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Reviewed by Dr Dan Rutherford, GP
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What is schizophrenia?
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| Symptoms of schizophrenia include delusions, disordered
thoughts and hallucinations. |
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Schizophrenia is a major mental illness that causes changes in
perception, thoughts and behaviour.
It is a complex condition that defies simple description, but a
distinction can be made between two broad types: acute schizophrenia and
chronic schizophrenia.
Acute schizophrenia
This is the form that probably most comes to mind when people
think of schizophrenia.
Acute schizophrenia is when a previously healthy person,
generally a young adult, shows increasingly odd behaviour over a fairly short
period of time of perhaps a few weeks.
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'Positive' symptoms
The most common symptoms of acute schizophrenia
are:
lack of insight
auditory hallucinations (hearing sounds, voices or music)
delusions of persecution
suspiciousness
flat mood
thoughts spoken aloud.
These symptoms are called the positive symptoms of
schizophrenia.
Not all patients with acute schizophrenia experience all of
these symptoms.
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It can take the form of hallucinations, irrational beliefs or
disordered thoughts, ie illogical or incoherent thinking of any degree of
severity.
Mood disturbance often accompanies acute schizophrenia and can
be of any type, such as depression, anxiety, irritability or
euphoria.
Emotional responses are often inappropriate for their
surroundings - for example, laughing at sad news or appearing unconcerned by
important events.
Generally, a schizophrenic knows where they are in time and
place, but the presence of disordered thoughts may make them feel
confused.
Higher mental reasoning is usually impaired and they often lack
insight into their condition. They find it difficult to plan things or organise
themselves.
Spotting the signs
Usually a person suffering from schizophrenia will not know
they are experiencing symptoms of the illness.
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Delusions
The following delusions are strongly suggestive of
schizophrenia:
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the belief they are under the control of another
influence
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that thoughts are being put into or taken out of their
mind.
If a person has delusions of persecution, they may be
suspicious of any questions about their mental state.
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By definition, hallucinations and delusions are experienced as
real by the person having them. As a result, the person with schizophrenia may
have different perceptions of the world compared with the rest of
us.
Often the person may feel persecuted or 'got at' in some way,
which can cause fear and anxiety. Other people may notice a change in the
person's behaviour, or in the content of their speech.
Sufferers may become preoccupied with certain issues that seem
bizarre to those around them.
They may express paranoid ideas or respond to the
hallucinations they experience. These hallucinations usually take the form of
hearing voices that other people cannot hear.
Chronic schizophrenia
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'Negative' symptoms
The most common symptoms of chronic schizophrenia
are:
social withdrawal
underactivity and slowness
lack of conversation or interests
odd ideas or behaviour
neglect of appearance
depression.
These symptoms are often called the negative symptoms of
schizophrenia.
Not all people with chronic schizophrenia experience all of
the symptoms.
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This is the longer-term state and is characterised
by:
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a lack of drive
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underactivity
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social withdrawal.
Left to their own devices, schizophrenics may spend long
periods of time doing nothing, or engage in repeated and purposeless activity.
Sometimes they can neglect themselves quite markedly.
As with the acute state, hallucinations and delusions are
common.
Sometimes in chronic schizophrenia the person appears to become
used to these disordered thoughts.
For example, they might harbour the idea that someone is trying
to get at them, but this does not cause any emotional reaction.
How common is schizophrenia?
Worldwide schizophrenia is present in two to four people per
1000 of the population at any one time. One in 100 people will develop
schizophrenia in their lifetime.
How does schizophrenia develop?
The cause of schizophrenia is unknown, but it may have a
genetic component. There is no ‘gene for schizophrenia’ but a family history of
the illness increases the risk of being affected:
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if a grandparent had the illness, the risk rises to 3 per cent.
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if one parent was affected, the risk is as high as 10 per
cent.
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this rises to 40 per cent if both parents have
schizophrenia.
Other predisposing factors in the development of schizophrenia
include complications during pregnancy or childbirth and difficulties in
childhood development.
Factors that may trigger an episode of schizophrenia include
stressful life events, and the use of illegal drugs such as
cannabis.
What can schizophrenics and their families do to help
themselves?
If you think you are experiencing symptoms of schizophrenia, you
should seek help from your doctor.
However, one of the features of the disease is sufferers do not
understand they are unwell during acute episodes of illness. It is therefore
important that family and friends are able to seek help on their
behalf.
The first point of call should be the person's family doctor or
mental health team worker.
Schizophrenics who are on long-term medication should continue
to take this medication, because it has a protective effect against future
relapses.
How does the doctor make a diagnosis?
The diagnosis is based on an assessment of the history given by
the patient and by any other people who are able to give further
information.
What is the course of the disease?
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About a quarter of the people diagnosed with schizophrenia will
have one episode of illness, make a good recovery and have no further
problems.
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A further 25 per cent will develop a long-term chronic illness
with no periods of remission.
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The remaining 50 per cent of those diagnosed will have a
long-term illness that comes and goes with periods of remission and
relapse.
The long-term outcome may be worse in people:
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with poor social support
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with a strong family history of schizophrenia
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in whom the illness came on slowly
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in whom treatment was delayed.
Male sex and continuing use of illicit drugs are also associated
with a poorer outcome.
The risk of relapse is significantly improved by continuing
appropriate medication for at least six months after an acute
episode.
Positive family intervention may also help to maintain periods
without illness, as can help with social skills training and psychological
therapy.
People with schizophrenia have higher rates of
depression
than the general population. There are also high rates of
suicide among people with
schizophrenia.
What medicines can treat schizophrenia?
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Injections
Antipsychotic drugs can be given as an injection that lasts
for days or weeks, called a depot injection.
It is often used to prevent a relapse after recovery from
acute illness.
It also helps those who prefer it to remembering daily
medication.
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There are many different
antipsychotic
medicines available, all of which aim to calm someone without making
them excessively drowsy. Modern treatments are called atypical antipsychotics
and include:
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amisulpride (eg Solian)
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olanzapine (eg Zyprexa)
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quetiapine (eg Seroquel)
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risperidone (eg
Risperdal)
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clozapine (eg Clozaril)
These are said to have fewer side effects than some of the older
antipsychotics, and so are now the usual treatment for most patients. Examples
of the older treatments include:
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chlorpromazine (eg
Largactil)
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hyaloperidol (eg Haldol)
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trifluoperazine (eg
Stelazine)
Although not a cure, studies show antipsychotic medicines
improve the symptoms of schizophrenia and help prevent relapse.
They are effective against the positive symptoms of
schizophrenia, eg hallucinations, but have little impact on the negative
symptoms such as lack of motivation and flat mood.
Antipsychotic medicines have important short-term and long-term
side effects. Side effects can include:
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sedation
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dry mouth
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constipation
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blurred vision
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light-headedness.
Antipsychotic medicines can also affect movement, for example in
slowing gait or causing tremor or abnormal face and body movements.
If these side effects occur, your doctor may change your dose or
prescribe other medicines to help with the side effects, or another
antipsychotic medicine can be tried that may cause less problems.
A long-term movement problem known as tardive dyskinesia occurs
in some patients who are on treatment for a prolonged period.
Because there is a high risk that schizophrenia symptoms will
recur, treatment should continue for at least one to two years. If taking
medication is a problem then a GP or specialist can prescribe injectable
antipsychotic treatment usually given monthly and many patients find this very
useful.
Is therapy helpful?
Research shows interventions with the families of
schizophrenics can reduce relapse rates.
These family interventions usually last several weeks and
consist of education about the illness and help with problem
solving.
Research also suggests a type of psychological therapy known as
cognitive behavioural therapy may help to reduce relapse rates. Further studies
are required in this area.
There is limited evidence that giving people with schizophrenia
help and training in social skills may help prevent relapses.
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References
Lawrie SM. Schizophrenia. Clinical Evidence Issue 9.
August 2003.
Drug treatments for schizophrenia. Effective Healthcare
Bulletin, December 1999 Oxford Textbook of Psychiatry, 2001.
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Based on a text by Dr John Theilmann Larsen and Henrik Lublin, specialist
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Last updated 04.07.2008
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