Schizophrenia and Psychosis

Throughout recorded history, the disorder we now know as schizophrenia has been
a source of bewilderment. Those suffering from the illness once were thought to
be possessed by demons and were feared, tormented, exiled or locked up forever.
In spite of advances in the understanding of its causes, course and treatment, s
chizophrenia continues to confound both health professionals and the public. It
is easier for the average person to cope with the idea of cancer than it is to u
nderstand the odd behavior, hallucinations or strange ideas of the person with s
chizophrenia.
As with many mental disorders, the causes of schizophrenia are poorly understood
. Friends and family commonly are shocked, afraid or angry when they learn of th
e diagnosis. People often imagine a person with schizophrenia as being more viol
ent or out-of-control than a person who has another kind of serious mental illne
ss. But these kinds of prejudices and misperceptions can be readily corrected.
Expectations become more realistic as schizophrenia is better understood as a di
sorder that requires ongoing -- often lifetime -- treatment. Demystification of
the illness, along with recent insights from neuroscience and neuropsychology, g
ives new hope for finding more effective treatments for an illness that previous
ly carried a grave prognosis.
Schizophrenia is characterized by a broad range of unusual behaviors that cause
profound disruption in the lives of people suffering from the condition, as well
as in the lives of the people around them. Schizophrenia strikes without regard
to gender, race, social class or culture.
Delusions & Hallucinations Are Common in Schizophrenia
One of the most obvious kinds of impairment caused by schizophrenia involves how
a person thinks. The individual can lose much of the ability to rationally eval
uate his or her surroundings and interactions with others. They often believe th
ings that are untrue, and may have difficulty accepting what they see as "true"
reality.
Schizophrenia most often includes hallucinations and/or delusions, which reflect
distortions in the perception and interpretation of reality. The resulting beha
viors may seem bizarre to the casual observer, even though they may be consisten
t with the schizophrenic's abnormal perceptions and beliefs.
For instance, someone with schizophrenia may act in an extremely paranoid manner
-- purchasing multiple locks for their doors, always checking behind them as th
ey walk in public, refusing to talk on the phone. Without context, these behavio
rs may seem irrational or illogical. But to someone with schizophrenia, these be
haviors may reflect a reasonable reaction their false beliefs that others are ou
t to get them or lock them up.
Nearly one-third of those diagnosed with schizophrenia will attempt suicide. Abo
ut 10 percent of those with the diagnosis will commit suicide within 20 years of
the beginning of the disorder. Patients with schizophrenia are not likely to sh
are their suicidal intentions with others, making life-saving interventions more
difficult. The risk of depression needs special mention due to the high rate of
suicide in these patients. The most significant risk of suicide in schizophreni
a is among males under 30 who have some symptoms of depression and a relatively
recent hospital discharge. Other risks include imagined voices directing the pat
ient toward self-harm (auditory command hallucinations) and intense false belief
s (delusions).
The relationship of schizophrenia to substance abuse is significant. Due to impa

irments in insight and judgment, people with schizophrenia may be less able to j
udge and control the temptations and resulting difficulties associated with drug
or alcohol abuse.
In addition, it is not uncommon for people suffering from this disorder to try t
o "self-medicate" their otherwise debilitating symptoms with mind-altering drugs
. The abuse of such substances, most commonly nicotine, alcohol, cocaine and mar
ijuana, impedes treatment and recovery.
Do you have schizophrenia? Take the test
The Onset of Schizophrenia
The onset of schizophrenia in most people is a gradual deterioration that occurs
in early adulthood -- usually in a person's early 20s. Loved ones and friends m
ay spot early warning signs long before the primary symptoms of schizophrenia oc
cur. During this initial pre-onset phase, a person may seem without goals in the
ir life, becoming increasingly eccentric and unmotivated. They may isolate thems
elves and remove themselves from family situations and friends. They may stop en
gaging in other activities that they also used to enjoy, such as hobbies or volu
nteering.
Warning signs that may indicate someone is heading toward an episode of schizoph
renia include:
Social isolation and withdrawal
Irrational, bizarre or odd statements or beliefs
Increased paranoia or questioning others' motivations
Becoming more emotionless
Hostility or suspiciousness
Increasing reliance on drugs or alcohol (in an attempt to self-medicate)
Lack of motivation
Speaking in a strange manner unlike themselves
Inappropriate laughter
Insomnia or oversleeping
Deterioration in their personal appearance and hygiene
While there is no guarantee that one or more of these symptoms will lead to schi
zophrenia, a number of them occurring together should be cause for concern, espe
cially if it appears that the individual is getting worse over time. This is the
ideal time to act to help the person (even if it turns out not to be schizophre
nia).
Schizophrenia is a mental disorder that is characterized by at least 2 of the fo
llowing symptoms, for at least one month:
Delusions
Hallucinations
Disorganized speech (e.g., frequent derailment or incoherence)
Grossly disorganized or catatonic behavior
A set of three negative symptoms (a flattening of one s emotions, alogia, avolit
ion; see below)
Only one of the above symptoms is required to make the diagnosis of schizophreni
a if the person s delusions are bizarre or if the hallucinations consist of a voic
e keeping up a running commentary on the person s behavior or thoughts, or two or
more voices conversing with each other.
Positive Symptoms
Delusions
Hallucinations
Disorganized thinking

Agitation
Negative Symptoms
Affective flattening- The person s range of emotional expression is clearly di
minished; poor eye contract; reduced body language
Alogia- A poverty of speech, such as brief, empty replies
Avolition Inability to initiate and persist in goal-directed activities (suc
h as school or work)
Although the above symptoms must be present for at least one (1) month, there al
so needs to be continuous signs of the disturbance that persist for at least six
(6) months. During this period, the signs of the disorder may be present in a
milder form, for instance as just odd beliefs or unusual perceptual experiences.
During this 6 month period, at least two of the above criteria must be met, or
only the criteria of Negative Symptoms must be present if even just in milder fo
rm.
Onset of schizophrenia prior to adolescence is rare. The peak age at onset for t
he first psychotic episode is in the early- to mid-20s for males and in the late
-20s for females. Though active symptoms typically do not emerge until an indivi
dual is in their 20's, oftentimes prodromal symptoms will precede the first psyc
hotic episode, characterized by milder forms of hallucinations or delusions. For
example, individuals may express a variety of unusual or odd beliefs that are n
ot of delusional proportions (e.g., ideas of reference or magical thinking); the
y may have unusual perceptual experiences (e.g., sensing the presence of an unse
en person); their speech may be generally understandable but vague; and their be
havior may be unusual but not grossly disorganized (e.g., mumbling in public).
Individuals with schizophrenia evidence large distress and impairments in variou
s life domains. Functioning in areas such as work, interpersonal relations, or s
elf-care must be markedly below the level achieved prior to the onset of the sym
ptoms to receive the diagnosis (or when the onset is in childhood or adolescence
, failure to achieve expected level of interpersonal, academic, or occupational
achievement).
Schizoaffective Disorder and Mood Disorder With Psychotic Features must be consi
dered as alternative explanations for the symptoms and have been ruled out. The
disturbance must also not be due to the direct physiological effects of use or a
buse of a substance (e.g., alcohol, drugs, medications) or a general medical con
dition.
If there is a history of Autistic Disorder or another Pervasive Developmental Di
sorder, the additional diagnosis of Schizophrenia is made only if prominent delu
sions or hallucinations are also present for at least a month (or less if succes
sfully treated).
0.3% 0.7% of individuals appear to acquire schizophrenia. although there is report
ed variation by race/ethnicity, across countries, and by geographic origin for i
mmigrants and children of immigrants. The sex ratio differs across samples and p
opulationHostility and aggression can be associated with schizophrenia, although
spontaneous or random assault is uncommon. Aggression is more frequent for youn
ger males and for individuals with a past history of violence, non-adherence wit
h treatment, substance abuse, and impulsivity. It should be noted that the vast
majority of persons with schizophrenia are not aggressive and are more frequentl
y victimized than are individuals in the general population.
The old criteria in the DSM-IV divided schizophrenia by different Types. Though
we not longer use such specifiers in the updated DSM-5, they remain below for in
formational/historical purposes.

A brief list of types of schizophrenia, according to DSM-IV:

Paranoid schizophrenia a person feels extremely suspicious, persecuted, grand
iose, or experiences a combination of these emotions.
Disorganized schizophrenia
a person is often incoherent but may not have de
lusions.
Catatonic schizophrenia a person is withdrawn, mute, negative and often assum
es very unusual postures.
Residual schizophrenia a person is no longer delusion or hallucinating, but
has no motivation or interest in life. These symptoms can be most devastating.