The Training and Education Center Network
Mental Health Association of Southeastern Pennsylvania
SCHIZOPHRENIA WHAT IS SCHIZOPHRENIA?
A brain syndrome characterized by difficulties in thinking,
perceiving reality, social functioning and self-care.
There is currently no laboratory test which can tell us for sure
that a person has Schizophrenia. To deal with this problem,
American psychiatrists use a common set of conditions that
must be present in a patient before they diagnose him/her as
having Schizophrenia. These criteria are listed in a book called
the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (widely known as the D S M – I V).
The term „Schizophrenia‟ is technically incorrect because it
implies a single disease. It has come to be believed by some
researchers that Schizophrenia may actually consist of a group
of different diseases with different causes.
SYMPTOMS OF SCHIZOPHRENIA:
See attached for DSM-IV criteria for diagnosing schizophrenia.
There is a wide variety of symptoms of schizophrenia, not all of
which are mentioned in the DSM-IV. The following list of
symptoms is according to Dr. E. Fuller Torrey:
Over sensitivity of the senses, e.g. normal
Under sensitivity of the senses, e.g. inability to feel
Flooding of the mind with thoughts and memories.
Inability to interpret and respond to incoming
sensations, and therefore, an inability to respond
Loosening of associations or inability to sort out
thoughts or coordinate them with the senses or
Misinterpretation of visual or hearing cues, e.g.,
misidentifying people, inability to understand what
Inability to select appropriate responses, e.g.,
Making up words, called neologisms.
Stringing together series of unrelated words, called
Hallucinations (sensory experiences with no
external stimuli… most commonly, hearing voices.)
Delusions (false ideas believed by the person, but
not by other people in his/her culture.) Delusions
experienced by persons with schizophrenia can
Paranoid delusions: beliefs that one is being
Grandiose delusions: beliefs that one owns
wealth, special power, or that one is a famous
Religious delusions: beliefs that one has
Nihilistic delusions: beliefs that reality does
horrible disease or a disease other than what
Mind control: beliefs that one can control
something else is putting thoughts into one‟s
Thought withdrawal: delusion that someone
or something else is taking one‟s thoughts.
Thought broadcasting: delusion that one‟s
thoughts are radiating out of one‟s head and
events going on around one all relate to one in
Difficulty distinguishing one‟s self from other
Disassociation and detachment from one‟s body
parts, e.g., believing one‟s arms and legs are
separate from one‟s body and that they go their
Exaggerated feelings, particularly guilt and fear,
e.g., fear that a small thread from a sweater may
Emotions inappropriate to a particular situation.
Flattening of emotions, difficulty feeling one‟s feelings.
Increased or decreased speed in movement.
Repetitious movements, e.g., tics, tremors, sucking
Catatonic behavior (remaining in one place or posture for
a long time without responding to external stimuli).
Ritualistic behaviors, postures, or gestures, e.g.,
walking through all doors backwards, rhythmically
Socially inappropriate behaviors, e.g. walking
THE CONCEPT OF POSITIVE AND NEGATIVE SYMPTOMS:
It has become increasingly popular for researchers to divide
the symptoms listed above into two categories:
Positive Symptoms: Experiences which are present,
but should be absent, e.g., hallucinations, oversensitivity
of the senses, loosening of associations, delusions.
abilities which are absent, but should be present, e.g.,
lack of initiative, blunted feelings, poor personal hygiene,
social withdrawal, inappropriate social behavior, poor
See attached for a more complete list of positive and negative symptoms.
Unfortunately, the traditional antipsychotic medications used to
treat Schizophrenia can only control the positive symptoms.
They do not affect and can sometimes worsen the negative symptoms.
The Food and Drug Administration has approved Clozaril and
Risperdal as drugs which can reduce both positive and negative
symptoms in some patients who have not responded to the
A particular person with schizophrenia may have only positive
symptoms, only negative symptoms, or both at a particular
point in time. The presence of positive and negative symptoms
in a particular person can also change over the course of his/her illness.
Selzer and his colleagues criticize the practice of grouping the negative
symptoms together as if they have a common cause and will respond to
a common treatment. Instead they propose the following five categories
of “negative symptoms”, based on their ideas about all the possible factors
that cause or contribute to negative symptoms, some of which can be
influenced by the active effort of the patient and some by manipulation of
Frontal brain dysfunction due to the illness (e.g., poor
performance in tasks and interpersonal situations.
Psychological responses to the illness (e.g., social
Interaction of frontal brain dysfunction and
psychological responses to the illness (e.g., lack of
motivation, apathy, poor personal hygiene).
Side effects of treatment (e.g., side effects of
antipsychotic medications, effects of not being involved in
Symptoms of Depression overlapping Schizophrenia (e.g.,
RECURRENCES OF THE ACUTE SYMPTOMS (“RELAPSE RATE”):
This question is difficult to answer because there
have been many different conclusions, but the following
statistics represent a summary of many different
long-term follow-up studies of people hospitalized for schizophrenia: a.
25% were much improved, relatively independent.
25% were improved, but still required an
15% were improved, but still required an
A common principle traditionally used by American
psychiatrists to summarize the research on relapse rate is
Approximately 1/3 of persons with Schizophrenia
will completely recover without needing medication
Approximately 1/3 of persons with Schizophrenia will
improve, but not completely recover even when maintained on medication. However, the medication controls their symptoms and reduces relapse rate.
An unfortunate 1/3 of persons with Schizophrenia will
NOT improve. Their symptoms do not respond
As someone who cares about an individual with Schizophrenia,
is there anything I can do to help prevent relapse?
YES!! You can start by learning as much as you can about
Schizophrenia so that you know what it is that you, your
relative, and the rest of your family are dealing with.
The onset of the early or acute symptoms usually occurs
when the person is experiencing emotional stress.
Research shows that the risk of relapse is significantly
higher during the 3 weeks after a stressful life change,
whether positive or negative. Therefore, you can help by:
Learning (and encouraging other family members
to learn) ways to create a low-stress atmosphere
Noticing sleeplessness for at least two consecutive
nights, as sleep disturbance can be one of the
Getting to know what your relative does and/or
If you suspect your relative‟s condition is
relevant) in case s/he wants to change the
Attempting to pinpoint what stresses may be
aggravating the illness, then reducing any of
relative who acknowledges and manages the
illness, let him/her know any signs of relapse
you‟ve observed so s/he can take appropriate
action, e.g., calling his/her treating professionals.
CAUSES OS SCHIZOPHRENIA
Can I or anyone else cause schizophrenia?
Recent research using modern brain technology supports the
theory that Schizophrenia is a group of brain diseases that can
be affected by, but not caused by the family or significant
others. The type and extent of disease vary with each
individual and may have different causes. Some research
indicates that Schizophrenia primarily affects the brain‟s
switchboard technically known as the limbic system. Other
research indicates dysfunction in the brain‟s frontal lobe.
It tends to run in families, but follows no simple mode of
genetic transmission. Therefore, except for identical
twins or children of 2 schizophrenic parents, the chances
that blood relatives of a person with Schizophrenia will
NOT have Schizophrenia are much, much greater than
their chances of having it. (See genetic risk statistics
It tends to begin between the ages of 16 and 25 (usually
between 16 and 20 for males and between 20 and 25 for
In the northern hemisphere, 5 – 15% more persons with
Schizophrenia than could be expected are born during the
peak season for the flu, in the late winter and early
spring months. This and other data support the notion
that some cases of Schizophrenia begin with damage to
the brain early in life, possibly even by a virus, while the
CAT scans of some persons with Schizophrenia show
enlargement of some of the brain‟s fluid canals
(ventricles). This enlargement does not seem to progress
past age 20 and correlates with poorer response to
We do not yet know for sure what causes Schizophrenia. However,
many theories of cause have been proposed. These theories vary
widely in the amount of research data that supports them:
Theories which best explain what we know about
Schizophrenia and are supported by research data that
schizophrenia inherit brains that are “allergic” to stress,
so that too much stress triggers the brain to malfunction.
Schizophrenia is transmitted through the parents‟
genes and is then set off by some factor(s) in the
environment, e.g., stress, diet, pollutants.
Current research indicates that an individual‟s risk
of developing Schizophrenia correlates with his/her
genetic relatedness to a relative with Schizophrenia.
person with schizophrenia schizophrenia having schizophrenia Niece, nephew, aunt or uncle
virus which does not attack the brain until late adolescence.
Biochemical Theories: The brains of persons with
Schizophrenia have too much of certain chemicals that
transfer nerve signals from one brain cell to another, e.g.,
the Dopamine Hypothesis: The overabundance of one of these chemicals called dopamine causes parts of the brain to malfunction.
immune systems of persons with Schizophrenia, but the
impact of this impairment has not yet been identified.
Theories which are not supported by valid research data,
Nutrition Theories (or orthomolecular psychiatry):
The brain malfunction is caused by too much or too
little of certain substances in one‟s diet.
Schizophrenia as a result of emotional trauma in
childhood caused by interactions with parents.
Family Interaction Theories: Rather than suffering
from an illness, a person with Schizophrenia is merely
acting “crazy” as a way of surviving confusing
communication or interaction patterns in the family.
TREATMENT OPTIONS (for control of Schizophrenia):
Approximately 70% of persons with Schizophrenia clearly
improve on these drugs, 25% improve slightly or not at
From their 1986 comprehensive review of antipsychotic
medication effectiveness studies, Anderson, Reiss, and
About 10 – 20% of persons with Schizophrenia could avoid
a relapse for 2.5 years without antipsychotics,
but there is currently no way of effectively
identifying these persons ahead of time.
About 30% of persons with Schizophrenia who would
relapse without antipsychotics remain well while taking them.
About 40 – 50% of persons with Schizophrenia
relapse within 2 years in spite of antipsychotics.
The risk of the potentially serious and potentially irreversible side
effect of tardive dyskinesia must be weighed against the likelihood
of increased relapse without antipsychotic medication.
Clinical studies indicate that clozapine leads to
significant improvement in 30 to 60% of patients
who have not responded to traditional antipsychotic
medication. These improvements can include:
Clozapine is also associated with a significantly
lower incidence of tardive dyskinesia, a potentially
irreversible neurological disorder caused by
Weekly blood counts are required of patients on
clozapine because of its potential to lower the white
blood cell count (called agranulocytosis). This effect
can lead to death if not detected early so the
medication can be stopped. However, this blood
monitoring adds to the considerable expense of
Clinical studies indicate that Risperidone has the
following beneficial effects for some patients:
Few movement side effects, with substantial
side effects in some individuals who had been
It is not yet known whether Risperidone can cause
Risperidone does not seem to cause lowering of the
white blood cell count, as clozapine can, so blood
monitoring is not necessary and this added
Lithium in combination with antipsychotics can reduce
hallucinations, delusions, and thought disorders in about
Lithium is another alternative for persons with
Schizophrenia who do not respond to antipsychotics.
Regular blood counts are required of patients on Lithium
because the therapeutic level in the blood is close to the
toxic level. The patient‟s potential to manage this
Tegretol in combination with antipsychotics can reduce
hallucinations, delusions, thought disorders, and agitation
in schizophrenic patients who are either violent or
responsive to Lithium, but cannot be maintained on it
As with Clozapine, blood counts are required of patients
on Tegretol (at least initially) because of its potential to
lower the white blood cell count. This effect can lead to
Other potential serious side effects of Tegretol include
aplastic anemia, hepatitis, and cardiac toxicity.
The effects of therapy seem to depend on the form of
Therapy * which focuses on restructuring the
personality through the exploration of the patient‟s
unconscious conflicts with significant others in early
childhood has been found to be useless and in some
cases harmful to persons with Schizophrenia.
*(referred to as insight-oriented, psychodynamic,
intensive, or exploratory therapy or psycho-
Supportive therapy which focuses on the teaching
of skills so that the patient can manage his/her
daily activities in spite of the symptoms and
disabilities of the illness can be very helpful,
Therapy also varies in terms of who is included in the
Family therapy: One patient and his/her family
Multiple family therapy: Several patients and their
Psychiatric or Psychosocial Rehabilitation:
“The goal of psychiatric rehabilitation is to assure that the
person with a psychiatric disability possesses those physical,
emotional, and intellectual skills needed to live, learn, and
work in his or her own particular environment. The major
interventions by which this goal is accomplished involve either
developing in clients the particular skills that they need to
function in their environments and/or developing the
environmental resources needed to support or strengthen the
present level of functioning.” (Anthony, Cohen and Cohen, p. 70)
Focuses on developing or maintaining vocational skills:
Transitional or supported employment programs.
Residential Programs for Transitional Living:
Supervised living arrangements that focus on developing
independent living skills at various levels of care.
Focuses on developing social skills and/or providing
opportunities for peer relationships to develop.
Educational or “Psychoeducational” Approaches:
Focus on educating patients and/or their families about the
illness, medication, coping skills for managing the illness,
and/or coping skills for managing the mental health system.
National Mental Health Consumers Association, call
National Alliance for the Mentally Ill (NAMI), call
National Mental Health Association, call (703) 684-7722.
National Depressive and Manic-Depressive Association,
Focus is on developing a diet and/or vitamin regimen thought
to reduce or eliminate symptoms of Schizophrenia. However,
this treatment alone has had questionable results in controlling
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