Schizophrenia: Definition, Symptoms, Causes and Diagnosis
Starting from a wide range of strange symptoms to the extremely captivating physical markers, the condition of schizophrenia keeps intriguing us more and more as we continue to explore it.
Schizophrenia is a complicated brain condition that comes with a host of disruptive and complex effects. Other than that, there are other aspects of the condition that are not known to many.
Let’s dive right into the guide to explore what schizophrenia actually is, what are the possible symptoms and causes and how to diagnose the condition?
How do we define Schizophrenia?
Schizophrenia is a very serious brain condition and mental disorder in which people start to develop abnormal interpretation of reality.
The consequences of Schizophrenia include a combination of delusions, hallucinations as well a certain kind of behavior which directly affects a person’s normal functioning and can be disabling as well.
Moreover, Schizophrenia is usually characterized by:
- Psychosis in which a person loses a contact with reality
- Hallucinations which include false perceptions about reality
- Delusions in which a person starts developing false beliefs
- Disorganized thinking and speech
- Disorganized motor behavior
- Flattened affect in which the range of emotions we generally feel start to restrict
- Cognitive deficits in which a person undergoes impairment in reasoning and problem solving
- Social and functional dysfunctioning
What is Psychosis?
Psychosis comprises of a set of symptoms like hallucinations, delusions as well as disorganized speech and thinking. This may also result in an inappropriate and bizarre motor behavior which is an evident sign for the loss of contact with reality.
What are Delusions?
Delusions are the faulty beliefs that a person fails to negate despite having obvious contradictory evidence against it.
Delusions in schizophrenia are extremely bizarre and are implausible e.g. believing that someone has intentionally taken out their internal organs from the body without even leaving any scar.
The most common types of delusions in schizophrenia include:
- Persecutory delusions
- Delusions of reference
- Delusions of thought insertion and thought withdrawal
What are Hallucinations?
Hallucinations are sensory perceptions that any other person is unable to perceive. The types of hallucinations include:
The most common type of hallucinations is auditory hallucination in which the person hears certain kind of comments about his/her behavior, voices having conversation with each other or making abusive or degrading comments. These can be extremely taxing for the patient.
What Does Disorganized Thinking and Speech Refer to?
The thought process or speech that is jumbled and doesn’t make sense is referred to as disorganized thinking and speech.
The severity level of symptoms is enough to cause significant problems with the process of normal communication. For example, a person having disorganized thinking and speech may respond with irrelevant and unrelated topics while having a conversation. He may also rapidly switch from one topic to another.
What is Disorganized or Abnormal Motor Behavior?
Certain movements ranging from childlike responses or silliness to unimaginable agitation are referred to as disorganized or abnormal motor behavior.
The behavior can also be manifested as repeated movements without having any purpose. In severe cases, it gets really hard for the patient to keep up with the normal social and functional life.
Did you know that people suffering from schizophrenia are often considered to have another condition called anosognosia?
Anosognosia is a synonym for “to not know a disease”. Basically, it is the lack of ability to accept that they are having a condition that is consistent with a certain set of symptoms and a formal diagnosis.
Schizophrenia in its active phase is often characterized by episodes in which the patient fails to make a clear distinction between real and unreal experiences.
Being similar to other illnesses, the frequency of symptoms, duration as well as severity of the condition varies from one person to another. The only difference being as the person ages and becomes older, there is a decrease in the incidence of severe psychotic symptoms.
However, not taking prescribed medications regularly, excessive intake of alcohol and drugs and other external stressors tend to increase the symptoms. Symptoms of schizophrenia generally fall into these major categories:
- Positive symptoms: (the symptoms abnormally present) These include hallucinations such as visual, auditory, gustatory, tactile or olfactory hallucinations. The patient might also exhibit paranoia and certain perceptions, beliefs or behaviors that are distorted or exaggerated.
- Negative symptoms: (the symptoms abnormally absent) This includes the reduced ability or the inability to initiate making plans, exhibiting verbal responses, emotional expression or finding pleasure.
- Disorganized symptoms: Patterns of thinking and speech which show confusion or are disordered. The person faces problems with thinking logically and exhibits behavior and movements that are bizarre.
Another functional area which is directly affected by schizophrenia is cognition. This eventually lead towards disrupted focus and reduced attention span. It also affects the ability to concentrate and retain which gradually reduces educational performance.
Schizophrenia symptoms generally start appearing during early adulthood. Symptoms must persist for the duration of at least six months in order to make a proper diagnosis.
The initial symptoms generally show in men during their late teens or during early 20s. While in women, the early signs are exhibited in 20s or early 30s. Initially, more subtle signs are likely to be present like relationship problems, poor academic performance and decreased motivation.
However, a psychiatrist undergoes a thorough medical examination and differential diagnosis in order to make a proper diagnosis.
When to See a Doctor?
Like we discussed earlier, people having schizophrenia lack awareness that the problems they are facing are mostly due to a mental condition which requires seeking help from a mental health professional.
So, the family and friends of the person are considered responsible to help him/her getting the medical attention he/she needs.
The actual cause of schizophrenia is still not known. But, it is evident from most of the researches that a combination of the following factors contributes towards the development of the condition:
- Brain chemistry
- Certain environmental factors
The imbalance of certain neurotransmitters like dopamine and glutamate may be a contributing cause to schizophrenia. Various neuroimaging techniques reveal that there exists a difference in the brain structure of people having schizophrenia. Some researches also support that schizophrenia is a brain disease.
A few factors that can act as triggers or are considered as risk factors include:
- Having a family history
- Complications during pregnancy and birth like, poor nutritional intake or exposure to certain viruses and toxins that may have a direct effect on the development of brain
- Intake of certain psychoactive or psychotropic drugs during teenage can also have a mind-altering effect
Schizophrenia is a chronic mental condition. There’s no denying about the importance of early diagnosis and intervention. The earlier the diagnosis, the easier would it be to manage the disorder.
The diagnosis can only be made by a mental health practitioner like a psychiatrist or a psychologist. There are two basic criteria on the basis of which a proper diagnosis can be made:
- Using the clinical criteria as per Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
- A combination of history, signs and symptoms
The earlier the diagnosis is being made, the more manageable the condition would be.
According to the DSM-5, both of the following must be present in order to make a diagnosis:
- ≥2 characteristic symptoms including hallucinations, delusions, disorganized speech, negative symptoms or disorganized behavior must be present for a significant part of the period of at least 6-months (at least one out of the first three symptoms must be present)
- Attenuated or prodromal signs of illness must be present and co-exist with the impairment in the functional, social or self-care routine.
We don’t have a definite test for schizophrenia yet. Diagnosis is generally being made after detailed analysis and assessment of history, signs and symptoms. Information from people having close relation with the patient like friends, family, teachers and coworkers is also very important.
Different laboratory tests and neuroimaging is used to rule out other mental disorders and substance use disorders while making a diagnosis for schizophrenia.
In some cases, the patients with schizophrenia have abnormalities in brain structure that are present on imaging but these structural abnormalities are insufficiently specific in order to have a diagnostic value.
Other mental conditions which are likely to show similar symptoms as that of schizophrenia include:
- Delusional disorder
- Schizophreniform disorder
- Schizoaffective disorder
- Brief psychotic disorder
- Schizotypal personality disorder
There exists a strong similarity between schizophrenia symptoms and symptoms of these brain conditions. A psychiatrist must consider having a differential diagnosis before reaching a final conclusion.
The disorders having symptoms similar to schizophrenia including substance-related psychosis and delirium are considered to be the important causes of secondary psychosis. These need to be excluded before reaching towards the final diagnosis of schizophrenia or other related spectrum conditions.
Other psychopathological dimensions like cognition or negative symptoms, as well as the quality of functional and social life, all need to be analyzed before starting a treatment.