What Exactly Is Schizophrenia?

If schizophrenia had a nickname, it would be: Misunderstood. That’s because it’s every shade of complicated. And, to confuse matters more, each of its symptoms appear in at least one other psychiatric disorder.

The easiest way to make sense of itis to say what it’snot。Schizophrenia is not characterized by split or multiple personalities (aka dissociative identity disorder), or the extreme shifts in mood that come with bipolar disorder. And people with schizophrenia aren’t prone to violence—or genius, for that matter, in spite of what you might have seen in the film“美丽的心灵。”

“The hallmark symptoms of schizophrenia—hallucinations and delusions, bizarre thoughts and perceptual difficulties—are typically what we think of, but ultimately it’s a brain disorder that involves progressive deterioration in cognitive abilities,” explainsDr. Frank Chen, MD,Chief Medical Officer at Houston Behavioral Healthcare Hospital in Texas. “Unfortunately, it’s an illness that doesn’t get any better, but you can use medications to palliate some of the symptoms and improve quality of life.”

因为精神分裂症是很难诊断,numbers on its prevalence vary, but experts estimate it affects about 2.4 million Americans. The disorder affects more men than women—the ratio is1.4 to 1—and it strikes men earlier, too. Age of onset for men tends to be in the late teens to early 20s; for women, onset typically occurs in the early 20s to early 30s. Experts believe this has something to do with the pruning of neurons, a process that takes place after birth in babies, which happens later for women than for men.

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How Schizophrenia Manifests

People with schizophrenia experience what’s called a psychotic break, which is the onset ofpsychosis: It’s when their mind is overtaken by hallucinations and/or delusions that make it hard to know what’s real and what’s not. But while the word “break” sounds sudden, symptoms of schizophrenia don’t happen in a single traumatic moment. Instead, they are usually gradual and can progress for years, and they can be easy to miss—until they’re impossible to ignore. Here’s how the disorder can manifest.

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Early Warning Signs

Also called the “prodromal phase,” early symptoms of schizophrenia are those that happen before a first episode of psychosis and usually during teenage or young adult years. The duration of the prodromal phase can vary, and in some people may last over 2 years. Early symptoms can be difficult to detect because they can mirror the typical behavior of an angsty teenager or young.

“When individuals first experience some of the bizarreness associated with this illness, they kind of look depressed,” says Dr. Chen. “They become much more reclusive. They don’t talk as much. A lot of times they’re hibernating in their room. Like most teenagers, they don’t share their thoughts with their parents. It’s easy to think it’s teenage angst, or that they’re just going through a phase.”

According to the National Alliance on Mental Illness, early signs of schizophrenia to look out for include:

  • A steep drop in grades or job performance
  • Trouble thinking clearly or concentrating
  • Suspiciousness or uneasiness with others
  • A decline in self-care, like not showering for days
  • 与平常相比,独自一人花更多的时间
  • Strong, inappropriate emotions such as laughing when someone dies or having no feelings at all

The Symptoms of Schizophrenia

Symptoms of schizophreniaare generally put into two categories: positive or negative. But don’t be fooled by the term “positive”; these symptoms aren’t positive in the good sense. “Positive symptoms are experiences which are not generally part of everyday experience,” says Dr. Russell Margolis, M.D., Clinical Director at the Johns Hopkins Schizophrenia Center in Baltimore and professor of psychiatry and behavioral sciences.

换句话说,positive symptomsare created or added to a person’s life by the disease. The experience of positive symptoms in schizophrenia designates that break with reality that comes with psychosis. Patients can experience eitherhallucinations or delusions, or both simultaneously.

Just like positive schizophrenia symptoms are added to someone’s life,negative symptomsare what the disease takes away. “They are the absence of something that’s normally present in life, such as goals, interests, and initiative,” says Dr. Margolis. “The person just doesn’t want to do things anymore. They may just want to sit around all day; they may not speak very much or have spontaneous ideas. It’s like everything is turned down.”

精神分裂症的积极症状包括:

  • Hallucinations:这些是不compreh感官体验ensible to others but feel perfectly real and vivid to the person experiencing them. Roughly70%of people with schizophrenia will have hallucinations. Auditory hallucinations—hearing voices or sounds that aren’t there—are the most common, affecting more than 83% of patients, followed by visual ones (57%), such as seeing body parts or unidentifiable things. Other, less common types (27%) of hallucinations include tactile or sense-of-touch ones, such as feeling bugs crawling on your body; olfactory or scent-related hallucinations (27%); and gustatory hallucinations (14%), which involve your sense of taste. No matter what the type of hallucination, a person with schizophrenia can’t be talked out of it or convinced that what they’re hearing or experiencing isn’t actually happening.
  • Delusions:定义为错误信念或信仰冲突with reality, people with schizophrenia hold strong to these notions despite plenty of evidence to the contrary. Delusions come in many forms; some of the more common ones include:
    • Delusions of persecution:The belief that someone or something means to do you physical or emotional harm, like believing that your next-door neighbor is entering your home while you are sleeping in order to poison your food or to spy on you.
    • Delusions of grandeur:The belief that you are an important, powerful, or a famous person such as a member of royalty, a deity, or a superhero with special powers such as an ability to know the future.
    • Delusions of reference:相信某事或某人在没有的时候指的是您。例如,您可能会相信自己在报纸上阅读的内容是指您或您的想法,或者是电影中的演员通过屏幕向您发送个人信息。
  • Thought insertion:The belief that your thoughts are not your own, rather they were placed there by an outside source.
  • Thought broadcasting:The belief that your thoughts are being broadcast so that someone or something can observe or collect them (say, aliens or the government), or that people around you can read your mind.
  • Thought Disorder:Margolis博士说:“这是一种无序的思考方式,即受影响的人很难以线性,有条理的方式保持思想。”“结果,单词和短语被滥用,没有用或过度使用,另一个人很难理解。”例如,一个有思想障碍的人可能会回答一个问题,例如“您来自哪里?”以一种无关紧要的方式解释他们不了解自己的祖先历史,以一种无关紧要的方式。否则,他们可能会以一种与原始概念隐约相关的想法来使主题脱颖而出。
  • Disorganized Behavior and Speech: This is characterized by trouble with goal-directed behavior, which can not only get in the way of starting and completing a task like making dinner or getting dressed for the day, but it can also impact your ability to work or interact with others. Speech can also be affected: Words may become so jumbled and confused that it’s often described as a “word salad.” Other ways disorganization can manifest:
    • A decline in overall daily functioning
    • Unpredictable or inappropriate emotional responses
    • Lack of impulse control
    • Bizarre behaviors that lack purpose
    • Routine behaviors such as bathing, dressing, or brushing teeth can be severely impaired or lost

The negative symptoms of schizophrenia include:

  • Avolition:A total lack of motivation, to the point of not being able to pursue any sort of goal, including seemingly simple things like making or taking a phone call
  • Anhedonia:An inability to experience pleasure from social situations or physical activities like eating, touching, or sex
  • Social withdrawal:Lack of interest in being with other people
  • Difficulty paying attention:Staring off aimlessly while someone is speaking, for example
  • Apathy:This might show up as lack of personal hygiene, or a lack of concern for yourself or others.
  • Affective flattening:An absence of “affect” or emotional expression, such as unresponsive facial expressions or vocal tones and very little body language or movement
  • Alogia:Difficulty speaking, which might mean a significant reduction in the amount of words spoken or in the ability to speak with ease or use detail when communicating

那精神分裂症的认知症状呢?

There’s some overlap between cognitive symptoms and both positive and negative ones, but cognition can be defined more narrowly as the capacity to think through and solve problems, explains Dr. Margolis.

“This is the kind of a thinking you would get on an IQ test, for instance, the ability to generate a certain number of words in a period of time, or the ability to connect one idea to another,” he says.

“Most people with schizophrenia do have some cognitive problems compared to where they were before they became ill.” The way their brain works and processes information can become weaker, and cognitive skills they used to have are harder to perform because their brain isn’t functioning normally.

精神分裂症和Ps有什么区别ychosis?

“Psychosis is symptoms—hallucinations and delusions—that can occur in a number of different entities,” says Dr. Chen. For instance, someone who is on cocaine or methamphetamine can have psychotic symptoms, so can someone at the very extremes of depression or mania. And of course, so can someone with schizophrenia.

The distinction, says Dr. Chen, lies in how long symptoms last. “Substance-induced psychosis is reversible. Once your depression resolves, the psychosis goes away. When you treat the mania, the psychosis goes away and you don’t have to treat it anymore. But in the case of schizophrenia, the psychosis is enduring. And if you stop the medications, the psychosis will invariably come back.”

Types of Schizophrenia

  • Paranoid Schizophrenia:
    The most common type of schizophrenia characterized by psychosis misaligned with reality. If you are suffering from paranoid schizophrenia, you may be unreasonably paranoid of others, have paranoid delusions that someone is after you and that they are trying to hurt you. Common paranoid delusions include coworkers, spouses, the government, and neighbors plotting to hurt you in some way. You may believe others are out to try to kill you, spy on your, make your life miserable, poison you, or cheat on you.Paranoid schizophreniahas a severe impact on relationships, understandably so, as if you are suffering from this disorder, you believe those that are close to you are trying to hurt you in some way. This may cause you to feel angered and agitated. To cause an even deeper impact on the situation, your paranoid delusions may be accompanied by hallucinations where you hear voices that are insulting you or prompting you to do bad things.
  • Schizoaffective Disorder:
    Schizoaffective disorderis a type of combination disorder that combines symptoms of schizophrenia with a mood disorder – most likely eithermajor depressionorbob app官网下载 。This type of schizophrenia is chronic and appears in intermittent episodes. Mood (affective) symptoms occur at the same time as the schizophrenic symptoms and the schizophrenic symptoms often stay put after the mood symptoms disperse. Common symptoms of schizoaffective disorder includedepression, mania, and classic schizophrenia.
  • 简短的精神病:
    This is a short-term occurrence of schizophrenia, where there is a sudden onset of symptoms that only persist for less than one month. The causes of these brief stints of psychoses include an obvious stressor (e.g., death of a loved one, trauma from natural disasters), no apparent stressor (i.e., the symptoms come on due to no obvious reaction to a disturbing event), andpostpartumpsychoses – occurring in women within 4 weeks of giving birth. During this brief episode of psychosis, you might experience hallucinations, delusions, and cognitive deficits, as present during more general schizophrenia. It is unknown what causes brief psychotic disorder to affect certain individuals, but certain genetic and environment factors have been examined as culprits, including predisposition to develop mood disorders and psychoses within the family history.
  • Schizophreniform Disorder:
    这是成熟精神分裂症的另一种短形式,在这种精神分裂症中,受影响的个人经历扭曲了思维,情感反应和对现实的看法。如果您患有这种疾病,您可能很难区分真实和想象的东西。尽管精神分裂症和普遍的精神分裂症的症状重叠,但主要差异是持续时间。如果您患有精神分裂症障碍,则会经历精神病症状六个月或更短的时间。如果它们的持续时间比这个时间范围更长,那么您可能会接受精神分裂症的诊断。
  • Delusional Disorder:
    As the name suggests, this is a form of psychosis where the main symptom is delusions – the inability to shake untrue beliefs. If you are suffering from this form of psychosis, it is not likely you are making up unbelievable scenarios – most delusions involve someone trying to poison you or harm you in some type of way. In reality, these delusions may be a heightened exaggeration of reality or just false altogether. A distinguishing characteristic of individuals suffering from this condition is that among other things, there is no bizarre behavior – you wouldn’t know someone is suffering from this condition if it weren’t for the delusions.
  • 共同的精神病: Also known as “folie a deux” (the folly of two), this is a rare form of psychosis where an otherwise healthy individual begins to adopt the psychotic beliefs/delusions of someone suffering from schizophrenia. For example, if you are suffering from schizophrenia and believe monsters are after you and trying to abduct you, if your spouse (otherwise healthy) also starts to believe that monsters are out to get you, your spouse would be considered to suffer from shared psychotic disorder. If you and your partner separate, the delusions resolve.

精神分裂症的危险因素是什么?

Experts can’t say exactly what causes schizophrenia, but they’ve been able to identify a number of key risk factors, and they believe it’s likely a combination of more than one that contribute to someone developing the disorder. Here are the factors at the top of the list:

Genetics

Genes appear to be by far the biggest risk factor for schizophrenia. “When you look at the illness overall, somewhere between 60% to80%of the risk of developing schizophrenia is genetic,” says Dr. Margolis, and the risk will depend on their family history, and whether a diagnosed relative is close or distant.

Margolis博士说:“如果您与精神分裂症有兄弟姐妹,您可能有10%的机会自己获得它。”“如果您患有精神分裂症的父母,它会降低一点,大约有6%的机会。如果您有祖父母,您的机会大约为5%。如果您有一个精神分裂症的姨妈或叔叔,那么机会是2%。”

These exact numbers are all subject to discussion as experts continue to learn more, says Dr. Margolis, but the takeaway is that your risk rapidly goes down the further removed you are from the relative with schizophrenia. It’s also important to note that there’s not just one gene implicated in schizophrenia.

For instance, one 2014 research consortium funded by the NIMH found108 genetic regions with variations that were significantly associated with schizophrenia risk, and more have been discovered since. For now, that means genetic tests for schizophrenia remain a dream, not a reality.

Pregnancy Complications

Researchers have found that severe complications during pregnancy—such as extreme malnutrition or asphyxia (oxygen deprivation)—are associated with an increased risk of the child developing schizophrenia later in life. But don’t freak out: “This does not by any means mean that schizophrenia would inevitably result if you have a pregnancy complication, it just increases the risk,” says Dr. Margolis.

There are at least two possible connections, the first being genetics. “You may already have some genetic vulnerability, but then some damage occurs that unmasks the vulnerability,” says Dr. Margolis.

Second, there is the more general biological factor that the brain is developing during pregnancy. “Anything that interferes brain development is likely to increase the risk of schizophrenia,” says Dr. Margolis. “Of course, it’s going to increase the risk of all sorts of other things, too.”

Substance Abuse

Abuse of alcohol or any illicit drugs has long been linked with an increased risk of developing schizophrenia, but there’s one drug in particular that has experts especially worried: Cannabis.

Onestudy out of Denmark, for instance, found strong associations between almost any substance abuse and later risk of developing schizophrenia, but marijuana was the clear leading culprit. Here’s a rundown of substance risks associated with schizophrenia development:

  • Cannabis: 5.2 times
  • Alcohol: 3.4 times
  • Hallucinogenic drugs: 1.9 times
  • Sedatives: 1.7 times
  • 苯丙胺:1.24次
  • Other substances: 2.8 times

“There is pretty striking evidence that marijuana use, especially in younger teens, is associated with increased risk for schizophrenia in a dose-response way: The more the use, the higher the risk,” says Dr. Margolis. Though the exact reason isn’t yet understood, he points to timing and what’s happening in the brain.

“The brain doesn’t reach its full maturity until the late teens-early twenties, and so there are a number of important biologic processes underway,” says Dr. Margolis. “The presumption is that somehow, marijuana is interfering with those processes.”

Older Sperm

Or rather, the sperm of older fathers, to be exact. Children born to middle-aged fathers may be at higher risk for developing a range of mental illnesses, possibly including schizophrenia, some evidence suggests. OnestudyinJAMA Psychiatryfound that kids born to fathers age 45 and older had about twice the risk of developing psychosis—a hallmark of schizophrenia—compared with those born to younger dads aged 20 to 24.

“This has been debated for a while, but it appears that there may be an increased risk of new mutations developing,” says Dr. Margolis. “It has to do with constant turnover of sperm, and the older someone is, the more chances there are of mutations occurring.”

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Read More About the Causes of Schizophrenia

Doctors and scientists are learning a lot about what causes schizophrenia to develop. Get the latest info!

Read More About Schizophrenia Signs and Causes

How is Schizophrenia Diagnosed?

这是事情变得棘手的地方。Diagnosing schizophreniacan be challenging for a few reasons. “It starts with the fact that there is no one unique feature of schizophrenia—people can have hallucinations and positive and negative symptoms of all types with other psychiatric disorders,” says Dr. Margolis. “So, the first step is to avoid being fooled and ruling out those other disorders.”

Second, there is no specific test for schizophrenia. “There’s no blood or genetic test, or any imaging test—though there’s great hope that as functional MRI scans get more sophisticated, we may be able to develop better tools for diagnosis,” says Dr. Margolis. “But for now, it’s a clinical diagnosis.” Part of that process involves making sure there are no other medical factors at play that can manifest like schizophrenia, such as a brain tumor or syphilis.

From there, a classic diagnosis comes from comprehensively evaluating the individual’s psychiatric history, starting from when they were well through to how their symptoms have progressed over time, and performing a detailed mental status examination of the person in the moment. For instance, are they currently experiencing hallucinations, delusions, or disordered thinking? This information is gathered not just from the patient, but also from close family members and friends.

“Some people with schizophrenia are very guarded and suspicious of everything as part of their illness, so they won’t reveal what they’re thinking,” explains Dr. Margolis. “Or, they can be so thought disordered that they won’t be able to communicate what they’ve experienced or how they behave. That’s why it’s vitally important to obtain information from outside informants.”

Schizophrenia Causes From Inside the Brain

The schizophrenia brain looks different than a healthy brain, but it’s not easy to spot on standard neuroimaging tests. A few key markers in schizophrenia:

  • Enlarged ventricles:这些是大脑中心充满液体的腔。Margolis博士说:“这是证明精神分裂症是一种脑部疾病的第一个一致的生物学发现。”“这表明他们已经失去了脑部问题,但是患者之间的心室大小有很大的变化,以至于诊断上没有帮助,至少还没有。”说到脑部的失去……
  • Reduced gray matter:有灰质体积的减少,不uronal cell bodies that process information in the brain, particularly in the temporal lobe, which processes memories and associates them with sensations of taste, sound, sight, and touch, as well as the frontal lobe, which is important for cognitive functions and control of voluntary movement or activity.
  • 不健康的生化水平: Many theories point to either an excess or shortage of neurotransmitters serotonin, glutamate, and dopamine. In the latter case, there’s an overactivity in dopamine signals, which plays a role in reward and desire—leading to the hallucinations and delusions, says Dr. Chen.
  • Less active frontal lobes:大脑的这一部分参与了未来的计划和推理,记忆形成,言语和语言生产,冲动控制等等 - 精神分裂症患者受损的所有认知技能。

Complications of Schizophrenia

As mentioned previously, the occurrence of suicide in schizophrenics is abnormally higher than other mental illness disorders. Such that, an estimated 20% to 40% of individuals suffering from schizophrenia will attemptsuicide在他们一生中的某个时候。多达13%的人可能成功完成该法案,大多数是男性。自杀是精神分裂症的棘手并发症,因为许多患有这种疾病的人都没有意识到自己的病情,这使得治疗变得更加困难。

Substance abuseis another common complication of schizophrenia. Nicotine addiction is the most common substance abuse among schizophrenics, with schizophrenics being addicted to nicotine three times the rate of the general population.

If you are suffering from schizophrenia, you have an increased propensity to abuse more harder substances in addition to nicotine, including marijuana, alcohol, and cocaine. Certainly compounding the already detrimental impact of substance abuse on one’s general health, taking medications to treat schizophrenia while abusing drugs makes the medication less effective, in fact, potentially dangerous. In addition, amphetamines (stimulants) make schizophrenic symptoms considerably worse.

What is the Treatment for Schizophrenia?

Antipsychotic medicationsare the gold standard, though they work more effectively for positive symptoms (hallucinations, delusion, thought disorder) than they do for negative or cognitive ones. There are several antipsychotics available, each with their own advantages and disadvantages, making it hard to say which ones are better than the others — it really depends on who’s taking it, says Dr. Margolis.

“In general, the older medicines tend to have a slightly higher rate of neurologic side effects,” he says, referring to so-called first-generation drugs like chlorpromazine and haloperidol. For instance, some patients will develop movement abnormalities that look like Parkinson’s disease, or akathisia, an urgent and unpleasant sense of restlessness. On the other hand, some of the newer, second-generation medications such as olanzapine and clozapine have a greater chance of causing metabolic syndrome—a cluster of symptoms including weight gain, diabetes, and high cholesterol—but not all of them carry this risk.

Another thing to consider with medication is the method of delivery. “Many patients with schizophrenia have a condition called anosognosia, where they don’t have awareness of their illness,” says Dr. Chen. “And if they don’t think they’re ill, they’re not going to take medications—so they’re notorious for being noncompliant.” Newer technologies like long-acting injectable medications or transdermal patches are helpful for these patients to stick with a treatment protocol.

Beyond medication,different types ofpsychotherapysuch as cognitive behavioral therapy can help people with schizophrenia manage their illness on a number of fronts. For one, medications aren’t perfect, and psychotherapy can help teach a person how to ignore or disengage with symptoms that slip through the cracks. It can also aid with common issues like managing strained family relationships, finding and holding down a job, and remembering to take medications and show up for doctors’ appointments.

Another treatment to consider isElectroconvulsive therapy (ECT), which involves stimulating the patient’s brain with small electric currents while they’re under anesthesia. “There’s some evidence that very severely ill patients respond well to a combination of clozepine and ECT together,” says Dr. Margolis. “It may be particularly effective in people who have schizophrenia with prominent mood symptoms such as depression or mania.”

How Common is Childhood Schizophrenia?

Childhood-onset schizophrenia (COS)is a rare and poorly understood illness, affecting only about1 in 40,000孩子们。当在13岁以下的儿童中被诊断出时,它被认为是cos。尽管症状与成人精神分裂症的症状非常相似,但在儿童中,症状比成人更难以诊断,因为症状很容易被误认为是正常的孩子样的行为。

For instance, early warning signs of COS include shyness, introversion, loneliness, depression, and manic-like behavior, all of which could be chalked up to “kids being kids.” And children have wild imaginations (Think: monsters in the closet), which can be used to explain away the possibility of hallucinations or delusions. What’s more, symptoms overlap with those found in other more common childhood disorders such as autism and ADHD, adding to the challenge of accurate diagnosis.

Treatment for COS looks very similar to that for adults—antipsychotic medication combined with psychotherapy, with the addition of academic and social support. Unfortunately, the condition is not likely to go away even with treatment, and instead continues into adulthood. Early diagnosis is key to helping children and their families better prepare to cope with the chronic illness.

Schizophrenia FAQs

What are the first signs of schizophrenia?

Early signs of schizophrenia can be easy to confuse with depression. They include:

  • A steep drop in grades or job performance
  • Trouble thinking clearly or concentrating
  • Suspiciousness or uneasiness with others
  • A decline in self-care, like not showering for days
  • 与平常相比,独自一人花更多的时间
  • Strong, inappropriate emotions such as laughing when someone dies or having no feelings at all

What is the difference between schizophrenia and schizoaffective disorder?

Both are categorized as a psychotic disorder, and both are defined as having psychotic symptoms (hallucinations, delusions). But in individuals with schizoaffective disorder, they will invariably have a mood state on top of their core psychotic symptoms, and so they sometimes flip into a state of mania or depression.

What can trigger schizophrenia

Triggers are very individual, and they can either set off the process of schizophrenia in someone who’s already vulnerable or lead to a relapse. Some common triggers include stress, substance abuse (especially marijuana abuse), a disrupted sleep/wake cycle, or discontinuing the use of antipsychotic medications.

Helpful Resources for Schizophrenia

国家心理健康研究所

联邦研究精神疾病研究机构,您将在这里找到有关精神分裂症的最新研究,新闻和统计数据,您可以探索参加即将进行的临床试验的想法,以寻找新的和更好的治疗方法。

National Alliance on Mental Illness

The nation’s largest grassroots mental health organization, NAMI provides information on understanding different mental health conditions and latest research, as well as resources to find a mental health provider and navigate health insurance. For free information and support, call the NAMI HelpLine at 1-800-950-NAMI (6264), or email info@nami.org.

Schizophrenia Alliance

This self-help group is managed by people who are dealing with schizophrenia or a related disorder firsthand. Here, you’ll find social support and fellowship with a community of people who share your challenges and encourage positivity and being proactive in your recovery.

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Last Updated: Feb 14, 2022