Schizophrenia Treatment

Schizophrenia is a brain disorder that disrupts the perception of reality and affects thinking, behaviour and emotions. Its symptoms include delusions, hallucinations, disordered thinking, changes in behaviour and social withdrawal. It usually begins in early adulthood and can last a lifetime. Schizophrenia is thought to result from a combination of genetic and environmental factors.

Symptoms of schizophrenia

Schizophrenia can have behavioural and cognitive effects, including confused thinking, speech or words that make no sense, slowed movements, sudden changes in sleep or eating habits, distorted perception, problems with speaking or writing, a tendency to withdraw from others and to cut off relationships, and reduced physical activity. The main symptoms are:

• Delusions: beliefs or thoughts that have no basis in reality.
• Hallucinations: hearing, seeing, smelling or feeling things that are not there.
• Disorganised thinking: being unable to make logical connections between thoughts.
• Incoherent speech: language becomes hard to understand, with words and sentences strung together without clear meaning.
• Emotional dysregulation: emotions that do not fit the situation, or blunted or heightened emotional reactions.

Positive symptoms

Delusions

Delusions are strange beliefs that are not based on reality and that the person will not give up even when presented with factual information. The belief does not change despite clear evidence that it is false, and it is generally not shared by other members of the person’s culture. Common types include:

• Persecutory delusions: the person says they are being watched, plotted against, targeted for assassination, listened to, poisoned or harassed. They may make endless, persistent complaints to the authorities to obtain their “rights”. Anger is intense, and there may be a tendency towards violence.

• Grandiose delusions: the person believes they have great talents or have made remarkable discoveries, and may frequently contact the media and institutions. They may claim to be a messiah, saint or prophet, gather followers and set up organisations. Without treatment, this can lead to harmful consequences for both the patient and those around them.

• Pathological jealousy (Othello syndrome): thoughts of being betrayed or of a partner’s infidelity, which can lead to divorce or even violence. The person may search their partner’s belongings, check their phone or bills, or follow them.

• Erotomanic delusions (de Clérambault syndrome): the person claims to be loved by someone of much higher status, harasses that person by calling or following them, and says they receive messages of love from that person’s words and behaviour.

• Somatic delusions: the person believes they have AIDS, cancer or another illness and refuses to believe examination and test results.

• Mixed type: more than one type of delusion is present.

Hallucinations

A hallucination is perceiving something through one of the five senses, and believing it is real, without any external stimulus. Types include:

• Auditory hallucinations: the most common type, hearing voices that are not there, sometimes as whispers. The person usually hears voices criticising them or speaking negatively; sometimes the voices give commands. This is very distressing, although neutral voices also occur. Hearing voices can also be seen in people grieving a loved one. This symptom often makes treatment most challenging.

• Visual hallucinations: seeing things that do not exist.

• Olfactory hallucinations: smelling odours that are not there, usually unpleasant ones such as urine, faeces, rotting meat, smoke or burning. They may result from damage to the olfactory system, trauma, a brain tumour or exposure to medicines.

• Tactile hallucinations: sensations such as insects crawling on the skin, pricking or tingling that are not real. The person often believes insects are moving under the skin. These are most often seen with drug use.

• Gustatory hallucinations: usually an unpleasant taste, often metallic. They can be a symptom of some types of epilepsy or of schizophrenia.

• Somatic hallucinations: pain or burning sensations in the body, usually in the internal organs. Some patients say animals are trying to take over their body or snakes are moving in their stomach. This shows how important it is not to neglect treatment.

Disorganised symptoms

These involve the person’s inability to think clearly and respond appropriately:

• using meaningless words and forming sentences that make no sense, which makes communication and conversation difficult
• jumping quickly from one thought to another
• moving slowly
• being unable to make decisions
• writing a great deal without meaning
• forgetting or losing things
• repetitive movements, such as walking in circles
• difficulty making sense of everyday sights, sounds and feelings

Negative symptoms

“Negative” refers to the absence of certain normal behaviours:

• withdrawal from family, friends and social activities
• low energy and lack of motivation
• loss of pleasure and interest in life
• lack of emotion and emotional expression, or emotions, thoughts and mood that do not fit the situation (for example, crying instead of laughing at a joke)
• poor personal hygiene
• problems at school, at work and in other activities
• instability (being very happy or very sad, or mood swings)
• catatonia (remaining motionless in the same position for a very long time)

Cognitive symptoms

These reflect changes in thinking and mental processes: poor concentration, loss of mental flexibility, memory problems and reduced problem-solving ability.

Treatment of schizophrenia

Treatment depends on the severity of symptoms and on the patient’s age and circumstances, and it should be tailored to the individual. It may include medication, psychotherapy and social support. Medication is used to control symptoms; psychotherapy helps the patient develop healthier ways of thinking about their life; and social support can help the person reintegrate into society.

Medication is usually central to treatment. Antipsychotic medicines are used to treat positive symptoms and reduce their severity, and they must always be used under a psychiatrist’s supervision. Other treatments include psychotherapy, cognitive behavioural therapy, social and family support, illness management programmes and attention to diet and exercise.

Early diagnosis

Because schizophrenia is a serious psychiatric disorder, early diagnosis and treatment are extremely important. Diagnosis should ideally be made when symptoms first appear. This helps the patient respond better to treatment, can slow the progression of the illness, improves quality of life and reduces treatment costs. Without treatment, schizophrenia can lead to serious consequences such as job loss, social isolation and homelessness; early diagnosis and treatment help to minimise these and allow people to continue with work, school and daily life.

Who develops schizophrenia?

Schizophrenia can affect people of any age, but it most often begins early in life, around the early to mid-twenties. It affects both sexes, and there is no difference by race or ethnic background. It usually arises from a combination of genetic vulnerability and environmental factors. Risk factors include:

• Family history: people with a family history of schizophrenia have a higher risk, although many people develop it without any family history.
• Environmental factors: difficult living conditions, traumatic experiences, stress and poor nutrition are thought to increase the risk.
• Birth complications: complications that may cause brain injury in infancy can increase the risk.

Only a psychiatrist can diagnose and treat schizophrenia. Because people with schizophrenia often do not seek help themselves, it is usually family members who first make contact. If you are worried about symptoms of schizophrenia in yourself or someone close to you, it is well worth speaking to a psychiatrist.

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