Schizophrenia is a long-term mental disorder that affects how a person thinks, feels, and behaves. Signs and symptoms of schizophrenia are variable and include changes in perception, emotion, cognition, thinking, and behavior. A diagnosis of schizophrenia requires continuous signs of the disturbance for at least 6 months, during which time the individual’s level of functioning is markedly below their norm in work, interpersonal relations, or self-care. When the onset is in childhood or adolescence, the person fails to achieve an expected level of interpersonal, academic, or occupational functioning. The 6-month period must include at least two of the symptoms below that are active for a significant portion of time during a period of 1 month. At least one of these must be from the first three in the list:
A diagnosis of schizophrenia requires ruling out schizoaffective disorder and depressive or bipolar disorder with psychotic features. In addition, the symptoms cannot be attributable to the physiological effects of a substance (e.g., a drug of abuse or medication) or another medical condition.
Schizoaffective disorder has features of both schizophrenia and mood disorders. A diagnosis of schizoaffective disorder is given with the following requirements:
The symptoms of schizophreniform are similar to those of schizophrenia; however, with schizophreniform disorder, they last less than 6 months (but at least 1 month). Patients with this disorder return to their baseline level of functioning after the disorder has resolved. If the disorder lasts longer than 6 months, it is diagnosed as schizophrenia.
A diagnosis of schizophreniform disorder must rule out schizoaffective disorder and depressive or bipolar disorder with psychotic features. In addition, symptoms cannot be attributable to the effects of a substance (e.g., a drug of abuse or medication) or another medical condition.
The symptoms of “brief psychotic disorder” are similar to those of schizophrenia; however, they last less than 1 month (but at least 1 day). Patients with this disorder can return to their baseline functioning after the disorder has resolved. If this disorder last longer than 30 days, then it is diagnosed as schizophreniform disorder or schizophrenia based on the duration of symptoms.
A diagnosis of brief psychotic disorder must rule out depressive or bipolar disorder with psychotic features, as well as psychosis due to the effects of substance (e.g., a drug of abuse or medication) or another medical condition.
Yes. All drugs of abuse (other than tobacco), are associated with poor function in schizophrenia patients. Alcohol abuse increases risk of hospitalization and, in some patients, may increase psychotic symptoms. Studies show that individuals reporting high levels of cannabis use are at a sixfold increased risk of schizophrenia compared with nonusers. The use of amphetamines, cocaine and other illicit drugs have a marked ability to increase psychotic symptoms.
A reasonable estimate is that 20 to 30 percent of all schizophrenia patients are able to lead somewhat normal lives with treatment. About 20 to 30 percent of patients continue to experience moderate symptoms, and 40 to 60 percent of patients remain significantly impaired by their disorder for their entire lives.
Antipsychotic medications are the mainstay of treatment for schizophrenia. Approximately 70 percent of patients treated with any antipsychotic achieve remission. Antipsychotics can be categorized into two main groups: the older conventional antipsychotics, which are known as first-generation antipsychotics, and the newer drugs, which are known as second-generation antipsychotics or serotonin dopamine antagonists.
Benzodiazepines are also effective for treating agitation during acute psychosis. The use of benzodiazepines may also reduce the amount of antipsychotic that is needed to control psychotic symptoms.
In addition to antipsychotic medications, research has shown that psychosocial interventions, including psychotherapy, can improve outcomes. Patients with schizophrenia benefit more from the combined use of antipsychotic drugs and psychosocial treatment than from either treatment used alone. Psychosocial therapies include a variety of methods to increase social abilities, self-sufficiency, practical skills, and interpersonal communication in schizophrenia patients.
Different types of therapy that have shown success in treating schizophrenia patients include:
A diagnosis of “delusional disorder” is given when a person experiences one or more delusions within a period of 1 month or longer. Apart from the impact of the delusion(s), functioning is not markedly impaired, and behavior is not obviously bizarre or odd. If manic or major depressive episodes have occurred, they have been brief compared to the duration of the delusional periods. The diagnosis requires that major schizophrenic features are not present, and the delusion(s) is not attributable to the physiological effects of a substance, another medical condition, or other mental disorder such as body dysmorphic disorder or obsessive-compulsive disorder.
Types of delusional disorders include:
Schizotypal personality disorder involves an acute discomfort with, and reduced capacity for, close relationships, as well as eccentric behavior and distorted cognition or perception, indicated by at least five of the following:
Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.
Yes, genetics do play a role in schizophrenia. First-degree biological relatives of people with schizophrenia have a 10 times greater risk for developing the disease than the general population.
While schizophrenia tends to run in families, no single gene is thought to be responsible. It’s more likely that different combinations of genes make people more vulnerable to the condition. However, having these genes does not necessarily mean that a person will develop schizophrenia.
The exact causes of schizophrenia are unknown. Research suggests a combination of physical, genetic, psychological and environmental factors can make a person more likely to develop the condition. Some people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode.
Factors involved in the development of schizophrenia include:
Other types of psychotic disorders with their own diagnosis include:
Catatonia is abnormal movement and behavior arising from a isturbed mental state. It may involve repetitive or purposeless overactivity. Behaviors associated with catatonia include:
Yes. A diagnosis of “substance/medication-induced psychotic disorder” may be given to a person who experiences delusions and/or hallucinations soon after substance intoxication or withdrawal, or after exposure to a medication. The substance or medication must be capable of producing the delusions and/or hallucinations, and the disturbance cannot be better explained by another psychotic disorder. A diagnosis of substance/medication-induced psychotic disorder requires that the drug effects cause significant distress or impairment in social, occupational, or other important areas of functioning.
Drugs that may cause delusions or hallucinations and have their own diagnostic coding for this psychotic disorder include alcohol, cannabis, phencyclidine, inhalants, sedatives, hypnotics, anxiolytics, amphetamines, cocaine, other hallucinogen, or other known or unknown substance.