Understanding Schizophrenia: Stigma, Symptoms, Risk, and Treatment

What Is Schizophrenia?

The American Psychiatric Association (APA) defines schizophrenia as a chronic brain disorder that affects less than 3 million people in the US. According to the Cleveland Clinic, “schizophrenia refers to a condition and to a spectrum of disorders that all involve a disconnection from reality, including hallucinations and delusions.”

Because schizophrenia can alter a patient’s perception of reality, most patients do not understand or acknowledge that they have the disease.

Symptoms and Stages

Symptoms of schizophrenia can vary in severity based on the patient and the stage of the condition.

In the early stage, symptoms are mild and consist of withdrawal, anxiety, and so on. Signs in the early stage consist of emotional, behavioral, and social changes such as withdrawal from group activities.

Following the early stage, patients teeter between active and residual phases. In the active phase, patients experience at least two of the following symptoms:

• delusions
• hallucinations
• disorganized speech
• disorganized movement
• negative symptoms

Negative symptoms — impaired emotional expression, decreased speech output, reduced desire to socialize, loss of interest in daily activities, decreased experience of pleasure — refer to what is abnormally lacking in a person with psychosis. During the active stage, psychotic symptoms are at their worst.

Following the active stage, there is the residual phase in which the patient’s symptoms appear to begin to resolve. Individuals in this stage may appear to be “cured,” but without consistent and proper treatments the symptoms will return during an active episode. 

While there are no known or definite causes of schizophrenia, organizations, such as the Cleveland Clinic, postulate that genetics, environment, birth conditions, and drug use can alter disease development risk.

Diagnosis

According to the Cleveland Clinic, there are only two approaches to a schizophrenia diagnosis.

One approach is guided using the Diagnostic and Statistical Manual of Mental Disorders. To be characterized as schizophrenic, patients must experience at least two of the five symptoms for one month, the symptoms must impact them for six months, or the condition must be impacting daily relationships.

The other diagnostic approach uses tests to rule out other potential causes of the symptoms. Imaging is used to rule out physical changes in the brain. Blood, urine, and cerebrospinal fluid tests rule out chemical changes, and brain activity testing rules out electrical changes.

Prevalence

According to the National Institute of Mental Health (NIMH), a subset of the NIH, between 0.25% and 0.64% of people in the United States have schizophrenia, although the international prevalence is slightly higher, ranging from 0.33% to 0.75%.

Annually, 2.77 million new cases of schizophrenia develop, amounting to approximately 22.1 million patients worldwide.

While schizophrenia is thought to impact all sexes equally, there is some evidence that biological males are more likely to experience earlier onset.

Data from the Cleveland Clinic suggests that men develop schizophrenia between the ages of 15 and 25 while women typically develop the disorder between 25 and 35.

Cases in which patients develop symptoms during adolescence are typically rare and often the most severe.

While prevalence rates of the disorder are relatively low, schizophrenia significantly impacts a person’s life span with an average of a 28.5 year reduction. Beyond that, the rate of suicide among schizophrenic people is considerably higher than the general population at 4.9%.

Treatment

While the disease is not curable, antipsychotics, psychotherapy, and electroconvulsive therapy have all been explored as ways to manage symptoms.

Medications

According to the National Alliance on Mental Illness (NAMI), a standard treatment for schizophrenia includes antipsychotics to minimize delusions and hallucinations.

There are two major types of antipsychotics: (1) first-generation, or typical, and (2) second-generation, also called atypical.

The Cleveland Clinic states that typical antipsychotics “block how your brain uses dopamine, a chemical your brain uses for cell-to-cell communication.” On the other hand, atypical antipsychotics block dopamine and serotonin use.

Some common examples of typical antipsychotics include the following:

• chlorpromazine
• fluphenazine
• haloperidol
• perphenazine
• thiothixene
• trifluoperazine

Although these medications effectively limit delusions and hallucinations, the benefits are often accompanied by involuntary muscle contractions, erratic movements, and muscle stiffness.

Unlike typical antipsychotics, second-generation antipsychotics do not have as many movement-related side effects. This benefit is offset by other side effects such as weight gain and diabetes, which often require additional treatment such as lifestyle changes and medication.

Some common examples of atypical antipsychotics include the following:

• aripiprazole
• clozapine
• risperidone
• paliperidone

Other Treatment Methods

In addition to medication, the NAMI highlights psychotherapy as an additional treatment for schizophrenia. Psychotherapy may include cognitive behavioral therapy, supportive psychotherapy, and cognitive enhancement therapy.

Cognitive behavioral therapy can help manage anxiety, depression, and substance use often associated with schizophrenia. Other forms of psychotherapy can also help patients maintain a treatment regimen to control symptoms and side effects.

Although electroconvulsive therapy is typically a last resort approach for schizophrenia, medication-resistant patients likely to put themselves or others at risk generally are recommended for this treatment.

The Cleveland Clinic states, “This treatment involves using an electrical current applied to your scalp, stimulating certain parts of your brain. That stimulation causes a brief seizure, which can help improve brain function for people with severe depression, agitation, and other problems. People who receive ECT receive anesthesia, so they’re asleep when this procedure happens, and it isn’t painful.”

Risk Factors

According to the National Institute on Mental Health, several different risk factors can contribute to the development of schizophrenia, including genetics, environment, and brain structure.

Although it is thought that schizophrenia can be hereditary and having a family member with the disease may indicate an increased risk of disease development, there is no hard and fast rule on how schizophrenia is passed down through families. At this time, researchers are still unable to pinpoint one gene that can trigger the illness.

A publication in Frontier Human Neuroscience suggests that there is an 81% genetic liability to schizophrenia. However, researchers in that article state, “in spite of recent advances in molecular genetics, our knowledge of the etiopathogenesis of schizophrenia and the genotype-environment interactions remain limited.”

An article in the Journal of Psychosis and Related Disorders suggests that approximately 33% of schizophrenia cases may be associated with environmental factors. The NIMH lists poverty, stressful and dangerous surroundings, and in utero exposure to viruses or nutritional problems as potential environmental factors.

In addition to genetic and environmental factors, physical changes in brain structure may also contribute to schizophrenia epidemiology. According to a 2010 publication in Current Directions in Psychological Science, disruptions in neural connectivity are an essential characteristic of schizophrenia. These disruptions may be caused by genetic and environmental factors or may be due to other reasons.

“The possibility that structural and functional changes as measured by MRI can be used diagnostically and prognostically is under active investigation, as we try to identify those people who are at greatest risk for onset of schizophrenia and learn to target treatments to different subgroups of patients,” concluded researchers in that publication.

Understanding the epidemiology and common symptoms of schizophrenia may help patients, their families, and healthcare professionals recognize and diagnose the condition earlier, reducing the stigma around the disease. In addition to early treatments for delusions and hallucinations, a better understanding of the disease may provide additional emotional support to patients and their loved ones.