Schizophrenia

Schizophrenia is an often misunderstood chronic brain disorder. It’s characterized by thoughts or experiences that seem out of touch with reality, disorganized behavior or speech, and decreased participation in daily activities. Common symptoms include hallucinations — sensory experiences that seem real but are actually products of the mind  — and delusions — fixed, false beliefs that go against reality. Schizophrenia interferes with a person’s ability to think clearly, manage their emotions, make clear decisions, and relate to others. 

According to the American Psychiatric Association, schizophrenia affects less than one percent of the U.S. population. According to the World Health Organization, it affects 20 million people worldwide and is not as common as many other mental disorders. 

Schizophrenia can occur in men and women of all ages. However, research shows that men often develop symptoms earlier than women, starting in their late teens or early 20s, while women most often show signs in their late 20s and early 30s. 

People with schizophrenia can have intense behavioral symptoms, most often confusion and disorientation, making it difficult for them to distinguish between reality and their delusions or hallucinations. It’s important to note that the symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Some might have their symptoms worsen or improve unpredictably, and others might have consistent symptoms.

Schizophrenia symptoms are considered to be either positive or negative, not because they are good or bad, but based on whether or not they mark the presence or absence of symptoms. Positive symptoms, such as hallucinations, delusions, and disordered thoughts and speech represent increased activation of certain areas of the brain. The positive symptoms tend to respond well to drug therapy. Negative symptoms, on the other hand, include symptoms that halt normal functioning and don’t respond as well to drug therapy, such as a lack of desire for any social connections and lack of emotional affect. 

There are five main types of schizophrenia symptoms: delusions, hallucinations, disorganized speech, disorganized behavior, and the aforementioned “negative” symptoms.

• Delusions: Broadly, a delusion is a firmly-held belief that a person has despite clear and obvious evidence to the contrary.
• Hallucinations: Hallucinations are sensations experienced as real even though they only exist in the mind. These can involve any of the five senses, but auditory hallucinations (hearing voices or other sounds in your head) are the most common for those with schizophrenia. 
• Disorganized speech: Schizophrenia can cause issues with concentrating, which can someone’s speech skills. Disorganized speech may look like someone giving partially or completely unrelated answers to questions, using made-up words or phrases that only have meaning to themselves, repeating words or statements, and/or rhyming words meaninglessly (also referred to as “clang”). 
• Disorganized behavior: Typically, people’s activities are goal-oriented, but those suffering with schizophrenia may not have goals connected to their actions. These individuals become unable to take care of themselves, work or interact like they used to with others. Disorganized behavior can be hard to identify, but it typically results in a lack of normal daily functioning, useless and excessive movement, lack of inhibition and impulse control, and behaviors that appear bizarre. 
• “Negative” symptoms: Negative symptoms can include lack of emotional expression, lack of enthusiasm, social withdrawal, and lack of awareness of one’s environment. 

These symptoms are sometimes categorized in three buckets: psychotic symptoms (altered perceptions, abnormal thinking, and odd behaviors), negative symptoms (mentioned above) and cognitive symptoms (problems in attention, concentration and memory).

Regardless of symptoms, most people with schizophrenia experience them either continuously or intermittently throughout their entire life after onset and are often severely stigmatized by people who do not understand the disorder. 

Researchers have found that there is a very strong genetic component to schizophrenia, but it’s still unknown exactly what causes some people to develop schizophrenia. Findings so far indicate that it’s likely a combination of genetic, psychological, physical, and environmental factors that can make a person more likely to develop the condition.

It is important to note that only a psychiatrist can diagnose an individual with schizophrenia, and this diagnosis can only be made after a full psychiatric assessment to rule out substance misuse or other neurological or medical illnesses whose symptoms mimic schizophrenia. However, understanding the possible causes and risk factors for schizophrenia can help clarify who might be at risk.

• Genetics: There is strong evidence of a genetic predisposition to schizophrenia. Researchers have not pinpointed one single gene that leads to schizophrenia developing, but many genes are thought to play a role. According to one research study, if a sibling or parent has the illness, your chances of having schizophrenia is around 10%. It is important to note that just because someone in your family has schizophrenia, it does not mean that other members of your family will have it as well.
• Environment: As with many other health conditions, there are certain environmental factors that can contribute to the development of schizophrenia. These include pre- or post-natal viral infections and exposure to toxins such as lead during gestation or childhood. 
• Societal factors: There has been a lot of research devoted to investigating societal issues that could potentially contribute to the onset of schizophrenia. There are many aspects being researched, but for example, there is research suggesting that people who grew up in metropolitan areas were more likely to be diagnosed with schizophrenia than those who lived in rural areas.
• Lifestyle factors: There are a few lifestyle factors that put someone at a higher risk to develop schizophrenia, but these factors are more correlational than causational. All types of stress, homelessness, drug abuse, bereavement, job or home loss, divorce, the end of a relationship, or abuse are examples of this. Although these experiences aren’t proven to directly cause schizophrenia, they can trigger its development in someone already vulnerable to it.
• Structural changes in the brain: Studies of people with schizophrenia have shown that there are subtle differences in the structure of their brains compared to those without schizophrenia. For example, some studies have found that individuals with schizophrenia have less gray matter in their brains, which plays an important role in information processing, memory, and evaluating rewards and consequences.
• Chemical changes in the brain: Research also indicates that people with schizophrenia have irregularities in the chemicals of the brain that allow brain cells to communicate with each other. For example, it has been shown that dopamine levels aren’t regulated properly in the brains of people who have schizophrenia. While the exact mechanism of how this happens is still being studied, it may account for certain schizophrenia symptoms.
• Pregnancy or birth complications: Complications before and during birth may increase the likelihood that a person will develop schizophrenia. These complications include: infection during pregnancy, low birth weight, premature labor, maternal obesity diagnosis during pregnancy, and infection during pregnancy.
• Loss or separation: Teenagers and adults are also more likely to develop schizophrenia if they experience the death or permanent separation of one or both parents as children.

While these are a few identified causes and risks, there is no single precipitating event identified that leads to the onset of schizophrenia.