Schizophrenia

Schizophrenia

  • Schizophrenia is a complex mental disorder that makes it difficult to:
    • Tell the difference between real and unreal experiences
    • Think logically
    • Have normal emotional responses,
    • Behave normally in social situations
  • Mental health experts are not sure what causes it. However, genetic factors appear to play a role
  • Certain environmental events may trigger schizophrenia in people who are genetically at risk for it
  • You are more likely to develop schizophrenia if you have a family member with the disease
  • Schizophrenia affects both men and women equally. It usually begins in the teen years or young adulthood, but may begin later in life. It tends to begin later in women, and is more mild.
  • Childhood-onset schizophrenia begins after age 5. Childhood schizophrenia is rare and can be difficult to tell apart from other developmental disorders of childhood, such as autism

Symptoms

  • Schizophrenia symptoms usually develop slowly over months or years. Sometimes you may have many symptoms, and at other times you may only have a few.
  • People with any type of schizophrenia may have difficulty keeping friends and working. They may also have problems with anxiety, depression, and suicidal thoughts or behaviors.

At first, you may have the following symptoms:

  • Irritable or tense feeling
  • Difficulty sleeping
  • Difficulty concentrating

As the illness continues, problems with thinking, emotions and behavior develop, including:

  • Lack of emotion (flat affect)
  • Strongly held beliefs that are not based in reality (delusions)
  • Hearing or seeing things that are not there (hallucinations)
  • Problems paying attention
  • Thoughts "jump" between unrelated topics ( “loose associations”)
  • Bizarre behaviors
  • Social isolation

Symptoms can vary, depending on the type of schizophrenia you have.

  • Paranoid schizophrenia symptoms may include:
    • Anxious
    • Angry or argumentative
    • False believes that others are trying to harm you or your loved ones.

Disorganized schizophrenia symptoms may include:

  • Problems with thinking and expressing ideas clearly
  • Childlike behavior
  • Showing little emotion

Catatonic schizophrenia symptoms may include:

  • Lack of activity
  • Muscles and posture may be rigid
  • Grimaces or other odd expressions on the face
  • Do not respond much to other people

Residual Schizophrenia

  • Its is possible to have residual schizophrenia, where the person may have some symptoms, but not as many as a person with the full blow illness

Tests

  • There are no medical tests to diagnose schizophrenia. A psychiatrist should examine the patient to make the diagnosis. The diagnosis is made based on a thorough interview of the person and family members.
  • The doctor will ask questions about:
    • How long the symptoms have lasted
    • How the person's ability to function has changed
    • Developmental background
    • Genetic and family history
    • How well medications have worked
  • Brain scans (such as CT or MRI) and blood tests may help to rule out other disorders that have similar symptoms to schizophrenia

Treatment

  • Antipsychotic medications are the most effective treatment for schizophrenia. They change the balance of chemicals in the brain and can help control symptoms.
  • Common side effects from antipsychotics may include:
    • Sleepiness (sedation)
    • Dizziness
    • Weight gain
    • Increased chance of diabetes and high cholesterol
    • Feelings of restlessness or "jitters"
    • Slowed movements
    • Tremor
  • Long-term use of antipsychotic medications may increase your risk for a movement disorder called tardive dyskinesia. This condition causes repeated movements that you cannot control, especially around the mouth.
  • When schizophrenia does not improve with several antipsychotics, the medication clozapine can be helpful. Clozapine (Clozaril)  is the most effective medication for reducing schizophrenia symptoms, but it also tends to cause more side effects than other antipsychotics.

Size effects of Clozapine (Clozaril)

  • Clozapine may cause heart failure, sudden death, or pneumonia in older adults with dementia-related conditions

Call your doctor right away if you have signs of infection such as:

  • fever, chills, body aches, flu symptoms;
  • mouth and throat ulcers;
  • cough, sore throat;
  • rapid heart rate; or
  • rapid and shallow breathing.

Stop using clozapine and call your doctor at once if you have any of these serious side effects:

  • headache with chest pain and severe dizziness, fainting, fast or pounding heartbeats;
  • seizure (black-out or convulsions);
  • skin rash, bruising, severe tingling, numbness, pain, muscle weakness;
  • unusual tiredness, trouble breathing;
  • feeling short of breath (even at night or with mild exertion), swelling in your hands or feet;
  • feeling like you might pass out;
  • slow heart rate, weak pulse, slow breathing (breathing may stop);
  • high blood sugar (increased thirst, extreme hunger, fruity breath odor, increased urination, drowsiness);
  • very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors;
  • twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs; or
  • nausea, vomiting, loss of appetite, and jaundice (yellowing of your skin or eyes).

Less serious clozapine side effects may include:

  • constipation;
  • dry mouth, blurred vision;
  • drooling, especially at night;
  • increased sweating;
  • drowsiness, dizziness, spinning sensation; or
  • sleep problems.
  • Schizophrenia is a life-long illness. Most people with this condition need to stay on antipsychotic medication for life

Prognosis

  • The outlook for a person with schizophrenia is difficult to predict. Most of the time, symptoms improve with medication. However, others may have difficulty functioning and are at risk for repeated episodes, especially during the early stages of the illness.
  • People with schizophrenia may need supported housing, job training, and other community support programs. People with the most severe forms of this disorder may not be able to live alone. Group homes or other long-term, structured places to live may be needed.
  • Symptoms will return if a person with schizophrenia does not take their medication.

Depression

  • Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods.
  • True clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for weeks or longer
  • The exact cause of depression is not known. Many researchers believe it is caused by chemical changes in the brain. This may be due to a problem with your genes, or triggered by certain stressful events. More likely, it's a combination of both

The following may play a role in depression:

  • Alcohol or drug abuse
  • Certain medical conditions, including underactive thyroid , cancer, or long-term pain
  • Certain medications such as steroids
  • Sleeping problems
  • Stressful life events, such as:
    • Breaking up with a boyfriend or girlfriend
    • Failing a class
    • Death or illness of someone close to you
    • Divorce
    • Childhood abuse or neglect
    • Job loss
    • Social isolation (common in the elderly)

Symptoms

  • People who have depression usually see everything with a more negative attitude, unable to imagine that any problem or situation can be solved in a positive way.

Symptoms of depression can include:

  • Agitation, restlessness, and irritability
  • Dramatic change in appetite, often with weight gain or loss
  • Very difficult to concentrate
  • Fatigue and lack of energy
  • Feelings of hopelessness and helplessness
  • Feelings of worthlessness, self-hate, and guilt
  • Becoming withdrawn or isolated
  • Loss of interest or pleasure in activities that were once enjoyed
  • Thoughts of death or suicide
  • Trouble sleeping or excessive sleeping
  • If depression is very severe, there may also be psychotic symptoms, such as hallucinations and delusions
    • Depression can appear as anger and discouragement, rather than feelings of sadness.

Tests

  • Your health care provider will ask questions about your medical history and symptoms. Your answers and certain questionnaires can help your doctor make a diagnosis of depression and determine how severe it may be.
  • Blood and urine tests may be done to rule out other medical conditions with symptoms similar to depression

Treatment

  • In general, treatments for depression include:
  • Medications called antidepressants
  • Talk therapy, called psychotherapy
  • If you have mild depression, you may only need one of these treatments. People with more severe depression usually need combination of both treatments. It takes time to feel better, but there are usually day-to-day improvements.
  • If you are suicidal or extremely depressed and cannot function you may need to be treated in a psychiatric hospital

Medications Used to Treat

  • Citalopram (Celexa)
  • Selective serotonin re-uptake inhibitors (SSRIs), including fluoxetine (Prozac),
  • Bupropion (Wellbutrin)
  • In some cases other medications such as Cymbalta a Serotonin norepinephrine reuptake inhibitors (SNRIs), is used to help with more of the physical pain associated with depression

Children and Medication

  • WARNING: Children, adolescents, and young adults should be watched more closely for suicidal behavior, especially during the first few months after starting medications

Herbal

  • St. John's wort is an herb sold without a prescription. It may help some people with mild depression. However, it can change the way other medicines work in your body, including antidepressants and birth control pills. Talk to your doctor before trying this herb

Talk therapy

  • Talk therapy is counseling to talk about your feelings and thoughts, and help you learn how to deal with them.
  • Types of talk therapy include:
    • Cognitive behavioral therapy teaches you how to fight off negative thoughts. You will learn how to become more aware of your symptoms and how to spot things that make your depression worse. You'll also be taught problem-solving skills.
    • Psychotherapy can help you understand the issues that may be behind your thoughts and feelings.
    • Joining a support group of people who are sharing problems like yours can also help. Ask your therapist or doctor for a recommendation.

Complications

  • People who are depressed are more likely to use alcohol or illegal substances.

Complications of depression also include:

  • Increased risk of physical health problems
  • Suicide

Prognosis

  • Some people with major depression may feel better after taking antidepressants for a few weeks. However, many people need to take the medicine for 4 - 9 months to fully feel better and prevent the depression from returning.
  • For people who have repeated episodes of depression, quick and ongoing treatment may be needed to prevent more severe, long-term depression. Sometimes people will need to stay on medications for long periods of time.