Schizophrenia

This condition is a chronic mental illness that impacts an individual’s behavior, emotions, and thoughts. It is a rare illness and generally affects less than 1 percent of the U.S. population. Although symptoms vary in severity, the disease can be debilitating for those who have been diagnosed, and the symptoms may impact work, schooling, and relationships. To help patients live independent and healthy lives, the illness is usually treated with long-term medications and individualized social and psychological therapies.

What Are the Risk Factors?

Researchers believe that there are both genetic and environmental risk factors in the development of this illness. Of these two, scientists believe that genetics are responsible for most of the risk.

In fact, having an identical twin with this disease means that a person’s risk of developing schizophrenia is around 50 percent. Children whose parents both have the condition have an estimated 36 percent chance of contracting the disease themselves. A child who has one parent with the condition has a 13 percent chance of developing it himself or herself, and having a first-degree relative with the condition raises an individual’s risk of the disease by 10 percent.

Some of the environmental factors believed to increase the risk of the illness include living in a dense urban area and being born to a parent who experienced famine or undernourishment during the first trimester of pregnancy.

People of all genders have an equal risk of this illness, and it is diagnosed at similar rates among people of all ethnic groups.

What Is the Typical Age of Onset?

Symptoms of schizophrenia typically begin between the ages of 16 and 30. The disease is very rarely seen in children, and it is also rare for the first signs of the illness to begin after the age of 45. Men tend to develop symptoms of the condition slightly earlier in life than women.

What Are the Symptoms?

Schizophrenia symptoms can affect speech and motor skills. For example, patients may respond to questions with answers that are completely unrelated to the question. Some patients may speak in strings of words that seem meaningless and that cannot be understood; this is known as a “word salad.” Patients may find it difficult to sit still and to complete tasks. They may move excessively and adapt socially inappropriate postures. Occasionally, they may become very still and exhibit a total lack of response.

Individuals with this condition may experience hallucinations and delusions. Hallucinations most commonly involve hearing voices that are not there, but the symptom may also include seeing things that are not there. Delusions are comprised of false beliefs that have no basis in reality. For example, patients may falsely believe that they are being harassed or harmed in some way or that certain remarks are directed at them. Alternatively, they may believe that they are famous or exceptionally gifted. Some patients have falsely believed that catastrophes or natural disasters are imminent.

Other typical symptoms include changes that overlap with a number of other mental health conditions, including depression. Patients may withdraw from and lose interest in activities they once enjoyed, and they may struggle with recalling memories, concentration, making plans, and finishing tasks they have started. Individuals may display what is known as a “flat affect.” This occurs when they speak in a monotone voice and have minimal changes in facial expression. In addition, patients with schizophrenia may sometimes neglect personal hygiene.

Are Symptoms Always Present?

Patients with this condition have periods of active symptoms and periods of remission. During active periods, symptoms may be quite severe. In remission, patients may be largely free of many schizophrenia symptoms, although some symptoms will always be present. The particular symptoms that remain during periods of remission are different for each patient. With proper medication and compliance with dosing schedules, some patients have maintained remission for up to two consecutive years.

What Are the Different Types of This Illness?

There are four major types of this condition, and each type has slight variations in symptoms.

The paranoid form of this disease often involves extreme paranoia, and patients typically act on these feelings. For example, a patient may believe that he or she is being pursued by the FBI or CIA. Patients with this type of condition generally feel little pleasure and may exhibit inappropriate emotional responses.

In contrast, patients with the catatonic form of this illness typically shut down completely. They may stand still or sit with atypical postures for prolonged periods, and they are often described as appearing paralyzed. These patients generally have no facial expressions, and they may lose the desire to eat and drink. Additionally, they may not feel an urge to urinate. If this catatonia lasts for more than a few hours, it is considered a medical emergency that requires hospital treatment.

The undifferentiated form of this disease is so named due to the presence of varied and vague symptoms. Patients may be both confused and paranoid, and they may also not talk very much or otherwise express themselves. They may neglect personal hygiene, refusing to shower and not wanting to change clothes.

Patients with schizoaffective disorder have symptoms of schizophrenia along with symptoms of depression or another mood disorder. For example, they may experience delusions and also have sleeping problems, anxiety, and a loss of interest in activities.

How Is This Condition Diagnosed?

Currently, there are no physical or mental tests that can definitively diagnose schizophrenia. As a result, the diagnostic process relies on performing an array of medical evaluations and mental health screenings to rule out other conditions. Psychiatrists, medical doctors with a specialty in mental health conditions, typically handle assessments.

A psychiatrist will typically begin a patient evaluation with a complete health history and physical examination. This exam can help doctors identify possible medical causes for any symptoms the patient may have and detect underlying physical ailments. Blood tests and tests for substance use may be ordered, and imaging studies such as MRI and CT scans may be beneficial.

After the physical exam and medical tests, a patient will have a psychiatric evaluation. This involves questions about the patient’s family and personal history of mental health conditions and questions about the patient’s thoughts, moods, behaviors, and substance use. The doctor will assess the patient’s risk of self-harm, suicide, or violence.

In particular, patients will be asked about their experiences with hallucinations and delusions. The psychiatrist will make general observations about the patient’s demeanor. To diagnose schizophrenia, the health care provider will follow the criteria set out in the most recent edition of the “Diagnostic and Statistical Manual of Mental Disorders” by the American Psychiatric Association.

While this illness may be diagnosed at a clinic, it is more often diagnosed in a hospital setting. Many individuals with the condition are unaware that they have it, and they may be taken to the hospital by family members or others after a crisis. Doctors observe patients for up to 10 days, and these medical professionals look for signs that allow them to diagnose a specific type of llness. Obtaining a specific diagnosis is necessary in order for insurance companies to pay for treatment.

What Is Schizophrenia Treatment Like?

Treatment for this condition is complex and involves a multidisciplinary approach from several medical and mental health professionals. Since the exact cause of the disease is unknown, treatment emphasizes methods that reduce symptoms and that improve the quality of life for patients.

This disease requires medication in order to be properly controlled, and it can take time to find the most effective combination and dosage of medication for a particular patient. Most patients take different types of drugs known as antipsychotics, and these may be used in combination with antidepressants and anti-anxiety medications.

Second-generation antipsychotics are the newest class of this drug, and they have fewer side effects than older medicines. They may be given orally, and patients who find it difficult to take pills on a regular basis can choose to have the medication given as an injection. Some examples of these drugs include aripiprazole, cariprazine, brexpiprazole, lurasidone, and risperidone, common names for these medications are Abilify, Vraylar, Rexulti, Latuda, and Risperdal. Medications are used during times of active symptoms and also during remission.

Psychosocial care is a core element of the treatment process for this disease. For many patients, a treatment model known as coordinated specialty care is used. This incorporates medication along with several kinds of psychotherapy, and it also includes family therapy, educational support, and employment services.

Patients participate in group and individual therapy sessions that can help them learn to change thought patterns and to cope with stress in a healthy manner. Social skills training is provided to help patients improve their communication skills. Patients practice different types of social interactions so that they are better able to participate in routine, family, and community activities. Regular engagement with psychosocial care interventions can help patients avoid hospitalization and relapses, lengthening their remissions.

Do Patients Need Hospital Treatment?

Patients with this illness may need periodic hospital treatment to properly manage their symptoms. Typically, patients will visit the hospital for the first time as a result of an initial psychotic episode. Doctors will carry out medical and psychiatric evaluations, and patients will be started on medications. Care will be taken to find an effective medication regimen before the patient leaves the hospital, and hospital staff will observe patients daily for side effects and will adjust dosages and medication combinations accordingly. Patients will also be provided with psychotherapy, social support services, and a case manager.

After an initial hospital stay, patients will continue with regular follow-up appointments and outpatient therapies. Additional hospital stays may be necessary if medication adjustments are needed or if patients experience new or worsening symptoms. In rare cases, patients who become violent with others or who make threats of suicide may be involuntarily sent to the hospital for a few days so that they can be properly assessed and kept safe.

Do Patients Need Daily Living Support?

The majority of patients will need some type of living assistance on a daily basis. Some patients may be unable to live independently. Community housing in group homes or supported living facilities can be a good option for many patients, and patients may also be able to live at home with their families. Case managers can provide details of housing options in a patient’s local area. Where possible, it is best for patients to reside with family or in supported housing; this helps greatly with symptom management.

How Can You Help Someone With This Condition?

Helping a friend or family member with this condition can be both challenging and rewarding. If you suspect that someone may have schizophrenia, it is essential to familiarize yourself with the possible symptoms and complications of the disease.

If your loved one has not yet been diagnosed, encourage him or her to have an assessment, and offer to go to the appointment together. If your loved one has been diagnosed, encourage him or her to comply with treatment by taking medications as prescribed. Try to attend family therapy sessions together. By educating yourself about this condition, you will be able to empower your loved one in his or her recovery.

If your friend or family member is living at home, try to do what you can to create a structured and organized living environment with a regular routine. This helps reduce stress for everyone involved. Try to set realistic goals for your loved one or friend, and encourage him or her to be as independent as possible.

People with this illness may struggle with memory and concentration. If you can, try to help your loved one remember to take his or her medications on the appropriate schedule. Keep a log of upcoming doctor’s appointments and therapy sessions, and write down any questions you may have in advance of appointments. Always be on the lookout for any new or worsening symptoms, including changes in mood or suicidal thoughts, and report these to medical personnel immediately.

With support from therapists, the community, and friends and family, individuals with this chronic illness can manage their symptoms more effectively and enjoy active lives.

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