Schizophrenia: The Top 10 Questions

Is schizophrenia genetic?

Scientists knew that there was a genetic role in the development of schizophrenia. Genes or biological markers are passed down from parents to their children. About 1 percent of the population has schizophrenia, but this number is greater if you take a look at the people who have blood relatives with schizophrenia. For instance, if you have an identical twin who has schizophrenia, then you have a 40-65 percent chance of developing the mental disorder. Moreover, if both of your biological parents also have schizophrenia, then your risk increases furthermore. In such cases, you have a 50 percent chance of developing schizophrenia. 

Scientists have identified that schizophrenia is not a result of one gene but several genes that contribute to the development of schizophrenia. Like diabetes, schizophrenia is also caused by a number of genes and influenced by many environmental factors. It has been estimated that there are about 10 gene variations linked to schizophrenia. If a person develops a number of these variations, then the chance of developing schizophrenia increases in them.

Is schizophrenia a disease?

Schizophrenia is a mental disorder that affects a person’s behavior, thinking, and perception. It is a very challenging disorder. People who have this brain disorder find it difficult to tell the difference between real and unreal. Moreover, it is also hard for them to think clearly and manage their emotions as well as function as a normal individual in the society. Although schizophrenia is not as common as other mental disorders, it is something that many people are aware of. Nearly 7-8 out of 1000 individuals develop schizophrenia at one point of their lives.

People with this disorder may hear things or see things that are not actually there. They believe that other people can hear their thoughts, control their thoughts, insert thoughts to their mind, or are taking thoughts out of their mind. Some also believe that other people are planning to harm them and no matter how hard you try to convince them that it is not true, they still insist to what they believe in. Their thoughts and beliefs are unshakable even if we show the evidence. This mental disorder can keep people become isolated or very agitated. It is a very scary illness for a person to have and also scary for others surrounding schizophrenic patients.

Does schizophrenia go away?

The symptoms of schizophrenia usually do not go away on their own, but they can be controlled with the use of drugs. There have been some cases where schizophrenic patients completely recovered on their own. However, these cases are exceptions rather than a norm. Typically, if you leave schizophrenic patients untreated, the psychosis gets worse over time. Patients with schizophrenia will continue to have the symptoms until they start on treatment.

Is there a cure for schizophrenia?

Schizophrenia is not a curable disease but rather a treatable illness, just like diabetes and heart diseases. If a patient is diagnosed correctly and the right treatment is started, the symptoms of schizophrenia can be controlled to an extent that the individual will function as a non-schizophrenic person. However, if the patient stops taking his or her medications, then the symptoms of schizophrenia can flare up again.

Don’t be discouraged even though there is no cure for schizophrenia right now. Remember that the illness is treatable and manageable. The key is to get the right treatment and support for your needs. If you are treated right, all the symptoms of schizophrenia will be completely under control and you will be able to function as a normal individual. Many patients who are on treatment with schizophrenia lead a happy life with satisfying relationships, work, and other activities.

When it comes to treating schizophrenia, there is no need for you to be hospitalized as long as you are getting the proper treatment and you are taking the drugs according to your doctor's instructions. Recovery from schizophrenia is possible with the right medications and as long as you are complying with the treatment.

How common is schizophrenia?

Schizophrenia, in comparison to other disorders, is not a common illness. However, schizophrenia is a well-known mental illness around the world. From one country to another, the incidence of schizophrenia is about 1 percent of the population, and in the USA, nearly 2.2 million Americans who are 18 and above develop schizophrenia.

In fact, one-fifth of the patients who receive benefits from Social Security disability insurance are patients who are diagnosed with schizophrenia. Out of the many disabilities identified throughout the world, schizophrenia ranks in the 9th position. 

Can you develop schizophrenia later in life?

The usual time period for the onset of schizophrenia is between the ages of 25-35 years old. However, there is a small minority of people who develop schizophrenia after their forties. This group of patients is said to have a late-onset schizophrenia. There is also another category known as very late-onset schizophrenia, where the condition starts around the age of 60. This condition is more commonly seen in women compared to men, especially women who are in their post-menopausal period. One of the theories used to explain how a late-onset schizophrenia develops suggest that the effect of estrogen withdrawal leads to the development of schizophrenia in this group of females.

Late-onset schizophrenia is not a rare condition. If you take a look at the one-year prevalence rate for patients between 18-54 years old who develop schizophrenia, the prevalence rate is around 1.3 percent, while the one-year prevalence rate for late-onset schizophrenic patients is about 0.6 percent. The prevalence rate itself gives us evidence that late-onset schizophrenia is not that rare.

There is a tendency for people with late-onset schizophrenia to be a little bit more paranoid compared to patients with early-onset schizophrenia. At first, late onset schizophrenia was thought to be rare, but it has been found out that a considerable number of patients who have been diagnosed with schizophrenia had their first episode of psychosis later in their life.

It is a very big challenge for psychiatrists to manage older patients with late-onset schizophrenia since most of these older patients are more likely to have comorbid illnesses and are likely to be on multiple drugs. As a result, treating schizophrenia can lead to drug interactions and the occurrence of antipsychotic medication side effects. Therefore, newer antipsychotic drugs, which are atypical antipsychotic drugs in low doses, are often preferred in treating low-onset schizophrenic patients. The advantage of using these newer drugs is that they are less likely to cause extrapyramidal side effects.

Even though most patients respond to the atypical antipsychotic drugs, late-onset schizophrenia is typically a chronic disease.

What are the signs and symptoms of schizophrenia?

The signs and symptoms of schizophrenia are divided into two types: positive and negative symptoms.

The Positive Symptoms of Schizophrenia

The positive symptoms of schizophrenia are present throughout the illness, and these symptoms can only be explained by the patient and not by anyone surrounding the patient. These symptoms are the initial presentation of schizophrenia. They include:

• Third person hallucinations

In third person auditory hallucinations, a person hears two or more voices talking about him or her. For example, the person may hear voices that say, “He is an evil person.” Third person auditory hallucinations may also be heard as commentary voices, where the person may hear voices that comment on every action that he or she is currently doing or planning to do. Some examples of such hallucinations are, “She is opening the door now”, “She is going to sleep now”, or “She wants to kill him.” These kinds of hallucinations are known as running commentaries.

Third person hallucinations and running commentaries are very common and are suggestive of schizophrenia. Third person hallucinations are one of the symptoms based on Schneider’s first-rank symptoms, which are used to diagnose schizophrenia. The mere presence of third person hallucinations is highly suggestive of schizophrenia.

• Delusions

These are certain unshakable false beliefs that the patient has, which may seem very strange to others. No matter how hard you try to convince these patients with evidence to prove that their beliefs are wrong, they still remain unconvinced. Some examples of delusions are patients who believe that someone on TV is controlling their brain or that the FBI is following them. Some even believe that they have super powers. They may have delusions of possession of thoughts, which include:

1. Thought insertion - The patients believe and are convinced that an external force is inserting thoughts to their mind.

2. Thought withdrawal - The patients believe and are convinced that an external force is taking their thoughts out of their mind.

3. Thought broadcasting - The patients believe and are convinced that their thoughts are known by others even without having any verbal communication. 

• They have trouble concentrating

Schizophrenic patients usually have a hard time focusing on a certain task. Although sometimes, they are able to pay attention for a short span of time, being unable to constantly maintain their focus makes their tasks more difficult. 

• Difficulty in dealing with abstract ideas

For example, if someone uses the phrase “we are walking on egg shells”, the patient will immediately look down around his feet and appear to be puzzled to see that the floor is empty without any egg shells.

• Abnormality in the stream of thoughts 

There are three main types. They are:

1. Pressure of thought – Rapid abundant thoughts keep on coming to their mind.

2. Poverty of thought - A few and unusually slow thoughts come to their mind.

3. Thought blocking - The mind suddenly becomes empty of thoughts.

The Negative Symptoms of Schizophrenia

Schizophrenic patients may sometimes lose interest in everything they do and are not able to complete their tasks as they used to in the past. These symptoms are a bit difficult to recognize because even teens and those who are depressed may have similar symptoms because of their fluctuating emotions.

The negative symptoms of schizophrenia include:

1. Affective blunting – patients have no facial expression, no eye contact, and have a monotonous voice.

2. Anhedonia – means that schizophrenic patients have an inability to experience pleasurable emotions or happiness. 

3. Lack of motivation - due to poor motivation, people with schizophrenia tend to regularly skip learning new things, have a poor assessment of their behavior, and usually have a challenging time in dealing with their negative actions or mistakes.  Without a certain drive to counter these negative thoughts and feelings, they will eventually lose their grasp on social and personal realities.

4. Self-neglect - individuals with schizophrenia are vulnerable to self-neglect due to their inability to make sound decisions. 

5. Social withdrawal – schizophrenic patients tend to isolate themselves from their family and friends, and most likely prefer to be on their own.

How does schizophrenia develop over time?

Schizophrenia usually begins with a prepsychotic phase, which is characterized by increasing negative symptoms such as social withdrawal, self-neglect, lack of motivation, or loss of emotions. After a few months or years later, a psychotic phase follows, which is characterized by the positive symptoms such as hallucinations, delusions, difficulty in dealing with abstract ideas, or disorders of thought stream.

Schizophrenia may continuously persist, can be episodic, or can last even for a lifetime. Most patients with schizophrenia have a relatively stable course, whereas a few patients may show a progressive worsening of the condition. 

The positive symptoms of schizophrenia usually respond to antipsychotic medications, but not the negative symptoms. Through the course of the disease, the negative symptoms become prominent.

Are there mild forms of schizophrenia?

Yes, there are mild forms of schizophrenia. Patients with mild schizophrenia mostly have negative symptoms such as anhedonia and lack of motivation. Mild schizophrenia is not as burdensome as other forms of schizophrenia. However, if it is not treated properly, the symptoms can get worse over time.

Can schizophrenia come back after treatment?

If you do not stick to the medications that were prescribed to you, then yes, your schizophrenia can come back. As long as you take your antipsychotic medications, your schizophrenia will be completely under control with no signs or symptoms.