Schizophrenia

Schizophrenia is the name given to a group of psychotic disorders which involve people experiencing thoughts, emotions and behaviours that would be considered unusual. To be diagnosed as having schizophrenia, a person must be having unusual experiences for a significant period of time. It is important to note, however, that there are other psychotic disorders that have similar symptoms.

What is schizophrenia caused by?

  • Genetics or family history.

  • Your environment. Things like being exposed to stress or trauma, if you didn’t receive sufficient nutrition as a child, had problems with brain development, or if your mother had the flu when she was pregnant with you, you have a higher risk of developing schizophrenia.

  • Biochemical factors. Some research has indicated that chemical imbalances in a person’s brain can contribute to developing schizophrenia.

  • Drug use. Some research suggests that drug misuse is related to the development of schizophrenia. It’s likely that substance misuse can bring on or worsen the symptoms and get in the way of the treatment of a person with schizophrenia.

What are the signs and symptoms?

There are three different types of ‘schizophrenic symptoms’; ‘positive symptoms’, ‘negative symptoms’ and ‘catatonia and inappropriate effect’.

Positive symptoms: These are when experiences are amplified, or when a person’s behaviour is excessive to the point that the general population would consider it unusual.

  • Auditory hallucinations - hearing voices talking, laughing or other things that are making noise. It can also mean noises in the person’s environment are painful to hear or too much for them to bear.
  • Feeling sensations that don’t exist - like burning, tingling and stinging.
  • Feeling disconnected from their body, ‘machine like’ or like they are ‘not real’.
  • Seeing things that aren’t there, or finding light too bright or blinding.
  • Experiencing delusions - having thoughts most people would disagree with. E.g. a person may believe they are someone that they actually aren’t, often a famous person.
  • Disorganized speech – not being able to organize thoughts and communicating them in a way which other people can’t understand.

Negative symptoms: These are when thoughts and behaviors which are normally present in the general population aren’t there. 

  • Lack of expression – when a person’s face, voice tone and gestures seem flat, or looking disinterested in surroundings.
  • Lack of motivation – having trouble doing simple things, not being able to get interested in everything, feeling sleepy.
  • Lack of pleasure – not enjoying things they used to, including relationships and activities.
  • Inattention – being easily distracted. This makes school, work and other activities difficult and frustrating to be a part of.

These symptoms don’t fit the categories of ‘positive’ or ‘negative’ symptoms. Examples include:

  • Catatonia – grimacing, making strange facial expressions, repeating certain gesture, or making manic gestures.
  • Catatonia inability – holding yourself in strange positions for a long time.
  • Inappropriate effect - responding to news in a way that doesn’t match what they heard, and isn’t appropriate. For example, laughing when they hear sad news.

Treatment

The most effective treatment for psychotic disorders involves a combination of medication and psychological support (like counselling). There are a number of self-help strategies which can in addition also help someone manage their symptoms in their day to day life. 

Psychological treatments: There are a range of psychological treatments which can be used as treatment for schizophrenia and other psychotic disorders including:

Psychoeducation: which involves educating and empowering a person and their family about their illness and how best to manage it. These are really important for preventing relapse.

Cognitive Behavioral Therapy (CBT): which can help a person to better understand their thinking, stay motivated, and to help take medication. It also helps reduce the distress they feel as a result of psychotic symptoms.

Social skills training: which is used to help a person with a psychotic disorder improve their social and life skills which can sometime reduce as part of the illness.

Cognitive Remediation: which helps a person to rebuild the basic parts of their thinking (like attention, concentration, and memory) which can be affected by illness. 

Medication: There are two main types of medication that are used to treat psychotic disorders such as schizophrenia and delusional disorder.

  • Anti-psychotic medication: can be really effective at treating psychotic symptoms such as delusions and hallucinations. However, they’re not as good at treating other symptoms like poor memory and concentration, and lack of motivation.
  • Anti-depressant medication: people with schizophrenia often experience symptoms of depression particularly when recovering from psychotic episodes. So antidepressants are often used to treat and manage depressive symptoms if necessary. 
  • There can be some serious side effects of anti-psychotic medication used to treat psychotic disorders. So, regular physical and mental health checks with a psychiatrist are important to make sure that the side effects aren’t causing or beginning to cause significant problems. 

Assertive community treatment: This type of treatment is used for people experiencing an ongoing psychotic disorder, if it’s available in their area. How it works:

  • Care of a person is usually managed by a whole team of health professionals, including a psychiatrist, nurses, psychologists and social workers.

  • Care is available 24 hours a day via a mental health crisis team.

  • The individual treatment plan is developed around the person’s needs, but it’s likely to involve medication, monitoring the person at home, and a range of psychological therapies