• Schizoprenia

Schizophrenia is a psychosis, the most severe kind of mental illness. Psychosis means that there is a break with the reality that is shared by others, and schizophrenia is just one condition that can make a person psychotic. Schizophrenia is defined as a certain set of signs and symptoms (see box above).

• Almost always a chronic, lifetime disease,
• Although the people who have it share those signs and symptoms, or at least enough of them to qualify for having the diagnosis, there may well be more than one precise illness that can cause these symptoms.
• The exact causes of schizophrenia are not yet known, although there are clues. As far as we now know, schizophrenia affects people who already have developed personalities that are more or less 'normal', having its onset sometime between late childhood and late middle-age, with the overwhelming majority of patients beginning with the disease during teenage years or young adulthood (20's, 30's).
• Whether every culture has an exactly equal incidence of schizophrenia is debated among the experts - some say 'yes, it's roughly one in a thousand people around the world'; and others say, 'no - it is more common in some countries than in others' - but the experts agree that no nation is completely without this disease. Schizophrenia is found in every sizeable population everywhere.
  • Do men and women have an equal chance of becoming schizophrenic? Many excellent authoratative sources state that yes, it's about equal in the two sexes, others - also authorities, say no- it affects several times more men than women.

There is no question, however, that the overall incidence of this disease is in the neighborhood of 1% (1 out of a hundred people), that both genders are affected, and that the disease, on average, affects males with greater severity and begins in males at an earlier age than females.

The effects of schizophrenia play havoc with a person's though processes, sensory perceptions and ability to communicate socially. These effects ordinarily disrupt a person's life, with the first 5-10 years of the disease generally bringing about deterioration of that person's general well-being, unless there is both a good response to antipsychotic medication and continued adherence to remaining on the medication. The debilitating effects of schizophrenia can be lessened with medication in most people, but a minority have symptoms that remain despite repeated attempts at different medical treatments. Although return to the personality and intellectual function that the schizophrenic had before the manifestations began has rarely (if ever) been reported, the disease stabilizes in most people after the first decades, and -in some- there is a partial remission later in life. According to a current medical textbook (Goldman: Cecil Medicine, 23rd ed.) "During a 25- to 30-year period, about a third of patients with schizophrenia show some recovery or remission, but the remaining patients have major residual symptoms or require long-term hospitalization."

Like just about every disease, the exact symptoms vary from person to person, and, like just about every form of mental illness, many of these symptoms can be mistaken for the kind of extreme behavior that some people without the illness demonstrate from time to time. However, schizophrenic behavior is so characteristic, and so striking, that patients are alike enough to be recognized as having this particular diagnosis - even if they come from entirely different cultures . From the beginning, when medical science first described this disorder, it has been felt to be due to a biological brain abnormality.

There has never been a case of a person who was born with the symptoms of schizophrenia, in other words- schizophrenic behavior comes to a person who behaved differently beforehand. Symptoms of schizophrenia change the person who developes the disease in two ways: 'new things' happen and 'old things' are lost. (1) The new things that occur are called positive signs and symptoms. These are abnormal patterns to thought and speech, and (often) hallucinations. The old things that are lost are called 'negative signs and symptoms', and these can include the ability to feel and display a full range of emotion.

• It is one of the most common psychoses worldwide, affecting something like 1% percent of those national populations that have been studied, with about an equal incidence in men and women.
• The manifestations of schizophrenia ordinarily appear first during young adulthood (during the teenage years or 20's).
  • Of the people who have been diagnosed as schizophrenic, a very small fraction became ill before puberty, at some time during late childhood, and another small minority of schizophrenics, that is larger than the group who were diagnosed as children, have a late onset of the disease in middle-age.

When a person has the flu, the very first symptoms are not of full-blown influenza, but of fatigue. In infectious diseases, this concept of a "pro-drome" seems natural to anybody who has had one, and remembers it. In essence, the quality of the symptoms during the prodrome are characteristic, but they are not just the same as that of the illness itself. In schizophrenia, the medical literature agrees that there are different ways that the illness begins. In some patients, there is a prodrome. In others, there does not seem to be.

Acute Onset, Gradual Onset

In psychiatry, the way that a person thinks and acts before there are the full-blown symptoms of the psychological disease is called the "pre-morbid personality", pre- for before, and morbid for sickness. Is that person really fine before they begin to act abnormal? For schizophrenia, no one really knows that answer.

• Schizophrenia is one of the neuro-psychiatric diseases, like autism, that is not evident at birth, but comes after an individual has developed at least some personality. In autism, the onset is very young, but in schizophrenia, the onset of this mental disease occurs in a fully, or nearly fully, developed mind.
• Although there are cases of people who were considered peculiar before the onset of schizophrenia, there are also many cases of people who seemed socially and psychologically average, and cases of people who seemed particularly well-adjusted, "popular" and high-achieving. Taken altogether, since such a group of people is by and large like those contempories who did not become schizophrenic, there is no compelling evidence that people can be recognized, generally, before the onset of symptoms as having the disease.

• "Youths with SZ tend to be predominantly male, experience an insidious onset, and have severe negative symptoms and greater cognitive impairments compared with individuals with adult-onset forms." (Frazier et al, 2007)
• Long term follow-up of children diagnosed with schizophrenia indicates a generally poor outcome, with a higher rate of suicide and symptoms of chronic depression (Remschmidt H et al, 2007)

Positive symptoms are called positive because they are extra, extra items that appear on a description of a schizophrenic person, as compared to somebody considered psychologically normal. If you were to make a list of features of a person's personality and behavor, say before and after they became schizophrenic, the positive features would newly appear on the second list.

• Positive features of schizophrenia include: delusions, thought disorders, and hallucinations.

The "negative"symptoms refer to what has been lost - what isn't there in the schizophrenic, as opposed to what is there in a normal person.

• Negative features include

This all sounds hopelessly without a concrete example. Have you had the experience of seeing a loved one change with the onset of schizophrenia? What's lost are

• Range of emotion

Whether or not schizophrenia has a uniform rate around the world, or an exactly equal incidence in men and women is debated. There is evidence that if psychiatric interviewers are given strict guidelines for making the diagnosis, that the incidence of the the disease is pretty constant from country to country ( ), there are also plenty of health service statistics that show different rates of schizophrenia in different countries, and as much as a 4 time excess of male schizophrenics over female schizophrenics. None the less, it can be said with certainty that schizophrenia affects populations worldwide and affects both men and women.

It can also be said, with certainty, that there are schizophrenics who have a strong family history, and those who have no family history.

There is statistical evidence that certain kinds of social stress are correlated with an increased chance of developing schizophrenia.

Although whether or not our distant ancestors included people who would be formally diagnosed with this disease if they were alive today cannot be known, written descriptions of people behaving in ways that fit the diagnosis exist. Further, schizophrenia is found today worldwide, in roughly the same percentage of the population (about 1%) regardless of the nationality, culture, or ethnic group.

Books

• Moore & Jefferson: Handbook of Medical Psychiatry, 2nd ed. Copyright © 2004 Mosby, Inc. ISBN 0-323-02911-6
  • Section IV – Schizophrenia and Other Psychotic Disorders
• Messias EL: Epidemiology of Schizophrenia: Review of Findings and Myths. Psychiatr Clin North Am - 01-SEP-2007; 30(3): 323-38

Journal Articles

• Sporn AL. Vermani A. Greenstein DK. Bobb AJ. Spencer EP. Clasen LS. Tossell JW. Stayer CC. Gochman PA. Lenane MC. Rapoport JL. Gogtay N. Clozapine treatment of childhood-onset schizophrenia: evaluation of effectiveness, adverse effects, and long-term outcome. [Journal Article. Randomized Controlled Trial. Research Support, N.I.H., Intramural] Journal of the American Academy of Child & Adolescent Psychiatry. 46(10):1349-56, 2007 Oct.
• Remschmidt H. Martin M. Fleischhaker C. Theisen FM. Hennighausen K. Gutenbrunner C. Schulz E. Forty-two-years later: the outcome of childhood-onset schizophrenia. [Journal Article] Journal of Neural Transmission. 114(4):505-12, 2007
• Lewandowski KE. Shashi V. Berry PM. Kwapil TR. Schizophrenic-like neurocognitive deficits in children and adolescents with 22q11 deletion syndrome. [Journal Article. Research Support, N.I.H., Extramural. Research Support, Non-U.S. Gov't] American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics: the Official Publication of the International Society of Psychiatric Genetics. 144(1):27-36, 2007 Jan 5.
• http://www.emedicine.com/Med/topic2072.htm
• Frazier JA - J Am Acad Child Adolesc Psychiatry - 01-AUG-2007; 46(8): 979-88
• van Haren, Neeltje E; Bakker, Steven C; Kahn, Rene S Genes and structural brain imaging in schizophrenia. Current Opinion in Psychiatry. 21(2):161-167, March 2008.

• http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

• http://www.mentalhealth.com/book/p40-sc01.html