Reviewed by Whitney White, MS CMHC, NCC., LPC
Schizophrenia is a mental disorder that may be caused by anomalies in the brain's structure, function, and chemistry, as well as environment and genetics. Without treatment, the disorder slowly and progressively becomes debilitating. According to the World Health Organization, around 1% of the population currently deals with this condition. Although there is no cure for this complicated mental illness, new medications show promise of alleviating many of the severe symptoms related to the condition with lesser motor side effects than older medications.
The prevalence of the condition is divided equally between men and women. However, schizophrenia often appears earlier in men (generally in the late adolescent years or early 20s) compared to women, who usually start to exhibit the symptoms in their twenties or early thirties. Schizophrenia rarely begins before puberty.
A Quick Overview of Schizophrenia
Schizophrenia exhibits itself differently in each person. The symptoms often start gradually and can even go undetected by friends and family at the start. However, in certain situations, symptoms of schizophrenia may start suddenly and can be somewhat devastating. As the illness develops, the symptoms may become more serious and eccentric.
Researchers believe that there is a link between genetic and environmental factors, which contribute to the disease. Scientists are still trying to learn more about the disorder, but many factors may play a part. According to one theory, malnutrition or exposure to a virus might have occurred during pregnancy, contributing to the condition. It is unknown why it so often begins during the teenage years, but there are many assumptions.
Many changes and development occur in the brain during puberty. These changes might trigger the disorder in people who are at high risk. Some experts believe it is associated with development in a part of the brain called the frontal cortex. Others think it is related to the myriad of connections between nerve cells that get removed with the brain’s maturity.
Hormones also play a crucial role in puberty. One theory is that women exhibit schizophrenia later than men because they experience puberty earlier, and the hormone estrogen might help with protection. It is important to know how to identify the signs of schizophrenia early in life.
Diagnosing schizophrenia can be difficult for different reasons. One reason is that people suffering from the condition usually do not know there is anything wrong, so they will probably not seek medical intervention. Another problem is that many of the changes that precede schizophrenia, known as the prodone, can be similar to other normal life changes. For instance, a teen who is developing the condition may abandon his usual friends and find new ones. They may also struggle with sleep or suddenly start getting poor grades.
Simultaneously, in the early stages, they may recommend low doses of antipsychotic meds to delay its progress. More studies are necessary to know if the drugs are effective for young people at risk of the condition. Family therapy, cognitive behavior therapy, and social skills training have been shown to have definite benefits for them, at least temporarily, when introduced early.
Schizophrenia makes it hard to differentiate between real and false, think clearly, relate with people, handle emotions, and function normally. It disrupts how the person thinks, behaves, and perceives the world.
The most common form of the condition is paranoid schizophrenia or schizophrenia with paranoia. This form causes the patient to have a different perception of reality. They may hear, see, or feel inexistent things, talk strangely, and believe that people seek to harm them or are constantly watching them. Such signs can lead to relationship issues, affect routine activities like eating or running errands, and cause drug or alcohol abuse as people try to self-medicate to alleviate symptoms.
The Early Warning Signs of Schizophrenia
As mentioned earlier, the signs of schizophrenia can be sudden and come without warning. However, for most people, the symptoms are gradual, with subtle warning signs and slow decline in normal functions, way before the first schizophrenic episode. In most cases, family members and friends will detect signs that something is wrong but cannot pinpoint the problem.
In the early stage of schizophrenia, the person may seem strange, emotionless, less driven, and reclusive to other people. They may start to withdraw into isolation, start to neglect self-care or appearance, say strange things, and be completely indifferent to life. They may stop usual hobbies and activities, and performance at school or work may decline quickly.
The most common early warning signs of schizophrenia include:
- Worsening personal hygiene
- Excessive sleeping or insomnia
- Forgetfulness and inability to concentrate
- Emotionless, expressionless gaze
- Social withdrawal
- Hostility or suspiciousness, overreaction to criticism
- Strange or irrational statements, an odd choice of words or speech manner
- Inability to express emotions, cry, or unfitting laughter or cries
Although these warning signs can come from a few other disorders, there is a cause for concern. When strange behavior is causing issues with you or a loved one, seek a medical opinion. If schizophrenia or another mental health disorder is the issue, prompt treatment will be helpful.
There are five main categories of symptoms regular with schizophrenia: hallucinations, delusions, disorganized behavior, disorganized speech, and negative symptoms. However, the early signs can vary significantly from one person to another, both in severity and pattern. Not everyone who has schizophrenia will exhibit the symptoms, and the symptoms may change eventually.
A delusion is a strong idea that the person has, regardless of the clear and obvious evidence that shows otherwise. delusions are prevalent among people with schizophrenia, occurring in over 90 percent of all cases. Usually, the delusions include irrational or eccentric or ideas such as:
Delusions of reference – associating special or personal meaning to a neutral environmental incidence. For instance, they might believe that someone on tv or a billboard is trying to send them a specific message.
Delusions of persecution – the idea that others are out to harm them. The delusions may include bizarre schemes or conspiracies.
Delusions of grandeur – ascribing value to oneself, like thinking you are a celebrity or important person like Jesus or Napoleon. It can also be the belief that you have superpowers like reading minds.
Delusions of control – the idea that someone or alien forces are trying to manipulate them. An instance may be thought transmission (someone transmitting their ideas and thoughts), thought insertion (that someone is giving them ideas), and thought withdrawal (someone stealing their thoughts).
These are sensations like a sound that feels real, even though they are only present in your head. Although hallucinations can affect any of the senses, auditory hallucinations (like hearing voices or other sounds) are more prevalent in schizophrenia. This may happen when you think your inner thoughts are coming from external sources.
Schizophrenic hallucinations are only meaningful to the person dealing with them. Often, the person may hear voices of someone familiar, and often they are critical, abusive, or vulgar. Visual hallucinations are also relatively prevalent, but all hallucinations are generally worse when the person is alone.
Schizophrenia can make concentration harder, which may be evident in how you talk. You may provide unrelated answers to questions, begin a sentence with one topic, finish it differently, talk incoherently, or say insensible things. Some of the signs of disorganized speech include:
- Neologisms – concocted words or phrases with no accepted meaning
- Loose associations – abruptly moving from one topic to another without any association between the last and the next.
- Perseveration – repeating words and statements
- Clangs – incomprehensible use of rhyming words
Schizophrenia is disruptive to goals, making it difficult to care for yourself, your work, and relate with others. Disorganized behavior may show as:
- Deterioration in general daily functions
- Strange and purposeless behavior
- Unpredictable or unfitting emotional reactions
- Lack of impulse control or inhibition
The negative symptoms are actually more of the absence of normal, acceptable behaviors in healthy people, including:
- Lack of emotional expression – blank or limited facial expressions, zero eye contact, and flat voice
- Loss of interest and enthusiasm – no motivation or interest in self-care.
- Lack of interest in the world – social withdrawal, inattention to the environment
- Strange or difficult conversations – unable to hold a conversation, short or incoherent replay, speaking monotonously.
Causes of Schizophrenia
Research indicates that having a close relative with schizophrenia may put someone at higher risk of developing the condition, but many people with schizophrenia have no relatives with the condition. Researchers continue to try to determine the full role that genetics may play.
Studies suggest that inherited genes can increase vulnerability to the disorder. Environmental factors may build on the vulnerability and trigger the disorder. Many studies point to stress – maybe during pregnancy or later developmental stage – as a primary environmental factor. Factors that can induce stress include:
- Exposure to a virus at infancy
- Prenatal exposure to a viral infection
- Low levels of oxygen at birth (due to extended labor or premature birth)
- Early loss of parents or separation
- Physical or sexual abuse during childhood
Abnormal brain structure or brain chemistry may also contribute to the development of schizophrenia.
Schizophrenia diagnosis follows a complete psychiatric evaluation, physical exam, and assessment of the patient’s medical history. Lab tests may be done to rule out medical conditions that may cause the symptoms. To get a diagnosis, patients must experience two or more of the five major symptoms for at least 30 days. Other criteria for diagnosis include:
Have dealt with major issues with performance at work or school, relationships with people and self-care
Show repeated signs of schizophrenia for a minimum of six months, with active symptoms for at least a month.
Have no other mental health conditions, substance abuse issues, or medical conditions that might cause the symptoms.
Points to Note
Many people with schizophrenia resort to self-isolation, act in fear and confusion and may deal with depression. Although schizophrenia is a chronic disorder, many opinions people have about the disorder have no factual basis. Most people with schizophrenia improve over time, not worsen. Treatment options are constantly improving, and patients can take steps to manage the symptoms.
Schizophrenia should be distinguished from multiple personalities or split personality. Dissociative identity disorder is different and less prevalent compared to schizophrenia. People with schizophrenia are only dissociated from reality and do not have a dissociative disorder.
Schizophrenia impacts about 1% of the population. Although the patient may require long-term treatment, the prognosis for schizophrenia is not hopeless, with proper treatment. The delusional thoughts and hallucinations can sometimes cause erratic behavior, but people with schizophrenia are not inherently violent or aggressive. In fact, people with any sort of mental health condition are more likely to be victims of crime than to perpetrate one.
Since schizophrenia is usually episodic, remission periods are the best time to practice self-help techniques to reduce any future episodes' duration, frequency, and severity. With the right support, therapy, and medication, many people living with schizophrenia manage their symptoms, function properly, and enjoy productive and rewarding lives. You can take an assessment test for schizophrenia here.