What is Schizophrenia?
Schizophrenia is a fairly common mental illness. Unfortunately, when the general public thinks of mental illness, schizophrenia is usually the first thing that individuals think of. Over the years, people have been falsely labeled as schizophrenics. There are many stereotypes associated with schizophrenia that are grossly untrue. In the 1940’s and 50’s, schizophrenia was referred to as dementia praecox. Medication was limited, but a variety of treatment modalities used such as water therapy, long-term steam baths, ice baths, insulin shock treatment, to name a few.
Schizophrenics, show distortions of reality; they have a myriad of symptoms, some of these are as follows:
What are symptoms of Schizophrenia?
Schizophrenia is commonly confused with “split” or multiple personalities. Schizophrenics have difficulty differentiating between what is “real” and what is not. According to the DSM-IV, symptoms of schizophrenia include 2 or more of the following behaviors with duration of at least one month:
- Delusions, which are false beliefs
- May or may not be paranoid in nature
- Delusions of grandiosity (thinking one is a famous person)
- Hallucinations, auditory, visual, smell or tactile
- Disorganized thinking or speech (where an individual may be talking about a certain topic, and jump from topic to topic, i.e. a flight of ideas. For example, an individual may be talking about his father’s pick-up truck, and how they took their truck to the grocery store to pick up groceries, and before too long, the conversation switches to cooking hamburgers, when the initial topic was trucks)
Other symptoms may include:
- Social withdrawal
- Absence of emotion
- Decreased hygiene and grooming, in which the individual will not shower or clean
- Catatonia, where individuals become fixed in their positions, immobile for quite some time
Schizophrenics displaying any of these symptoms are considered to be in the active phase of the disorder. Also it is important to note that schizophrenia involves a dysfunction in one or more major life areas, i.e., interpersonal relations, work, school, or self-care.
What are the causes of Schizophrenia?
There is a definite familial component. In studies of identical twins where one twin has been diagnosed with schizophrenia, there is an approximately 30-40% increase in the development of schizophrenia in the second twin. In studies of fraternal twins, there is about a 10% increase. About 1% of the general population will develop schizophrenia. Familial patterns, according to the DSM-IV: 1st degree biological relatives of individuals diagnosed with schizophrenia have a 10 times greater risk of being diagnosed with schizophrenia than the general population.
There is much evidence supporting the dopamine theory; i.e., schizophrenics have increased levels of dopamine, a neurotransmitter found in the brain, which triggers the psychosis. Drugs that block dopamine seem to reduce schizophrenic symptoms.
Not addressed as frequently as this author would like are the environmental influences contributing to the development of schizophrenia. Although studies using PET scans have documented the presence of enlarged ventricles in the brains of schizophrenics, there is ample evidence that in certain study groups, environmental influences may contribute to schizophrenic-like symptoms including full blow psychotic break. Some believe there has to be a predisposition for this. The Parnas, by Silvano Arieti, is an excellent book on the subject. He was born in Pisa, Italy in 1914 and immigrated to New York in 1939. He died in 1981. Arieti was a well-known psychiatrist and psychoanalyst who worked with Holocaust survivors, and extensively researched the connection between religion and ability to survive. His book chronicles the final days of Giuseppe Roques, who was the lay leader, or Parnas, of the Sephardic Jewish community of Italy, who was killed by the Nazis in 1944. Another book by the same author is called the Interpretation of Schizophrenia, for which he won a National Book Award for Science. In this book, the author clearly points out that environmental influences that can lead to the development of schizophrenia. He talks about the schizophrenogenic mother and the situations that occur in a dysfunctional home with children who have few coping mechanisms to handle severe environmental stressors. The book discusses the types of behaviors that have to occur on a repetitive basis in order to induce schizophrenic and psychotic-like symptoms. This book was inundated with bad press, so much so that numerous theories were used to demolish the paradigm of the schizophrenogenic mother, which is a shame. Does it exist in all mothers? Of course not. Does it exist in some? Most definitely. But it is not atypical to find in our society individuals who come together to ban an idea or concept by making sweeping generalizations to prove an idea or theory false, without examining any of the possible benefits that may exist, and in this case were found in the initial study. Throwing the baby out with the bathwater. To continue, there has to exist specific behaviors displayed by a schizophrenogenic mother and perpetrated upon a child for a double bind situation to occur. This is when an individual can never win, with no escape from the situation. In addition, situations like this must present themselves over and over again. The child develops a great mistrust of their environment, along with psychotic thinking and thought patterns, which continues over time, even after the double bind situation ceases to exist. Subsequently, if a mother continuously and severely disciplines her child, and sends her child false messages with no avenue for escape, the child cannot win. An example of schizophrenic communication between a mother and child would be a child asking his mother if he could have ice cream for dessert after supper. The mother’s immediate response might be “You know, I really have to go out to the post office.” This communication style has completely avoided the initial question posed by the child, and occurring on a repetitious basis, the child feels like he is not being heard, there is no acknowledgement, and combined with the double bind scenario, may lead to the development of mental illness.
The majority of schizophrenics do not marry. In fact, approximately 65% have very limited social contacts. Even though it has been documented that schizophrenics have a higher level of aggressiveness, specifically in an institutional setting, it is in actuality no greater than in the general population. This concern has actually received a fair amount of press this summer. An example of the alarmist mentality supported by stereotypes and misinformation surrounding mental illness in general, a bill has been proposed that would require an individual’s past history of mental illness be disclosed to potential employers. This would only include individuals who have been admitted into a hospital due to their mental illness, which could include schizophrenia, along with other diagnoses, the rationale being that these individuals could potentially be a danger to themselves or others. In addition, the bill would also make it impossible for this population to obtain firearms. The AMI (Alliance for the Mentally Ill) has been strongly advocating that this is not only inappropriate, but is a violation of an individual’s rights. They go on to state that there is no evidence to support a greater likelihood of a killing spree by a member of this population than the general population. These issues always come to the forefront after a sociopath goes on a killing rampage, walking into a place of business or school, firing weapons and killing or wounding many individuals. These individuals are generally not schizophrenic, but sociopathic. Please see Sociopathy on Peace and Healing.com.
Other interesting findings that may be associated with schizophrenics: Individuals with high arched pallets (roof of the mouth), widely set eyes, subtle malformations of the ears, hair swirls at the crown of the head going counterclockwise. Again, there are no strong P-values in studies that would draw a direct correlation, but these have been found as commonalities.
Age of onset of schizophrenia
Most commonly diagnosed between the late teen years and early 30’s. Prior to adolescence it is rarely diagnosed. Interestingly enough, there does appear to be a difference between the sexes in onset. Age of onset for men is between the ages of 18-25 and for women, 25-30, according to the DSM-IV. There is a subset of women, approximately 3-8% with an onset age of 40 or more years. It is extremely rare for a male to be diagnosed with schizophrenia at this age. Cultures and races have been greatly studied. It is interesting to note there is a substantial increase in African Caribbeans living in the United Kingdom who are diagnosed with schizophrenia, higher in fact than any other culture studied. The reason for this statistic is unclear. Correctly making a diagnosis of schizophrenia is very important. Drugs may induce schizophrenic-like symptoms. The ingestion of hallucinogenic drugs can also mimic schizophrenic symptoms, also amphetamine psychosis. Thyroid storm can also cause psychotic or manic-like symptoms.
It is so much easier to label an organic cause, brain disorder, due to increased levels of dopamine, and indeed this is the case. However in some cases, it is not. Therapists need to look at entire family dynamics. They need to focus on mother-father relationships with the child, and the development of the child, as well as communication styles in the home.
What is the treatment of Schizophrenia?
There are many medications used to treat schizophrenia. It would be exhausting to mention all of these. A few of the newer anti-psychotic medications will be reviewed. The atypical psychotics which over the last few years have received a lot of positive attention: Olanzapine, which is Zyprexa, which blocks Serotonin and Dopamine receptors, and has been quite effective, as well as Risperidone and Risperidal, which also blocks Serotonin and Dopamine receptors. Weight gain is a common side-effect to these medications; however, in the last 6 months, Aripiprazole, brand name Abilify, and also blocks Dopamine and Serotonin levels, has been associated with far less weight gain. This author has prescribed Abilify and has had good success with this medication.
The very first anti-psychotic medication developed, which was a huge star on the horizon of mental illness and was most promising, was Chlorpromazine, which is Thorazine. Others medications include Haloperidol, brand name Haldol, Loxapine, brand name Loxantane. This is not a phenothiazine type medication, but is used for psychosis, and has been effective. Other common medications are Thioridazine, Meloril, Thiophixene, brand name Navane, Trifluoperazine, which is Stelazine. There are other medications, for example Prolixine. Prolixine Deconate can be given as an injectable every 15 days. These are helpful because individuals who are somewhat noncompliant with medication or attempt to cheat in taking their medication, this can be very effective in getting individuals to a baseline of health, where they will be in a position to be compliant and take their medication.
Side-effects of anti-psychotic medications
Patients may experience Parkinson’s like symptoms, also called extra pyramidal symptoms. Other symptoms may include tremors, muscle rigidity, loss of facial expression. Hand tremors are most common, but leg tremors may occur. Muscle contraction may occur, also called dystonia, restlessness, weight gain is a common side-effect, and also tardive dyskinesia which is an unfortunate symptom since it causes much distress. It involves spontaneous movements about the face, mouth and body. Some individuals experience lip smacking or chewing movements, sometimes the tongue will protrude out of the mouth. About 27% of individuals who take anti-psychotic medication for years do develop these side-effects. These side-effects only add to social isolation and stereotypes of the mentally ill.
ECT (electro-convulsive therapy)
Since ECT was introduced in 1938, it has undergone many changes. Today it is extremely safe, but still carries a stigma from the past. It is extremely beneficial in depression, specifically depression that does not respond to medication, and more specifically, in depression of the elderly. It has been effective in schizophrenia, specifically catatonic schizophrenia. Success after only 10 treatments is not uncommon. The most common side effect of ECT is short term memory loss, which does come back. It is important to note that when ECT is performed, it does produce a small seizure. In greater than 95% of the cases, the body does not shake; rather, fine motor tremors are seen. These tremors can even be called fasciculation’s, which are very slight. You may see some finger or toe twitching, and some large muscle groups twitch, and that would be the extent of the side effects during the treatment itself.
Traditional group therapy has not been greatly effective in treating schizophrenics. Success is dependant on a variety of factors. Someone who has worked with chronically ill patients should examine the population very closely before putting the groups together. Groups can be effective in terms of recognition of illness, therapeutic issues and concerns of families and communication styles. However, it is highly advisable that all group members be at somewhat of a similar stage of recovery, their negative symptoms having fairly well abated, and with similar cognitive abilities. If these criteria are met, group therapy may be effective. The groups should be comprised of no greater than 10 individuals. Anything larger than that can exacerbate symptomatology.
Family therapy is a must, especially upon discharge and returning a patient home. The family needs to understand the illness. All family members need to understand how to address and talk to schizophrenics during their recovery phase. Family members are not to talk down to them, not to pacify them. On the other hand, family members should speak slowly calmly, questions may have to be repeated, they should not be demanding or over task them; however expectations are important, and clean clothes, showering and dressing themselves appropriately are a must, although individuals may not want to brush their teeth or may neglect some of their personal hygiene, especially if decompensation occurs. You want to avoid statements like, “your breath smells bad,” “you should brush your teeth” or “I wish you’d brush your teeth.” You want to make statements that encourage, or you may want to role model by brushing your teeth standing next to the person. You may want to make statements like, “we can avoid a trip to the dentist if we brush our teeth more frequently.” Anything that would be encouraging is helpful. Always encourage by praise and support. It is always helpful to empower the individual with positive statements to reinforce their self-esteem.
Immediate family members are often neglected when one member has been diagnosed with schizophrenia. It is strongly encouraged that the family attend therapy sessions, as well. Group therapy where schizophrenia is targeted allows immediate family members an opportunity to vent their frustrations and voice their sadness. Daily schedules should be maintained. It is important for family members to spend one-on-one time with each other, separate and apart from the affected family member.
There should be a daily routine, as daily rituals are comforting to the schizophrenic. Decrease any type of over-stimulation in the very first week or two. Large family gatherings should not occur. Even eating at the same table with all family members may be too much stimulation. Always try to include the individual if you are going on an outing, but don’t push. Try to put yourselves in the shoes of the mentally ill. Understand how they might feel with questions you might ask or places you might ask them to go.
There are many social and vocational rehabilitation programs. These have been extremely effective. They also given the individual a strong sense of encouragement and increase their self-esteem. These programs are available in many States and have helped to increase independence in schizophrenics.
I frequently am questioned regarding the best way to get a schizophrenic family member to take medication. This is a common problem. If anyone else in the household also takes medication, it is good to take them together. That would also help the individual feel like he is not abnormal. Never, never hide medication in food. This may increase paranoia should the individual find it. Never push or threaten hospitalization, although you can discuss the cons, “if you don’t take medication, you may have to go back to the hospital, you don’t want that, I don’t want that.” This can be helpful if not presented in a threatening manner.
Schizophrenics frequently display asocial behaviors. It is not uncommon for them to pick their nose at an event. They may grab or touch their genitals during a very somber family moment. It is important not to address this with intense anger. You can actually use humor, pull them aside and whisper in their ear, “what are you doing?” and explain to them what they are doing, and even tell them firmly to stop the activity, explaining why. There is a direct correlation between the amount of anxiety a schizophrenic is feeling and the asocial behavior. It is very common during an assessment process with a health care professional to see an increase in asocial behavior.