Schizophrenia is often mischaracterized by movies and television as a sort of multiple-personality disorder. How many times have you heard someone called a “schizo” for suddenly changing his mind? Despite the way it’s often treated (and mistreated) by the media, schizophrenia is a serious mental disorder that affects one in a hundred people. It has nothing to do with multiple personalities, and has everything to do with a patient’s ability to tell what’s real from what is not.
Symptoms of schizophrenia are defined in their relationship to the mental processes of those who do not have the disease. “Positive” symptoms are those that are not found in healthy people: hallucinations (including hearing voices), delusions, and psychotic episodes.
“Negative” symptoms, on the other hand, are those processes that people with schizophrenia experience less of than is usual: slurred or confusing speech, a loss of emotions, being unable to relate to others, feeling out of control or unable to motivate oneself to perform even basic self-care tasks. The disorder can also manifest as difficulties in memory, attention, and information processing.
Because schizophrenia can cause people to have problems telling the difference between real experiences and hallucinations, treatment can be very difficult: the delusions they experience can seem at least as real as the doctors who offer help. Patients may leave a treatment regimen and relapse after a strong hallucination convinces them to ignore the advice of their care provider.
The causes of schizophrenia aren’t completely understood, but it’s likely that a variety of both genetic and environmental conditions (drug and alcohol use, a troubled childhood, a mother who was stressed or malnourished while pregnant) factor in. Symptoms typically set in during late adolescence or early adulthood, and the sooner a care provider is seen and intervention can start, the more likely it is that a case can be prevented from progressing into severe psychosis.
There are a few different subtypes of schizophrenia, which each have a characteristic mosaic of symptoms. In paranoid schizophrenia, perhaps the best-known type, the patient experiences delusions and hallucinations, but does not experience most negative symptoms: he typically experiences no loss of emotion, disordered thinking, or speech difficulties.
In comparison, in disorganized schizophrenia, severe problems in social function arise, and the patient tends to experience either inappropriate emotions or none at all. In catatonic schizophrenia, the patient fails to respond to her environment and may either appear paralyzed, or move continually but aimlessly.
Residual schizophrenia describes the condition of a patient whose symptoms fail to progress to a severe level, or whose symptoms have lessened to a point where the individual can resume normal or near-normal function. In some cases, patients may present with more than one set of schizophrenic symptoms: in this case, they are diagnosed with undifferentiated schizophrenia.
While there is nothing that can be done to prevent schizophrenia, treatment is possible, especially with early diagnosis. Antipsychotic medications can help reduce the frequency and severity of hallucinations and delusions, but it’s important to remember that not every antipsychotic drug will be effective in every patient. Some people may have to try different prescriptions alone or in combination before they find one that works.
Antipsychotics also have little effect on negative symptoms such as disordered thinking and emotionlessness. To help the patient manage this aspect of the disease, various types of therapy can be offered depending on the specific needs of the situation. Often patients are also referred to substance abuse programs, as high rates of drug and alcohol use are found in individuals diagnosed with schizophrenia. In severe cases, patients may be hospitalized during psychotic episodes to prevent them from harming themselves or others.