Although the popular perceptions of schizophrenia have changed, the mental health disorder — it’s not classified as a disease, as it can’t be verified as a physical condition — is still not clearly understood outside of the medical profession. This is largely due to the fact that schizophrenia is a complex condition that can manifest as a wide variety of symptoms in different people. To complicate things further, symptoms can also differ in individuals at different stages of the disorder.
The cause of schizophrenia is unknown. Although there are various theories, it’s generally diagnosed when symptoms meet the standard definition of the disorder, and when other similar conditions — such as bipolar disorder — have been rejected.
Delusions and Hallucinations
Schizophrenia is a severe, long-term mental health disorder that doctors classify as a kind of psychosis. This means that sufferers can’t correctly perceive what is going on in the world around them, and interpret events that are occurring in a different way than others. Symptoms may involve hallucinations, delusions, an inability to feel emotions or pleasure, and disorganized thinking, among others. The disorder usually appears in those in their teens and twenties, although it can show up in those in their thirties (more often in women).
Schizophrenia can be hereditary, and around 10 percent of people whose first-degree relatives are sufferers are affected. The disorder can’t be cured, but the symptoms can be managed to the point that sufferers can, for instance, hold a job, and maintain relationships. Recent research points to a cause that is both genetic and environmental, and treatment usually involves a combination of antipsychotic drugs and cognitive behavioral therapy.
Paranoia and Disorganization
As the root cause of the disorder is unknown, schizophrenia is best understood by its symptoms. There are two main subtypes of schizophrenia — the paranoid subtype and the disorganized sub-type. The paranoid subtype suffers from auditory hallucinations — “hearing voices” — or delusional thoughts, or both, relating to persecution and conspiracy. The sufferer often thinks that a person, or a group of people — often family members — are “out to get” him or her.
The hallucinations revolve around a specific theme, which usually remains constant for the sufferer, and the individual’s actions generally relate to the content of this theme. The brain of a person suffering from schizophrenia mistakes the thought of a voice giving instructions as a real voice.The voices appear to be genuine to the sufferer. Delusions include the thought that, for instance, people talking on television are sending special messages, or giving instructions, to the sufferer.
The feelings of persecution can lead to hostility toward others, although those experiencing schizophrenia are rarely violent. As the condition progresses, memory and mental coherency can suffer. One problem is sufferers might not talk about their auditory hallucinations, so the disorder may be difficult to spot in the early stages. The paranoid subtype can more easily be treated, and sufferers can stabilize to a level where they can work, have relationships, and lead relatively normal lives.
The disorganized subtype suffers from disorganization of the thought process — sufferers become muddled and confused. This subtype experiences less pronounced hallucinations and delusions, but may not be able to think clearly enough to function normally. They might not, for instance, wash or perform other acts of personal hygiene. The sufferer will lose the ability to experience emotions, a condition which is called the “blunted” or “flat” affect, and may respond in an inappropriately cheerful manner to events, for example, by laughing at a funeral. Communication becomes difficult, and speech becomes garbled, with words being used in the wrong order. This is sometimes referred to as “word salad.”
Nature and Nurture
What causes schizophrenia? The root cause is unknown. Environmental, biological and, more recently, genetic causes have been explored. Some researchers believe that there is an environmental element — a virus, or malnutrition in the womb — that works in conjunction with genetic or biological factors to cause the condition. The focus until recently has generally been biological, and dopamine has been the subject of much investigation.
Dopamine is a chemical that works as a neurotransmitter in the brain — that is, it’s used to send signals to nerve cells. When drugs like clozapine are used to block dopamine, schizophrenia patients see an improvement. This has led to the suggestion that schizophrenia sufferers may produce too much dopamine, and this may be a cause of the condition. NMDA receptors — receptors that are found in nerve cells and are activated when glutamates bind to them — have also been considered as a cause.
Genes May Hold the Key
Recent research, however, has focused on genetics, with one influential study cataloguing 108 genes that are implicated in causing schizophrenia. Another important study focused on a specific gene, C4, as a specific cause of schizophrenia. The C4 gene is involved in the immune system. In the blood, it binds to microbes to signal that they should be engulfed by cells of the immune system, and therefore destroyed.
In the brain, C4 has a different purpose, and binds to neurons at the points where they connect to other neurons. This is to signify that the connection between the neurons (called the synapse) should be engulfed and destroyed. Schizophrenia often first appears in teenagers due to a developmental phase in the brain at this age when the synapses are pruned. Researchers believe that schizophrenia could be a result of the C4 gene marking too many synapses for pruning. This is an exciting step forward, and more research is being carried out on the C4 gene. If a root cause for schizophrenia is discovered, it’s possible that a cure can be found.
Meanwhile, doctors continue to manage the symptoms in patients with schizophrenia by using a combination of drugs and cognitive behavioral therapy. “Typical” antipsychotic drugs like chlorpromazine have been used to treat schizophrenia since the 1950s, although these can have side effects like movement disorders. “Atypical antipsychotic” drugs like clozapine are used if patients fail to respond to typical antipsychotic drugs. Clozapine works by blocking dopamine receptors in the brain. It’s effective, but it must be closely monitored, as a side effect can be a dangerously low white blood cell count.
Therapy Aids Recovery
Psychosocial therapy can aid patients whose conditions have stabilized due to the use of antipsychotic medication. Therapists can encourage schizophrenia patients to stick with their medication, and can help with a patient’s self-management of the disorder, their relationships, and integration into society (like employment).
Cognitive behavioral therapy, which focuses on solving the current problems of a patient by breaking them down into smaller parts that can then be analyzed, can help schizophrenia sufferers work out whether their perceptions are true representations of the outside world. Therapy is an important part of the management process for schizophrenics.