Schizophrenia

I

Introduction

Schizophrenia, term for a group of mental disorders marked by a variety of symptoms. Literally, the term means “split mind”, but, contrary to a common misconception, schizophrenia does not imply a split personality, in the sense of someone acting as two different people. Not until the 20th century was schizophrenia distinguished from other forms of psychosis.

II

Symptoms

Symptoms of schizophrenia, only some of which are present in any one individual, occur in thoughts, perceptions, feelings, movements, and interpersonal relationships. Thought disorders may be observed as a failure to make logical connections or by the development of delusions. Hallucinations—particularly hearing one's thoughts spoken aloud or hearing imaginary voices giving commands or making comments—are the principal perceptual problems. Emotional reactions to a situation appear to observers to be either flat or inappropriate. Disturbances in movement may appear as catatonia (a rare condition in which the patient maintains a rigid posture) or, more commonly, as apparently purposeless, excited movements that have a repetitive sameness about them. Relationships with others are usually disturbed, often because the schizophrenic person tends to be withdrawn.

Schizophrenia almost always develops before middle age. Typically, the first episode takes place during adolescence or young adulthood and tends to be followed by others. Its appearance is evidenced by a deterioration in a person's work, social relationships, and ability to care for himself or herself, together with one or more of the symptoms noted above.

No simple catalogue of symptoms, however, can convey the devastation of schizophrenia. It is the most severe major mental illness. A schizophrenic person's odd speech and behaviour may cause others to laugh nervously, but these symptoms are the product of torment rather than playfulness. Being unable to order and control one's own thoughts, being isolated by a vision of reality all one's own, being commanded to act by disembodied voices—these are the experiences that make schizophrenia such a frightening and lonely experience.

III

Causes

Scientists agree that schizophrenia has no one single cause. Rather it is the product of an interplay of biology, psychology, and culture, just as is normal personality. The incidence of schizophrenia ranges from 0.03 per cent to 0.12 per cent a year for people over 15 years of age. The prevalence ranges from 0.01 per cent to 3 per cent worldwide. The disorder runs in families; that is, close relatives of a schizophrenic person are more likely to develop the disorder than is the population at large. Whereas only one or two out of every 100 people become schizophrenic over a lifetime, about ten out of every 100 children who have one schizophrenic parent eventually develop the disorder. Investigators have long debated whether this increased risk is the product of heredity or the result of difficulties in being reared by a parent with a disorganized personality.

In recent years, much evidence has demonstrated that schizophrenia can involve the inheritance of some genetic defect. For example, in the case of identical twins (who share exactly the same genes), when one twin is schizophrenic, the chances of the other twin becoming schizophrenic as well are somewhere between 35 and 58 per cent. Just what is inherited—a biochemical abnormality, a neurological abnormality, a faulty enzyme—is, however, still open to question, and many scientists believe that the strength of the inherited component in schizophrenia varies from one individual to another.

Psychological research has linked a number of environmental conditions to schizophrenia. For example, unclear communication within families is one potential condition, although investigators are still uncertain whether this disordered communication is the cause or result of schizophrenia in a given family member. The disorganized family life often associated with poverty has also been implicated in schizophrenia; in addition, poverty may lead mothers to neglect their health, which may in turn affect the health of a foetus or newborn child.

Brain research, on the other hand, has provided several clues to organic factors related to schizophrenia. For instance, dopamine—one of the brain's chemical messengers, or neurotransmitters—may be present in abnormal quantities in schizophrenics. In addition, the use of brain-scanning techniques has demonstrated structural abnormalities in areas of some schizophrenics' brains.

IV

Treatment

The most powerful treatment for alleviating schizophrenic symptoms is antipsychotic medication (psychoactive drugs). These drugs, available since the mid-1950s, have, for the first time, enabled schizophrenic individuals to function without experiencing crushing fear or troublesome symptoms. They are used not only to stop acute episodes of schizophrenia, but also to prevent future breakdowns. The drugs do have drawbacks, however; they can produce minor side effects such as drowsiness or dry mouth, and they also can have long-term consequences. Some patients who have taken antipsychotic drugs for many years have developed a condition known as tardive dyskinesia. Characterized by abnormal movements of the mouth and tongue, tardive dyskinesia is especially serious because it has no known cure and may not disappear if the drug is stopped. Neither does every schizophrenic patient benefit from antipsychotic drugs, and some seem not to need them at all. Some form of psychotherapy is usually used to treat schizophrenic patients. Psychotherapy is also used to help patients who do receive medication to overcome social and vocational difficulties that may have developed as a result of their illness.