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Schizophrenia
- Jul 26, 2021
- 7 min read
It’s Mental Monday! Let’s talk…schizophrenia.
National Schizophrenia Awareness Day – 25th July 2021
What is “Schizophrenia”?
According to the NHS website, schizophrenia is a severe, long-term condition “often described as a type of psychosis” where a person with the condition “may not always be able to distinguish own thoughts and ideas from reality.” Mayo Clinic states it is a condition that causes people to “interpret reality abnormally” and causes hallucinations, delusions, extremely disordered thinking, and behaviour that impairs daily functioning. Mind says that “many people think that it may actually be several overlapping conditions, rather than one single condition.”
Hence the air quotes in the heading.
As there is no clear definition – at least not one that everyone agrees on – some people strongly believe the term “schizophrenia” should not be used as it can feel quite stigmatising. Regardless of your opinion or the stigmas which (should not) surround it, what matters more is ensuring people find help.
DSM Diagnosis:
Disclaimer: this is for informational purposes only and not meant to be used as a self-diagnosis or a diagnoses in any form.
Schizophrenia falls under the Diagnostic and Statistical Manual of Mental Disorders chapter for Schizophrenia Spectrum and Other Psychotic Disorders Class, as it is defined as a psychotic, chronic brain disorder.
Two or more of the following for at least 1 month (or longer period of time)
delusions
hallucinations
disorganised speech
grossly disorganised or catatonic behaviour
negative symptoms, such as diminished emotional expression;
and at least one of them must be a 1, 2, or 3:
Impairment in one of the major areas of functioning (e.g. work, interpersonal relations, or self-care) for a significant period of time since the onset of the disturbance.
Some signs of the disorder must last for a continuous period of at least 6 months. This six-month period must include at least one month of symptoms (or less if treated) that meet criterion A (active phase symptoms) and may include periods of residual symptoms. During residual periods, only negative symptoms may be present.
Schizoaffective disorder and bipolar or depressive disorder with psychotic features have been ruled out:
no major depressive or manic episodes have occurred
if mood episodes (depressive or manic) have occurred during active phase symptoms, they have been present for a minority of the total duration of the active and residual phases of the illness.
4. The disturbance is not caused by the effects of a substance or another medical condition.
5. If there is a history of autism spectrum disorder or a communication disorder (childhood onset), the diagnosis of schizophrenia is only made if prominent delusions or hallucinations, along with other symptoms, are present for at least one month.
Symptoms
Symptoms vary in type and severity over time, and can include:
Hallucinations: sensations that are not real (e.g. hearing voices, smelling or seeing things that are not there)
Delusions: strong beliefs that cannot possibly be true (e.g. someone is following you or you have extraordinary powers)
Muddled thoughts
Loss of interest in everyday activities
Lack of care about personal hygiene
Avoidance of others, including friends
During discussions about schizophrenia, doctors may refer to symptoms as “positive” and “negative”. This does not mean ‘good’ and ‘bad’.
“Positive symptoms” = behaviours that the condition adds to your life (e.g. hearing/seeing things others do not).
“Negative symptoms” = behaviours that takes away from your life (e.g. loss of interest in activities or personal hygiene).
Types
“Schizophrenia” is a term used to classify a series of mental health disorders that fall along the same spectrum (Nyan Treatment Center). There are several types, but the main 5 include:
1. Paranoid Schizophrenia
This is the one that the movies/media like to exaggerate. It is the most common form of schizophrenia and is characterised by delusions and hallucinations (positive symptoms).
2. Catatonic Schizophrenia
This type is rare as it involves physical movement which is unique to this form of schizophrenia. Catatonia is its own disorder, but catatonic schizophrenia is characterised by negative symptoms and those who suffer with this form tend to not be very responsive – they may not react to stimuli, stay in strange body positions or make odd movements.
3. Hebephrenic / Disorganised Schizophrenia
This type is characterised by disorganised speech and behaviour and inappropriate emotional responses (or the lack of them).
4. Residual Schizophrenia
A person has this type of schizophrenia if they have a past history of positive symptoms but now only have lingering negative symptoms, or none at all. The lingering symptoms may include poor attention, some mental disorganisation and emotional withdrawal.
5. Undifferentiated Schizophrenia
People suffering with this form may not fit the other classifications because they may show symptoms for more than one type, or they may exhibit both positive and negative symptoms.
Please note: according to MentalHelp.net and Healthline these subtypes have been removed from the DSM in 2018, however, some mental health professionals still refer to theses subtypes. The reason for the removal is that they overlapped with one another and did not contribute to the diagnostic validity and reliability.
Causes
The cause of schizophrenia is unknown. Most experts believe that a combination of genetics, brain chemistry and environmental factors are behind the condition. There are some factors that may be responsible for increasing the risk of developing schizophrenia, including:
Family history
Complications at birth/during pregnancy (e.g. malnutrition, or exposure to toxins/viruses that may impact brain development)
Mind-altering drugs during teenage year/young adulthood
It is thought that some are more vulnerable to developing schizophrenia and that certain situations can trigger the condition (e.g. stressful life events/drug misuse).
According to Mind, roughly 1 in every 100 people are diagnosed with schizophrenia at some point in their life.
For men, it usually starts between their early to mid-20s; for women, it usually starts in their late 20s. Diagnosis is uncommon in children and rare for those older than 45. The symptoms in teens is harder to recognise as their symptoms can overlap with hormonal mood swings and depression, such as:
Trouble sleeping
Withdrawal
Irritability
Depressed mood
Lack of motivation
Those of black ethnicity are more likely to be diagnosed with schizophrenia. Disclaimer: there is no evidence of being more biologically vulnerable to it if you are of black ethnicity. According to Mind, this is because of differences in life experiences compared to other ethnicities (e.g. discrimination, racism, migration) that are stressful and can therefore trigger schizophrenia. This could also be due to (direct or indirect) discrimination in the healthcare system, for example, psychiatrists with very different cultural, social, or religious experiences may misdiagnose schizophrenia more often. This is another example of why it is imperative that we work together to eliminate discrimination. To find out more about Mind’s Equality and Human Rights Improvement Work, click here.
Other conditions that share the same symptoms as schizophrenia includes:
schizoaffective disorder
schizotypal & schizoid personality disorder
bipolar disorder
Misconceptions
There are many misconceptions surrounding schizophrenia, including:
‘split personality’: this is more associated with dissociative identity disorder.
it makes someone dangerous/violent: there is no evidence that schizophrenia itself causes violence. Someone with the condition is much more likely to harm their self. There are lots of reasons that someone might commit a violent crime, such as drug and alcohol misuse (which are more likely to play a part than schizophrenia).
Treatments
Those with schizophrenia will require lifelong treatment, usually through a combination of medicine and therapy that is individually tailored. Many may recover, but will have relapses (periods when the symptoms can return). A GP or therapist are also able to suggest a community mental health team that can offer day to day support.
Seeking help, such as visiting your GP, as soon as possible is the best thing you can do. The earlier the treatment, the better it will be for the individual as going untreated can result in:
suicide thoughts and/or attempts
anxiety disorders and OCD
depression
alcohol/drug abuse
inability to work/attend school
financial problems/homelessness
social isolation
aggressive behaviour (although very uncommon)
other health & medical problems
The condition is unpreventable, but a well-managed condition reduces the chance of severe relapses by:
taking medications as prescribed
talking to others
recognise signs of an acute period
work with one of the many charities and support groups available
Friends/Family of Someone Suffering with Schizophrenia
If you support, care or know someone suffering from schizophrenia, there are some ways you can help.
First and most importantly, take care of yourself. You are no good to anyone if you are running on empty or are providing support at the sacrifice of your own physical or mental wellbeing.
Tackle stigmas and misconceptions around mental health problems. This will help your loved one feel less “crazy” or judged by society for something they cannot help and did not ask to have.
Do your research. Notice what is going well for your friend and plan ahead or anticipate for difficult times.
Help with everyday things (e.g. shopping and washing).
Ask if they are comfortable for you to accompany them to their appointments. Talk to the doctor about any concerns, how you can help, and to learn more about the condition.
Remember their experiences feel real. Don’t discuss if it is true or not; focus on how they feel and if they are willing to talk to someone about how they are feeling.
If you prefer learning through reading stories, or have a child that has a sibling with schizophrenia and you would like to teach them about the condition without the scary, medical terms, I recommend Neal Shusterman’s Challenger Deep. It is a uniquely moving story, an emotional puzzle cleverly written as you dive into the schizophrenic mind, and is based upon Schusterman’s own experience with his son, who was diagnosed with schizophrenia at only 16 years old.
For further information, help or support:
There is a lot of useful information on the NHS website. Speaking to your GP can point you in the right direction of what support or services you may require.
Mind covers a range of mental health conditions and provides information on where to get help, treatments and alternative therapies. Confidential and understanding, Mind works with local partners to provide mental health services to as many people as possible.
Telephone: 0300 123 3393 (9am-6pm Monday to Friday) or text 86463 Email: info@mind.org.uk Website: www.mind.org.uk/information-support/helplines
Confidential, judgement-free emotional support for those struggling. They cannot help directly (i.e. provide treatment or diagnosis) but they can, however, point you in the right direction for local therapies and support groups. They are simply someone to talk to about what you are going through, which you can do through the phone, a letter or an email for free at any time of day or night – and can be anonymous if you prefer.
Telephone: 116 123 (24 hours a day, free to call) Email: jo@samaritans.org Website: https://www.samaritans.org/how-we-can-help/contact-samaritan/
For children and young people up to the age of 19, Childline offers private and confidential services. Whether it’s over the phone, through email or their 1-2-1 counsellor chat online, Childline is a free service to talk about any problem (big or small).
Telephone: 0800 1111 Website: https://www.childline.org.uk/get-support/contacting-childline/
The UK’s first 24/7 text service. Free on all major mobile networks, anytime, for anyone in crisis. If you need immediate help and are struggling to cope, Shout is a place to go.
Telephone: 85258 Website: https://www.giveusashout.org/about-us/contact-us/
*Theses are but a few of the many support groups and charities. Help is out there if you need it. It may feel like it, but you are not alone.
Please share this as millions could scroll past and ignore the post, but if there is a chance that this can make a difference to just one person, that is a chance we must take. Find us on Instagram. Let’s raise awareness, bury the stigmas and encourage people to make the conversation louder. To learn about more mental health conditions, stay tuned for the next Mental Monday, which updates the first Monday of every month. Let’s talk then!
National Schizophrenia Awareness Day – 25th July 2021
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