In men, schizophrenia symptoms usually begin in the early- to mid-20’s, while in women, symptoms normally start in the late 20's. It is rarely diagnosed in children or adults older than 45.
Schizophrenia includes various difficulties with thinking (cognitive), behavior, and/or emotions.
Signs and symptoms may differ, but revolve around a diminished ability to function, such as with delusions, which are untrue beliefs not rooted in reality.
Example situations would be: you're being injured or hassled, certain gestures or remarks are made towards you, you have an extraordinary ability or fame, another person is in love with you, a major devastation is about to happen, or your body is not functioning properly.
Delusions happen in as many as four out of five people with schizophrenia.
Hallucinations normally manifest as seeing or hearing things that don't exist. Yet for the person with schizophrenia, they have the capacity to influence function and normal experiences. Hallucinations can manifest in any of the senses, but hearing voices is the most typical form. Disorganized thinking is secondary from disorganized speech.
Effectively communicating thoughts and ideas is impaired, and answers to questions may be partially or completely unrelated to each thought. Seldom does speech include putting together meaningless words that can't be understood, known as word salad.
Tremendously disorganized or uncharacteristic motor behavior may manifest in a number of ways, ranging from childlike silliness to unpredictable agitation. The behavior is not purposeful, which makes it hard to perform and complete tasks. Abnormal motor behavior can include struggling to follow instructions, unfitting and bizarre postures, a complete lack of response, or impractical and excessive movement.
Negative symptoms include decreased or lack of ability to function normally, as shown in a person who is unable to generate emotion, such as:
• Not making eye contact
• Unchanging facial expressions
• Speaking without inflection, or in monotone
• Not adding hand or head movements that normally provide the emotional emphasis in speech.
Also, the person may have a decreased ability to plan or do activities, such as:
• Increased quietness and disregard for personal hygiene
• Loss of interest in daily routine
• Social withdrawal or inability to experience pleasure
Schizophrenia symptoms in teenagers are the same as in adults, but the condition can be more difficult to recognize in this age group, because it may be perceived as typical teenage rebellion. Unlike with adults, teens may be less likely to have delusions and more commonly suffer from visual hallucinations.
Seeking medical treatment for individuals with schizophrenia may pose a challenge, as they may lack awareness of the mental illness, hence, detection of the condition lies with the people around them, such as family and friends. Although you can't force someone to seek professional help, you can offer positive reinforcement by being patient, showing the benefit of seeing a doctor, and offering support, especially with the inappropriate behavior. However, urgent medical attention may be needed if your loved one appears to be a danger to themselves or others.
In some cases, emergency hospitalization may be needed. Each state has their own laws on involuntary commitment to a mental health facility, so contact your community mental health agencies or police departments for details.
If you have a loved one who is in danger of committing suicide or has made a suicide attempt, have someone watch them 24 hours a day. If a suicide attempt has been made, call 911 or your local emergency number immediately. If you think you can safely bring the person to the emergency room, then do so as soon as possible.
Diagnosis of schizophrenia is made by a psychiatrist.
A person who is showing signs and symptoms of schizophrenia will most likely not voluntarily seek medical help. Instead, concerned friends or family members will be the ones to prompt medical attention, through which the person will be referred to a psychiatrist for a more specialized diagnosis and treatment.
There is no singular test to absolutely determine whether a person is afflicted with this illness or not. Hence, diagnosis is not so simple, as with other mental illnesses. Prepare a list of all the symptoms your loved one is experiencing, and include a detailed description and possible scenarios in which they show unusual behaviors. Also, note key personal information, such as major life stressors and possible life-altering changes.
List all medications taken, including dosages for prescription drugs, herbs, vitamins, and supplements. Make sure to accompany your loved one as they may have impaired judgement and thinking.
Here are some recommended questions to understand schizophrenia:
• What caused the condition?
• What tests are necessary to confirm diagnosis?
• Can this condition be treated fully or is it a life-long ailment?
• What are the treatment options and what would be the best recommendation for my loved one?
• What alternative treatments are available?
• How will I be able to care for my loved one?
• Are there available reading materials that I can take home and study?
• What other resources would you recommend for me to better understand schizophrenia?
The doctor will most likely ask you questions related to what your loved one is experiencing, such as:
• What are the changes that prompted you to seek medical help for your loved one?
• Are the symptoms always present?
• Has there been an attempt to hurt himself/herself?
• Is there any disruption in their ability to care for themselves, such as feeding, going to work or school, or bathing regularly?
• Has your loved one been diagnosed with a medical condition?
• What drugs is your loved one taking?
Medical and psychiatric evaluations, physical exams, and other tests may be conducted once schizophrenia is suspected. A complete blood count (CBC) will be performed to rule out any underlying medical condition as well as determine alcohol and drug levels in the blood. MRI or CT scans may also be ordered as part of imaging studies.
A thorough psychological evaluation will be run to check the person’s mental status by observing their appearance and demeanor, and asking about their thoughts, moods, delusions, hallucinations, substance abuse, and potential for violence or suicide.
The American Psychiatric Association has developed a Diagnostic and Statistical Manual of Mental Disorders (DSM) to properly diagnose and categorize mental disorders.
Your doctor will need to first rule out substance abuse, medication, or a medical condition before confirming schizophrenia.
In addition, a person must have some disturbance for about six months and at least two of the following symptoms for at least one month:
• Delusions
• Hallucinations
• Disorganized speech (indicating disorganized thinking)
• Extremely disorganized behavior
• Catatonic behavior, ranging from a coma-like daze to bizarre, hyperactive behavior
• Negative symptoms, which impair normal functioning
Also, the person must have an apparent decrease in their ability to work, attend school, or perform normal daily tasks a majority of the time.
A diagnosis of schizophrenia is made after considering all these symptoms and the criteria the person meets.
Types of Schizophrenia
Schizophrenia manifests differently in each person. This makes it doubly difficult to recognize and diagnose. But familiarizing yourself with its different subtypes will better equip you to understand your loved one’s condition. The subtypes are categorized according to the dominant characteristic or symptom manifested in a person:
Paranoid Schizophrenia: This subtype of schizophrenia is the most common. It is characterized by a predominance of hallucinations and delusions, particularly auditory hallucinations and delusional thoughts about conspiracy and persecution.
People with this particular illness typically do not exhibit signs or symptoms of schizophrenia until later in life and are more functional than people with other subtypes. They are able to maintain employment and engage in relationships.
Aside from the late onset of the illness, it is difficult to diagnose because people with paranoid schizophrenia are usually good at appearing normal. The symptoms also typically revolve around a theme over time. These will also be consistent with the person’s general attitude and temperament. For example, if a person believes in a conspiracy, they will be secretive. If a person fears persecution, they will be astute, hostile, and easily angered; the people around them never suspect a thing.
They will not readily discuss their symptoms, especially if they believe in a conspiracy or threat of persecution. Most will only seek help after some major, stressful life event has happened that worsened their symptoms. In addition, the patient will have to be open to discussing their symptoms. This could be a real challenge because they may not, and probably do not, understand that their paranoia and delusions are based on make-believe; to them, these are valid and real suspicions.
Symptoms of a paranoid schizophrenic can worsen to the point that those associated with other subtypes can manifest. This may include disorganization of thoughts as their delusions or hallucinations more persistently interfere with reality. They may also have difficulty remembering recent events, speak incoherently, and behave irrationally.
Despite the difficulty, people who suspect their loved one has a mental illness or is acting strangely, have to be more observant of their symptoms. They also have to be supportive to make the person feel more open to diagnosis and treatment.
Catatonic Schizophrenia: Catatonia refers to immobility or an unresponsive stupor. This particular subtype of schizophrenia is characterized by disturbances in movement, whether an increase or a decrease. A dramatic reduction in activity is called catatonic stupor. It involves the cessation of voluntary movement. On the other end of the spectrum is catatonic excitement, which is a dramatic increase in activity. The middle ground of the spectrum is stereotypic behavior, which are movements that are seemingly purposeless and done repeatedly.
People who are in a catatonic stupor may be further categorized into two responses. The first is waxy flexibility. People who have this symptom are amenable to changes in their positioning. They can maintain a pose that people place them in for long periods of time. On the other hand, some people exhibit a strong physical resistance to repositioning attempts; they would remain in the same position even if it seems uncomfortable for the general populace.
Some people assume odd body positions, limb movements, and facial contortions. This may be confused with tardive dyskinesia, which mimics these unusual behaviors. Other iterations of catatonic schizophrenia symptoms are echolalia and echopraxia. Echolalia is the mimicking, in an almost parrot-like manner, of words and statements that another person is saying. Meanwhile, its sister, echopraxia, is the copying of movements. These two are also common symptoms of Tourette’s Syndrome and may be misdiagnosed as such.
Disorganized Schizophrenia: This subtype was previously labeled as hebephrenic. As its name suggests, it is characterized by a disorganization in a person’s thought process. This may refer to a physical, emotional, or verbal disconnect.
Physical symptoms include difficulty in routine, everyday tasks, such as brushing teeth, bathing, or dressing. The severity of the symptoms may vary from slight impairment to total loss.
There may also be some impairment in the person’s emotional processes. Mental health professionals often observe a blunted or flat effect, which is the inability to evoke appropriate emotional responses to certain situation, such as being inappropriately jocular or giddy and chuckling in solemn activities like funeral services.
The last set of symptoms affect the person’s command of language. This impairs their ability to communicate effectively. At its worst, the person’s speech will become incomprehensible due to their inability to form coherent thoughts. They may develop difficulties using words or ordering them together into sentences. This is different from problems articulating words and enunciating sounds.
Due to its characteristics, it may be confused with other mental health illnesses. The key here is the support team. They must be able to observe the person closely and have enough courage to seek answers and the truth. It is only with the correct diagnosis that an appropriate treatment plan can be made.
Undifferentiated Schizophrenia: Sometimes, however, a person exhibits symptoms of several subtypes of schizophrenia. Or, they may manifest the symptoms of a particular subtype for some time and then change or add other symptoms that are characteristic of other subtypes. This fluctuation causes an uncertainty as to what subtype they may have. In this case, they are classified under undifferentiated schizophrenia.
Mild Schizophrenia: Mild schizophrenia is not an indication of the severity of the illness. It is characterized by the prevalence of negative symptoms, which are non-active characteristics like social withdrawal, lack of motivation, and a general disinterest in many aspects of life. These are not signs of depression, but mild schizophrenia is often mistaken as depression.
People afflicted with mild schizophrenia come off as unreachable on an emotional level, and they have difficulty connecting with people. However, the assumption that they are heartless or emotionless is false. People with mild schizophrenia do not lack emotion, they are just unable to convey their feelings due to a lack of expression and reaction. It is also common for people with mild schizophrenia to have anhedonia, which is the inability to achieve pleasure in any way.
People with mild schizophrenia may also be categorized under undifferentiated schizophrenia because of inconclusive symptoms. Although mild schizophrenia is neither really debilitating nor dangerous, paying careful attention to these symptoms is important. This allows the person to manage the illness better and prevent it from becoming worse. The biggest caution with mild schizophrenia diagnoses is that people often brush off their symptoms and avoid treatment; they may not think it necessary. But delaying treatment may cause symptoms to worsen. This can disrupt life as one knows it and complicate things unnecessarily.
Other indications of mild schizophrenia are: neglect of proper nutrition and personal hygiene — some go to the extent of not eating at all; inattentiveness to the world (spending long periods of time deep in thought); and even talking to one’s self out loud.
Childhood Schizophrenia: As mentioned in earlier sections, the onset of schizophrenia typically occurs in the 20s or later. However, there have been cases of childhood schizophrenia. It is uncommon, but not unheard of. It is especially disruptive and dangerous because a child will not have the parameters of reality established the way an adult does. The child is less equipped to understand their delusions and hallucinations are inconsistent with reality. The illness translates to a child’s abnormal interpretation of reality. As such, it affects their cognitive, behavioral, and emotional processes, and, more importantly, their development in all of these areas as well.
As a whole, childhood schizophrenia is generally the same as adult schizophrenia, except it occurs earlier in life. Because schizophrenia is a life-long condition, this may seem a terrible fate for a child, but early detection and treatment can greatly improve their long-term outcome.
Schizoaffective Disorder: This disorder is not a subtype of schizophrenia, but is still noteworthy in this section. Schizoaffective disorder is an illness characterized by symptoms of schizophrenia and a mood disorder. The illness is further classified into two types: depressive and bipolar.
As their names suggest, depressive type schizoaffective disorder manifests both symptoms of schizophrenia and depression, while bipolar type schizoaffective disorder manifests symptoms of schizophrenia and mania. To clarify, it is not bipolar schizophrenia, because schizoaffective disorder is not a subtype of schizophrenia.
But since this illness exhibits both of these symptoms, its effects on a person’s day-to-day life can be just as intrusive and disruptive. It can debilitate a person’s career and injure their relationships. If anything, the combination of a mood disorder and schizophrenia can wreak more havoc in a person’s life.
The following conditions place a person at a higher risk for schizoaffective disorder: having a close blood relative who also has schizoaffective disorder, bipolar disorder, or schizophrenia; taking psychoactive or psychotropic (mind-altering) medications; or stressful events that may trigger symptoms.
Treatment and management of schizophrenia are continuous and last the patient’s entire life. Medications and psychosocial therapy are the most effective ways to manage the condition.
In some cases, hospitalization is also needed due to the presence of severe symptoms, especially those that put themselves or others at risk.
The treatment team includes different health care professionals, such as a psychologist, social worker, psychiatric nurse, and possibly a case manager to coordinate care. Medications are the cornerstone of schizophrenia treatment and thus must not be missed or skipped.
Antipsychotic medications are the most prescribed drugs to treat schizophrenia, as they can control symptoms by directly affecting dopamine and serotonin.
If someone refuses to take pills, medication may need to be given via injections. Someone who is agitated may need to be given benzodiazepine, such as lorazepam (Ativan), to first calm down, which may be combined with an antipsychotic.
Newer and second-generation antipsychotic medications are generally preferred, because they generate lesser side effects than conventional medications. These include:
• Aripiprazole (Abilify)
• Asenapine (Saphris)
• Clozapine (Clozaril)
• Iloperidone (Fanapt)
• Lurasidone (Latuda)
• Olanzapine (Zyprexa)
• Paliperidone (Invega)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Ziprasidone (Geodon)
Some first-generation medications include:
• Chlorpromazine
• Fluphenazine
• Haloperidol (Haldol)
• Perphenazine
These antipsychotics are often cheaper than their newer counterparts, which is an important consideration, since treatment is life-long. In general, the goal of treatment with antipsychotic medications is to effectively control signs and symptoms at the lowest possible dosage, then gradual increase the dosage or combine with other drugs and make observations on the most effective combination. Once psychosis retreats, psychological and social (psychosocial) interventions become more important, along with medication.
These may include:
• Individual therapy, which teaches how to cope with the early signs of schizophrenia relapse and stress.
• Social skills training, which aims to improve communication and social interactions.
• Family therapy, which is a support service for families who are coping with the condition.
A case manager or someone on the treatment team can help find resources the family or person needs. With appropriate treatment, most people with schizophrenia can manage their condition.
