What is Schizophrenia?

Contents:

- Overview

- Symptoms

- Diagnosis

- Treatment

- What can you do?

- Removing Stigma

Overview

Schizophrenia is one of the most taboo mental illnesses to take about in western culture. There is a lot of fear associated with it and a lot of misinformation, which as we know leads to stigmatization and stereotypes. The data pertaining to the prevalence of schizophrenia is mixed with some saying as it’s as low as .3% and others as high as 1.2%. Regardless, both of these stats are lower than most mental illnesses. Despite its lower prevalence, it is one of the most is not the most debilitating and chronic mental illness. The actual term, schizophrenia means “split mind”. This is meant to describe the confusion of thoughts and break from reality that occur. However, this can be misleading because it makes people associate it with split personality characterized by dissociative identity disorder (previously known as multiple personality disorder).

Symptoms

Symptoms of schizophrenia are categorized as “positive”, negative, and cognitive. Don’t mistake positive for meaning they are “good” symptoms. Positive in this context just means the symptoms the individual is experiencing are not typical and are an "addition", so to speak, to their normal behavior. The negative symptoms mean the opposite, they are behaviors, feelings, and functions that are taken away or dulled by schizophrenia. Then lastly, cognitive symptoms are those that impact thought, memory, concentration, etc. You may have also previously heard of different kinds of schizophrenia, paranoid schizophrenia or catatonic schizophrenia. These were subtypes among others used to place people on the schizophrenia spectrum but weren’t very specific or lasting.

Positive

- Delusions

- Hallucinations (hallucinations can include any sensing any stimuli that isn’t there, touch, smell, see. Although auditory hallucinations are the most common)

Negative

- Flat affect (they aren’t showing much emotion in their face or when they communicate

- Reduced or jumbled speech (sometimes referred to as word salad)

- Anhedonia & Avolition (reduced joy and interest in activities once loved, and lack of motivation to partake in them)

- Isolation & social disinterest

- Inappropriate or dulled response in conversation (especially when the individual is sharing emotional news that would typically illicit and emotional response)

Cognitive

- Difficulty concentrating

- Poor memory

- Difficulty expressing thoughts or emotions

- Slowed reaction time

While schizophrenia manifests itself differently depending on the person, there are three main phases of the syndrome that most people go through, the prodromal, active, and residual phases. The prodromal phase starts at the onset of the illness, before the individual has become psychotic and had their first psychotic episode. During this phase the individual begins experiencing some of the negative symptoms of schizophrenia, social withdrawal, flat affect, anhedonia, etc. The active phase is when the individual moves on to experience hallucinations and delusions. This phase is typically when a person is hospitalized or treated for their schizophrenia. Finally, the residual phase is when most of the positive symptoms have subsided and the individual is left with the negative and cognitive symptoms.

Diagnosis

Typically, when a person is diagnosed with schizophrenia, it is when they’re experiencing their first psychotic episode. Before this, in the prodromal phase, the symptoms can often be misdiagnosed as depression or anxiety. When a mental health professional is diagnosing someone with schizophrenia, it’s important that they rule out any other medical conditions or substances that may be causing psychosis. Psychosis can be a symptom of many other problems such as Alzheimer’s, a brain tumor, syphilis, etc. Once they rule these things out they reference the DSM-5 for a psychological diagnosis. The criteria for schizophrenia spectrum disorder includes that two or more of the following five symptoms have persisted for at least a month:

-delusions

-hallucinations

-disorganized speech

-catatonia or disorganized behavior

-negative symptoms

One of the two symptoms have to be either delusions, hallucinations, or disorganized speech. Other symptoms have to have been occurring for at least six months and significantly effect functioning. In the DSM-5 schizophrenia is listed under the category “Schizophrenia and Other Psychotic Disorders”. This is because there are other disorders that can include psychosis and not be schizophrenia, these include bipolar disorder, schizoaffective disorder, schizoid personality disorder, and schizotypal personality disorder.

Treatment

Medication is the best way to treat schizophrenia, in combination with therapy. Antipsychotics can very effectively treat the positive symptoms of schizophrenia, treatment for the negative symptoms aren’t as developed. The negative symptoms end up being the more pervasive and chronic parts of the illness, that people struggle with. Antidepressants and antianxiety medications can be prescribed too, depending on the symptoms, though antipsychotics are most commonly prescribed. Schizophrenia is chronic, and does tend to worsen over time, if not properly treated.

What can you do?

Individual with Schizophrenia

· Don’t ignore your symptoms, seeking help and accepting a diagnosis is important

· Don’t believe and self-stigmatize based on the stereotypes you know about schizophrenia

· Try not to isolate, and accept help from family and friends

· Try your hardest to properly take your medication, the symptoms typically are far worse than the side effects.

· If your medication isn’t working, or you’re experiencing awful side effects, be honest with your doctor and they can help you work out a more effective medication plan

· Understand that your support system and therapy is important as well, medication isn’t a cure-all

Loved One

· Don’t try to place your loved one into the stereotypes that are seen in the media and popular culture about schizophrenia

· Understand that you shouldn’t be scared of them, those with schizophrenia are typically non-violent and are much more likely to be victims of violent crimes.

· Be a supportive friend/family member, recognize the symptoms and if they are worsening or change

· Take time for yourself, helping someone with anything they’re going through can be taxing and stressful

· Be aware of the warning signs of suicidal ideation and call the National Suicide Prevention Hotline (1-800-273-8255) if necessary.

· Inform yourself on schizophrenia

Things you shouldn't say to those with schizophrenia:

- Are you dangerous/Could you hurt me?

- What do the voices say/Do the voices tell you to do bad things?

- But you seem normal

- So, you have multiple personalities?

- I’m a little psycho/schizophrenic too

- Did you take your meds?

Removing Stigma

Because the stigma associated with schizophrenia is so common and pervasive in our culture, removing stigma can be difficult. An important thing to do, is be aware of the language you are using. Throwing around the word “psycho” and “psychotic”. When I hear people used these words in daily life they are very rarely using them correctly. Psychosis is a symptom of mental illness that causes a break from reality. When people use this word, they often group it with the word “psychopath”, which is not the same thing and it associates psychosis with violence, apathy, narcissism, etc. Detangling those words from each other is important to changing the perception of schizophrenia.

Sources

Nimh » schizophrenia. (n.d.). Retrieved April 15, 2019, from https://www.nimh.nih.gov/health/statistics/schizophrenia.shtml

Medscape. (n.d.). Schizophrenia overview | clinical presentation. Retrieved from https://www.youtube.com/watch?v=WQ7oEn8DmR8

Publishing, Harvard Health. “The Negative Symptoms of Schizophrenia.” Harvard Health, https://www.health.harvard.edu/mental-health/the-negative-symptoms-of-schizophrenia. Accessed 21 Apr. 2019.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author