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Schizophrenia is considered to be one of the most severe forms of mental illness. It is classified as a psychotic disorder, meaning that individuals with schizophrenia have lost contact with reality (having any type of psychotic disorder indicates that the person has lost contact with some aspect of reality).
The disorder was one of the first forms of mental illness to be formally identified, and it was originally classified as dementia praecox. In the early 1900s, the psychiatrist Eugene Bleuler coined the descriptive term schizophrenia to describe the disorder as an indication that Bleuler believed that the disorder can be described as a splitting of one’s cognition or thinking from their personality. This notion of schizophrenia being a disorder of a “split mind” led to one of the most common misconceptions regarding the disorder.
Schizophrenia is not:
Only a licensed, trained, mental health professional, such as a psychiatrist or psychologist, can formally diagnose any psychiatric/psychological disorder. There are no blood tests, brain scans, or other medical test that can formally be used to make a definitive diagnosis of any type of mental illness. The diagnosis of a disorder such as schizophrenia is made on the basis of a thorough assessment using specific behavioral signs as diagnostic criteria.
The major features of schizophrenia include displaying one or more of the following:
In the United States, the diagnosis of schizophrenia is made when an individual satisfies the diagnostic criteria developed by the American Psychiatric Association (APA) and formally presented in the current Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5). In the current diagnostic scheme, the classic five major subtypes of schizophrenia have been eliminated due to the current empirical evidence that suggests that schizophrenia is one specific disorder that manifests in several different ways. Older diagnostic categories of paranoid schizophrenia, catatonic schizophrenia, undifferentiated schizophrenia, etc., are no longer given.
The diagnosis of schizophrenia is made on the basis of the following:
When a person is considered to be formally diagnosed with schizophrenia, other specifications are also made, such as if the symptoms are believed to be indicative of a first time episode of schizophrenia or if there been multiple other episodes of the disorder.
Schizophrenia is a relatively uncommon disorder. According to APA, overall, females and males have equivalent prevalence rates of schizophrenia but males may have a greater propensity to display negative symptoms that females. The disorder typically appears to emerge between one’s late teenage years and their mid-30s. The presentation of schizophrenia is rare in children, but it does occur. The psychotic symptoms that occur in schizophrenia tend to diminish as one becomes older, and this has been explained as an age-related association with the declines in specific neurotransmitters (e.g., dopamine).
Many individuals complain of issues with depression, may have cognitive issues, and may have idiosyncratic-type behaviors prior to the formal onset of the disorder. As a result, many early theories of the cause of the disorder attempted to link it to child-rearing practices by the person’s parents; however, these theories have long been abandoned.
There is no identified formal cause of schizophrenia. Instead, according to APA, articles in the journal Schizophrenia Bulletin, and the book Schizophrenia, the general hypotheses suggest that schizophrenia is most likely a biological condition that occurs as a result of one or more of the following:
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People who are diagnosed with schizophrenia are also at an increased risk to have other co-occurring mental health disorders, including substance abuse issues or formal substance use disorders. APA recognizes that the most common substance of abuse for individuals diagnosed with schizophrenia is tobacco. It is not uncommon for an individual diagnosed with schizophrenia to also be diagnosed with a tobacco use disorder, and early studies suggested that over 70 percent of individuals who had chronic diagnoses of schizophrenia also had nicotine dependence.
Research suggests that the nicotine in tobacco products, especially in cigarettes where it is delivered rapidly through smoking, may have some therapeutic-type effects for individuals who are diagnosed with schizophrenia, and this connection may explain why tobacco use is quite common in individuals with this diagnosis. However, despite any potential benefits, the risks of chronic tobacco abuse, such as the development of cancer, heart disease, emphysema, and other diseases, outweigh any potential benefits that individuals may derive from its use.
While an individual diagnosed with schizophrenia is at increased risk for the use of any specific substance, there are several substances that appear to be more prone to be abused by those with schizophrenia:
While individuals with schizophrenia may become involved in individual or group therapy, therapy is not the first line treatment option for schizophrenia. Instead, the primary form of treatment includes the use of antipsychotic medications. Early antipsychotic medications such as Thorazine (a major tranquilizer) were effective in reducing some of the symptoms of schizophrenia (especially the positive symptoms such as hallucinations and delusions), but their use also resulted in significant side effects, including the neurological condition tardive dyskinesia, which consists of involuntary movements of the face and other parts of the body.
Over the years, other drugs have been developed for the treatment of psychotic disorders, and some of the more familiar drugs include Seroquel (quetiapine), Zyprexa (olanzapine), Risperdal (risperidone), and many others. Early medications typically targeted the neurotransmitter dopamine and decreased its availability in the central nervous system; however, newer antipsychotic medications often target more than one neurotransmitter. Most individuals with schizophrenia will remain on some form of medication for a good part of their life, if not for their entire life.
People who have a diagnosis of schizophrenia and a co-occurring substance use disorder would still be treated with antipsychotic medications and other medications as well as undergoing concurrent treatment for their substance abuse issue. Depending on the individual’s capacity to participate in treatment, this may include substance use disorder therapy, support group participation, and other forms of behavioral interventions. Individuals who have developed physical dependence on drugs would be placed in a formal physician-assisted withdrawal management program. The treatment outcomes for individuals with schizophrenia are far more positive when co-occurring issues like substance use disorders are also addressed.
Therapy can be useful for treating issues associated with adjustment and family issues, and in teaching relaxation techniques for individuals with schizophrenia. Often, compliance with medications can be an issue, and therapy can help individuals maintain compliance with their medications. Group or family therapy can also be useful in addressing some of the functional issues that occur in individuals who are diagnosed with schizophrenia.
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