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July 2011
Schizophrenia

Schizophrenia is a severe disorder which effects between 1% and 2% of the population. While it is much less common than depression, it can cause very severe disruptions in an individual’s life and ability to function. While the hallmark of this illness is a disruption in the individual’s ability to accurately assess outside reality, as well as internal realities within the individual’s own mind, there is commonly only a partial disruption. This disorder is known as one of the psychotic disorders, meaning that there is impairment in this ability to accurately assess internal and external reality.

Schizophrenia is a disorder that involves what is known as both “positive” and “negative” symptoms.

Positive symptoms are changes in thinking and perception and include:

  • Delusions, which are beliefs viewed as false by external observers, but which are believed to be true by the individual, despite evidence to the contrary. Delusions may have a variety of themes, and be primarily religious, related to physical conditions, grandiose, or involving extreme fearfulness due to feelings of persecution or of being controlled by others. Some delusions seem so unrealistic as to be impossible to appreciate that the individual believes them to be true.
  • Hallucinations are disturbances of sensory perception which may affect any of the senses: visual, hearing, smell, taste, or touch. Most common in schizophrenia are auditory hallucinations, in the form of hearing voices speaking to the individual in the absence of alcohol, drugs, or any actual sounds coming from outside the person.
  • Disorganized speech and thoughts are also typical of schizophrenia. Individuals often have difficulty forming a logical sequence of thoughts reflected in their conversation. At other times, speech and thinking may be so disorganized that the individual may appear to be incoherent.  
  • Disorganized behavior is also commonly seen in schizophrenia and can lead to significant difficulty in performing everyday tasks or engaging in goal-directed activities. It may also be characterized by unpredictable outbursts or agitation which are not triggered by any outside event.

Another category of symptoms are “negative” symptoms.
 
Negative symptoms include:

  • An absence or a significant decrease in the usual emotional expression, and emotional responsiveness to the environment, especially lack of pleasurable responses.
  • Alogia, which is also described as “poverty of speech”, refers to an overall apparent lack of thought reflected by lack of speech. In this situation, responses may be brief, empty of content, or completely non-existent.
  • Avolition refers to a lack of goal-directed activity apparently because the individual cannot initiate the activity, or because of an apparent lack of interest in activities of any kind.

There may be varying pictures of changes in speech and thinking, changes in perceptions, and in negative symptoms in the individual with schizophrenia, and these may change from time to time.

Like most other mental illnesses, the causes of schizophrenia are not yet identified, but it seems clear that a variety of genetic influences on brain function play a substantial role.

There are a wide range of treatments which are available to address various aspects of the illness. These include a variety of medication, known as antipsychotic medications, which can help alleviate the immediate symptoms, and in some cases reduce the likelihood that these symptoms will recur at a later time. The significant complicating factor in medication treatment is the fact that many individuals with schizophrenia may be using illegal drugs and/or alcohol. While some clinicians believe that the use of these illegal drugs or alcohol may be an attempt by the patient to reduce their symptoms, in reality the use of these other drugs complicates the diagnosis and the treatment. There are wide range of social and vocational rehabilitation treatments which  focus on assisting with regaining the ability to better deal with daily life, both work and at home, which have been impaired by the illness. In addition, certain forms of psychotherapy may be important in the long term treatment. There is good evidence that a long term relationship with an individual or a team of individuals caring for the patient results in better outcomes.

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