Schizophrenia

Summary

• Schizophrenia can be managed.
• Antipsychotic drugs can increase risk of metabolic syndrome.
• Metabolic syndrome is a risk factor for heart disease, diabetes, and stroke.

Schizophrenia is a long-term mental illness that affects millions of adults. It disrupts a person’s thinking, which can cause unusual outward behavior. The exact cause of schizophrenia is unknown. Schizophrenia has no cure, but its symptoms can be managed well with proper treatment. This is done through both drug and non-drug therapies.

Non-drug therapies include support groups, as well as one-on-one counseling. They are not to be used in place of drug treatment, but along with it. These talk therapies teach individuals how to better cope with and manage their illness. It means they will also be more likely to remain on their medication.

Drug treatment

Drug therapy helps deal with the positive symptoms of the illness. This refers to symptoms not found in people who are healthy. This includes hearing and seeing things that others do not. A person with these symptoms does not know what is real and what is false. Positive symptoms are also referred to as psychotic symptoms. Drugs used to treat them are called antipsychotics.

Antipsychotics

The first antipsychotic drugs came out in the 1950s. These conventional drugs gave new hope to individuals who had delusions and hallucinations. Later on, second generation atypical antipsychotics came out. These drugs are as effective as the first ones. Sometimes more than one antipsychotic drug may need to be tried. A person should work closely with her doctor to see which drug treatment works best.

Antipsychotic side effects

Like all medications, antipsychotics are not without side effects. These may include dizziness, drowsiness, and constipation. Dry mouth and blurred vision are also common. More severe problems involve muscle movement issues, such as stiffness and restlessness. One rare, but serious, movement disorder is tardive dyskinesia (TD) which cannot always be treated.

Second generation, atypical drugs can sometimes cause other severe side effects. Abdominal obesity and low HDL “good” cholesterol are two such issues. Others include a rise in blood pressure, blood sugar levels, and triglycerides. These risk factors combined are known as metabolic syndrome.

Metabolic syndrome

This is a group of risk factors for heart disease, diabetes, and stroke. Blood tests are needed in order to make a proper diagnosis. Having three or more of the following 5\five factors means you have metabolic syndrome:

1. Excess stomach fat
2. Low HDL (“good”) cholesterol
3. High blood pressure
4. High blood sugar
5. High triglycerides (fat in blood)

Treating metabolic syndrome and diabetes

Your doctor may put you on medication to control some of these risk factors. As with your antipsychotic drugs, these need to be taken exactly as prescribed.

Healthy lifestyles can go a long way in treating, or preventing, metabolic syndrome and diabetes. This may require lifestyle changes in the following areas:

• Losing weight
• Exercising
• Eating a healthy diet
• Quitting smoking

Healthy weight

Keeping a healthy weight is a crucial part of controlling metabolic syndrome and diabetes. This can be helped by eating a heart healthy diet. This is a diet low in fat and salt. It includes whole grains, lean meats, and plenty of fruits and vegetables. Aerobic exercise is another great way to burn calories and help keep you fit. Talk to your doctor before starting any new physical activity.

Your Body Mass Index (BMI) will help you find your ideal weight range. This compares your weight with your height and measures total body fat. You can find out your BMI from your doctor, or from an online BMI calculator.

Your waist as well as your weight should be measured at each doctor visit. A guideline for a healthy waist measurement for women is less than 35 inches. For men it is less than 40 inches.

Further help and hope

People with schizophrenia can lead rich and rewarding lives. The key is to find the proper treatment and to stay on it. Healthy lifestyle changes, therapy, and family support also play vital roles in recovery. Long-term support is offered through self-help groups and rehab programs. These teach skills for coping with the illness and better managing life.

Resources

BMI calculator (NCEP)
www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm

Metabolic Syndrome Fact Sheet
www.nami.org/factsheets/metabolicsyndrome_factsheet.pdf

NAMI Peer-to-Peer is a free, 10-week education course on the topic of recovery for any person living with a serious mental illness.
www.nami.org/Find-Support/NAMI-Programs/NAMI-Peer-to-Peer

National Alliance on Mental Illness: ”Tell Me About Schizophrenia” video
www.nami.org/Videos/Tell-Me-About-Schizophrenia

Schizophrenia Digest is a magazine dedicated to hope, dignity, and support by providing information about schizophrenia for individuals, families, friends, and others.
www.szdigest.com

Schizophrenia for Dummies by Jerome Levine, MD and Irene S. Levine, PhD. For Dummies, 2008.

Understanding Schizophrenia and Recovery
www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=67729

By Kevin Rizzo

©2013-2019 Carelon Behavioral Health

Source: National Heart, Lung, and Blood Institute, www.nhlbi.nih.gov ; National Institute of Mental Health, www.nimh.nih.gov; National Alliance on Mental Illness, www.nami.org

Reviewed by Sanjay Vaswani, MD, CMQ, DFAPA, VP, Regional Medical Director, Beacon Health Options

Summary

• Learn all you can about the disease.
• Know the warning signs of relapse.
• Encourage the person by staying positive.

To help someone with schizophrenia you should first learn all you can about the disease. This shows your concern and puts you in a better position to help. You will learn that most people with the illness are not violent; neither do they have split personalities. They are simply someone in need of special care. You will then be able to treat the person with respect rather than fear.

Schizophrenia has no cure, but its symptoms can be managed well with proper treatment. You can help your friend or loved one by making sure he gets this treatment. This is only half the battle though. Staying with the treatment is the hard part. This is because people with the illness often are not aware there is any problem. This is where family and friends must step in.

Warning signs

By knowing early warning signs, you can help your friend or loved one avoid relapse. Here are some signs and symptoms to watch out for:

• Hearing or seeing things that others do not
• Not knowing what is real or false
• Feelings of paranoia
• Strange speech patterns
• Lack of emotion or expression
• Extreme withdrawal
• Marked changes in appearance
• Major personality changes
• Anger or fear toward family members
• Odd behaviors
• Great trouble focusing
• Severe sleep problems

Not everyone will have the same warning signs. They also may change throughout the course of the illness. Sometimes the signs will appear very quickly. Other times, they may come and go slowly over months or years.

Other ways of helping

Sometimes, the best way to help someone with schizophrenia is just to be there. This allows your friend or loved one to open up about his struggles. You don’t need to have all the answers. You just need to provide encouragement and support. Listen to him, and let him know he is not alone.

Here are other ways to help friends or loved ones recover:

• Go with him to doctor appointments.
• Attend support group meetings.
• Help her establish daily routines for sleeping, eating, and taking pills.
• Praise his successes and don’t dwell on his failures.
• Be patient with her.
• Encourage him by staying positive.
• Invite her to partake in healthy activities.
• Stay informed about the disease.
• Don’t ignore mentions of suicide: Call the person’s doctor or 911.

Help with substance use disorder

Many people with schizophrenia also struggle with substance use disorder. This can mask some of the signs of the disease. It also makes treatments less helpful and the person less likely to stay on them. Marijuana use is of special concern as it can make the symptoms worse. Even smoking cigarettes can disrupt treatment of the illness. You can be there to assist someone who wants to quit smoking or using drugs. Help the person to get involved in rehab therapy and support groups. Show your own support by getting involved in the groups as well.

Help for caregivers

There is a great deal of stress involved in caring for someone with schizophrenia. Caregivers also need to take care of themselves. Just like the person with schizophrenia, caregivers need to get proper rest and nutrition. Ask for extra help from other family members or friends when it’s needed. A healthy caregiver will make for a healthier person with schizophrenia.

Resources

100 Questions & Answers About Schizophrenia: Painful Minds, 2nd ed. by Lynn E. DeLisi, MD. Jones & Bartlett Publishers, 2009.

NAMI Peer-to-Peer is a free, 10-week education course on the topic of recovery for any person living with a serious mental illness.
www.nami.org/Find-Support/NAMI-Programs/NAMI-Peer-to-Peer

National Alliance on Mental Illness: ”Tell Me About Schizophrenia” video
www.nami.org/Videos/Tell-Me-About-Schizophrenia

Schizophrenia Digest is a magazine dedicated to hope, dignity, and support by providing information about schizophrenia for individuals, families, friends, and others.
www.szdigest.com

Schizophrenia for Dummies by Jerome Levine, MD and Irene S. Levine, PhD. For Dummies, 2008.

Surviving Schizophrenia, 6th Edition: A Family Manual by E. Fuller Torrey. Harper Perennial, 2013.

By Kevin Rizzo

©2013-2019 Carelon Behavioral Health

Source: National Institute of Mental Health, www.nimh.nih.gov; National Alliance on Mental Illness, www.nami.org

Reviewed by Sanjay Vaswani, MD, CMQ, DFAPA, VP, Regional Medical Director, Beacon Health Options

Summary

• Often confused with bipolar disorder
• Symptoms of psychosis and depression
• Doctor must properly diagnose

Schizophrenia is sometimes confused with other mental health disorders, most often bipolar disorder and schizoaffective disorder, but sometimes Alzheimer’s disease or Parkinson’s disease. Drinking and drug overuse can mimic some of the signs of schizophrenia. Other personality disorders, major depression, and even brain tumors can also be mistaken for it. A widely found bond between most of this is something called psychosis.

What is psychosis?

It is a loss of a link to reality. It means a person will not know what is true and what is false. This may consist of seeing or hearing things that aren’t really there, called hallucinations. It also involves false beliefs, called delusions. Sometimes this is expressed as overt fear and distrust of others. Often this is aimed at friends and family members. Other symptoms include severe mood swings, strange speech patterns, and odd behaviors. Many people with bipolar disorder, some people with severe depression, and most people with schizophrenia, will have psychosis.  

Bipolar disorder

A person with this disorder has periods of extreme high and low moods. The high times are called mania. The low times are called a depression. A mixed state means the highs and lows come about at the same time. Both bipolar disorder and schizophrenia mostly start in the teenage and young adult years. Other common traits include an added chance of substance use disorder and taking one’s own life. Due to the likeness of the two diseases, a doctor must make the proper diagnosis.

Parkinson’s and Alzheimer’s diseases

Some of the symptoms of Parkinson’s disease are like those of schizophrenia. These include the lack of facial expression and altered speech. Other signs that effect movement are not always present in schizophrenia. Alzheimer’s disease also shares some of the signs of schizophrenia, such as delusions and hallucinations. A major difference is that both Alzheimer’s and Parkinson’s most often start at age 50 or older.

Depression

A depressed person often loses his natural desires. This may include a lack of concern for hobbies, social events, and sex. The person may also have increased thoughts of death and taking one’s own life. Depression is a common trait among many mental health disorders. The negative symptoms of schizophrenia can be very similar to those of depression. Bipolar disorder differs from simple depression because it also includes periods of mania or hypomania.

Substance use disorder

Drinking and drug use can also mask some of the symptoms of schizophrenia. This is true both during times of use as well as times of withdrawal. Marijuana use can even make the symptoms worse. Drug overuse is very common with the disease.

Proper diagnosis

A physical exam and lab tests may be needed to rule out other likely illnesses. Next, a full mental health review may be needed. Your doctor might send you to a psychiatrist. It’s important to give a complete list of symptoms and family history of mental illness. You should also have a loved one with you who can give other key info.

Resources

Depression and Bipolar Support Alliance
www.dbsalliance.org

Mood Disorder Questionnaire
www.dbsalliance.org/pdfs/MDQ.pdf

National Alliance on Mental Illness: ”Tell Me About Schizophrenia” video
www.nami.org/Videos/Tell-Me-About-Schizophrenia

Schizophrenia and Related Disorders Alliance of America
www.sardaa.org

By Kevin Rizzo

©2013-2019 Carelon Behavioral Health

Source: National Institute of Mental Health, www.nlm.nih.gov; Depression and Bipolar Support Alliance, www.dbsalliance.org; National Alliance on Mental Illness, www.nami.org

Reviewed by Sanjay Vaswani, MD, CMQ, DFAPA, VP, Regional Medical Director, Beacon Health Options

Summary

• Drug and talk therapy is effective
• Person must stay on medicine
• Group and family support improve outlook

The outlook for people with schizophrenia used to be quite bleak. The lack of helpful treatment left them with little hope. Many were forced to live out their lives inside institutions. Today the picture is much brighter. While no cure has been found, there have been great advances in treatment. The result is that people with the disease can now live fruitful lives.

Drug therapy

The onset of antipsychotic drugs in the 1950s brought welcome relief to people with schizophrenia. Positive symptoms of the disease, such as hallucinations and delusions, were greatly subdued. Later on, a second wave of antipsychotic drugs became available. These new drugs gave new hope to people with little desire for life.

Second generation antipsychotics may have side effects. One of the most common side effects is weight gain. There is also a greater risk of getting diabetes. Milder issues, such as feeling dizzy or drowsy, usually go away on their own. Sometimes the drug or dose may need to be switched to reduce side effects or increase benefits. This must only be done at a doctor’s direction.

Staying on the drug treatment is the key to success. This is not always easy. Individuals often stop treatment for various reasons. The person may feel that the drugs no longer work or are no longer needed. Another reason is the unwanted side effects. There is also the lack of insight that is part of the disease itself. Those who stop drug treatments are at great risk of relapse. This may result in the need to be hospitalized.

Non-drug therapy

Non-drug therapies include support groups, as well as one-on-one counseling. They are not to be used in place of drug treatment, but along with it. These talk therapies are a vital part of the recovery process. People learn how to better cope with and manage their illness. They are also more likely to remain on their medication.

Individual therapy, or counseling, provides help on a one-on-one basis. The individual is taught proper coping skills for dealing with his illness. This may include learning practical things like healthy eating habits and having regular sleep routines. The therapist will also help the individual to work through her depressive and delusional thoughts.

Group therapy brings people together to discuss their disease. Members encourage each other through their success stories. They can also console each other by sharing their failures. Just hearing that someone else struggles with the same things you do can be helpful. Group therapy lets you know that you are not alone in the fight.

Family support is crucial to any person’s recovery. Therefore, it is advised that family members also take part in sessions. This begins with learning about the disease. The family is taught how to look for signs of oncoming schizophrenic episodes. They can then help ensure their loved one receives and remains on the needed treatment.

Help and hope

People with schizophrenia can lead rich and rewarding lives. The key is to find the proper treatment and to stay on it. Therapy and family support also play a vital role in recovery. Long-term support is offered through self-help groups and rehab programs. These teach skills for coping with the illness and better managing life.

Resources

NAMI Peer-to-Peer is a free, 10-week education course on the topic of recovery for any person living with a serious mental illness.
www.nami.org/Find-Support/NAMI-Programs/NAMI-Peer-to-Peer

National Alliance on Mental Illness ”Tell Me About Schizophrenia” video
www.nami.org/Videos/Tell-Me-About-Schizophrenia

Schizophrenia and Related Disorders Alliance of America
www.sardaa.org

Schizophrenia Digest is a magazine dedicated to hope, dignity, and support by providing information about schizophrenia for individuals, families, friends, and others.
www.szdigest.com

Schizophrenia for Dummies by Jerome Levine, MD and Irene S. Levine, PhD. For Dummies, 2008.

By Kevin Rizzo

©2013-2019 Carelon Behavioral Health

Source: National Institute of Mental Health; www.nimh.nih.gov; National Alliance on Mental Illness, www.nami.org

Reviewed by Sanjay Vaswani, MD, CMQ, DFAPA, VP, Regional Medical Director, Beacon Health Options

Summary

• Stay on treatment.
• Side effects vary from mild to severe.
• Meds may need to be adjusted by a doctor.

Schizophrenia is a long-term mental illness that affects millions of adults. It disrupts a person’s thinking, which can result in unusual outward behavior. People with the illness often “hear” voices. They may also “see” things that aren’t really there. These voices and visions, known as hallucinations, are very real to the person. In addition, the person may believe things that are not based in reality, something called delusions. Other symptoms are similar to those of depression.

The exact cause of schizophrenia is unknown. The disease runs in families, but seems to be triggered by environmental factors as well. Treating the illness, therefore, is focused on relieving the symptoms. This is done through both drug and non-drug therapies.

Non-drug therapies include support groups, as well as one-on-one counseling. They are not to be used in place of drug treatment, but along with it. These talk therapies are a vital part of the recovery process. People learn how to better cope with and manage their illness. They are also more likely to remain on their medication.

Drug treatment

Drug therapy helps deal with the positive symptoms of the illness. This refers to symptoms not found in people who are healthy. This includes hearing, seeing, and believing things that others do not. A person with these symptoms does not know what is real and what is false. Positive symptoms are also referred to as psychotic symptoms. Drugs used to treat them are called antipsychotics.

Antipsychotics

The first antipsychotic drugs came out in the 1950s. These conventional drugs gave new hope to people who had delusions and hallucinations. Brand names for these drugs include:

• Haldol®
• Loxitane®
• Mellaril®
• Navane®
• Proxlixin®
• Stelazine®
• Thorazine®
• Trilafon®

Like all medications, these drugs are not without side effects. These side effects may include dizziness, drowsiness, and constipation. Dry mouth and blurred vision are also common. More severe problems involve muscle movement issues, such as stiffness and restlessness. One rare, but serious, movement disorder is tardive dyskinesia (TD) which cannot always be treated.

Second generation antipsychotics

Second generation antipsychotics are called atypical, and are as effective as the first generation drugs. Second generation antipsychotics may also cause side effects such as weight gain, increased blood sugar levels, and increased triglycerides. These risk factors combined are known as metabolic syndrome. This is a serious condition that can lead to heart disease, diabetes, and stroke.

Atypical antipsychotics include:

• Abilify®
• Clozaril®
• Fanapt®
• Geodon®
• Invega®
• Latuda®
• Risperdal®
• Saphris®
• Seroquel®
• Zyprexa®

Relapse and recovery

A common problem is that sometimes individuals will stop taking drug treatments. This can be due to many factors. Substance use disorder can deter a person from taking treatment or make treatments less effective. Another reason is the unwanted side effects. There is also the lack of insight that is part of the illness itself. The person may feel that the drugs no longer work or are no longer needed. Those who stop drug treatments are at great risk of relapse. This may result in the need to be hospitalized.

Sometimes it may take a while to find the right type of treatment. More than one antipsychotic drug may need to be tried. A person should work closely with her doctor to see what works best. With the right medication, therapy, and support, schizophrenia is an illness that can be managed.

Resource

National Alliance on Mental Illness: ”Tell Me About Schizophrenia” video
www.nami.org/Videos/Tell-Me-About-Schizophrenia

By Kevin Rizzo

©2013-2019 Carelon Behavioral Health

Source: National Alliance on Mental Illness, www.nami.org; National Institute of Mental Health

Reviewed by Sanjay Vaswani, MD, CMQ, DFAPA, VP, Regional Medical Director, Beacon Health Options

Summary

Early schizophrenia warning signs:

• Confused thinking
• Extreme mood swings
• Paranoia, anxiety, or fearfulness

What is schizophrenia?

It is an illness that affects people from all races, genders, and wage levels. This health problem makes it hard for a person to tell what is real or not. It also makes it hard for a person to think and act normally. Schizophrenia is not a split personality. It is not caused by growing up in a dysfunctional family. It is not caused by laziness or being weak. It has a physical cause just like high blood sugar or a heart problem.

Early signs

Some estimates say that 1 percent of all people have it. The first signs most often appear between the ages of 15 and 25, but can show up before the age of 12. If your doctor suspects your child has it, he will look for these early warning signs:

• Seeing things or hearing things that are not real
• Confused thinking
• Problems with telling dreams from reality
• Believing TV, movies, or video games are real
• Wide mood swings
• Odd behavior
• Paranoia, or thinking that others are trying to hurt them on purpose
• Worry and fearfulness

Adult schizophrenia can come on all of the sudden. Children will show slow changes in their behavior. Many parents also say that their child showed signs of being “different” from a very early age.

Treatment choices

Medicines are the main treatment. There are many new ones on hand. If the first type does not help, ask your doctor to try another. Also, it may take time to adjust the dose. Adjusting or lowering the dose can help with unpleasant side effects.

Family and one-to-one therapy can also help everyone cope with the changes and feelings that result from their child’s illness. Structured programs can help your child with her daily living skills. She may be able to sign up for special services or special education programs.

Tips for parents

• When a child first begins having signs of a psychotic illness, it can be scary for the family. Learning all you can about schizophrenia can help ease some of your fears.
• You must work with your child’s doctor to get the pills adjusted. While one-to-one or family therapy can help everyone adjust to the illness, drugs are still the most successful type of care. Many parents let their child stop taking the pills when she starts to get better, only to find she becomes ill again fairly quickly. Finding the right mixture and dose of drugs takes time. Also, as your child grows and changes, she may need to change the type or dose of pills.
• For many people, psychotic disorders are made worse by stress. Once your child is stabilized, work with your child and your doctor to learn how to take care of stress.

Learn to notice the signs of relapse such as strange behavior, withdrawal, or aggression. Work with your mental health professional to find ways to deal with it before it becomes a crisis.

By Haline Grublak, CPHQ

©2010-2019 Carelon Behavioral Health

Reviewed by Philip Merideth, MD, Peer Advisor, Beacon Health Options

Summary

• Loss of touch with reality
• Hearing or seeing things
• Flat response
• Paranoia

Just as there is no single cause of schizophrenia, there is also no single symptom. There are, in fact, quite a number of them. Most of these symptoms can be found in other medical conditions as well. Not everyone will have the same warning signs. They also may change throughout the course of the illness. Sometimes the signs will appear very quickly. Other times, they may come and go slowly over months or years. All this presents a challenge in proper diagnosis of the disease.

Schizophrenia has three basic types of symptoms

Positive

These are also called psychotic symptoms. They refer to symptoms not found in people who are healthy. These include hearing, seeing, and believing things that others do not. A person with these symptoms does not know what is real and what is false. He may feel threatened because he believes people are out to get him. Often his speech patterns will sound unusual or jumbled.

Negative

This refers to an absence of traits that should be present in healthy people. These involve a lack of emotion or expression. They may have a flat response, or blank stare, even when confronted with something remarkable. The person tends to talk very little and be withdrawn. They will have trouble finding any purpose or pleasure in life. In these ways, it is easy to mistake them for being depressed.

Cognitive

These symptoms refer to how a person thinks. They are therefore not as easy to observe. People with this illness have trouble staying focused. They will also have memory problems. One of the biggest issues is a lack of insight into the illness itself. The person is often not even aware that she has a problem. This deters her from getting treatment or staying on treatment.

Other warning signs to look for:

• Marked changes in appearance
• Major personality changes
• Anger or fear toward family members
• Strange behaviors
• Great trouble focusing
• Severe sleep problems

There are several other conditions that can be the cause of such symptoms. Bipolar disorder and Alzheimer’s disease are among them. Substance use disorder can also mimic the symptoms of schizophrenia. Marijuana use can even make the symptoms worse.

Subtypes

In the past, schizophrenia was sometimes broken down into subtypes based on the symptoms. Someone who was intensely suspicious of others, for instance, was said to have paranoid schizophrenia. Another subtype was called catatonic schizophrenia. This referred to a person who was highly unresponsive, and sometimes displayed unique body positions. Other subtypes were called disorganized, undifferentiated, and residual. These subtypes are no longer recognized as requiring special classification or treatment.

Misconceptions

People with schizophrenia do not have split personalities. However, they do carry a much higher risk of suicide, especially among males. It is vital to keep a close watch on anyone who talks about suicide. Professional help should be sought right away, and the person should not be left alone. If you are considering taking your life, or if a loved one talks of suicide, get help right away. Call 911 or visit the closest emergency room.

Proper diagnosis

A physical exam and lab tests may be needed to rule out other likely illnesses. Next, a thorough mental assessment may be necessary. Your doctor might refer you to a psychiatrist. It’s important to provide a complete list of symptoms and family history of mental illness. You should also have a loved one with you who can provide other key info.

Resources

National Alliance on Mental Illness: ”Tell Me About Schizophrenia” video
www.nami.org/Videos/Tell-Me-About-Schizophrenia

Schizophrenia and Related Disorders Alliance of America
www.sardaa.org

National Suicide Prevention Lifeline
(800) 273-TALK (1-800-273-8255)

By Kevin Rizzo

©2013-2019 Carelon Behavioral Health

Source: Mental Health America, www.mentalhealthamerica.net ; National Institute of Mental Health: www.nimh.nih.gov; National Alliance on Mental Illness, http://www.nami.org

Reviewed by Sanjay Vaswani, MD, CMQ, DFAPA, VP, Regional Medical Director, Beacon Health Options

Summary

• Usually occurs earlier in males than females
• Marijuana may be a trigger

Schizophrenia in children does exist, but is less frequently diagnosed. Much more often, the disease is found in teens and young adults. Males tend to show signs of the illness a little earlier than females. Symptoms may be seen in boys around the age of 16 or 17. With girls, it usually does not appear until a couple of years later.

There is no known cure for schizophrenia, but it can be managed. Early detection and treatment is helpful. Although seldom noticed in young children, some experts believe it begins in the womb. Genes are thought to be one cause of the illness. This is consistent with the fact that the disease often runs in families. A person whose parent or sibling has the illness has a 10 percent chance of also getting it. This compares to a one percent chance for people in general. Despite starting at such an early stage, the signs usually don’t show until years later.

Prodromal period

The early stage of schizophrenia in youth is known as the prodromal period. The warning signs are not always easy to identify. This is because they are similar to what a lot of teens go through anyway. Drug use can also mimic some of the symptoms.

Some of these signs include an increase in mood swings and paranoia. The student may begin to perform poorly in school. They might start to hang out with a new set of friends, or withdraw completely. They will often have sleep issues as well. They may act younger than their actual age. Sometimes these signs are noticed more by teachers than parents.

Other signs and symptoms of schizophrenia include:

• Seeing and hearing things
• Using strange speech patterns
• Displaying odd behaviors
• Losing touch with reality
• Being overly anxious or afraid
• Showing very little expression
• Being depressed
• Having a lack of any pleasure in life

Factors other than genes may play a large role in determining who gets the disease. Childhood trauma is one such factor. Some other reasons involve the early development of the brain. Sometimes this occurs prior to birth. Exposure to a virus or poor nutrition are two possible causes. Typically, the illness does not appear until after puberty. During the teenage and young adult years, the brain is still forming connections. Interference with this process may trigger the disease.

Marijuana and schizophrenia

Marijuana use during the teenage years has been linked to schizophrenia. Those whose family has a history of the illness are at greater risk. Prolonged use during this time may as much as double that risk. THC, which is found in marijuana, is known to affect the brain. It is not clear that smoking pot causes the disease. It is, however, believed to be a trigger for those already at risk. For those who have schizophrenia, smoking pot can make the symptoms worse.

Treatment

Some antipsychotic drugs, such as Abilify® and Risperdal®, are FDA approved for teenagers. This is good news to both the teen with schizophrenia and the parents. Working closely with the doctor will help ensure which drug and dose works best. Side effects, such as weight gain and increased risk of diabetes, should be closely watched.

Suicide

The risk of suicide is very real with people who have schizophrenia. This is especially true among young males. If a person talks about taking his life, do not leave him alone. Seek professional help. Call 911 or visit the closest emergency room.

Resources

Facts for Families: Schizophrenia in Children
www.aacap.org/App_Themes/AACAP/docs/facts_for_families/49_schizophrenia_in_children.pdf

National Suicide Prevention Lifeline
(800) 273-TALK (1-800-273-8255)

Schizophrenia Digest is a magazine dedicated to hope, dignity, and support by providing information about schizophrenia for individuals, families, friends, and others.
www.szdigest.com

Schizophrenia for Dummies by Jerome Levine, MD and Irene S. Levine, PhD. For Dummies, 2008.

Surviving Schizophrenia, 6th Edition: A Family Manual by E. Fuller Torrey. Harper Perennial, 2013.

By Kevin Rizzo

©2013-2019 Carelon Behavioral Health

Source: Mental Health America, www.mentalhealthamerica.net; American Academy of Child and Adolescent Psychiatry, www.aacap.org/App_Themes/AACAP/docs/facts_for_families/49_schizophrenia_in_children.pdf; Harvard Health Publications, www.health.harvard.edu/blog/teens-who-smoke-pot-at-risk-for-later-schizophrenia-psychosis-201103071676; University of Alabama at Birmingham, www.uab.edu/news/latest/item/2417-rare-new-schizophrenia-clinic-treats-teens-fast-after-first-diagnosis

Reviewed by Sanjay Vaswani, MD, CMQ, DFAPA, VP, Regional Medical Director, Beacon Health Options

Summary

• There is no single cause.
• Genetics and biology play a part.
• Stressful events and substance use disorder may be triggers.

Despite much research and many clinical trials, the exact cause of schizophrenia remains unknown. Rather than a single cause, it appears to be produced by a combination of factors. Having these factors does not mean a person will have the illness. It just means that they are more at risk of getting it.

Genetics

Schizophrenia runs in families. If a parent or sibling has it, there is a 10 percent chance of also getting it. This compares to a one percent chance for people in general. It is not linked to any one specific gene. There are several genes that may increase the risk of getting the disease. It is not clear why some people develop the disease while others do not. Other factors are believed to play a vital part.

Biology

The brain cell structure of people with the illness differs from that of healthy people. There are also chemical changes that take place. An imbalance affects the way brain cells transmit messages. This can cause problems with reactions to senses, such as sight and sound. This may explain why people with the illness see, hear, and believe things others do not.

Environmental

Other outside factors are believed to help trigger schizophrenia. Some of these can occur even before birth. A fetus exposed to a virus or poor nutrition may be at greater risk. Childhood trauma is also thought to be an influence.

Although these events occur early on, sometimes the illness does not show up until after puberty. This is due to the many changes the body and mind undergo during that time. This happens in the teen and young adult years. The disease tends to be seen at an earlier age in males than in females.

Psychological

Stressful events later in life can also trigger schizophrenia. These include divorce, the loss of a job or loved one, and other life changes. These events, by themselves, do not promote the disease. They can be a trigger for people already at risk for getting the illness, however.

Substance use disorder

Drug overuse is known to be a trigger for the illness. Marijuana specifically has been shown to have ties to the disease. Regular use during teenage years when the brain is developing is of particular concern. Substance use disorder can also mask and complicate the illness. Recovery is harder because the illicit drugs can interfere with the medications. Also, people are less likely to stay on their prescribed medicines.

Treating schizophrenia

Just as there is no specific cause for schizophrenia, there is also no known cure. However, the symptoms of the disease can be treated and managed. Antipsychotic drugs are used to bring the symptoms under control. Counseling and group therapy are then added to help the person manage their thought processes. The combined use of drug and talk therapy is effective. Individuals who stay on their medicine and have lots of family support can do well. Treatment is usually long-term and may need to be adjusted from time to time by the doctor.  

Resources

Schizophrenia
www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

National Alliance on Mental Illness: ”Tell Me About Schizophrenia” video
www.nami.org/Videos/Tell-Me-About-Schizophrenia

By Kevin Rizzo

©2013-2019 Carelon Behavioral Health

Source: National Alliance on Mental Illness, http://www.nami.org/Template.cfm?Section=Schizophrenia9&Template=/ContentManagement/ContentDisplay.cfm&ContentID=117957; National Health Service UK, http://www.nhs.uk/Conditions/Schizophrenia/Pages/Causes.aspx

Reviewed by Sanjay Vaswani, MD, CMQ, DFAPA, VP, Regional Medical Director, Beacon Health Options

Summary

• Affects a person’s thinking and sense of reality
• Person may see and hear things that aren’t there
• No known cure, but can be treated

Schizophrenia is a long-term mental illness that affects millions of adults. It disrupts a person’s thinking, which can cause unusual outward behavior. People with the illness often “hear” voices or “see” things that aren’t really there. These voices and visions, known as hallucinations, are very real to the person. In addition, they may believe things that are not based in reality, something called delusions. These experiences can cause great fear within the affected person. They can also cause other people to be fearful of them and to avoid them.

There is no known cure for schizophrenia, but its symptoms can be treated and managed.

Symptoms

The symptoms of schizophrenia are similar to those of some other mental illnesses. This can make proper diagnosis difficult. It may be mistaken for bipolar disorder or Alzheimer’s disease, for instance. Brain tumors or substance use may also mimic its symptoms.

Schizophrenia has three basic types of symptoms:

Positive: This refers to symptoms not found in people who are emotionally healthy. This includes hearing and seeing things that aren’t present, believing things that aren’t true, and odd speech and other behaviors. A person with these symptoms does not know what is real and what is false. For example, he may feel threatened because he believes people are out to harm him.

Negative: This refers to an absence of traits that are present in most healthy people. These involve a lack of emotion or expression. The person tends to talk or move very little and be withdrawn. In this way, it is easy to mistake it for depression.

Cognitive: These symptoms refer to how a person thinks. They are therefore not as easy to observe.  People with this presentation have trouble staying focused. They will also have memory problems. One of the biggest issues is a lack of insight into the illness itself. The person is often unaware that she has a problem. This deters the person from getting, or staying on, treatment.

Treatment

The exact cause of schizophrenia is unknown. The disease runs in families, but seems to be triggered by environmental factors as well. Treating the illness, therefore, is focused on relieving the symptoms. This is accomplished through both drug and non-drug therapies.

Drug therapy mostly helps the person deal with the positive symptoms of the illness. These drugs, called antipsychotics, first came out in the 1950s.

A common problem is that sometimes individuals will stop taking drug treatments. This can be due to many factors. The person may feel that the drugs no longer work or are no longer needed. Another reason is the unwanted side effects, such as weight gain. There is also the lack of insight that is part of the illness itself. People who stop drug treatments are at great risk of relapse. This may result in the need to be hospitalized.

Non-drug therapies include support groups, as well as one-on-one counseling. They are not to be used in place of drug treatment, but along with it. These talk therapies are a vital part of the recovery process. It helps people learn how to better cope with, and manage, their illness. For example, the person is also more likely to remain on his medication.

Resources

National Alliance on Mental Illness: ”Tell Me About Schizophrenia” video
www.nami.org/Videos/Tell-Me-About-Schizophrenia

Schizophrenia
www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

By Kevin Rizzo

©2013-2019 Carelon Behavioral Health

Source: National Alliance on Mental Illness, www.nami.org; National Institute of Mental Health, www.nimh.nih.gov

Reviewed by Sanjay Vaswani, MD, CMQ, DFAPA, VP, Regional Medical Director, Beacon Health Options

Summary

• Used along with drug therapy
• Can be one-on-one or in a group
• Group and family support is key

Talk therapy, also known as psychotherapy, is often used with drug therapy to treat schizophrenia. This includes support groups, as well as one-on-one counseling. These talk therapies are a vital part of the healing process. People learn how to better cope with and manage their illness. They are also more likely to remain on their medicine. Talk therapy is not to be used in place of drug treatment, but along with it.

Counseling

Individual therapy, or counseling, provides help on a one-on-one basis. The person is taught proper coping skills for dealing with her illness. This may include learning practical things like healthy eating habits and having regular sleep routines. The therapist will also help the individual to work through depressive and delusional thoughts.

Cognitive-behavioral therapy (CBT)

CBT is a type of talk therapy that focuses on thoughts and actions. CBT helps individuals to test their thoughts and to ignore the voices in their head. It is also used to teach coping skills for dealing with daily stress and trials. CBT, along with proper drug treatments, can greatly reduce the chance of relapse.

Group therapy

Group therapy involves individuals gathering to discuss their disease. Members encourage each other through their success stories. They can also console each other by sharing their failures. Just hearing that someone else struggles with the same things you do can be helpful. Group therapy lets you know that you are not alone in the fight.

Family support is crucial to any individual’s recovery. Therefore, it is strongly advised that family members also take part in therapy sessions. This begins with learning about the disease. The family is taught how to look for early signs of schizophrenia episodes. They can then help ensure their loved one receives and remains on the needed treatment. The family also learns the best ways to assist and encourage their loved one. Another aspect of this therapy deals with the effect the disease has on each family member. 

Rehabilitation programs

Rehab programs provide social skills and job training for people with schizophrenia. Problem solving and thinking issues are addressed, as well as how to relate with others. This assists the person in finding a job and keeping it. It may also help him to be a better citizen.

Substance use disorder programs

Many people with schizophrenia also struggle with substance use disorder. This can mask some of the symptoms of the disease. It also makes treatments less helpful and the person less likely to stay on them. Marijuana use is of special concern as it can make the symptoms worse. Even the very common use of tobacco can disrupt treatment of the illness. People with substance use issues will need a separate program for dealing with them. This often involves rehab therapy and support groups. 

Suicide prevention

Suicide is a real danger for people with schizophrenia. They are far more likely to have these thoughts than most people. This is even truer among young males. Any person who talks about suicide should be taken seriously and not be left alone. Call 911 or the National Suicide Prevention Lifeline at (800) 273-TALK (1-800-273-8255).

Resources

100 Questions & Answers About Schizophrenia: Painful Minds, 2nd ed. by Lynn E. DeLisi, MD. Jones & Bartlett Publishers, 2009.

National Alliance on Mental Illness: ”Tell Me About Schizophrenia” video
www.nami.org/Videos/Tell-Me-About-Schizophrenia

National Suicide Prevention Lifeline
(800) 273-TALK (1-800-273-8255)

Schizophrenia Digest is a magazine dedicated to hope, dignity, and support by providing information about schizophrenia for individuals, families, friends, and others.
www.szdigest.com

Schizophrenia for Dummies by Jerome Levine, MD and Irene S. Levine, PhD. For Dummies, 2008.

Surviving Schizophrenia, 6th Edition: A Family Manual by E. Fuller Torrey. Harper Perennial, 2013.

By Kevin Rizzo

©2013-2019 Carelon Behavioral Health

Source: National Institute of Mental Health, www.nimh.nih.gov; National Alliance on Mental Illness, www.nami.org

Reviewed by Sanjay Vaswani, MD, CMQ, DFAPA, VP, Regional Medical Director, Beacon Health Options