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Schizophrenia

Schizophrenia is a mental disorder that makes it hard to:

  • Tell the difference between what is real and not real
  • Think clearly
  • Have normal emotional responses
  • Act normally in social situations

Causes, incidence, and risk factors

Schizophrenia is a complex illness. Mental health experts are not sure what causes it. Genes may play a role.

Schizophrenia occurs in just as many men as in women. It usually begins in the teen years or young adulthood, but it may begin later in life. In women, it tends to begin later and is a milder condition.

Schizophrenia in children usually begins after age 5. Childhood schizophrenia is rare and can be hard to tell apart from other developmental problems such as autism.

Symptoms

Schizophrenia symptoms usually develop slowly over months or years. Sometimes  the person may have many symptoms, other times only a few.

People with schizophrenia may have trouble keeping friends and working. They may also have problems with anxiety, depression, and suicidal thoughts or behaviors.

Early symptoms may include:

  • Irritable or tense feeling
  • Trouble concentrating
  • Trouble sleeping

As the illness continues, the person may have problems with thinking, emotions, and behavior, including:

  • Bizarre behaviors
  • Hearing or seeing things that are not there (hallucinations)
  • Isolation
  • Reduced emotion
  • Problems paying attention
  • Strongly held beliefs that are not real (delusions)
  • Thoughts that "jump" between different topics (“loose associations”)

Signs and tests

There are no medical tests to diagnose schizophrenia. A psychiatrist should examine the person and make the diagnosis. The diagnosis is made based on an interview of the person and family members.

The psychiatrist will ask about:

  • How long the symptoms have lasted
  • How ability to function has changed
  • Developmental background
  • Genetic and family history
  • How well medicines have worked
  • Substance abuse
  • Medical conditions

Brain scans (such as CT or MRI) and blood tests may help rule out other conditions that have similar symptoms.

Treatment

During an episode of schizophrenia, the peson may need to stay in the hospital for safety reasons.

MEDICATIONS

Antipsychotic medicines are the most effective treatment for schizophrenia. They change the balance of chemicals in the brain and can help control symptoms.

While helpful, these medicines can cause side effects. Many side effects can be managed though. For this reason, they should not prevent the person from getting treated for this serious condition.

Common side effects from antipsychotics may include:

  • Dizziness
  • Feelings of restlessness or jitteryness
  • Sleepiness (sedation)
  • Slowed movements
  • Tremor
  • Weight gain

Long-term use of antipsychotic medicines may increase the risk of a movement disorder called tardive dyskinesia. This condition causes repeated movements that the person cannot control. Call the health care provider right away if you think you or your family member may have this condition due to the medicine.

When schizophrenia does not improve with antipsychotics, other medicines may be tried.

Schizophrenia is a life-long illness. Most people with this condition need to stay on antipsychotic medication for life.

SUPPORT PROGRAMS AND THERAPIES

Support therapy may be helpful for many people with schizophrenia. Behavioral techniques, such as social skills training, can help the person function better in social and work situations. Job training and relationship-building classes are also important.

Family members and caregivers are very important in the treatment of schizophrenia. Important skills that may be learned at such programs include:

  • Coping with symptoms that are present even while taking medicines
  • A healthy lifestyle, including getting enough sleep and staying away from recreational drugs
  • Taking medicines correctly and how to manage side effects
  • Watching for the return of symptoms, and knowing what to do when they return
  • Getting the right support services

Expectations (prognosis)

The outlook with schizophrenia is hard to predict. Most of the time, symptoms improve with medication. But many people may have some trouble functioning. They are at risk of repeated episodes, especially during the early stages of the illness.

People with schizophrenia may need housing, job training, and other community support programs. People with the most severe forms of this disorder may not be able to live alone. They may need to live in group homes or other long-term, structured residences.

Symptoms are very likely to return when medication is stopped.

Complications

Having schizophrenia increases the risk of:

  • Developing a problem with alcohol or drugs (substance abuse). Using alcohol or other drugs increases the chances that symptoms will return.
  • Physical illness. This is due to an inactive lifestyle and side effects of medication.
  • Suicide

Calling your health care provider

Call your health care provider if you or a family member experiences:

  • Voices telling you to hurt yourself or others.
  • The urge to hurt yourself or others.
  • Feelings of being scared or overwhelmed.
  • Seeing things that are not really there.
  • Feelings that you cannot leave the house.
  • Feelings that you are not able to care for yourself.

Prevention

Schizophrenia cannot be prevented.

Symptoms may be prevented by taking medication exactly as instructed by the doctor. Symptoms are likely to return if medication is stopped.

Changing or stopping medications should only be done by the doctor who prescribed them.

References

Freudenreich O, Weiss AP, Goff DC. Psychosis and schizophrenia. In: Stern TA, Rosenbaum JF, Fava M, et al., eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Elsevier Mosby; 2008:chap 28.

Lyness JM. Psychiatric disorders in medical practice. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 404.

Updated: 1/31/2013

David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.


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