Schizophrenia
Introduction
Schizophrenia is a chronic brain disease that impacts how an individual interprets reality and interferes with how a person thinks, manages emotions, makes decisions and relates to others.[1,2] This serious mental disorder affects less than one percent of the U.S. population.[3] The exact cause of schizophrenia is unknown but researchers believe that the combination of genetics, physical, psychological and environmental factors can make a person more susceptible to developing the condition.[4,5]
Symptoms and warning signs
Active schizophrenia varies by the person but can often include symptoms of delusions, hallucinations, disorganized speech, trouble with thinking, and lack of motivation.[6] Schizophrenia can occur at any age; however, it often appears in the late teens to early 20s for men, and the late 20s to early 30s for women.[7] Many individuals develop subtle warning signs and a gradual decline in functioning; in some cases, schizophrenia appears suddenly and without warning.[8]
The seven most common early warning signs include:[9]
Depression, social withdrawal
Hostility or suspiciousness, extreme reaction to criticism
Deterioration of personal hygiene
Flat, expressionless gaze
Inability to cry or express joy or inappropriate laughter or crying
Oversleeping or insomnia; forgetful, unable to concentrate
Odd or irrational statements; strange use of words or way of speaking
Complications
Left untreated, those with schizophrenia may develop problematic behaviors/actions. As such, research has found a link between schizophrenia and crime. Ghoreishi et al., (2014) note that individuals diagnosed with schizophrenia are 4 to 6 times more likely to commit a violent crime.[10] A study led by Seena Fazel (2014), found that within five years of being diagnosed, 10.7% of men and 2.7% of women had been convicted of a violent offense.[11] Fazel also concluded that three risk factors predicted future violence: past violent behaviors, substance abuse and past attempts at self-harm.[12] Once incarcerated, many individuals with mental illnesses do not receive necessary treatment, leading to their condition to worsen.[13]
Without proper care, many individuals with schizophrenia turn to self-medication in the form of substance use. Substance use disorders are more prevalent in those with schizophrenia than the general population;[14] a study by Khokhar et al., (2019) found that 47% of individuals with schizophrenia struggle with drug or alcohol abuse compared to 16% of those without the psychiatric disorder.[15]
Treatment
Schizophrenia requires lifelong treatment and the current treatments available help individuals manage symptoms in addition to improving their quality of life.[16,17] Current treatments include: antipsychotic medications, psychotherapy, psychosocial therapy and electroconvulsive therapy.[18]
Antipsychotic medications - These medications are often prescribed to ease symptoms of delusions and hallucinations, by interacting with chemicals in the brain such as dopamine and serotonin.[19] First generation medications are considered typical or conventional antipsychotics and include:
- Chlorpromazine (Thorazine)
- Fluphenazine (Prolixin)
- Haloperidol (Haldol)
- Perphenazine (Trilafon)
- Thioridazine (Mellaril)
- Thiothixene (Navane)
- Trifluoperazine (Stelazine)
Second generation medications are considered atypical antipsychotics and include:
- Aripiprazole (Abilify)
- Aripiprazole lauroxil (Aristada)
- Asenapine (Saphris)
- Brexpiprazole (Rexulti)
- Cariprazine (Vraylar)
- Clozapine (Clozaril)
- Iloperidone (Fanapt)
- Lumateperonee (Caplyta)
- Lurasidone (Latuda)
- Olanzapine (Zyprexa)
- Olanzapine/samidorphan (Lybalvi)
- Paliperidone (Invega Sustenna)
- Paliperidone palmitate (Invega Trinza)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Ziprasidone (Geodon)
In addition to antipsychotic drugs, a doctor can prescribe mood stabilizers or antidepressants depending on one’s symptoms.[20] These include:
Mood Stabilizers
- Lamotrigine (Lamictal)
- Lithium
- Carbamazepine (Tegretol)
- Valproic acid (Depakote)
Antidepressants
- Citalopram (Celexa)
- Fluoxetine (Prozac)
- Paroxetine (Paxil, Pexeva)
- Sertraline (Zoloft)
- Escitalopram (Lexapro)
Psychotherapy - Two modalities of psychotherapy commonly used to treat schizophrenia are cognitive behavioral therapy and cognitive enhancement therapy. Cognitive behavioral therapy (CBT) is a type of talk therapy where one works with a mental health counselor to become aware of inaccurate or negative thinking to view puzzling situations more clearly and respond to them effectively.[21] CBT is shown to improve functioning and quality of life.[22] Cognitive enhancement therapy (CET) is a recovery-phase cognitive rehabilitation training program for adults with schizophrenia or schizoaffective disorder and it is designed to improve neurocognition, cognitive style, social cognition and social adjustment.[23]
Psychosocial Therapy - This type of therapy is designed to help an individual with emotional or behavioral disturbances adjust to situations that require social interaction with members of the family, work group, community, or any other social unit.[24] Psychosocial therapies are a variety of different types of psychotherapy, social and vocational training.[25] They aim to provide support, education and guidance to people with mental illness and their families and are an effective way to improve the quality of life for individuals with mental illness as well as their families.[26] Psychosocial treatments can lead to fewer hospitalizations and less difficulties at home, at school and at work.[27] Social skills training, rehabilitation, family education, self-help groups, coordinated specialty care, assertive community treatment and social recovery therapy are just some of the different types of psychosocial therapy sessions individuals with schizophrenia can partake in.[28]
Electroconvulsive Therapy (ECT) - ECT is a medical treatment that provides a mild electrical current to the brain to induce a brief seizure, while one is under anesthesia.[29,30] It is most commonly used in patients with severe major depression or bipolar disorder but is also used for other severe mental illnesses such as schizophrenia; it is typically used when medication and psychotherapy does not work.[31]
With proper care and treatment, it is possible to live well with schizophrenia.[32] In addition to working with psychiatrists and other licensed mental health care providers (e.g., psychologists and psychotherapists), services often exist at the national and local level to help individuals live a better and healthier life. These include: community mental health teams, trained peer support, early intervention teams, crisis services, acute day hospitals, assertive outreach teams and other community health advocates.[33]
Contributed by: Ariana McGeary
Editor: Jennifer (Ghahari) Smith, Ph.D.
REFERENCES
1 Mayo Foundation for Medical Education and Research. (2020, January 7). Schizophrenia. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443#:~:text=Schizophrenia%20is%20a%20serious%20mental,functioning%2C%20and%20can%20be%20disabling.
2 Schizophrenia. NAMI. (n.d.). Retrieved from: https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizophrenia
3 What is schizophrenia? Psychiatry.org - What is Schizophrenia? (n.d.). Retrieved from: https://psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia
4 NHS. (2019, November 11). Living with - Schizophrenia. NHS choices. Retrieved from: https://www.nhs.uk/mental-health/conditions/schizophrenia/living-with/
5 Mayo Foundation for Medical Education and Research. (2020, January 7). Schizophrenia. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443#:~:text=Schizophrenia%20is%20a%20serious%20mental,functioning%2C%20and%20can%20be%20disabling.
6 What is schizophrenia? Psychiatry.org - What is Schizophrenia? (n.d.). Retrieved from: https://psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia
7 Schizophrenia. NAMI. (n.d.). Retrieved from: https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizophrenia
8 Smith, M., Robinson, L., & Segal, J. (2021, November). Schizophrenia symptoms and coping tips. HelpGuide.org. Retrieved from: https://www.helpguide.org/articles/mental-disorders/schizophrenia-signs-and-symptoms.htm
9 Ibid.
10 Ghoreishi, Abolfal & Kabootvand, Soleiman & Zangani, Ebrahim & Bazargan-Hejazi, Shahrzad & Ahmadi, Alireza & Khazaie, Habibolah. (2014). Prevalence and attributes of criminality in schizophrenic patients. Journal of injury & violence research. 7.10.5249/jivr.v7i1.635.
11 Mondics, J. (2014, June 4). Risk of violent behavior in people with schizophrenia has increased with hospital closures. Treatment Advocacy Center. Retrieved from: https://www.treatmentadvocacycenter.org/fixing-the-system/features-and-news/2565-risk-of-violent-behavior-in-people-with-schizophrenia-has-increased-with-hospital-closures
12 Ibid.
13 Courtesy of FBI's Criminal Justice Information Services Division Assistant Director Michael A. Christman and Bureau of Justice Statistics Director Alexis R. Piquero. (2017, April 7). Addressing mental illness in the criminal justice system. The United States Department of Justice. Retrieved from: https://www.justice.gov/archives/opa/blog/addressing-mental-illness-criminal-justice-system
14 Watson, S. (2022, May 2). Schizophrenia in the prison system. WebMD. Retrieved from: https://www.webmd.com/schizophrenia/schizophrenia-prison-system
15 Khokhar, J. Y., Dwiel, L. L., Henricks, A. M., Doucette, W. T., & Green, A. I. (2018). The link between schizophrenia and substance use disorder: A unifying hypothesis. Schizophrenia research, 194, 78–85. https://doi.org/10.1016/j.schres.2017.04.016
16 Mayo Foundation for Medical Education and Research. (2020, January 7). Schizophrenia. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443#:~:text=Schizophrenia%20is%20a%20serious%20mental,functioning%2C%20and%20can%20be%20disabling.
17 U.S. Department of Health and Human Services. (2022, May). Schizophrenia. National Institute of Mental Health. Retrieved from: https://www.nimh.nih.gov/health/topics/schizophrenia#part_2277
18 WebMD Editorial Contributors. (2021, March 4). Schizophrenia treatment: Types of therapy and medications for treating schizophrenia. WebMD. Retrieved from: https://www.webmd.com/schizophrenia/schizophrenia-therapy
19 Ibid.
20 Ibid.
21 Mayo Clinic Staff. (2019, March 16). Cognitive behavioral therapy. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
22 American Psychological Association. (2017, July). What is cognitive behavioral therapy? American Psychological Association. Retrieved from: https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
23 Cognitive enhancement therapy: Best center. NEOMED. (2022, August 22). Retrieved from: https://www.neomed.edu/bestcenter/practices/cognitive/
24 American Psychological Association. (n.d.). Apa Dictionary of Psychology. American Psychological Association. Retrieved from: https://dictionary.apa.org/psychosocial-therapy
25 Psychosocial treatments. NAMI. (n.d.). Retrieved from: https://www.nami.org/About-Mental-Illness/Treatments/Psychosocial-Treatments#:~:text=Psychosocial%20treatments%20include%20different%20types,mental%20illness%20and%20their%20families.
26 Ibid.
27 Ibid.
28 WebMD Editorial Contributors. (2021, March 4). Schizophrenia treatment: Types of therapy and medications for treating schizophrenia. WebMD. Retrieved from: https://www.webmd.com/schizophrenia/schizophrenia-therapy
29 ECT (electroconvulsive therapy): What it is & side effects. Cleveland Clinic. (2022, April 6). Retrieved from: https://my.clevelandclinic.org/health/treatments/9302-ect-electroconvulsive-therapy
30 McDonald, W., & Fochtmann, L. (2019, July). What is electroconvulsive therapy (ECT)? Psychiatry.org - What is Electroconvulsive Therapy (ECT)? Retrieved from: https://www.psychiatry.org/patients-families/ect
31 Ibid.
32 Psychosocial treatments. NAMI. (n.d.). Retrieved from: https://www.nami.org/About-Mental-Illness/Treatments/Psychosocial-Treatments#:~:text=Psychosocial%20treatments%20include%20different%20types,mental%20illness%20and%20their%20families.
33 NHS. (2019, November 11). Living with - Schizophrenia. NHS choices. Retrieved from: https://www.nhs.uk/mental-health/conditions/schizophrenia/living-with/