The Good News about Schizophrenia

It’s easy to dwell on the negatives when dealing with schizophrenia, but the truth is, there are many reasons for hope:

·         We know, without question, that schizophrenia is a no-fault disorder of the brain and that with appropriate treatment and supports, the illness doesn't necessarily have to have a chronic, deteriorating course. People do and can recover!

·         Early diagnosis and the availability of community-based treatment and social supports can restore an individual’s dignity, improve her quality of life, and enable her to make meaningful contributions to her family and community. Your loved one may find a different path than you or she anticipated, but it can still be a good one.

·         The ultimate goal of recovery is about more than relief of symptoms. Recovery entails helping people get back to work or school, live with others, and make their own life decisions. Patients and families should accept no less.

·         The role of families and friends is critical to recovery. They need to:

§  Support and anchor their loved ones during the acute phases of the illness

§  Help their loved ones find the tools they need to recover and avoid relapse

·         Continue to educate themselves to better cope with the challenges they encounter, working individually and collectively to fight stigma and discrimination based on misunderstanding.

Just as scientists now know that there are many different types of cancer, researchers may one day learn that schizophrenia is a family of similar disorders that are currently lumped under one term. This discovery could pave the way for more targeted and personalized treatments. Because the precise causes of schizophrenia are still unknown for any particular individual, scientists are exploring a number of possibilities including genetic, viral, infectious, chemical, developmental, and environmental explanations. There has never been more research being conducted on the causes and cures for schizophrenia than there is today.

Schizophrenia Risks - cont'd....

Prenatal factors

What happens to you before you’re born — or during the process of birth- can affect you all your life. The likelihood of schizophrenia developing has been linked to several prenatal (before birth) factors:

·         The age of the birth father: One prenatal risk factor that’s been linked to schizophrenia is the age of the birth father. Children with fathers who are over the age of 50 are three times more likely to develop schizophrenia than children whose fathers are under 30 years old at the time of their birth. Some researchers have suggested that this may be the result of sperm mutations that occur with advancing age.

·         Influenza: Studies have shown that children born to mothers who contracted the flu while pregnant (especially during the second trimester) also have a greater chance of developing schizophrenia.

·         Starvation: Maternal starvation is linked to increased risk of schizophrenia in offspring. Starvation can occur either because of poverty or because of eating disorders such as anorexia.

·         Stress: Recently, a large epidemiological study looked at stressors such as the death of a close relative or a diagnosis of cancer, heart attack, or stroke in a close relative as risk factors for having children who would develop schizophrenia later in life. Only one of these factors increased risk: The risk of developing schizophrenia or a related disorder was 67 percent greater among the children of mothers who experienced the death of a close family member during the first trimester than those who did not have that stress. The vast majority of fetuses exposed to these prenatal environmental stressors did not develop schizophrenia, leaving the perplexing question of why some did and others didn't still unanswered.

Schizophrenia Risks

Obstetrical and birth complications

The ways in which birth complications double the risk for schizophrenia are not known. But several studies show that various obstetrical and birth complications do increase risk.

A statistical review of multiple studies looking at the link between obstetric complications and schizophrenia found three groups of complications associated with the disorder:

·         Complications of pregnancy, including bleeding, diabetes, Rh incompatibility, and pregnancy-induced high blood pressure

·         Abnormal fetal growth and development, including low birth weight, cardiovascular congenital anomalies, and small head circumference

·         Complications of delivery, including lack of uterine muscle tone, inadequate oxygen intake by the baby, and emergency cesarean section (C-section)

·         Other life experiences

Although parents have been let off the hook as far as finger-pointing blame for schizophrenia goes, the current consensus is that other environmental stressors and stress in general may contribute to the onset of schizophrenia. For example, urban life, geographic migration, and poverty are all associated with increased rates of schizophrenia.

Other studies have shown that individuals with schizophrenia smoke marijuana more often than the general population. Some prospective studies now show that smoking marijuana (before the onset of psychotic symptoms) increases the likelihood of schizophrenia by two to four times. On the other hand, the overwhelming majority of people who smoke marijuana don’t develop schizophrenia.

Myths Associated with Schizophrenia

People wrongly associate the symptoms of schizophrenia with split or multiple personalities (like Dr. Jekyll and Mr. Hyde), antisocial behavior (similar to what we see in serial killers), and developmental disabilities. Others believe that schizophrenia is a character defect and that the individual could behave normally if he really wanted to.

Here are a few of the most common misconceptions about schizophrenia:

Schizophrenia is the same as a split or multiple personality. Schizophrenia is not the same as multiple personality, which is an exceedingly rare, totally different disorder that is now more commonly called a dissociative identity disorder. (Under stress, people with this disorder often assume different identities, each with different names, voices, characteristics, and personal histories.)

People with schizophrenia are violent. People with schizophrenia are more likely to be victims rather than perpetrators of crimes. Many people believe that most people with schizophrenia have a propensity for violence, but the reality is that most people with schizophrenia don’t commit violent crimes, and most violent criminals don’t have schizophrenia. For example, serial killers (people who commit three or more subsequent murders) usually aren’t psychotic (out of touch with reality); they’re likely to be diagnosed with an antisocial personality disorder (a disorder in which people disregard commonly accepted social rules and norms, display impulsive behavior, and are indifferent to the rights and feelings of others).

However, people with untreated schizophrenia, who refuse to take medication and whose thinking is out of touch with reality are at increased risk of aggressive behavior and self-neglect. The risk of violence also increases if someone with schizophrenia is actively abusing alcohol or illicit drugs. For better or worse, the aggressive behavior is usually directed toward family or friends rather than toward strangers.

Poor parenting causes schizophrenia. For many years, clinicians were taught and actually believed that schizophrenia was caused by parents who were either too permissive or too controlling. The term schizophrenogenic mother was once used to describe such parents — the blame usually fell heavily on mothers because they tended to spend the most time with their offspring.

Another outdated theory is the double-bind theory, which suggested that schizophrenia is due to inconsistent parenting, with conflicting messages. These ideas were not based on controlled studies, and these theories no longer have credibility today. Schizophrenia is a no-fault disorder of the brain.

People with schizophrenia are mentally retarded. Some people think that schizophrenia is synonymous with mental retardation (now called developmental disabilities). No. Like the general public, people with schizophrenia have a wide range of intellectual abilities. They may appear less intelligent because of the impaired social skills, odd behaviors, and cognitive impairments that are characteristic of schizophrenia.

However, they’re not lacking in intelligence, and schizophrenia is distinct from developmental disabilities (physical and mental deficits that are chronic and severe and that generally begin in childhood).

Schizophrenia is a defect of character. Negative symptoms of schizophrenia give people the mistaken impression that those with the disorder are lazy and could act “normally” if they wanted to. This idea is no more realistic than suggesting that someone could prevent his epileptic seizures if he really wanted to or that someone could “decide” not to have cancer if he ate the right foods. What often appears as character defects are symptoms of schizophrenia. When the negative symptoms of schizophrenia are persistent and primarily caused by schizophrenia, they’re referred to as deficit syndrome.

There’s no hope for people diagnosed with schizophrenia. Sixty years ago when people were diagnosed with schizophrenia, they were either kept at home behind closed doors by embarrassed and forlorn families who saw no other alternative, or consigned to long-term stays in distant state hospitals for care that was largely custodial (they weren’t treated — they were just taken care of). Other than using highly sedating drugs, doctors had few tools available to them to relieve the agitation and torment of their patients or to help restore their functioning.

In contrast to how things were in the past, schizophrenia is now considered highly treatable. Several generations of new medications and the emergence of new forms of therapies have enabled doctors to treat the symptoms of the large majority of patients with schizophrenia enabling them to live meaningful, productive lives in their communities.

The Symptoms of Schizophrenia

There are almost 300 named psychiatric disorders, and schizophrenia is one of them. Although many mental illnesses have symptoms that overlap, schizophrenia has a distinct pattern of symptoms. No two cases of schizophrenia look exactly the same, but most people with schizophrenia display three types of symptoms:

Positive symptoms: The term positive symptoms is confusing, because positive symptoms (as the term might suggest) aren’t “good” symptoms at all. They’re symptoms that add to reality, and not in a good way. People with schizophrenia hear things that don’t exist or see things that aren’t there (in what are known as hallucinations). The voices they hear can accuse them of terrible things and can be very jarring (for example, causing them to think that they’ve hurt someone or have been responsible for some cataclysmic world event).

People with schizophrenia can also have delusions (false beliefs that defy logic or any culturally specific explanation and that cannot be changed by logic or reason). For example, an individual may believe that there is a conspiracy of people driving red cars that follows his every movement. He will use the fact that there are red cars everywhere he goes as evidence that the conspiracy is real.

Negative symptoms: These symptoms are a lack of something that should be present; behaviors that would be considered normal are either absent or diminished. For example, people with schizophrenia often lack motivation and appear lazy. They may be much slower to respond than most other people, have little to say when they do speak, and appear as if they have no emotions, or exhibit emotions that are inappropriate to the situation. They may also be unable to get pleasure from the things that most people enjoy or from activities that once brought pleasure to them. Families often get frustrated when a relative with schizophrenia does nothing but sleep or watch TV — they wrongly attribute this behavior to the patient not being willing to assume responsibility or “pull himself up by his bootstraps.”

Negative symptoms are part and parcel of the illness for at
least 25 percent of people with schizophrenia.

Cognitive symptoms: Most people with the disorder suffer from impairments in memory, learning, concentration, and their ability to make sound decisions. These so-called cognitive symptoms interfere with an individual’s ability to learn new things, remember things they once knew, and use skills they once had. Cognitive symptoms can make it hard for a person to continue working at a job, going to school, or participating in activities she may have enjoyed at one time.

In addition to the symptoms mentioned above, people with schizophrenia may also have sleep problems, mood swings, and anxiety. They may experience difficulties forming and maintaining social relationships with other people. They may look different enough that other people notice that something is very odd or strange about them and that they don’t quite look “normal.” They may have unusual ways of doing things, have peculiar habits, dress inappropriately (such as wearing a heavy coat or multiple layers of clothes in the summer), and/or be poorly groomed, which can discourage other people from getting involved with them.

What causes schizophrenia?

Schizophrenia is a no-fault, equal-opportunity illness most likely caused by a number of factors, both genetic and environmental. Most scientists now accept a two-hit theory for the cause of schizophrenia, which suggests that the genetic susceptibility is compounded by one or more environmental factors:

Genetic susceptibility: Based on family genetic history, some people are more vulnerable to the disorder than other people are.

Environmental factors: In someone genetically predisposed, certain environment factors may come into play, such as:

• Physical trauma that occurs to the fetus during childbirth

• Oxygen-deprivation or some psychological or physical problem that occurs to the mother during pregnancy and affects the developing fetus

• Emotional stress, such as the loss of a parent or loved one during young adulthood.

Although schizophrenia is genetically influenced, more than genetics is involved in its development. Studies of identical twins show that, if one twin develops schizophrenia, the other twin has only a 40 percent to 50 percent chance of also developing the illness. There’s also an increased risk among fraternal twins when one develops schizophrenia, the other has between a 10 percent and 17 percent chance, far less than that of identical twins. Having a parent with schizophrenia also increases a person’s risk of developing the disease, to about 10 percent. And if you have a sibling with the disorder — not your twin — you have a 6 percent to 9 percent chance of developing the disorder yourself.

Scientists still don’t know the precise causes of schizophrenia for any particular individual, yet family members and patients themselves tend to dwell on (or even obsess about) finding a “reason” or a “cause” for the illness. Although this instinct is a natural one, finding the precise cause or explanation is impossible, not to mention counterproductive — finding a reason doesn’t help treatment, and it often creates unnecessary and misplaced guilt, with one family member blaming another.

What is Schizophrenia?

Schizophrenia is a brain disorder characterized by a variety of different symptoms, many of which can dramatically affect an individual’s way of thinking and ability to function. Most scientists think that the disorder is due to one or more problems in the development of the brain that results in neurochemical imbalances, although no one fully understands why schizophrenia develops.

People with schizophrenia have trouble distinguishing what’s real from what’s not. They are not able to fully control their emotions or think logically, and they usually have trouble relating to other people. They often suffer from hallucinations; much of their bizarre behavior is usually due to individuals acting in response to something they think is real but is only in their minds.

Unfortunately, because of the way schizophrenia has been inaccurately portrayed in the media over many decades, the illness is one of the most feared and misunderstood of all the physical and mental disorders. Schizophrenia is a long-term relapsing disorder because it has symptoms that wax and wane, worsen and get better, over time. Similar to many physical illnesses (such as diabetes, asthma, and arthritis), schizophrenia is highly treatable — although it isn’t yet considered curable.

But the long-term outcomes of schizophrenia aren’t as grim as was once believed. Although the disorder can have a course that resulted in long-term disability, one in five persons recovered completely. Some people have only one psychotic episode, others have repeated episodes with normal periods of functioning in between, and others have continuing problems from which they never fully recover.