Schizophrenia

Schizophrenia is an illness of the mind that affects 1 percent of the world's population, including 1percent of Canada's population. It is one of the most serious and debilitating mental illnesses because at present there is no cure, and it can be very difficult to treat.

Schizophrenia

Schizophrenia is an illness of the mind that affects 1 percent of the world's population, including 1percent of Canada's population. It is one of the most serious and debilitating mental illnesses because at present there is no cure, and it can be very difficult to treat. It is an illness that lasts a lifetime. Out of the 1 percent who develop schizophrenia, 25 percent go into a type of remission after 1 or 2 psychotic breaks, 25 percent remain ill, but are able to function in society if they continue their medication and receive treatment, 25 percent have a much lower prognosis and will be required to receive substantial supports in addition to their medications, 15 percent are not able to stabilize on any of the presently available medications, and cannot function normally in society at any level, and finally 10 percent die from complications and/or suicide directly related to schizophrenia.

In the early 1800s, many mental illnesses were lumped into a single psychotic illness called Einheitpsychose. Later, French psychiatrists, Jean-Pierre Falret and Bénédict Morel began to separate out what we today might call manic depression or bipolar as, Folie Circulair. They labelled the more bizarre behaviours as Demence Precoce. German psychiatrists Ewald Hecker and Karl Ludwig Kahlbaum used the term Hebephrenia rather than Demence Precoce, and Cyclothymia for the more bipolar-like illnesses. It was first labelled Schzophrenia in the early part of the 20th century by Paul Eugen Bleuler. He defined it as "a split from reality" and this new definition replaced the earlier less exact classification of Dementia Praecox. Although "schizo" is the Latin term for a split or break, schizophrenia has nothing to do with "split" or multiple personalities.

Schizophrenia in males usually starts during the teenage years but has been known to appear up to the age of 30. In females, onset is often delayed until the mid twenties, and can appear much later in life than is usual for males. Because this illness strikes during the prime vocational training and social development years, it can severely disrupt an individual's foundation for the rest of his/her life. At present, there is no definitive test for Schizophrenia. Diagnoses are based on the self-reporting of symptoms or clinical examination. According to the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), in order to make a diagnosis the patient should show evidence of 2 or more of the symptoms listed during a 30-day period, and show a disruption to their social or occupational functioning, and the symptoms should last for at least 6 months.

Schizophrenia involves positive symptoms such as hallucinations, delusions and disordered thoughts; and negative (deficit) symptoms, which include poverty of speech, flat affect (reduced emotional expression), apathy, or even an inability to experience pleasure. Other symptoms can include those that take away from the personality of the patient, and neuro-cognitive symptoms that involve reductions in cognitive capabilities such as a reduction in short term memory. It can be confused with other conditions including bipolar disorder, borderline personality disorder, and even some types of drug use can mimic the symptoms. Neurological exams are often required to rule out other illness that can sometimes cause psychotic symptoms such as syphilis, HIV or brain tumours. Many researchers believe that schizophrenia is actually a spectrum of several different or distinct illnesses that we cannot identify with current medical knowledge.

It is estimated that schizophrenia costs various levels of the Canadian government up to 4 billion dollars each year in direct medical costs, the loss of productivity of a group of adults in their prime productive years and/or the cost of their caregivers. This disease causes fear and suspicion. It is one of the most highly stigmatized illnesses in society. The stigma can push people to deny that they have the illness. In the general population 43 percent of people do not take prescribed medications properly. For those who have been diagnosed with schizophrenia, the rate of correct compliance with medication protocols is only between 10 and 20 percent. This suggests that 80 to 90 percent of persons with schizophrenia do not take their medication properly. The result is a treatment system where people continue to rebound to hospitalization over and over again with psychotic breaks between periods where they are unsteady but somewhat stable. It is common to describe this as a "revolving door syndrome." Such patients repeatedly go off their medications, get sick, have psychotic breaks, return to the hospital to re-stabilize on their medication, only to be released on their own where they go off their medication and the cycle starts again.

The causes of schizophrenia are hotly debated and the area of much research. At present researchers believe that genetics, prenatal development, early environment, and neurobiology are all potentially contributory. The closest agreement is that there is a vulnerability to the illness that is either inherited or acquired early in life that can escalate to lead to schizophrenia when an individual endures certain "triggers" later in life. As to a genetic predisposition, it is possible that several genes interact to increase the risk of developing schizophrenia. This would account for the documented evidence of schizophrenia running in families.

Obstetric complications such as hypoxia (deficiency of oxygen reaching the tissues of the body) have also been shown to increase the risk of a child later developing schizophrenia. Studies have shown pregnant women experiencing malnutrition, folic acid or vitamin D deficiencies, and episodes of maternal stress can greatly increase the chances that her child may become ill later in life. There is also some limited research showing that prenatal exposure to the flu, or even exposure to parasites present in cat feces, can be contributory. In addition, schizophrenia has been shown to be triggered by the heavy use of hallucinogenic or stimulant narcotics. If one already has a genetic predisposition toward developing the illness, even cannabis use can be a trigger.

Some of the early environmental situations that are thought to be triggers include things like severe life stressors, dysfunctional living arrangements and poverty. Studies have shown increased levels of schizophrenia in populations of recent immigrants due to the stress involved in trying to adapt to a new country or social group, facing possible discrimination or even poor housing situations. These adversities may lead to cognitive issues by altering dopamine transmission in the brain.

Conventional treatments for schizophrenia primarily involve pharmaceutical interventions with a class of medications called neuraleptics or antipsychotics. The first antipsychotic medications were discovered by accident in Europe in the 1950s when anaesthetics were given to those very ill with schizophrenia as part of a test. There have been many evolutions in treatment medications since then. The older generation of typical antipsychotic drugs such as Haloperidol primarily sedated the patient and could lead to neuromuscular side effects. The newer atypical antipsychotic drugs began to be in wide use in the 1990s. They include medications such as Risperidone or Olanzapine. Although they have many opponents because they are expensive, and their side affects can lead to weight gain and diabetes, they are the treatment of choice for many with schizophrenia. Many of these side affects can be lessened by taking lower doses of a sustained release formulation such as Paliperidone, which became available in 2006.

Recovery for someone with schizophrenia can depend on the view of the evaluator. For many, stability and independent living are victories. For others, being gainfully employed and off any kind of governmental assistance is the primary goal. Being able to return to a level of behaviour and functioning that was present before development of the illness is still beyond the reach of most sufferers. Since stress can lead to relapse, the desire to return to normalcy by taking a full time job can lead to the type of stress that creates relapses.

When asked, most people with schizophrenia will tell you that the greatest hurdle is dealing with the stigma attached to their disease. To many, schizophrenia is linked with violence. While research shows that sufferers are much more likely to hurt themselves than others, when someone does act out violently because of the nature of the hallucinations, it is usually in a manner that garners media attention.


Further Reading

  • Dr. E. Fuller Torrey, Surviving Schizophrenia: A Manual for Families, Consumers and Providers (2001); Kim T. Mueser and Susan Gingerich, The Complete Family Guide to Schizophrenia (2006).

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