Schizophrenia

By Mao-Hsuan, Huang, M.D.

Schizophrenia is a chronic brain disorder. It has a lifetime prevalence of about 1% and accounts for a huge health care burden. Schizophrenia does not mean split personality or multiple-personality. Most people with schizophrenia are not dangerous or violent. They also are not homeless nor do they live in hospitals. Most people with schizophrenia live with family, in group homes or on their own.

When schizophrenia is active, symptoms can include delusions, hallucinations, trouble with thought and lack of motivation. With treatment, most symptoms of schizophrenia will improve. Experts are unraveling the causes of the disease by studying genetics, conducting behavioral research, and using advanced imaging to look at the brain’s structure and function. These approaches hold the promise of new, more effective therapies.

Signs and Symptoms

Symptoms usually first appear in early adulthood. Men often experience symptoms in their late teens or early 20s and women often first show signs in their 20s and early 30s. More subtle signs may be present earlier, including troubled relationships, poor school performance and reduced motivation. The symptoms of schizophrenia fall into three categories: positive, negative, and cognitive.

Positive symptoms: Positive symptoms are psychotic behaviors not generally seen in healthy people. Symptoms include hallucinations and delusions.

Negative symptoms: Negative symptoms are associated with disruptions to normal emotions and behaviors. A loss or a decrease in the ability to initiate plans, speak, express emotion or find pleasure. Symptoms include:

• “Flat affect” (reduced expression of emotions via facial expression or voice tone)

• Reduced feelings of pleasure in everyday life

• Difficulty beginning and sustaining activities

• Reduced speaking

Cognitive symptoms: Problems with attention, concentration, memory and declining educational performance. Symptoms include:

• Poor “executive functioning” (the ability to understand information and use it to make decisions)

• Trouble focusing or paying attention

• Problems with “working memory” (the ability to use information immediately after learning it)

Treatments and Therapies

Antipsychotics

Antipsychotic medications are usually taken daily in pill or liquid form. Some antipsychotics are injections that are given once to three times a month. Some people have side effects when they start taking medications, but most side effects go away after a few days or after adjustment of medications. Doctors and patients can work together to find the best medication or medication combination, and the right dose. 

Rehabilitation and Psychosocial Treatments

After the symptoms of schizophrenia are controlled, various types of therapy can continue to help people manage the illness and improve their lives. Therapy and supports can help people learn social skills, cope with stress, identify early warning signs of relapse and prolong periods of remission. Because schizophrenia typically strikes in early adulthood, individuals with the disorder often benefit from rehabilitation to help develop life-management skills, complete vocational or educational training, and hold a job. Family support is also very important to the health and well-being of people with schizophrenia.