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Schizophrenia, also sometimes colloquially called split personality disorder, is a chronic, severe, debilitating mental illness that affects about 1% of the population, more than 2 million people in the United States alone.
With the sudden onset of severe psychotic symptoms, the individual is said to be experiencing acute schizophrenia. Psychoticmeans out of touch with reality or unable to separate real from unreal experiences.
There is no known single cause of schizophrenia. As discussed later, it appears that genetic factors produce a vulnerability to schizophrenia, with environmental factors contributing to different degrees in different individuals.
There are a number of various treatments for schizophrenia. Given the complexity of schizophrenia, the major questions about this disorder (its cause or causes, prevention, and treatment) are unlikely to be resolved in the near future. The public should beware of those offering "the cure" for (or "the cause" of) schizophrenia.
Schizophrenia is one of the psychotic mental disorders and is characterized by symptoms of thought, behavior, and social problems. Symptoms of schizophrenia may include delusions, hallucinations, catatonia, negative symptoms, and disorganized speech or behavior. There are five types of schizophrenia based on the kind of symptoms the person has at the time of assessment: paranoid, disorganized, catatonic, undifferentiated, and residual. Children as young as 6 years of age can be found to have all the symptoms of schizophrenia as their adult counterparts and to continue to have those symptoms into adulthood. Although the term schizophrenia has only been in used since 1911, its symptoms have been described throughout written history. Schizophrenia is considered to be the result of a complex group of genetic, psychological, and environmental factors. Health-care practitioners diagnose schizophrenia by gathering comprehensive medical, family, mental-health, and social/cultural information. The practitioner will also either perform a physical examination or request that the individual's primary-care doctor perform one. The medical examination will usually include lab tests.
In addition to providing treatment that is appropriate to the diagnosis, professionals attempt to determine the presence of mental illnesses that may co-occur. People with schizophrenia are at increased risk of having a number of other mental-health conditions, committing suicide, and otherwise dying earlier than people without this disorder.
Medications that have been found to be most effective in treating the positive symptoms of schizophrenia are first- and second-generation antipsychotics. Psychosocial interventions for schizophrenia include education of family members, assertive community treatment, substance-abuse treatment, social-skills training, supported employment, cognitive behavioral therapy, and weight management.
Cognitive remediation, peer-to-peer treatment, and weight-management interventions remain the focus topics for research.
What is schizophrenia?
Schizophrenia, also sometimes colloquially called split personality disorder, is a chronic, severe, debilitating mental illness that affects about 1% of the population, corresponding to more than 2 million people in the United States alone. Other statistics about schizophrenia include that it affects men about one and a half times more commonly than women. It is one of the psychotic mental disorders and is characterized by symptoms of thought, behavior, and social problems. The thought problems associated with schizophrenia are described as psychosis, in that the person's thinking is completely out of touch with reality at times. For example, the sufferer may hear voices or see people that are in no way present or feel like bugs are crawling on their skin when there are none. The individual with this disorder may also have disorganized speech, disorganized behavior, physically rigid or lax behavior (catatonia), significantly decreased behaviors or feelings, as well as delusions, which are ideas about themselves or others that have no basis in reality (for example, the individual might experience paranoia, in that he or she thinks others are plotting against them when they are not).
Paranoid schizophrenia: The individual is preoccupied with one or more delusions or many auditory hallucinations but does not have symptoms of disorganized schizophrenia.
Disorganized schizophrenia: Prominent symptoms are disorganized speech and behavior, as well as flat or inappropriate affect. The person does not have enough symptoms to be characterized as suffering from catatonic schizophrenia.
Catatonic schizophrenia: The person with this type of schizophrenia primarily has at least two of the following symptoms: difficulty moving, resistance to moving, excessive movement, abnormal movements, and/or repeating what others say or do.
Undifferentiated schizophrenia: This is characterized by episodes of two or more of the following symptoms: delusions, hallucinations, disorganized speech or behavior, catatonic behavior or negative symptoms, but the individual does not qualify for a diagnosis of paranoid, disorganized, or catatonic type of schizophrenia.
Residual schizophrenia: While the full-blown characteristic positive symptoms of schizophrenia (those that involve an excess of normal behavior, such as delusions, paranoia, or heightened sensitivity) are absent, the sufferer has a less severe form of the disorder or has only negative symptoms (symptoms characterized by a decrease in function, such as withdrawal, disinterest, and not speaking).
Hearing, seeing, feeling, smelling, or tasting things that have no basis in reality (hallucinations)
Disorganized speech
Disorganized behaviors
Catatonic behaviors
Lack of speech
Lack of motivation
In asking questions about mental-health symptoms, mental-health professionals are often exploring if the individual suffers from hallucinations or delusions, depression and/or manic symptoms, anxiety, substance abuse, as well as some personality disorders (for example, schizotypal personality disorder) and developmental disorders (for example, autism spectrum disorders). Since some of the symptoms of schizophrenia can also occur in other mental illnesses, the mental-health screening is to determine if the individual suffers from schizoaffective disorder or other psychotic disorder, depressive disorder, bipolar disorder, anxiety disorder, or a substance-abuse or personality disorder. Any disorder that is associated with bizarre behavior, mood, or thinking, like borderline personality disorder or another psychotic disorder, as well as dissociative identity disorder (DID), also known as multiple personality disorder (MPD) may be particularly challenging to distinguish from schizophrenia. In order to assess the person's current emotional state, health-care providers perform a mental-status examination as well. In addition to providing treatment that is appropriate to the diagnosis, determining the presence of mental illnesses that may co-occur (be comorbid) with schizophrenia is important in improving the life of individuals with schizophrenia. For example, people with schizophrenia are at increased risk of having a substance-abuse, depressive, or anxiety disorder and of committing suicide.
What are treatments for schizophrenia and the side effects of those treatments?
Medications While there are a number of helpful treatments available, medication remains the cornerstone of treatment for people with schizophrenia. These medications are often referred to as antipsychotics since they help decrease the intensity of psychotic symptoms. Many health-care professionals prescribe one of these medications, sometimes in combination of one or more other psychiatric medications, in order to maximize the benefit for the person with schizophrenia. Medications that are thought to be particularly effective in treating positive symptoms of schizophrenia includeolanzapine (Zyprexa), risperidone(Risperdal), quetiapine (Seroquel),ziprasidone (Geodon), ar ipiprazole (Abilify), paliperidone (Invega), asenapine (Saphis), lurasidone (Latuda), and lloperidone (Fanapt). These medications are the newer group of antipsychotic medications, also called secondgeneration antipsychotics. They are known for having the ability to work quickly compared to many other psychiatric medications. As a group of medications, side effects that occur most often include sleepiness, dizziness, and increased appetite. Weight gain, which may be associated with higher blood sugar levels, elevated blood lipid levels, and sometimes increased levels of a hormone called prolactin, may also occur. Although older antipsychotic medications in this class like haloperidol (Haldol), perphenazine (Trilafon), and molindone (Moban) are more likely to cause muscle stiffness, shakiness, and very rarely uncoordinated muscle twitches (tardive dyskinesia) that can be permanent, health-care practitioners appropriately monitor the people they treat for these potential side effects as well. Also, more recent research regarding all antipsychotic medication seems to demonstrate that the older (first-generation) antipsychotics are just as effective as the newer ones and have no higher rate of people stopping treatment because of any side effect the
medications cause. Not all medications that treat schizophrenia in adults have been approved for use in treating childhood schizophrenia. Mood-stabilizer medications like lithium (Lithobid), divalproex (Depakote),carbamazepine (Tegretol), and lamotrigine (Lamictal) can be useful in treating mood swings that sometimes occur individuals who have a diagnosable mood disorder in addition to psychotic symptoms (for example,schizoaffective disorder, depression in addition to schizophrenia). These medications may take a bit longer to work compared to the antipsychotic medications. Some (for example, lithium, divalproex, and carbamazepine) require monitoring of medication blood levels, and some can be associated with birth defects when taken by pregnant women. Antidepressant medications are the primary medical treatment for the depression that can often accompany schizophrenia. Examples ofantidepressants that are commonly prescribed for that purpose include serotonergic (SSRI) medications that affect serotonin levels like fluoxetine(Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), andescitalopram (Lexapro); combination serotonergic/adrenergic medications (SNRIs) like venlafaxine (Effexor) and duloxetine (Cymbalta), as well asbupropion (Wellbutrin), which is a dopaminergic (affecting dopamine levels) antidepressant medication. Despite its stigmatized history, electroconvulsive therapy (ECT) can be a viable treatment for people whose schizophrenia has inadequately responded to a number of medication trials and psychosocial interventions. When treating pregnant individuals with schizophrenia, health-care practitioners take great care to balance the need to maintain the person's more stable thoughts and behavior while minimizing the risks that medications used to treat this disorder may present. While some medications that treat schizophrenia may carry risks to the fetus in pregnancy and during breastfeeding, careful monitoring of how much medication is administered and the health of the fetus and of the mother can go a long way toward protecting the fetus from any such risks, while maximizing the chance that the fetus will grow in the healthier environment afforded by an emotionally healthy mother. Psychosocial interventions Family psycho-education: In addition to educating family members about the symptoms, course, and treatment of schizophrenia, this form of treatment consists of providing family support, problemsolving skills, and access to care providers during times of crises. When this intervention is consistently provided for at least several months, it has been found to decrease the relapse rate for the individual with schizophrenia and improve the person's social and emotional outcomes. Also, the burden that family members experience as a result of having a loved one with schizophrenia is lessened, family members tend to be more knowledgeable about the disorder and feel more supported by the professionals involved, and family relationships are improved. Assertive community treatment (ACT): This intervention consists of members of the person's treatment team meeting with that individual on a daily basis, in community settings (for example, home, work, or other places the person with schizophrenia frequents) rather than in an office or hospital setting. The treatment team is made up of a variety of professionals. For example, a
psychiatrist, nurse, case manager, employment counselor, and substance-abuse counselor often make up an ACT team. ACT tends to be successful in reducing how often people with schizophrenia are hospitalized or become homeless. Substance abuse treatment: Providing medical and psychosocial interventions that address substance abuse should be an integral part of treatment as about 50% of individuals with schizophrenia suffer from some kind of substance abuse or dependence. Social skills training: Also called illness management and recovery programming, social-skills training involves teaching clients ways to handle social situations appropriately. It often involves the person scripting (thinking through or role-playing) situations that occur in social settings in order to prepare for those situations when they actually occur. This treatment type has been found to help people with schizophrenia resist using drugs of abuse, as well as improve their relationships with health-care professionals and with people at work. Supported employment: This intervention provides supports like a work coach (someone who periodically or consistently counsels the client in the workplace), as well as instruction on constructing a rsum, interviewing for jobs, and education and support for employers to hire individuals with chronic mental illness. Supported employment has been found to help schizophrenia sufferers secure employment, earn more money, and increase the number of hours they are able to work. Cognitive behavioral therapy (CBT): CBT is a reality-based intervention that focuses on helping a client understand and change patterns that tend to interfere with his or her ability to interact with others and otherwise function. Except for people who are actively psychotic, CBT has been found to help individuals with schizophrenia decrease symptoms and improve their ability to function socially. This intervention can be done either individually or in group sessions. Weight management: Educating people with schizophrenia about weight gain and related health problems that can be a side effect of some antipsychotic and other psychiatric medications has been found to be helpful in resulting in a modest weight loss. That is also true when schizophrenia sufferers are provided with behavioral interventions to assist with weight loss.
focuses on improving how well the person with schizophrenia functions in real-world situations as a result of this treatment. Peer-to-peer treatment is a promising possible intervention since it promotes active constructive involvement from people who have schizophrenia, provides role models for individuals whose functioning is less stable, and may be accessible in individual and group settings, in person as well as by telephone or through the Internet. However, further research is necessary to demonstrate its effectiveness in decreasing symptoms or otherwise clearly improving functioning for people with schizophrenia. In terms of weight management, more research is needed to explore how to best help people with schizophrenia retain the weight loss they achieve and even to prevent weight gain in the first place.