Schizophrenia, a brain disorder affecting approximately one percent of the population. Around one million people are currently being treated as outpatients for this psychotic disorder

Schizophrenia is a mental illness characterized by prominent and persistent disturbances in the way a person thinks, feels, sees and hears. The illnes can be either progressive or episodic. While it is a serious illness, the prognosis varies from individual to individual.

On the average, men experience their first psychotic episode in their early- to mid- twenties and women in their late twenties. However, it may strike in late adolescence when it seems the pressures exerted during the transition into adulthood overtax the system. Schizophrenia can emerge during middle age, particularly in women. As a rule, when the disorder appears early the course tends to be more severe.

Schizophrenia may initially appear as a gradual decline in behavior or a dramatic break with reality. When the latter is the case, onset can be profoundly abrupt and alarming: a person can seem perfectly normal one day, then, for all intents and purposes, lost the next. In other cases, there is a sense that the person, even in childhood, has never been quite normal.

Schizophrenia involves disordered thinking (reflected in a disturbance in the logical and coherent structure and form of speech), delusions (fixed beliefs that are unshakeable with logic and reason and are not in keeping with one's socio cultural background), and hallucinations (hearing sounds and seeing things that don't exist for others). Usually a person with schizophrenia has trouble distinguishing what is real from what is in his head.

Persecutory delusions are also typical of the illness. An individual with schizophrenia may truly believe that others are spying on him, tormenting him, following him, making fun of him or trying to trick him. 

Referential delusions, the belief that everyday things within one's environment --advertisements, newscasts, passages from books, song lyrics, and the like-- are directly addressed to him, are common. 

Schizophrenic thinking may also include delusions of influence, the belief that outside forces are directly affecting or controlling one's thoughts, actions, or sensations. This delusional thinking goes beyond strongly held beliefs; rather, it involves complete and utter convictions in the face of all contradictory evidence.

Feelings are also affected. A person suffering from schizophrenia may be extremely moody or his feelings profoundly flat. Sometimes his feelings are not appropriate to his situation. He may laugh or be silly at somber or serious occasions, or appear to have no reaction to clearly upsetting circumstances.

The behavior of an individual with schizophrenia may also be grossly disturbed: his actions will appear strange, bizarre, or disorganized. He may withdraw from all social interactions. In severe cases, a person with schizophrenia is unable to perform even the simplest of daily tasks. He may dress in an unsuitable or disheveled fashion, and have trouble maintaining basic hygiene. He may exhibit inappropriate sexual behaviors. Consequently, people suffering from schizophrenia often live in a world circumscribed by disordered perceptions, emotions, and behavior, most of which are beyond their control.

Although there is little doubt that schizophrenia is a brain disorder, it is not clear just what causes the brain to malfunction. Studies indicate that genetic and environmental factors play a role. Other studies point to such biological components as gestational and birth complications (a viral condition present during pregnancy, for example), genetic mutation or a delay in a child's neurological development that combine to cause brain distortions which manifest usually during young adulthood. Recently, research into the brain's structure and chemical balance has yielded some promising results.


  • Delusions (false beliefs), hallucinations (perceptions without external stimuli) incoherence, bizarre ideas and behavior
  • Dramatic moodiness and mood swings as well as flat emotional tone
  • Inability to socialize and work normally
  • Agitation
  • Occasionally violent eruptions
  • Profound withdrawal
  • Loss of interest in hygiene or personal appearance.

What Your Doctor Looks For

Disorganized speech and behavior; a flat emotional quality; expressions of profoundly paranoid or grandiose thinking; deteriorating social and vocational functioning; chaotic appearance. In order for a clinician to arrive at a diagnosis of schizophrenia, a combination of symptoms and signs must be present for a significant portion of time during at least a one-month period with some aspects of the disorder persisting for over six months.


The first and most effective form of treatment for schizophrenia is medication. Neuroleptics that affect dopamine neurotransmitter systems are effective in managing and reducing psychotic symptoms. This group of drugs traditionally includes haloperidol (Haldol), fluphenazine (Prolixin), chlorpromazine (Thorazine), and thioridazine (Mellaril). At the same time, these drugs can produce problematic side-effects including low blood pressure, drowsiness, dry mouth, blurred vision, lethargy, constipation, and weight gain. The high potency medications like Haldol and Prolixin may produce restlessness, muscle spasms, and tremors as well, but tend to cause fewer problems with blood pressure, blurred visions, dry mouth, and drowsiness. The most disturbing side-effect, tardive dyskinesia, an involuntary series of tics in the tongue, facial muscles, arms and legs, can occur after years of taking the drugs.

Newer neuroleptics, including risperidone (Risperdal), olanzapine (Zyprexa) clozapine (Clozaril) and quetiapine work particularly well on the more tenacious forms of schizophrenia. And because they work more selectively among the brain's dopamine neurotransmitter systems , they tend to have fewer side-effects. They may not cause tardive dyskinesia at all. However, because clozapine (Clozaril) can cause a dangerous drop in the blood's white cells, which can interfere with the body's ability to to fight infection, it must be monitored closely with weekly blood counts. In fact, the use of all such anti-psychotic medication requires close monitoring.

Once the more troubling symptoms recede, individuals may be tempted to discontinue the medications. Yet, if the medications are stopped , it is highly likely that symptoms will return, and the disorder will reemerge full force, sometimes immediately, sometimes after a delay of a few months.

For this and other reasons, drug treatment is almost always one aspect of a more elaborate plan for treating schizophrenia. The illness is severe and chronic, and invariably interferes with normal functioning. Therefore, treatment usually includes day or partial hospitalization, rehabilitative therapy, training in social skills, and vocational training. In many cases, assisted or supervised living situations make it possible for adults with schizophrenia to lead relatively independent lives. In addition, to psychiatric management, supportive therapy, family support and education are regularly part of the treatment plan. A case manager is often needed to help the person deal with the complex set of services he or she needs.

During an acute psychotic episode -- during the first psychotic break, when medications have been discontinued, or when an attack forces its way through the preventive effects of the medication, for example -- full hospitalization may be required. Also, a physician may decide to hospitalize the patient so that he can work out the right medication protocol. If the diagnosis follows an attempt at suicide, the individual may also be hospitalized until it is established that she no longer presents a danger to herself.

As with any chronic disease, relapses may occur, often following stressful events. Schizophrenia is a serious illness that requires long-term intensive treatment.

When To Seek Treatment

If you begin to experience schizophrenic symptoms, you may not be able to judge that they are unusual; it may therefore be up to friends and family members to recognize the problem and seek help. If you begin to experience, or notice in someone close to you, any of the symptoms listed above, call your physician immediately.


Fair. The later the onset, the better the prognosis. Many patients experience a full or almost full recovery from schizophrenia, although this might take many years. However, for others, the cumulative effect of schizophrenia is severe and long lasting. Some people who have schizophrenia continue to decline in their ability to function at work and in relationships and few return quickly to the level of functioning they had before their first psychotic episode. Many individuals with schizophrenia abuse drugs or alcohol, and there is a high rate of suicide associated with the disorder.

Yet, this does not mean that the diagnosis of schizophrenia automatically assigns a person to a lifetime of institutions, or homelessness. Most people who suffer from schizophrenia can be treated and the condition can be managed with reasonable success. Many recover in time and others are helped substantially with medications, family support, and special living arrangements to lead fully satisfying lives.


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