According to the National Alliance on Mental Illness (NAMI), 85% of Americans recognize schizophrenia as a mental health disorder but only 24% are actually familiar with the condition. Moreover, many people’s understanding of the disorder is colored by misconceptions and stereotypes—many of which have been fueled by inaccurate portrayals in the media—with the majority believing people with schizophrenia have a “split personality” and are prone to violent behavior. This makes schizophrenia one of the most misunderstood and stigmatized mental illnesses. So to help dispel the myths and alleviate some of the mystery surrounding this serious disorder, this article is going to tackle the question, exactly what is schizophrenia?
What Is Schizophrenia?
Schizophrenia is a complex, chronic mental health disorder that can make it difficult to think clearly, manage emotions, make decisions, and relate to other people. According to the National Institute of Mental Health (NIMH), the disorder affects less than 1% of the general population. However, people with the condition are at far greater risk of suicide, with an estimated 5% dying by suicide during their lifetime.
Even though there appears to be no one cause of schizophrenia, experts agree it’s likely a combination of family history (genetics), brain chemistry, and environmental factors. In fact, a recent study of twins concluded that the disorder is approximately 80% genetic, while another study found that variations in one particular gene may lead to the highest risk of developing the condition.
Although schizophrenia can develop at any age, men tend to have their first episode in their late teens to early 20s, while women usually don’t show symptoms until their late 20s to early 30s. It’s also uncommon for the disorder to be diagnosed in children younger than 12 or adults older than 40.
Additional risk factors for schizophrenia include:
- Father of older age
- Exposure to certain viruses
- Malnutrition during pregnancy
- Prenatal exposure to toxins and stress
- Childhood trauma
Identifying Schizophrenia Symptoms
Schizophrenia is a complex disorder that can present with a number of symptoms. However, symptoms seen will fall into one of three main categories:
The positive symptoms of schizophrenia are what’s known as the psychotic symptoms, as they represent exaggerations and distortions of normal perception and thinking. These symptoms are considered positive because they’re not generally present in a person without schizophrenia. Positive symptoms include:
- Delusions (false beliefs)
- Thought disorders (disorganized thinking)
As the term suggests, negative symptoms are those symptoms that are generally present in healthy people but are diminished or absent in schizophrenia. These symptoms involve emotion and motivation and include:
- Flat affect (decreased facial expressions, monosyllabic and monotone speech)
- Reduced ability to feel pleasure
- Difficulty initiating and sustaining activities
The cognitive symptoms of schizophrenia are those that affect attention and memory. These symptoms may be mild to severe and include:
- Impaired decision-making skills
- Difficulty focusing or paying attention
- Problems processing new information
It’s important to remember that the symptoms of schizophrenia aren’t static and can vary in both type and severity over the course of a lifetime. Depending on the individual, this waxing and waning can include multiple periods of near to complete remission.
Types of Schizophrenia
Until the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released in 2013, schizophrenia was divided into five different subtypes:
- Paranoid schizophrenia
- Disorganized schizophrenia
- Catatonic schizophrenia
- Undifferentiated schizophrenia
- Residual schizophrenia
However, the American Psychiatric Association (APA) decided these subtypes weren’t helpful, as patients’ symptoms often overlapped with other subtypes or changed from one subtype to another. Thus, the DSM-5 did away with individualized subtypes, though it continues to utilize some to help provide further clarity regarding diagnosis.
Diagnosing schizophrenia involves ruling out other conditions, including brain tumors, medical conditions, substance abuse, and other psychiatric diagnoses, including bipolar disorder. Common methods used to confirm a diagnosis of schizophrenia are:
- Physical exam: A physical exam can help rule out medical conditions that cause symptoms similar to those seen in schizophrenia.
- Screening tests: Screening exams for substance abuse and tests that aid in ruling out conditions with symptoms similar to schizophrenia may be used.
- Imaging studies: Magnetic resonance imaging (MRI) and computed tomography (CT) scans may be used to rule out brain tumors or other structural abnormalities.
- Psychiatric evaluation: The performance of a general medical and psychiatric history as well as mental status exam can help confirm a diagnosis of schizophrenia.
In addition, even though symptoms in teenagers are similar to those seen in adults, cases involving this group may be more difficult to diagnose because symptoms of schizophrenia mimic issues commonly seen in teenagers. These symptoms include:
- Social withdrawal
- Decreased school performance
- Difficulty sleeping
- Irritable or depressed mood
- Lack of motivation
Teenagers with schizophrenia may also be less likely to experience delusions and more likely to have visual hallucinations than adults with the condition.
The DSM-5 will be used to finalize the diagnosis by evaluating whether the individual has had at least two specific symptoms associated with schizophrenia for a period of 6 months. This is a further change from the DSM-IV, which required only one symptom to confirm diagnosis. These symptoms are:
- Disorganized speech
- Disorganized or catatonic behavior
- Negative symptoms
Because of the complexity of schizophrenia, an accurate diagnosis is best obtained from a health care provider with experience treating mental health conditions.
Treatment of Schizophrenia
Although acute symptoms, including severe delusions or hallucinations, suicidal thoughts, and inability to care for oneself, may require hospitalization, schizophrenia can usually be managed effectively on an outpatient basis with a combination of:
- Psychosocial support
- Self-help strategies
The primary medications used in schizophrenia treatment are antipsychotics, which affect brain levels of dopamine—a neurotransmitter involved in the pathology of schizophrenia. Yet many people with the condition are reluctant to take them, as antipsychotic medications can cause serious side effects. However, working with your mental health professional to find the lowest effective dose can help lessen and even eliminate these side effects.
Once you and your health care provider have found the medication—or combination of medications—that works for you, a variety of psychological and social interventions can be helpful in improving quality of life. These interventions include:
- Psychotherapy: Therapy designed to help individuals normalize their thought patterns—such as learning to challenge delusional beliefs and ignore hallucinations—cope with the stress that comes with a diagnosis of schizophrenia, and identify early warning signs of relapse can be useful in managing the disorder.
- Social skills training: This type of intervention is focused on improving communication, social interactions, and the ability to participate in daily activities.
- Vocational rehabilitation: This type of intervention, along with employment support services, helps people prepare for, find, and maintain jobs.
Individuals with schizophrenia who utilize these approaches not only improve their communication, motivation, and self-care but also learn new skills and coping mechanisms. And this can help someone whose education and job path was disrupted get back to attending school, going to work, and socializing. It’s also been shown that people who undergo regular psychosocial treatment are more compliant with medication and have fewer relapses and hospitalizations.
In addition, a recent study demonstrated that the use of a type of psychotherapy called acceptance and commitment therapy (ACT)—a mindfulness therapy that teaches people to accept their symptoms, rather than avoid them—in people hospitalized for psychosis was effective in treating negative symptoms and reducing rates of rehospitalization.
When you’ve been diagnosed with schizophrenia, it’s also important to take care of yourself. Strategies such as reducing stress and seeking out social support can help reduce the frequency and severity of symptoms as well as feelings of hopelessness and helplessness. And this can help your medication and therapeutic interventions work more effectively.
In fact, being proactively involved in your treatment and refusing to accept the stigma that results from misconceptions about schizophrenia will not only increase your self-esteem but will also help you feel more in control of your health and your life.
In addition, studies have shown that eating a healthy diet can have an appreciable impact on the prevention and treatment of schizophrenia. For example, one study found that omega-3 fatty acids may prevent or mitigate the course and symptoms of the disorder, while another discovered that initiation of a low-carbohydrate, ketogenic diet led to the disappearance of symptoms in a patient with lifelong schizophrenia.
Additional studies have also shown that people with schizophrenia experience greater levels of oxidative stress, obesity, and nutrient deficiencies, especially niacin. And eating a diet rich in fruits, vegetables, lean protein, and healthy fats can increase levels of antioxidants in the body, reduce blood sugar fluctuations, supply necessary nutrients, and help prevent symptoms or reduce their severity.
Moreover, several studies have found that high doses of the amino acid glycine are effective in reducing the negative symptoms of schizophrenia, with one study showing an impressive 34% reduction in symptoms.
While there’s still no known cure for schizophrenia, with early diagnosis, proper medication, psychosocial support, and appropriate self-care, it’s possible to manage symptoms and lead a full and fulfilling life. But the first step is asking for help, so if you believe you or a loved one is suffering from schizophrenia, don’t let stigma or fear stop you from seeking the help you need.