out of the hospital. It reduces symptoms of the hallucinations and delusions bring the person to a calm and ground state.
Psychotherapy is unquestionably needed to go hand in hand with medication. Patient has to understand what is happening to them and needs to learn to deal with this aspect. Professionals that work with the disordered patient train him/her to build self-esteem and self-confidence. Other programs help patients learn basic skills like expressing needs and interacting appropriately. Sometimes if the patient is released from the hospital and put into a community, they may lose that training. In that case, group therapies are available to the patient to enable him/her to adjust. Group therapy is much cheaper than one on one.
Schizophrenia is a problem for family members such as brothers, sisters, sons, daughters, husbands, wives, uncles, aunts, grandfathers, and grandmothers. They may all be profoundly involved in the care of family members with schizophrenia. Family members may be extremely embarrassed by the psychotic behavior of their ill relative. A common reaction is to move as far away from the family home as possible.
Individuals with schizophrenia frequently occupy an inordinate amount of their family’s energy and time, leaving little for other family members. When a person develops schizophrenia, other family members may lose a relationship. The family members who did not develop schizophrenia may develop survivor guilt. The siblings or children of individuals with schizophrenia often try to compensate for their ill family member by being as perfect as possible. Most children and siblings of individuals with the disease are themselves haunted by a fear that they too will develop the illness. As an interviewee said, “Growing up with a mentally ill mother was oppressive and worrisome and it interfered with the development of my sense of self. I was terrified that I was like my mother and therefore had something wrong with me.”
Schizophrenia changes family relationships very heavily. Husbands and wives whose spouse becomes ill often must become their spouse’s parent. There are many things that family members can do to ease some of the burden of having relative with such a harsh disease. Education is most important, and this should always include even small children in the family whose ability to understand is much greater than most adults assume.
There is, as yet, no simple lab test to make a diagnosis. Therefore, the diagnosis is based on the symptoms – what the person says and what the doctor observes. To reach a diagnosis of schizophrenia, other possible causes such as drug abuse, epilepsy, brain tumor, thyroid or other metabolic disturbances, as well as other physical illnesses that have symptoms like schizophrenia, such as hypoglycemia and Wilson’s disease, must be ruled out. The condition must also be clearly differentiated from bipolar (manic-depressive) disorder (see Glossary). Some patients show the symptoms of both schizophrenia and manic depression. This condition is termed “schizoaffective” disorder. Its relation to schizophrenia is unclear at present.
No matter what happens during the first visit to the doctor, the diagnosis of schizophrenia usually takes a long time. This is because it can be a very difficult diagnosis to make: the symptoms necessary for diagnosis either go unrecognized, or do not show themselves fully, until the illness is advanced. There are also many differences among individuals in the way in which symptoms present themselves. Most doctors, well aware of the stigma that still surrounds this illness, don’t like to voice their suspicions until they are sure that this diagnosis is correct.
If your doctor does diagnose schizophrenia, do not assume that he or she has ruled out the possibility of another illness. Do not hesitate to ask about other illnesses and ask on what grounds the doctor has determined that schizophrenia is the problem. Where an illness as confusing and variable as schizophrenia is concerned, you should ask for a second medical opinion and a psychiatric referral, whether or not you are satisfied with your doctor’s response. A request of this nature is perfectly acceptable. Do not feel that the doctor will take it as a personal criticism.
Most families reported that a crisis or psychotic episode – that is, a severe break with reality – occurred a few months to a year after they began to notice unusual behavior. Some said, however, that the crisis occurred with little or no warning.
During a crisis episode, your relative will exhibit some or all of the following symptoms: hallucinations, delusions, thought disorder, and disturbances in behavior and emotions. Families who have been through these psychotic episodes warn that no amount of preparation can fully protect you from the shock, panic, and sickening dread you will feel when your relative enters this stage of schizophrenia. Understand also that your relative may be as terrified as you are by what is happening: “voices” may be giving life-threatening commands; snakes may be crawling on the window; poisonous fumes may be filling the room. You must get medical help for your relative as quickly as possible, and this could mean hospitalization. If your relative has been receiving medical help, phone the doctor or psychiatrist immediately. Ask which hospital you should go to and for advice about what to do.
Don’t shout. If your relative appears not to be listening to you, it may be because other “voices” are louder. Don’t criticize. Your relative cannot be reasoned with at this point. Don’t challenge your relative into acting out. Avoid continuous eye contact. Don’t block the doorway. Don’t argue with other people about what to do.
It is far better, if possible, to have your relative go to the hospital voluntarily. If you do not think your relative will listen to you, see if a friend can talk the person into doing so. Some have found that presenting their relative with a choice seemed to work. “Will you go to the hospital with me, or would you prefer that John take you?” Such an approach may serve to reduce the person’s feeling of helplessness. Offering choice, no matter how small, provides some sense of being in control of the horrible situation in which they find themselves.
Schizophrenia is not only hard for a patient to live with but for families of the patient as well. Medication has made treatments a lot easier and patients don’t have to spend much time in hospitals. It is crucial for families to learn how to build trust and be in contact with a patient in order to offer the support to the ill person that they so desperately require. My family had a first hand experience with a schizophrenic. It was hard on all of us, especially when they did not know much about the illness or its treatments in Russia. They did not want my great-grandmother in the hospital because she was unruly. Giving her medication was a constant struggle each time it was administered to her. I remember being about 9 and watching her sit in a chair with no back for five-six hours at a time with no motion. She would sit in a corner of the room and mumble to herself. I remember thinking “What is wrong with her?” I never understood or knew what she had; I only could assume she was crazy. I remember asking her what she was mumbling and she responded “I inherited 5.5 million rubbles and I will give you some part of it when you’re older.” She also said that the President of Russia wanted to marry her. She had gone to the red house looking for him. The police had taken her to the station and questioned her, ultimately realizing that she belonged in the hospital. She never seemed to be violent, although sometimes she gave me a sense of fear because she would sit in the dark and stare at one point. I felt bad and tried to talk to her but reaction was unpleasant. My great-grandmother never wanted to eat.
This experience emotionally affected me in a positive as well as a negative light. It was hard to watch her suffer, as much as she did. I feel that ultimately I learned to be more empathetic to people with those types of disorders.
Although schizophrenia is a tragic disease, with the advances today there is definitely hope for it. Recovery can be successful if the proper steps are taken. Knowledge of this mental illness is crucial to understand and cope with. Getting involved with the patient to help increase their self-esteem is most important of all. Different forma of treatments are available, such as drugs and supportive psychotherapy. Our immediate concern should be to open lines of communication and to express the concern. Optimistic attitude is needed because being pessimistic will not lead us anywhere.
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