What is Schizophrenia?

Did you know that about 1 in 200 people in the United States will be diagnosed with schizophrenia during their lifetime? This mental disorder causes many different symptoms, and it can appear in many different ways (Cleveland Clinic, n.d.).

This mental disorder causes people to lack the ability to differentiate between what is real and what is a symptom. Though not everyone experiences the same symptoms, there are guidelines that are used to diagnose schizophrenia. Psychologists and psychiatrists use diagnostic criteria from the DSM-5, which is an acronym for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.

The DSM-5 Diagnostic Criteria

In order to have schizophrenia, a person must present with at least two or more symptoms, which we will describe below.

Hallucinations

Hallucinations can be described as sensory experiences that appear real to a person experiencing them but are in fact created by their mind. Hallucinations can be visual, olfactory (smell), gustatory (taste), auditory, and tactile (touch; Badii, 2019). Less commonly known, hallucinations can also be kinesthetic or proprioceptive. “Kinesthetic” refers to a person’s sense of bodily movement. Thus, kinesthetic hallucinations generally refer to the person’s experience of feeling the body move when it is not moving or not moving in the way the person feels the movement to be. Proprioception refers to a person’s sensation of their body’s parts in relation to the body. Proprioceptive hallucinations may include the sense of floating or being upside down when this is not the case.

Delusions

Delusions are false beliefs that a person has that conflict with reality. Even though they are presented with contrary evidence, a person experiencing the delusion is unable to let go of their convictions. They may occur alongside hallucinations (Verywell Mind, 2021). For example, a person might feel as though ants are crawling on their skin while falsely believing the CIA placed the ants there to torment them. They might hear a voice and interpret it as the commanding voice of God, instructing them on what to do next.

Disorganized Speech

A schizophrenic person may speak incoherently or respond to questions with unrelated answers. They may also say things that don’t make sense or change the subject of the conversation often. All of this falls under the diagnostic criterion of disorganized speech. Additionally, a person experiencing this symptom might also suddenly stop speaking or forget what they were saying, they may invent or begin to use new words, or repeat the same words over and over again (Psycom, 2021).

Disorganized Behavior

Disorganized behavior, as it relates to psychosis, can present in many forms. For example, individuals with disorganized behavior may present as catatonic, with unpredictable agitation, or with childlike silliness. Catatonia may present as a rigid and unchanging posture, an utter absence of verbal and motor response to stimuli, or even an excessive or repeated series of movements that lack purpose. Some individuals with disorganized behavior will echo the speech of others, stare intensely, grimace, speak or talk to themselves, or behave in a manner which reflects an internal preoccupation with the hallucinations the person is experiencing (e.g., smiling, laughing, gesturing, or looking around; American Psychiatric Association, 2013).

Negative Symptoms

The first four psychotic symptoms are often referred to as “positive symptoms.” In this case, positive does not mean “good.” Instead, positive means the addition or increase of experiences/behaviors which are ordinarily absent (e.g., hallucinations or delusions). Thus, negative symptoms are those behaviors that are diminished or absent but are ordinarily present. One example of this is known as flat affect, an absence of observable emotion. It is characterized by an unchanging facial expression, along with a tone of voice that does not change in strength or pitch. Another example of a negative symptom, avolition, is characterized by a significant reduction in motivation for purposeful activities. Alogia is an absence or significant reduction of speech. Individuals with alogia will typically not spontaneously volunteer statements. They typically provide brief responses only when spoken to or do not speak. Asociality is when the individual does not appear to have an interest in interacting with others. Anhedonia is a lack of or significant diminishment in pleasure in enjoyable things (American Psychiatric Association, 2013).

What Is the Main Cause of Schizophrenia?

Unfortunately, there is no known definitive cause of schizophrenia. There are certain things, such as stress and anxiety, that can trigger or worsen an already existing condition, but they are not the root causes of this mental illness. Most likely, a combination of factors is responsible for this brain disorder, including imbalances in certain chemicals in the brain and a person’s genetic makeup (Cleveland Clinic, n.d.). According to Sawa and Snyder (2002), there are currently three lines of inquiry in an effort to establish and determine the underlying disturbances that potentially lead to schizophrenia: examining the mechanism of action of the drugs used to treat it, examination of neuroanatomical abnormalities of patient brains, and examination of candidate genes in those susceptible to schizophrenia.

Even though it is widely accepted that schizophrenia has a genetic component, it’s important to note that there are several distinct genetic abnormalities which have been identified, meaning it requires more than one genetic “hit” to produce symptoms in those affected. Although different researchers have suggested widely-ranging chromosomal abnormalities in schizophrenia patients, there is no highly reliable candidate gene yet (Sawa & Snyder, 2002).

What Is The Age of Onset for Schizophrenia?

Generally speaking, everyone is at risk for developing schizophrenia, regardless of their age and gender. However, certain people are more likely to be diagnosed with this disorder, depending on the abovementioned causes. When it comes to gender, men typically begin having psychotic symptoms in their late teen years or in their early 20s. Women typically begin developing symptoms of schizophrenia a bit later, usually in their late 20s or early 30s (Cleveland Clinic, n.d.).

Treatment Options

The main treatment options for this condition include proper medication and counseling. Medicine and therapy can help alleviate or stop the symptoms or better adjust to and tolerate persisting symptoms. For almost all patients suffering from schizophrenia, pharmacotherapy with antipsychotic medications is the right treatment plan. Additionally, in order to optimize treatment adherence and allow the individual to have a good quality of life, psychosocial interventions that work synergistically with medication are recommended. Regular, ongoing evaluations are important because they help doctors determine whether the patient is responding well to the medication prescribed, is not responding, or has developed side effects (Canadian Psychiatric Association, 2005).

Currently, there are two primary types of antipsychotics drugs being used: first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs), but it’s important to note that SGAs have been increasingly replacing FGAs and are the first line of treatment of schizophrenia. It’s also worth mentioning that there are pharmacologic strategies for each phase of schizophrenia which are divided into three phases: acute, stabilizing, and stable phase. (Canadian Psychiatric Association, 2005).

Reference List

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (5th ed.). American Psychiatric Publishing.

Badii, C. (2019, July 11). Everything You Need to Know About Hallucinations. Healthline. Retrieved March 17, 2022, from https://www.healthline.com/health/hallucinations#outlook

Canadian Psychiatric Association. (2005). CLINICAL PRACTICE GUIDELINES: Treatment of Schizophrenia. The Canadian Journal of Psychiatry, 50, 12–29.

Flat Affect in Schizophrenia: Symptoms and Treatment. (2022, February 12). Verywell Mind. Retrieved March 17, 2022, from https://www.verywellmind.com/flattened-affect-2953086#:%7E:text=Flat%20affect%20(diminished%20emotional%20expression,or%20pitch%20of%20the%20voice.

Gross disorganization. (n.d.). ShareYrHeart. Retrieved March 17, 2022, from https://shareyrheart.com/diagnosis-dictionary/gross-disorganization

Psycom.net. (2021, May 22). Disorganized Schizophrenia (Hebephrenia): Symptoms & Treatment. Psycom.Net - Mental Health Treatment Resource Since 1996. Retrieved March 17, 2022, from https://www.psycom.net/disorganized-schizophrenia-hebephrenia#:%7E:text=People%20with%20disorganized%20speech%20might,with%20no%20connections%20between%20topics

Sawa, A., & Snyder, S. H. (2002, April 26). Schizophrenia: Diverse Approaches to a Complex Disease. Science. Retrieved March 21, 2022, from https://www.science.org/doi/10.1126/science.1070532

Schizophrenia: Symptoms, Causes, Treatments. (n.d.). Cleveland Clinic. Retrieved March 17, 2022, from https://my.clevelandclinic.org/health/diseases/4568-schizophrenia#:%7E:text=According%20to%20the%20DSM%2D5,disorganization%20and%20diminished%20emotional%20expression.

What Does It Really Mean to Be Delusional? (2021, February 13). Verywell Mind. Retrieved March 17, 2022, from https://www.verywellmind.com/definition-of-delusion-4580458#:%7E:text=Delusions%20are%20defined%20as%20fixed,involve%20some%20level%20of%20paranoia.

Authored by:

Nina M Benjamin Silber