Schizophrenia Symptoms, Types, Causes, and Treatment

What Is Schizophrenia?

A panoramic concept shows the face of a man with schizophrenia.

Schizophrenia is a chronic, severe, debilitating mental illness characterized by disordered thoughts, abnormal behaviors, and anti-social behaviors. It is a psychotic disorder, meaning the person with schizophrenia does not identify with reality at times.

Who Is Affected?

Schizophrenia affects more than 2 million people in the U.S.

  • Schizophrenia affects about 1.1% of the world's population
  • 3.5 million Americans have schizophrenia
  • Schizophrenia is most commonly diagnosed between the ages of 16 to 25
  • Schizophrenia can be hereditary (runs in families)
  • It affects men 1.5 times more commonly than women
  • Schizophrenia and its treatment has an enormous effect on the economy, costing between $32.5-$65 billion each year

How Common Is Schizophrenia in Children?

Children may also be affected by schizophrenia.

Schizophrenia in young children is rare. The National Institute of Mental Health (NIMH) estimates only 1 in 40,000 children experience the onset of schizophrenia symptoms before the age of 13.

Types of Schizophrenia

Schizophrenia health care check list.

There are five types of schizophrenia (discussed in the following slides). They are categorized by the types of symptoms the person exhibits when they are assessed:

  • Paranoid schizophrenia
  • Disorganized schizophrenia
  • Catatonic schizophrenia
  • Undifferentiated schizophrenia
  • Residual schizophrenia

Paranoid Schizophrenia

A woman suffering from paranoid schizophrenia is distressed.

Paranoid-type schizophrenia is distinguished by paranoid behavior, including delusions and auditory hallucinations. Paranoid behavior is exhibited by feelings of persecution, of being watched, or sometimes this behavior is associated with a famous or noteworthy person a celebrity or politician, or an entity such as a corporation. People with paranoid-type schizophrenia may display anger, anxiety, and hostility. The person usually has relatively normal intellectual functioning and expression of affect.

Disorganized Schizophrenia

A young woman pours a pot of spaghetti on her head.

A person with disorganized-type schizophrenia will exhibit behaviors that are disorganized or speech that may be bizarre or difficult to understand. They may display inappropriate emotions or reactions that do not relate to the situation at-hand. Daily activities such as hygiene, eating, and working may be disrupted or neglected by their disorganized thought patterns.

Catatonic Schizophrenia

A man is in a catatonic state.

Disturbances of movement mark catatonic-type schizophrenia. People with this type of schizophrenia may vary between extremes: they may remain immobile or may move all over the place. They may say nothing for hours, or they may repeat everything you say or do. These behaviors put these people with catatonic-type schizophrenia at high risk because they are often unable to take care of themselves or complete daily activities.

Undifferentiated Schizophrenia

A young man with undifferentiated schizophrenia wears a tinfoil hat while staring into a TV.

Undifferentiated-type schizophrenia is a classification used when a person exhibits behaviors which fit into two or more of the other types of schizophrenia, including symptoms such as delusions, hallucinations, disorganized speech or behavior, catatonic behavior.

Residual Schizophrenia

A schizophrenic girl's reflection shows her inner turmoil.

When a person has a past history of at least one episode of schizophrenia, but the currently has no symptoms (delusions, hallucinations, disorganized speech or behavior) they are considered to have residual-type schizophrenia. The person may be in complete remission, or may at some point resume symptoms.

What Are Causes of Schizophrenia?

Rate of gray matter loss: Composite MRI scan data showing areas of gray matter loss over 5 years, comparing 12 normal teens (left) and 12 teens with childhood-onset schizophrenia. Red and yellow denotes areas of greater loss. Front of brain is at left.

Schizophrenia has multiple, intermingled causes which may differ from person to person, including:

  • Genetics (runs in families)
  • Environment
  • Brain chemistry
  • History of abuse or neglect

Is Schizophrenia Hereditary?

Twin sisters look at each other.

Schizophrenia has a genetic component. While schizophrenia occurs in only 1% of the general population, it occurs in 10% of people with a first-degree relative (parent, sibling) with the disorder. The risk is highest if an identical twin has schizophrenia. It is also more common in people with a second-degree relative (aunts, uncles, cousins, grandparents) with the disorder.

Schizophrenia Symptoms

Intense anxiety is a symptom of schizophrenia.

Many people with schizophrenia do not appear ill. However, many behavioral changes will cause the person to seem 'off' as the disease progresses. Symptoms include:

  • Social withdrawal
  • Anxiety
  • Delusions
  • Hallucinations
  • Paranoid feelings or feelings of persecution
  • Loss of appetite or neglecting to eat
  • Loss of hygiene

Symptoms may also be grouped into categories, discussed in the following slides.

Positive (More Overtly Psychotic) Symptoms

A person with schizophrenia may experience psychotic symptoms.

The "positive," or overtly psychotic, symptoms are symptoms not seen in healthy people, include:

  • Delusions
  • Hallucinations
  • Disorganized speech or behavior
  • Dysfunctional thinking
  • Catatonia or other movement disorders

Negative (Deficit) Symptoms

A man sits by himself.

"Negative" symptoms disrupt normal emotions and behaviors and include:

  • Social withdrawal
  • "Flat affect," dull or monotonous speech, and lack of facial expression
  • Difficulty expressing emotions
  • Lack of self-care
  • Inability to feel pleasure (anhedonia)

Cognitive Symptoms

A schizophrenic may have difficulty remembering simple tasks.

Cognitive symptoms may be most difficult to detect and these include:

  • Inability to process information and make decisions
  • Difficulty focusing or paying attention
  • Problems with memory or learning new tasks

Affective (or Mood) Symptoms

A depressed woman.

Affective symptoms refer to those which affect mood. Patients with schizophrenia often have overlapping depression and may have suicidal thoughts or behaviors.

How Is Schizophrenia Diagnosed?

Doctor with stethoscope.

The diagnosis of schizophrenia is made both by ruling out other medical disorders that can cause the behavioral symptoms (exclusion), and by observation of the presence of characteristic symptoms of the disorder. The doctor will look for the presence of delusions, hallucinations, disorganized speech or behavior, and/or negative symptoms, along with social withdrawal and/or dysfunction at work or in daily activities for at least six months.

The doctor may use physical examination, psychological evaluation, laboratory testing of blood, and imaging scans to produce a complete picture of the patient's condition.

How Is Schizophrenia Diagnosed? (Continued)

A mental-health professional diagnoses a patient.

Mental health screening and evaluation is an important part of the diagnosis process for schizophrenia. Many other mental illnesses such as bipolar disorder, schizoaffective disorder, anxiety disorders, severe depression, and substance abuse may mimic symptoms of schizophrenia. A doctor will perform an assessment to rule out these other conditions.

Schizophrenia Treatment - Medications

Zyprexa 10 mg vial, Abilify Discmelt 15 mg tablet, Risperdal M-Tab 1 mg ODT, Geodon 20 mg vial

Antipsychotic medications are the first-line treatment for many patients with schizophrenia. Medications are often used in combination with other types of drugs to decrease or control the symptoms associated with schizophrenia. Some antipsychotic medications include:

  • olanzapine (Zyprexa)
  • risperidone (Risperdal)
  • quetiapine (Seroquel)
  • ziprasidone (Geodon)
  • aripiprazole (Abilify)
  • paliperidone (Invega)

Schizophrenia Treatment - Medications (Continued)

Lamictal XR 25 mg tablet, Depakote 125 mg sprinkle cap, Zoloft 100 mg tablet, Cymbalta 20 mg capsule

Mood swings and depression are common in patients with schizophrenia. In addition to antipsychotics, other types of medications are used.

Mood stabilizers include:

  • lithium (Lithobid)
  • divalproex (Depakote)
  • carbamazepine (Tegretol)
  • lamotrigine (Lamictal)

Antidepressants include:

  • fluoxetine (Prozac)
  • sertraline (Zoloft)
  • paroxetine (Paxil)
  • citalopram (Celexa)
  • escitalopram (Lexapro)
  • venlafaxine (Effexor)
  • desvenlafaxine (Pristiq)
  • duloxetine (Cymbalta)
  • bupropion (Wellbutrin)

Schizophrenia Treatment - Psychosocial Interventions

Family psycho-education teaches family members problem-solving skills.

Family psycho-education: It is important to include psychosocial interventions in the treatment of schizophrenia. Including family members to support patients decreases the relapse rate of psychotic episodes and improves the person's outcomes. Family relationships are improved when everyone knows how to support their loved one dealing with schizophrenia.

Schizophrenia Treatment - Psychosocial Interventions (Continued)

A psychiatrist, nurse, case manager, employment counselor, and substance-abuse counselor often make up an ACT team.

Assertive community treatment (ACT): Another form of psychosocial intervention includes use of out-patient support groups. Support teams including psychiatrists, nurses, case managers, and other counselors, meet regularly with the schizophrenic patient to help reduce the need for hospitalization or a decline in their mental status.

Schizophrenia Treatment - Psychosocial Interventions (Continued)

About 50% of individuals with schizophrenia suffer from some kind of substance abuse or dependence.

Substance abuse treatment: Many people with schizophrenia (up to 50%) also have substance abuse issues. These substance abuse issues worsen the behavioral symptoms of schizophrenia and need to be addressed for better outcomes.

Schizophrenia Treatment - Psychosocial Interventions (Continued)

A group socializes around a laptop computer.

Social skills training: Patients with schizophrenia may need to re-learn how to appropriately interact in social situations. This kind of psychosocial intervention involves rehearsing or role-playing real-life situations so the person is prepared when they occur. This type of training can reduce drug use, and improve relationships.

Schizophrenia Treatment - Psychosocial Interventions (Continued)

A woman helps a job applicant fill out forms.

Supported employment: Many people with schizophrenia have difficulty entering or re-entering the work force due to their condition. This type of psychosocial intervention helps people with schizophrenia to construct resumes, interview for jobs, and even connects them with employers willing to hire people with mental illness.

Schizophrenia Treatment - Psychosocial Interventions (Continued)

A doctor uses cognitive behavioral therapy (CBT) intervention with a patient.

Cognitive behavioral therapy (CBT): This type of intervention can help patients with schizophrenia change disruptive or destructive thought patterns, and enable them to function more optimally. It can help patients "test" the reality of their thoughts to identify hallucinations or "voices" and ignore them. This type of therapy may not work in actively psychotic patients, but it can help others who may have residual symptoms that medication does not alleviate.

Schizophrenia Treatment - Psychosocial Interventions (Continued)

Weight gain can be a side effect of some antipsychotic and other psychiatric medications.

Weight management: Many anti-psychotic and psychiatric drugs cause weight gain as a side effect. Maintaining a healthy weight, eating a well-balanced diet, and exercising regularly helps prevent or alleviate other medical issues.

What Is the Prognosis for Schizophrenia?

A family supports each other.

The prognosis for people with schizophrenia can vary depending on the amount of support and treatment the patients receives. Many people with schizophrenia are able to function well and lead normal lives. However, people with schizophrenia have a higher death rate and higher incidence of substance abuse. When medications are taken regularly and the family is supportive, patients can have better outcomes.

Sources:

IMAGES PROVIDED BY:

  1. BigStock
  2. iStock
  3. iStock
  4. iStock
  5. iStock
  6. iStock
  7. iStock
  8. iStock
  9. iStock
  10. Image reprinted with permission from eMedicine.com, 2010 - Paul Thompson, MD, UCLA, Laboratory of Neuroimaging (NIMH media file).
  11. iStock
  12. iStock
  13. iStock
  14. iStock
  15. iStock
  16. iStock
  17. iStock
  18. iStock
  19. Images included with permission and copyrighted by First DataBank, Inc.
  20. Images included with permission and copyrighted by First DataBank, Inc.
  21. iStock
  22. iStock
  23. BigStock
  24. iStock
  25. iStock
  26. iStock
  27. iStock
  28. iStock

REFERENCES:

  • American Academy of Child and Adolescent Psychiatry: "Schizophrenia In Children."
  • Brown University: "Schizophrenia (DSM-IV-TR #295.1–295.3, 295.90)."
  • National Alliance on Mental Illness (NAMI): "Schizophrenia in Children and Adolescents."
  • National Institute of Mental Health (NIMH): "What Is Schizophrenia?"
  • Schizophrenia and Related Disorders Alliance of America (SARDAA): "About Schizophrenia."
  • UpToDate: "Schizophrenia: Clinical Manifestations, Course, Assessment, and Diagnosis."
WebMD does not provide medical advice, diagnosis or treatment. See additional information