schizophrenia

What is schizophrenia?
Schizophrenia is a chronic, severe, and disabling brain disorder. It affects about 1 percent of people all over the world (including 2.4 million Americans) and has been recognized throughout recorded history.
People with schizophrenia may hear voices other people don't hear or believe that others are reading their minds, controlling their thoughts, or plotting to harm them. These experiences are terrifying and can cause fearfulness, withdrawal, or extreme agitation. People with schizophrenia may not make sense when they talk, may sit for hours without moving or talking much, or can seem perfectly fine until they talk about what they are really thinking. Since many people with schizophrenia have difficulty holding a job or caring for themselves, the burden on their families and society is significant as well.
Available treatments can relieve many of the disorder's symptoms, but most people who have schizophrenia must cope with some residual symptoms as long as they live. Nevertheless, this is a time of hope for people with schizophrenia and their families. Many people with the disorder now lead rewarding and meaningful lives in the community. Researchers are developing more effective medications and using new research tools to understand the causes of schizophrenia and find ways to prevent and treat it.
This brochure will present information on the symptoms of schizophrenia, when they appear, how the disease develops, current treatments, new directions in research, and support groups for patients and their loved ones.

When does it start and who gets it?
Psychotic symptoms (such as hallucinations and delusions) usually emerge in men in their late teens and early twenties and in women in their mid-twenties to early thirties. They seldom occur after age 45 and only rarely before puberty, although cases of schizophrenia in children as young as five have been reported. In adolescents, the first signs can include a change of friends, a drop in grades, sleep problems, and irritability. Since many normal adolescents exhibit these behaviors as well, a diagnosis can be difficult to make at this stage. In young people who go on to develop the disease, this is called the "prodromal" period.
Research has shown that schizophrenia affects men and women equally and occurs at similar rates in all ethnic groups around the world.
What are the symptoms of schizophrenia?
The symptoms of schizophrenia fall into three broad categories:
• Positive symptoms are unusual thoughts or perceptions that include hallucinations, delusions and thought disorder.
• Negative symptoms represent a loss or a decrease in the ability to initiate plans, speak, express emotion, or find pleasure in everyday life. These symptoms are harder to recognize as part of the disorder and can be mistaken for laziness or depression.
• Cognitive symptoms (or cognitive deficits) are problems with attention, certain types of memory, and the executive functions that allow us to plan and organize.1 Cognitive deficits can also be difficult to recognize as part of the disorder but are the most disabling in terms of leading a normal life.
Positive symptoms
Positive symptoms are easy-to-spot behaviors not seen in healthy people and usually involve a loss of contact with reality.1 They include hallucinations, delusions, thought disorder, and disorders of movement. Positive symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether or not the individual is receiving treatment.
Hallucinations. A hallucination is something a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel. "Voices" are the most common type of hallucination in schizophrenia. Many people with the disorder hear voices that may comment on their behavior, order them to do things, warn them of impending danger, or talk to each other (usually about the patient). They may hear these voices for a long time before family and friends notice that something is wrong.1 Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects (although this can also be a symptom of certain brain tumors), or feeling things like invisible fingers touching their bodies when no one is close by.
Delusions. Delusions are false personal beliefs that are not part of the person's culture and do not change, even when other people present proof that the beliefs are not true or logical. People with schizophrenia can have delusions that are quite bizarre, such as believing that neighbors can control their behavior with magnetic waves, people on television are directing special messages to them, or radio stations are broadcasting their thoughts aloud to others. They may also have delusions of grandeur and think they are a famous historical figure. People with paranoid schizophrenia can believe that others are deliberately cheating, harassing, poisoning, spying upon, or plotting against them or the people they care about. These beliefs are called delusions of persecution.
Thought Disorder. People with schizophrenia often have unusual thought processes. One dramatic form is disorganized thinking where the person may have difficulty organizing his thoughts or connecting them logically. Speech may be garbled or hard to understand. Another form is "thought blocking" where the person stops abruptly in the middle of a thought. When asked sometimes the person says it felt as if the thought had been taken out of his head. Finally, the individual might make up unintelligible words, so-called "neologisms."
Disorders of Movement. People with schizophrenia can be clumsy and uncoordinated. They may also show involuntary movements and may show grimacing or unusual mannerisms. They may repeat certain motions over and over or, in extreme cases, may become catatonic. Catatonia is a state of immobility and unresponsiveness that was more common when treatment for schizophrenia was not available; fortunately, it is now rare.2, 3
Negative symptoms
The term "negative symptoms" refers to reductions in normal emotional and behavioral states. These include:
• flat affect (immobile facial expression, monotonous voice),
• lack of pleasure in everyday life,
• diminished ability to initiate and sustain planned activity, and
• speaking infrequently, even when forced to interact.
People with schizophrenia often neglect basic hygiene and need help with everyday living activities. Because it is not as obvious that negative symptoms are part of a psychiatric illness, people with schizophrenia are often perceived by others as lazy and not willing to better their lives.
Cognitive symptoms
Cognitive symptoms are subtle and are often detected only when neuropsychological tests are performed. They include:
• poor executive functioning (the ability to absorb and interpret information and make decisions based on that information),
• inability to sustain attention, and
• problems with working memory (the ability to keep recently learned information in mind and use it right away).
Cognitive impairments often interfere with the patient's ability to lead a normal life and earn a living, and can cause great emotional distress.
Are people with schizophrenia violent?
People with schizophrenia are not especially prone to violence and often prefer to be left alone. Studies show that if people have no record of criminal violence before they develop schizophrenia and are not substance abusers, they are unlikely to commit crimes after they become ill. Most violent crimes are not committed by people with schizophrenia, and most people with schizophrenia do not commit violent crimes. Substance abuse always increases violent behavior, whether or not the person has schizophrenia (see sidebar). If someone with paranoid schizophrenia becomes violent, their violence is most often directed at family members and takes place at home.