Schizophrenia is one of the psychoses – i.e. one of the mental illnesses in which those affected perceive or process reality in a different way. In the case of schizophrenia, the patients live in phases in a different world. They suffer from paranoia, hallucinations and motor disorders.
Read here what exactly schizophrenia is, early signs of schizophrenia, how to recognize it and how it can be treated.
What is schizophrenia?
Schizophrenia is a serious mental disorder. Those affected suffer in phases from massive changes in their thoughts, feelings and perception. Their behavior also changes dramatically, often appearing bizarre or frightening to outsiders.
Experts count schizophrenia among the endogenous psychoses: Psychoses are mental illnesses in which the patients perceive or process reality in a different way. “Endogenous” means that the disease in question arises “from within” through various factors, i.e. without a recognizable physical cause and without a recognizable connection to specific experiences.
People with schizophrenia do not have a split personality, as is widely believed. So you don’t carry multiple personalities that appear alternately, as is the case with dissociative identity disorder.
Schizophrenia can be a serious mental illness if not recognized and treated early. It has a varied appearance and is one of the so-called “endogenous psychoses”.
Clinical pictures are summarized as psychoses, which, among other things, are associated with a loss of reality, delusions, disorders of thinking, language and emotions.
The term “endogenous” means that the disease arises from a multitude of factors “from within”, without recognizable physical causes and without justifiable connection with experiences.
Schizophrenic disorders are generally characterized by underlying and characteristic disturbances of thought and perception, and by inadequate or superficial affects.
Clarity of consciousness and intellectual abilities are usually not impaired, although certain cognitive deficits may develop over time.
Schizophrenia is often incorrectly associated with split personalities, as if a person with schizophrenia has multiple personalities within them. This is by no means the case. Schizophrenia also has nothing to do with reduced intelligence.
Although an acutely ill person may behave in an apparently nonsensical manner to an outsider, the actions that are difficult to understand do not result from a loss of intelligence, but are the product of misperceptions and misinterpretations of the environment.
Men and women are equally affected, with men generally having an earlier onset. The time of the first illness is usually between the ages of 15 and 25 for men and somewhat later for women, between the ages of 20 and 35. About 20% of all affected women fall ill after the age of 40.
Causes and risk factors of schizophrenia
How schizophrenia develops has not yet been finally clarified. An interaction of different factors (genetics, environmental factors, biographical factors and many more) is assumed in the development and persistence of the disease.
People who develop schizophrenia are probably more sensitive to internal and external stimuli. Even before the onset of the disease, they have a lower tolerance for psychological, physical and biographical stress factors.
This particular vulnerability plays a role in triggering and maintaining the disorder. Other possible risk factors/causes include:
Genetic causes of schizophrenia
A genetic predisposition definitely plays a role in the development of schizophrenia. For example, if an identical twin has schizophrenia, about 45 percent of the time the other twin will also have it.
The risk of developing the disease is just as high if both parents are schizophrenic. If only one parent is affected, the risk for children is still 12 percent. By way of comparison, only about one percent of the average population suffers from schizophrenia.
Stress and negative experiences
People who develop schizophrenia are probably particularly sensitive to stress. Even before the disease breaks out, they often find it difficult to deal with stressful situations. At a certain point the load becomes too great. Then the stress becomes the trigger that triggers the disease.
Many schizophrenic patients report critical life events before the onset of the disease. This can be, for example, the loss of someone close to you or a problematic professional situation. But positive situations can also cause stress – for example a wedding or the birth of a child.
Changes in the brain
Messenger substances in the brain (neurotransmitters) presumably play an important role in the onset of schizophrenia. Dopamine, for example, is important for motivation and inner drive, but also for motor control. All this is disturbed in schizophrenia. When people with schizophrenia take amphetamines, their bodies release more dopamine. At the same time, the schizophrenia symptoms worsen.
Glutamate and serotonin also seem to play a role. The latter has a mood-enhancing effect and influences the perception of pain and memory.
In addition, certain brain structures are altered in people with schizophrenia. The limbic system, which is responsible for regulating emotions, is particularly affected.
Drugs and schizophrenia
It is unclear whether drugs can cause schizophrenia. Some experts suspect a connection between schizophrenia and the use of drugs such as cocaine, LSD, amphetamines or cannabis.
What is clear is that some drugs can produce delusions, hallucinations and other conditions consistent with the symptoms of schizophrenia. However, the effect wears off after a while.
Some studies show that the use of drugs significantly worsens the course of the disease in schizophrenia. The fact that a genetic predisposition in combination with certain substances can also trigger schizophrenia has not yet been clarified.
What are the early signs of schizophrenia?
The early signs of schizophrenia in adults usually appear months and years before acute schizophrenia. Unfortunately, however, they are so unspecific that neither the person concerned nor those around them associate them with early symptoms of a psychosis.
Those affected sometimes suffer from listlessness, sleep or drive disorders. Some have a depressed mood for months. You feel tense, sometimes nervous, restless or have trouble concentrating. For others, thoughts get confused and are disturbed by other thoughts.
Increased sensitivity to light and noise and easier irritability can also indicate the onset of schizophrenia. Those affected are often more involved in conflicts. You are increasingly suspicious relate everything to themselves or suffer from delusions.
As a rule, those affected withdraw more and more from their social environment, neglect their appearance, are less involved in school/work, appear moody and uninterested.
Acute and chronic phase of the disease
Schizophrenia usually progresses in phases. The symptoms that occur in the acute phase are referred to as “positive schizophrenia symptoms“: Here, symptoms that healthy people do not show predominate.
Hallucinations often occur, for example, the patients hear voices that are not there. Many sufferers also have delusions such as paranoia. Overall, patients tend to be more active or overactive in the acute phase of the disease.
The chronic phase, on the other hand, is characterized by negative or symptoms, which means that the focus is now on restrictions on certain mental functions and emotionality.
The patients fall into an external and internal lethargy: They become listless and appear exsymptom. Every activity is difficult for them. They neglect their social contacts and withdraw. Some even neglect their personal hygiene. This behavior does not only affect her private life.
Those affected are often no longer able to work. In this phase, many find it difficult to get out of bed at all, let alone get through a whole working day. In addition, schizophrenic patients often appear emotionless in the chronic phase of the disease.
They no longer show happiness. Her voice is monotonous and her facial expressions expressionless. Your interest in hobbies, job and social contacts dwindles. Your language impoverished.
What are Subtypes of schizophrenia?
There are three subtypes of schizophrenia
Depending on the predominant symptoms in the acute phase, there are three subtypes of schizophrenia: paranoid schizophrenia, hebephrenic schizophrenia and catatonic schizophrenia.
In practice, however, it has been shown that there are no rigid categories for schizophrenia: Typical symptoms of one form also occur in patients who have typical symptoms of another form. A clear classification of patients into one of the three subtypes is therefore often not possible.
- Paranoid schizophrenia.
- Hebephrenic schizophrenia.
- Catatonic schizophrenia.
What is schizophrenia paranoid?
Paranoid schizophrenia is the most common form of the disorder. The most prominent symptoms in the acute phase are delusions and hallucinations.
A common delusion is about paranoia. Here, those affected are convinced that they are being pursued by a person, an organization or even by extraterrestrials. They fear being constantly monitored and bugged.
Relationship mania is also often found in paranoid schizophrenia: those affected believe that the actions or statements of a certain person are directed at them. Other variants of delusions include delusions of grandeur and delusional messages.
Among the hallucinations in paranoid schizophrenia, acoustic hallucinations are very common: for example, the patients hear voices that do not exist in reality. Sometimes the voices are friendly, but often they are threatening because they are giving orders or insulting the patient.
Physical hallucinations are also possible: For example, some patients are convinced that individual body parts are dissolving or are not in the right place. Less common in paranoid schizophrenia are visual and tactile hallucinations.
What is hebephrenic schizophrenia?
In this form of schizophrenia, thinking, emotions and drive are particularly badly affected. For many patients, thinking seems incoherent and illogical. That is reflected in the language. Some patients talk a lot and without context.
Some only speak in fragments of words or neglect the sentence structure. For outsiders, what is said is then no longer understandable. Conversely, in acute phases, it can also happen that those affected no longer speak at all.
The emotional disturbances in hebephrenic schizophrenia result in detached and often inappropriate behavior. For example, those affected laugh while reporting that they are very unhappy. Or they fool around at a funeral. Those affected often irritate and snub those around them.
In an acute phase, the patient’s mood can be either euphoric (manic) or depressed. This change can be confused with the symptoms of a bipolar disorder.
What is Catatonic schizophrenia?
Psychomotor disorders are typical of catatonic schizophrenia. The patients perform strange movements, for example with their hands, arms or legs. They bend their bodies or walk around aimlessly. At these moments, patients are highly agitated. They often stereotypically repeat what someone else is saying.
At other moments they fall into a state of rigidity (stupor). They then often remain in an unusual position for hours. Although patients are awake, they stop responding and speaking in this state (mutism).
Catatonic schizophrenia is rare today – possibly because modern drugs work better than drugs used in the past.
Schizophrenia – course/prognosis
In order to get an overall picture of the course, it makes sense to divide it into episodes or relapses, although such a course does not appear in every patient. The onset and progression is just as infinitely varied as the clinical picture.
The initial symptoms can break out acutely or develop gradually over a longer period of time and are hardly noticeable to the person concerned.
In this preliminary phase (prodromal phase) there is in many cases a particular emotional sensitivity, tension and loss of interest. The progressive misjudgment of reality (delusions, alienation experiences) leads to a certain insecurity and social withdrawal in everyday life and the disease breaks out.
During the next phase, the symptoms spread rapidly and the typical symptoms (often delusions of relationship and persecution, hearing voices) appear. There is an acute flare -up, in which mostly delusion and hallucination, restlessness and excitement combined with often nonsensical behavior that is not understandable for those around you are in the foreground.
After an acute attack, the symptoms usually subside again and relaxation occurs. In some of those affected, the symptoms only weaken and some residual symptoms remain.
If the full picture of schizophrenia persists, it becomes chronic, in the further course it usually comes, but individually differently, to the so-called negative symptoms such as lack of drive, lack of initiative and lack of feeling. In the acute phase or in the presence of residual symptoms, serious crises with suicidal intentions can occur.
The various phases are usually of different intensity and duration, although staying in one phase is quite possible. More than half of all schizophrenias have a favorable course, so that there are little or no problems with social integration. A stable partnership, a good social network, female gender, an acute onset of the disease and consistent drug therapy favor the chances of recovery. Without treatment with antipsychotic drugs, about 85% of people with schizophrenia relapse, compared to only 15%.
Since the course of schizophrenia varies greatly from person to person, there is no universally valid prognosis. Some patients experience only a single acute phase of the disease, while in others the course is severe and leads to chronic schizophrenia. Others again and again have schizophrenic phases, which also subside thanks to the treatment. The acute symptoms usually become weaker over time. Nevertheless, schizophrenia often requires lifelong treatment.
Hebephrenic schizophrenia has a poorer prognosis than the other forms of the disease. It starts insidiously, but often becomes chronic and then proceeds without symptom-free phases. At the same time, the patient’s personality is changing.
Risk of suicide
The fears that schizophrenia causes are often very distressing for patients. After a few relapses, those affected often fall into deep despair. This can even lead to suicide – the suicide rate among schizophrenia patients is around ten percent.
Young men are particularly at risk. A good connection to therapists, family or friends is therefore particularly important.
Increased risk of other diseases
Statistically, patients with schizophrenia have a significantly increased risk of various other diseases. These include metabolic and cardiovascular diseases, cancer and lung diseases. Treating physicians should pay particular attention to corresponding signs in schizophrenia patients.
Every fourth to fifth person is cured
Since schizophrenia patients have been treated with a combination of neuroleptics and psychotherapy, the prognosis of the disease has improved significantly. About 20 to 25 percent of patients recover completely with this treatment.
But even if the patients are not completely cured, outpatient care is often sufficient to lead a largely normal life despite the schizophrenia. The social environment has a major influence on this: If patients receive a lot of understanding and support from friends and family, this can have a positive influence on the course of the disease.
How is schizophrenia diagnosed?
If you suspect that you or a loved one is suffering from schizophrenia, you should contact a specialist clinic for schizophrenia or a specialist in psychiatry. There are now also some early detection and therapy centers that have specialized in the disease.
In order to be able to make the diagnosis of schizophrenia, a detailed discussion with the person concerned is necessary. The psychological symptoms that occur are discussed in detail. There are defined criteria and special clinical questionnaires for this . The main symptoms that are asked about are defined in the ICD-10 for schizophrenia:
- Thoughts becoming loud, inspiration, withdrawal, propagation.
- delusions of control or influence; feeling of being made regarding bodily movements, thoughts, actions or sensations; delusions.
- Commentary or dialogical voices.
- Persistent, culturally inappropriate, or totally unrealistic delusions.
- Persistent hallucinations of any sensory modality.
- Thought tearing off or insertions into the flow of thoughts.
- Catatonic symptoms such as agitation, postural stereotypes, negativism, or stupor.
- Negative symptoms such as conspicuous apathy, lack of speech, flattened or inadequate affect.
For a diagnosis of schizophrenia, at least one definite symptom (or two or more if less definite) from Groups 1-4 or at least two symptoms from Groups 5-8 must be present almost continuously for a month or more.
Exclusion of other diseases
Schizophrenia-like symptoms can also occur in brain disorders (such as epilepsy, brain tumors), various mental disorders (such as depression, bipolar disorder, anxiety disorders) and with intoxication (e.g. from cocaine, LSD or alcohol). These must be ruled out before the doctor can definitively diagnose schizophrenia. This requires various investigations.
For example, blood and urine tests can be used to detect drugs and medication in the body that may be responsible for the symptoms. Blood tests also help rule out a metabolic disorder or inflammation.
An imaging study of the brain using computed tomography or magnetic resonance imaging shows whether abnormalities in the brain could be causing the schizophrenia symptoms. If the examinations raise the suspicion of encephalitis, the cerebrospinal fluid must also be examined.
In addition, the doctor can use special tests to check the various brain functions, such as organizational thinking, memory performance and the ability to concentrate.
Schizophrenia often occurs together with other mental illnesses (such as anxiety disorders, bipolar disorder, etc.). This can complicate the diagnosis.
Treatment of schizophrenia
Schizophrenia is treated with medication and psychotherapy. The problem is that patients in acute schizophrenic phases lack insight into the illness. If there is a risk that the patient will endanger himself or others, compulsory admission to a clinic may be necessary.
When an acute phase breaks out, the patient is first treated in a clinic to stabilize him. He can then usually organize his life at home independently again.
Drug treatment of schizophrenia
Depending on the form and severity of the symptoms, different groups of drugs can be used to treat schizophrenia:
- Neuroleptics (antipsychotics): They were the first effective drugs to treat psychosis. By intervening in the metabolism of neurotransmitters, they reduce states of tension and anxiety, delusions and hallucinations. However, neuroleptics have strong side effects such as muscle stiffness, tremors, muscle twitching, subdued emotions, tiredness, listlessness and reduced reaction speed.
- Atypical neuroleptics: These further developments of the “classic” neuroleptics work better and have fewer side effects. Well-known representatives include risperidone and clozapine.
- Antidepressants: In addition to antipsychotic drugs (classic or atypical neuroleptics), the doctor sometimes prescribes antidepressants. This makes sense for schizophrenic patients who are depressed at the same time. Antidepressants have a positive effect on mood, drive and performance.
- Sedatives: During an acute psychotic phase, many patients experience severe anxiety. Then sedatives can help. However, since they make you dependent, they are only used for a short time if possible.
In contrast to sedatives, neuroleptics cannot make you dependent – neither physically nor psychologically.
Psychotherapy in schizophrenia
Psychotherapy is becoming increasingly important in the treatment of schizophrenia. It can have a long-term positive effect on the course of the disease. Cognitive behavioral therapy is usually chosen. Important elements of psychotherapeutic treatment are:
Reducing fears through information: First of all, it is important to allay the patient’s fear of the disease by providing detailed information about schizophrenia. Relatives also benefit from more knowledge, for example by developing more understanding for the patient and being able to support them better. Communication training also helps here, making it easier to deal with the patient.
Dealing with stress and stressful situations: During therapy, the patient learns, among other things, how to cope better with stressful situations that can aggravate their symptoms. The key aspect here is how to deal with stress.
Processing frightening experiences: With the help of psychological schizophrenia therapy, the patient can also better process the frightening experiences that he went through during the acute phases of the illness. This stabilizes him overall.
Recognizing early signs of schizophrenia: Patients also learn to recognize the early warning signs of a schizophrenic phase. These can be very different. Sleep disorders or severe irritability, for example, often herald a new outbreak. It is then important to reduce the sources of stress and, possibly in consultation with the doctor, to increase the dose of medication for a short time.
After an inpatient stay, the patient usually needs support at home. Social educators take on this task. They help those affected to find their way around in everyday life again.
Many patients find it particularly difficult that their ability to concentrate, their working memory and their ability to plan ahead have suffered as a result of the disease. Then cognitive rehabilitation can help. She works with behavioral therapy measures and special training on the computer. This increases the likelihood of returning to work. Insight into the disease and adherence to therapy are also strengthened.
Schizophrenia in children
In most cases, schizophrenia does not appear until after puberty in young adulthood. An estimated two percent of patients fall ill in childhood or adolescence. Before the age of ten, however, schizophrenic disorders are extremely rare. “Early onset schizophrenia” (EOS) is what doctors call the first manifestation of schizophrenia between the ages of 13 and 18. It is particularly observed in male adolescents.
Because the disease is so rare in children, children and adolescents, it is often only discovered at a late stage. The fact that schizophrenia symptoms in children and adolescents differ from those in adult patients also contributes to this.
In addition, the personality of children or adolescents is naturally constantly evolving. Mood swings are normal to some extent during puberty. However, if children and young people fall into prolonged depressive phases or if they experience severe speech and writing difficulties or delusions, a doctor or psychiatrist should be consulted as a matter of urgency.
Schizophrenia: information for relatives
If someone falls ill with schizophrenia, it is extremely stressful for the relatives. In the acute phases, the patient lives in his delusional world and can hardly be reached. Perhaps his delusion also extends to the relatives, whom he accuses of dark intentions and treats them with distrust.
At the same time, the relatives are important supports for the patient. Their understanding and support are critical to the progression of the disease.
As a relative of a schizophrenia patient, you should therefore accept offers of help that provide you with detailed information about the disease and how to deal with those affected. It is important, for example, that you encourage the patient to be as independent as possible. He must neither be under- nor over-challenged. Special communication training can also be useful for you.
Also try to talk to the doctors and therapists treating you and get advice if you are overwhelmed and don’t know what to do. Groups of family members can also be of great help.