Understanding and Dealing with Schizophrenia

By: Michael G. Conner, Psy.D

Revised: May 21, 2014

Schizophrenia is a disorder of the brain which can affect how a person thinks, feels and acts. The impact varies from minimal to severe.  Some people will experience symptoms only a few times in their life.  Other will need to manage their symptoms through medication and self-care.  The worst form of the disorder can make it difficult for a person to tell the difference between real and imagined experiences, to think logically, to express normal emotional responses or to behave normally in social situations. Severe forms are rare.  Severe forms of schizophrenia can be draining on both the person with schizophrenia and their families. These people will often have difficulty functioning in society, at work and in school.   Society, families and employers can make a tremendous difference in the quality of life and severity of symptoms experienced.  Family support and assistance is crucial in some cases.   The experience of schizophrenia varies considerably.  No cure for schizophrenia has been discovered, but with proper treatment, many people with this illness can lead productive and fulfilling lives.  Approximately 1/3 of all cases are highly responsive to treatment and may live their lives totally symptom free.  Approximately 1/3 are not responsive to treatment or their response is of questionable benefit.  Understanding the disorder, the cause, the symptoms, treatment approaches and how the quality of care can effect the outcome is important.

What Causes Schizophrenia?

Schizophrenia affects about 1.5% of the world population. In the United States, about 3.0 million people have this disease. Symptoms may first appear between the ages of 15 and 35. Onset of symptoms later are often the result of other conditions.  Symptoms often appear earlier in males than females.

  • Schizophrenia is NOT a "split personality."
  • Schizophrenia is NOT caused by bad parenting.
  • Schizophrenia is NOT caused by personal weakness.

Schizophrenia is a complex and puzzling disease.  There are a number of theories about the cause of this disease.  Research has not determined if one or all of the following theories define the factors causing the disease:

  • Genetics (Heredity). Scientists recognize that the disorder tends to run in families and that a person inherits a tendency to develop the disease. Schizophrenia may be triggered by environmental events, such as viral infections or highly stressful situations or a combination of both. Similar to other genetically-related illnesses, schizophrenia appears when the body undergoes hormonal and physical changes, like those that occur during puberty in the teen and young adult years.
  • Chemistry. Genetics help to determine how the brain uses certain chemicals. People with schizophrenia have a chemical imbalance which means they are either very sensitive to or produce too much of a brain chemical called dopamine. Dopamine, which is a neurotransmitter, allows nerve cells in the brain to send messages to each other. The imbalance of this chemical affects the way a person's brain reacts to stimuli--which explains why a person with schizophrenia may be overwhelmed by sensory information (loud music or bright lights) which other people can easily handle. This problem in processing different sounds, sights, smells and tastes can also lead to hallucinations or delusions.
  • Complications during pregnancy and birth. Some researchers suspect a viral infection, improper nutrition during pregnancy, or birth complications may increase the chances of a person developing schizophrenia.

What Are The Different Types of Schizophrenia?

  • Paranoid schizophrenia.  A person feels extremely suspicious, persecuted, grandiose, or experiences a combination of these emotions.
  • Disorganized schizophrenia.  A person is often incoherent but may not have delusions.
  • Catatonic schizophrenia.  A person is withdrawn, mute, negative and often assumes very unusual postures.
  • Residual schizophrenia.  A person is no longer delusional or hallucinating, but has no motivation or interest in life. These symptoms can be the most devastating.

What Are The Symptoms of Schizophrenia?

The appearance of symptoms varies from person to person; symptoms may develop slowly over months or years, or may appear very abruptly.  Stress, poor health, illicit drug abuse or alcohol abuse can worsen or contribute to the onset of schizophrenia.

Initial symptoms, which usually appear gradually, may include mild feelings of tension, inability to sleep or concentrate, or loss of interest in school, work and friends.   As the disease becomes worse most individual will experience more disabling and bizarre symptoms such as delusions, hallucinations or disordered speech and thoughts.  Schizophrenia may appear in cycles known as relapse or remission. During times of relapse, the person suffering from schizophrenia may experience one or all of the following symptoms: 

  • Delusions -- false ideas. For example, individuals may believe that someone is spying on him or her, or that they are someone famous.
  • Hallucinations -- imaginary voices which give commands or comments to the individual. It is less common for the person to think he or she sees, feels, tastes, or smells something which really doesn't exist.
  • Disordered thinking -- moving from one topic to another, but making no sense. Individuals may make up their own words or sounds.

During periods of remission, psychotic symptoms may lessen, although some symptoms such as social withdrawal, inappropriate or blunted emotions and extreme apathy, may persist.

What Treatments Are Available For Schizophrenia?

If you suspect someone you know is experiencing symptoms of schizophrenia, encourage them to see a psychologist, psychiatrist or psychiatric nurse practitioner.  A primary medical care physician, psychiatrist or nurse practitioner can prescribe medications.  Primary care doctors are often reluctant to prescribe psychotropic medications but may if they have a close working relationship with a psychiatrist or clinical psychologist.  There are no chemical tests for schizophrenia.

Schizophrenia is usually a lifelong illness, although many can live productive and meaningful lives.  Most people with this illness will probably take medication for the rest of their lives as do patients with diabetes or high blood pressure.  Antipsychotic medications help to normalize the biochemical imbalances that cause schizophrenia. They are also important in reducing the likelihood of relapse. Like all medications, antipsychotic drugs should be taken only under close supervision of a psychiatric nurse practitioner, psychiatrist or other physician.

Two Major Types Of Antipsychotics:

Traditional Antipsychotic Medications. 

These medications include drugs like haldol, melleril and trilophon.   These drugs have different effect profile and depending on the person, may control the hallucinations, delusions, and confusion of schizophrenia.  Hallucinations are often hardest to control. 

Traditional antipsychotics have side effects which may be mild to serious; some occurring only at high doses. Side effects for antipsychotics often cause a patient to stop taking them. However, it is important to talk with a doctor before making any changes in medication since many side effects can be controlled. Be sure to weigh the risks against the potential benefits that antipsychotic drugs can provide.

Mild side effects:  Dry mouth, blurred vision, constipation, drowsiness and dizziness. These side affects usually disappear a few weeks after the person starts treatment.

More serious side effects:  Trouble with muscle control, muscle spasms or cramps in the head and neck, fidgeting or pacing, tremors and shuffling of the feet (much like those symptoms affecting people with Parkinson's disease).

Side effects:  The effects of prolonged use of traditional antipsychotic medications are increasingly rare but may include facial ticks, thrusting and rolling of the tongue, lip licking, panting and grimacing.

New Antipsychotics Medications

New medications include drugs like zeprexia, resperidol and clazoril.  These newer drugs appear to have the ability to treat a broader range of symptoms of schizophrenia, have helped patients who did not respond to traditional medication, and may have fewer side effects than traditional antipsychotics.

Orthomolecular Approaches

Research centers in Canada have been pioneering nutritional and natural approaches to treating and managing symptoms of schizophrenia with a significant degree of success.  These approaches are slowly finding their way into American mental health.  Naturopathic medicine is intensively involved and aware of these approaches where as American psychiatry has not shown interest.  This discrepancy of interest may be the result of the close and profitable  relationship between pharmaceutical companies and American Medicine.  These approaches are based on intensive examination and treatment of biochemical impact as well as consequences that are associated with schizophrenia.  A number of remarkable discoveries have been made demonstrating that for some people, symptoms can be effectively eliminated or managed as well or better without antipsychotic medications.

Counseling and Psychotherapy.

Counseling and support are effective means to reduce stress, help manage symptoms and prevent relapse.  Some forms of psychotherapy can be very helpful.  Other forms can actually destabilize a patient.  People with schizophrenia often have a difficult time performing ordinary life skills such as cooking and personal grooming as well as communicating with others in the family and at work.   Isolation, loneliness and withdrawal are significant problems.  Rehabilitation can help a person regain the confidence to take care of themselves and live a fuller life. Different forms of "talk" therapy, both individual and group, can help both the patient and family members to better understand the illness and share their coping problems.

Steps You Can Take To Help

  • Contact a qualified mental health professional for purposes of evaluation, treatment  and support.
  • Recognize that the quality of care, treatment and support varies dramatically among communities.
  • Recognize that several trials of medication may be necessary before the correct medication, dosage and medication to manage side effects can be established.
  • If medications are essential, help the patient stay on the medication.
  • Nutrition, proper sleep, exercise, stress management and maintaining social involvement are crucial.  Keep the lines of communication open about problems or fears the patient may have.
  • Understand that caring for the patient can be emotionally and physically exhausting. Take time for yourself and seek assistance from professionals to help you better understand and deal with the disease.
  • Keep your communications straight forward and brief when speaking with someone who is schizophrenic.
  • Always remember that schizophrenic people can be intelligent and they can have excellent memories.
  • Don't talk to people who are schizophrenic as if they are hard of hearing or deaf.
  • Do not argue with a person who has unusual or bizarre beliefs.
  • Ask for help if you need it; join a support group or seek out a professional counselor who can help.

copyright 1998 to 2006, Michael G. Conner