"Schizophrenia" What is Schizophrenia?
• About 70 million people in the world and 3.1 million people in the United States have the mental illness schizophrenia.(MHA) Despite the fact that millions of people suffer from schizophrenia and it was identified over 125 years ago as a separate and distinct mental illness, it is perhaps the most misunderstood and stigmatized mental illness of all. • Some people have the misconception that schizophrenia is a split or multiple personality disorder. • Although the word schizophrenia derived from the Greek words schizo and phrene which when translated literally mean split mind, this term was not used to convey a noticed split personality. This word was instead given to describe the often fragmented thinking noticed in people suffering with this type mental illness. • Many people still believe that a mentally ill person is likely to act out violently towards other's. Although research does suggest an increase of risk for violent behavior particularly in early occurrences ones schizophrenia. These acts of violence occur from only a subset of people with the disorder and account for only about 3 to 5% of the total violence in our society. However, how much ones mental illness actually contributes to these noted acts of violence is unknown, because other factors often exist such as substance abuse and violent environments and these are also contributing factors.
• According to the National Alliance on Mental Illness (NAMI) the greatest risk for violent acts to occur by a mentally ill person is when that person also has a substance abuse disorder. However substance abuse always increases the risk of violence even among people without mental disorders. There is also a small elevation of risk for increased violence if a person is being non-compliant with their treatment. • Despite some peoples perceptions, the vast majority of people with schizophrenia that are receiving proper medical treatment, and are abstaining from alcohol and drug abuse, pose little to no more threat of violence towards other's than anyone else does. The majority of people with schizophrenia are not violent and are living relatively independent lives. Most are in fact very productive contributing members to our society.
• Schizophrenia is a serious mental illness that has an effect on how a person feels, behaves, and thinks. It is a brain disorder that interferes with and deteriorates how ones thoughts, emotions, and behavior relate with each other. This interference and deterioration effects a persons ability to interpret reality. This loss of contact with reality causes delusions (false beliefs) about ones identity and the hearing and seeing of things that in reality are not there. • Schizophrenia is not the same as schizoaffective disorder, schizophasia, multiple personality disorder or schizoid personality disorder. The onset of schizophrenia most typically occurs in men between their teen years and mid twenties. In women the onset usually occurs in their mid twenties to mid thirties.
Random Schizophrenia Facts: • On average, people with schizophrenia die earlier than the general population. Men an average of 15 years earlier and women an average of 12 years earlier. • A person with schizophrenia is twice as likely as the general population to become diabetic or suffer from chronic obstructive pulmonary disease.(COPD) • The risk for dying from conditions such as diabetes, COPD, cancer, stroke, and cardiovascular disease are increased for those with schizophrenia. • People with schizophrenia are more a threat to themselves than others. • Statistics show that 40-60% of people with schizophrenia attempt suicide. • Statistics show that historically between 10 and 15% of people with schizophrenia commit suicide. • Antipsychotic medications used for treating schizophrenia do not produce a “high” or addictive behavior. • People with schizophrenia often make the common mistake of trying to ignore the illness as if it does not exist. • There are five different types of schizophrenia; residual, catatonic, disorganized, paranoid, and undifferentiated. • People with mental illness are more likely to be diagnosed with a substance use disorder than people without mental illness. • The signs and symptoms of schizophrenia vary from individual to individual.
Schizophrenia Symptoms: • The signs of schizophrenia are different for everyone. Some may experience only one or two symptoms while others may experience many. Symptoms may develop slowly over months or years, or may appear very abruptly. In some people their detachment from reality is a constant part of their life, while in others their symptoms will come and go in cycles of relapse and remission. • People with schizophrenia do not always act abnormally. They may appear perfectly responsible and in control, even when experiencing some of their symptoms. Schizophrenia symptoms are usually put into three categories: Positive symptoms, negative symptoms, and disorganized symptoms.
Positive schizophrenia symptoms • Positive schizophrenia symptoms are the obvious psychotic abnormal symptoms that appear in a person with schizophrenia that do not appear in a healthy person. They are things added to ones personality or behavior patterns that should not be there. They include: • Delusions: individuals may believe that someone is spying on him or her, or that they are someone famous. • Movement disorder: strange mannerisms, pacing, posturing, or rocking back and forth with no purpose. • Thought disorder: moving from one topic to another, in a nonsensical fashion. Individuals may make up their own words or sounds. • Hallucination: seeing, feeling, tasting, hearing or smelling something that doesn't really exist. The most common experience is hearing imaginary voices that give commands or comments to the individual.
Negative schizophrenia symptoms • Negative schizophrenia symptoms reflects the absence of certain normal behaviors in people with schizophrenia. They include: • Lack of emotion • Abnormal emotion expression such as crying at a joke when a normal response would be to laugh. • Social withdrawal from family and friends • Problems successfully functioning in the normal activities of life such as at work or school. • Poor hygiene • Catatonia • Loss of interest in life
Disorganized symptoms of schizophrenia • Disorganized symptoms of schizophrenia effect ones ability to think things through clearly so as to respond appropriately to them. They include: • • • •
Talking in sentences that do not make sense. Problems making decisions. Forgetting or losing things. Problems making sense of everyday sights, sounds, and feelings. • Shifting quickly from one thought to the next. • Pacing and walking in circles. • Excessive writing but without meaning.
• The symptoms suffered by a person with schizophrenia can be very debilitating. Schizophrenia can have severe negative effects on ones everyday life. These symptoms can effect a persons relationships, employment, finances, schooling, and overall enjoyment of life. One can only try and imagine how fearful and terrifying it must be to hear voices, believe that others are plotting to harm you or are trying to control your mind. Hallucinations and delusional thinking are severe symptoms very commonly experienced by those who suffer from schizophrenia. Some commonly expressed hallucinations and delusions by people with schizophrenia, include: • The government was watching me with planted video cameras. • I at times thought that aliens were communicating with me through street lights. • I heard voices and could not sleep at night. • The voice told me to kill myself in a slow painful way. • My thoughts seemed to broadcast through the radio. • I began feeling more and more that everyone was trying to get me. • I thought that maybe I was the Jesus of old.
What Causes Schizophrenia? • Despite much research scientists still have not pinpointed the precise cause of schizophrenia. However research has led some scientist to believe that people with schizophrenia are born with a predisposition for developing the illness, which they acquired during the early development of their brains. • This predisposition in the brain when accompanied by various other factors then triggers the onset of schizophrenia. The most common factors and triggers responsible for the development of schizophrenia, include:
• Brain chemical imbalance: The brains of people with schizophrenia have abnormal production or reaction to the important chemical neurotransmitter dopamine and maybe others. Dopamine is responsible in sending messages through the brain and effects how the brain perceives things. • Environmental Factors: Stress inducing environmental factors such as social pressure, physical or sexual abuse, loss of loved ones, hormones, malnutrition, and early exposure to viruses. The major brain changes that occur during puberty has also been identified as a possible contributing factor. Stressors can have profound effects on the amount of activity that's going on in the inflammatory immune system and the immune system impacts brain function. Evidence suggests that inflammation plays a role in the origin of schizophrenia. (NCBI) • Hereditary factor: People who have a family history of schizophrenia have a higher probability for developing it. If ones mother, father, brother or sister has the illness, statistics show a 10 percent chance of developing it. If ones twin, or both father and mother has the disorder then the probability of developing it rises to 40 percent. Whereas the general population only has an overall 1 percent risk of developing schizophrenia.
Schizophrenia Treatment: • Anyone can get schizophrenia. People throughout the world of all races, cultures, backgrounds, and socioeconomic groups are diagnosed with schizophrenia. Treatment results reported by The National Alliance on Mental Illness (NAMI) is encouraging. It is reported that with treatment about 80 percent of people with schizophrenia are able to lead productive and relatively independent lives. In 50 percent of the cases recovery is significant or even complete. About 20% of sufferers will experience relapse and will require a longer-term more structured treatment program. • So recovery is achievable in half of all cases for people who seek treatment for their schizophrenia. Recovery is defined by NAMI as not showing any symptoms and living in the community engaging in positive social interactions with their family and friends. In situations where a full recovery is not achieved, treatment often greatly reduces the severity of symptoms and still improves one's quality of life. Treatment for schizophrenia may include: • Drug Therapy: Antipsychotic medication is often very successful in treating schizophrenia. Antipsychotics have an affect on the brains dopamine and serotonin neurotransmitters which helps to normalize the chemical imbalance and relieve the most troubling schizophrenia symptoms. Schizophrenia appears to include not only a thought disorder but also anxiety and mood disorder. For this reason antidepressants and short term use of antianxiety medications are sometimes included in the treatment plan. The most commonly prescribed drugs for treating schizophrenia, include:
• Conventional antipsychotics:
• Newer atypical antipsychotics:
• Chlorpromazine (Thorazine) • Fluphenazine (Prolixin) • Haloperidol (Haldol) • Thiothixene (Navane) • Trifluoperazine (Stelazine) • perphenazine (Trilafon) • Thioridazine (Mellaril)
• • • • • • • •
Aripiprazole (Abilify) Clozapine (Clozaril) Ziprasidone (Geodon) Quetiapine Fumarate (Seroquel) Olanzapine (Zyprexa) Risperidone (Risperdal) Paliperidone (Invega) Asenapine (Saphris)
Antidepressants: The two most commonly used antidepressant types are SSRI's and SNRI's Selective serotonin reuptake inhibitors (SSRI)
• • • • •
Sertraline (Zoloft) Escitalopram (Lexapro) Fluoxetine (Prozac) Citalopram (Celexa) Paroxetine (Paxil)
Serotonin and norepinephrine reuptake inhibitors (SNRI)
• Duloxetine (Cymbalta) • venlafaxine (Effexor)
Antianxiety Medications: • • • •
Alprazolam (Xanax) Clonazepam (Klonopin) Diazepam (Valium) Lorazepam ( Ativan)
• All of the medications mentioned on these slides and these medications above have there own levels of side effects and risks. Researchers are working to better understand these side effects so as to lessen the risk and manage the complications associated with them. It is very important to take these medications only under a doctors orders and in the dosage and frequency amount specified by ones doctor. One should also investigate and discuss with their doctor's all possible side effects, their severity, and risk levels, as it is their health and quality of life that is in question.
Psychosocial therapy • While medication can help relieve the symptoms associated with schizophrenia, psychosocial therapy can help one deal with other important issues. Issues often associated with the illness, such as occupation, self-care, relationships, motivation, and communication can be addressed. • Through psychosocial therapy patients can learn coping mechanisms, how to manage their symptoms, how to identify early warning signs of relapse, how to respond to them, and how to prevent relapses. They are thus less likely to relapse or have need for hospitalization. Those who receive psychosocial therapy who are also on a drug treatment regime are more likely to adhere to it. Psychosocial therapies include: • Individual psychotherapy • Family therapy • Group therapy/support groups
• Rehabilitation: Can help a person with schizophrenia to reach their greatest functioning level and thus live as independently as possible. Rehabilitation program staff members can help one to find work, housing, and helpful social activities. • Support Groups: These can be very helpful for those with schizophrenia and for their family members and friends. There are local support groups and there are also helpful online support groups, such as: • NAMI Care Group NAMI Family Support NAMI Peer to Peer Online Support Group • Hospitalization: Most people with schizophrenia can be treated without need for hospitalization. However, for those with particularly severe symptoms, or those that are a danger of hurting themselves or others, hospitalization may be necessary to stabilize them.
• Electroconvulsive Therapy (ECT): Controlled electric current is applied to the head while the patient is under anesthesia in order to induce gran mile seizure. This procedure can be effective but is most often used for patients that are nonresponsive to drug therapy. Severe long term memory loss has been experienced in some patients after the procedure and is the major risk that is reported for ECT. • Vagus Nerve Stimulation (VNS): This is a treatment that involves using electrical impulses to stimulate the vagus nerve to send electrical signals to the brain-stem. The brain-stem then sends signals to other areas of the brain. This procedure requires the surgical placement of a stimulation device under the skin. Their are some usually tolerable post surgical risks for this procedure, such as headaches, nausea, chest pain and hoarseness. There have also been some reports of surgical complications similar to those found in other minor surgeries, but these are rare.
Mental Health Supplements: • Various herbs and dietary supplements have been used with some success in relieving schizophrenia symptoms. Mental health supplements are usually considered most successful when taken as supplemental treatments. Any consideration of adding a mental health supplement to a persons course of treatment should be discussed with their doctor before making any final decisions. Some of the most common mental health supplements used for schizophrenia symptoms, include: • • • • • • • • • • •
Gamma-aminobutyric acid (GABA): 5-HTP: Glutathione Ginkgo Passionflower Flaxseed oil Folic acid Kava kava L-glutamic acid Glycine *The above mental health supplements have been used for improving mood and relieving anxiety. Before taking such supplements one should always check with their doctor for any known side effects or potential harmful interactions that could occur with other medications they may be taking.
• There are various treatment methods available to help improve the lives of those who suffer from schizophrenia. Researchers are continuing to work to fully understand its cause so as to uncover any potential preventive care or early discovery methods, so as to find even better ways to prevent or treat it. • In the U.S. drug therapy is the most common first line treatment method for a patient experiencing a psychotic episode. If the response to drug therapy is favorable, and the patient has remained symptom free over a period of time, usually at least six months, an attempt may be made to gradually withdraw the drug from the patient. (Harvard Health) To further increase ones chances of full recovery, the patients and their families by means of psychotherapy can learn the early signs of relapse, how to respond to it, and how to prevent it. • The form of psychotherapy known as cognitive behavior therapy (CBT) when combined with drug therapy has shown to work well in treating schizophrenia. However, there have also been some studies reported that seem to support CBT as a viable and effective treatment of schizophrenia without the use of any medication. One of those studies results is reported in the Cambridge Journals Abstract.
• This study was small in scale as to participants (20), and included only participants that had for at least six months prior either discontinued or refused the use of medication as treatment. This studies reported conclusion seems encouraging. The study reported that all participants had achieved reductions in social impairment, delusions, and hallucinations. And that fifty percent of participants experienced significant reductions in these symptoms. • This study certainly seems to provide evidence that CBT should be at least considered a viable treatment method for people who refuse medication. As for using CBT treatment independent of drugs as a primary and viable treatment method in place of drug therapy, further more randomized, larger scale, controlled trials seem in order.
Early Treatment Helps: • If you or someone you know are experiencing the noted symptoms of schizophrenia go see a medical professional right away. How soon the treatment process begins after the onset of the illness can be a factor in the overall treatment outcome. • Early treatment with antipsychotic drugs is associated with significant symptom reduction. Treatment can lead to a full recovery or at least help limit the severity of your symptoms, and help improve the quality of your life. If you don't seek help most likely your condition will worsen. • Healing from schizophrenia is a process that takes patience. The chances of treatment helping you are far greater than it not. But it is important to recognize that it can sometimes take time for the treatment to attain its full positive effects. There is no one set treatment that works for everyone, treatment must be tailored for each specific individual. • For example, with drug therapy treatment the type of medication(s) used, the combination of drugs used, and the dosage amounts, often have to be adjusted. Be patient and allow sufficient time for doctors to find the treatment that best works for you.