Schizophrenics are scary. Are they dangerous?

Q: I just met a guy who is schizophrenic and I was scared because I heard those people are dangerous. Are they?

A: No, People with schizophrenia are typically not dangerous. Sometimes the delusional thoughts and hallucinations of schizophrenia can lead to violent behavior, but most people with schizophrenia are neither violent nor a danger to others. In fact there are a lot of common misconceptions about Schizophrenia.

For example, Schizophrenia is not the same as split personality or multiple personality disorder. Multiple personality disorder is a different and much less common disorder than schizophrenia. Also Schizophrenia is not a rare condition because it affects about 1 in 100 people during their lifetime. In addition, people with schizophrenia are not without hope because they can be helped. Although long-term treatment may be required, with proper treatment, many people with schizophrenia are able to enjoy life and function within their families and communities.

               

Let me take some time and explain a little about schizophrenia because understanding is a large part of reducing stigma of mental health.

What is schizophrenia?

Schizophrenia is a brain disorder that affects the way a person acts, thinks, and sees the world making it difficult to distinguish between what is real and unreal, to think clearly, to manage emotions, and generally relate to other people.

Most cases of schizophrenia appear in the late teens or early adulthood but it can appear for the first time in middle age or even later. In rare cases, schizophrenia can affect young children and adolescents, although the symptoms are a little different. Usually, the earlier schizophrenia develops, the more severe it affects a person and it also tends to be more severe in men than in women, however, in women, it tends to begin later and is generally much less severe.

People with schizophrenia have an altered perception of reality. They may see or hear things that don’t exist, speak in strange or confusing ways, believe that others are trying to harm them, or feel like they’re being constantly watched. With such confusion between what is real and what is imaginary, schizophrenia makes it difficult, even frightening, to carry out activities of daily life. So it is understandable then, that people with schizophrenia may withdraw and isolate themselves from the outside world and perhaps act with confusion and fear while showing a general indifference to life and daily activities.

In some people, schizophrenia appears suddenly and without warning but for most people, it comes on slowly bringing feelings of confusion, subtle warning signs and a gradual decline in functioning long before the first severe episode happens. Friends and family of people with schizophrenia have said that they knew something was wrong but they just couldn’t put their finger on what it was.

The causes of Schizophrenia are still uncertain and its symptoms are quite variable but we do know that it is a biological disorder of the brain. It appears that schizophrenia results from genetic and environmental factors. If you have a parent with Schizophrenia there is a much stronger chance of developing the disorder, yet surprisingly most schizophrenics have no family members with the disorder.

Environmentally, research is increasingly pointing to stress as a major factor in schizophrenia, either during pregnancy or early childhood development. High levels of stress are believed to trigger schizophrenia by increasing the body’s production of the hormone cortisol.

Stress-inducing environmental factors may include:

·         Prenatal exposure to a viral infection

·         Low oxygen levels during birth (from prolonged labor or premature birth)

·         Exposure to a virus during infancy

·         Early parental loss or separation

·         Physical or sexual abuse in childhood

In addition, areas of the brain governing thought and higher mental functions behave abnormally in persons with schizophrenia and these same areas of the brain also appear to have deteriorated or developed abnormally. Researchers have also found that the fluid-filled spaces in the schizophrenic brain are larger, filling the spaces where solid brain matter should be.

There are 3 phases of Schizophrenia: A beginning phase where symptoms begin to increase called the (Prodromal phase), an Active phase, where the symptoms are at their worst, and an ending phase where symptoms tend to linger called a (Residual Phase). These phases usually happen in order and will generally show up one or twice throughout the course of the illness but a person could suffer many more episodes.

When in remission, a person with schizophrenia may seem relatively unaffected and can more or less function in society.

The signs and symptoms of schizophrenia can be very different from person to person because not everyone with will have all the symptoms, the symptoms can be different, and the symptoms may change over time.

However there are five symptoms that are characteristic of schizophrenia:

·         Delusions,

·         Hallucinations,

·         Disorganized speech,

·         Disorganized behavior,

·         “Negative” symptoms”

Delusions are firmly-held ideas that a person has despite clear and obvious evidence that it isn’t true. Delusions of illogical, bizarre ideas or fantasies are extremely common in schizophrenia and occur in more than 90% of those afflicted. Common schizophrenic delusions include:

·         Delusions of persecution – Belief that “others” are out to get them often with delusions of persecution involving bizarre ideas and plots. For example “Aliens are trying to alter my brain with a special chemical they put in the food” or “Government agents are plotting against me”.

·         Delusions of reference – A neutral environmental event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a person on TV is sending a message meant specifically for them.

·         Delusions of grandeur – Belief that they are famous or important like Jesus Christ or a powerful historical figure. They can also have delusions of having unusual or special powers like being able to fly or read minds.

·         Delusions of control – Belief that their thoughts and actions are being controlled by outside alien forces. Common delusions of control are that their thoughts are being transmitted to others, someone is planting thoughts in their head, or even removing their thoughts from them completely.

Hallucinations are sights, sounds or other sensations that the person experiences as being real but only acting out in the person's mind. Although hallucinations can involve any of the five senses, hearing voices or sounds are the most common but seeing hallucinations is also common.

These hallucinations are usually meaningful and often the voices are someone they know tend to be worse when the person is alone. It is common for the voices to be critical, vulgar, or abusive.

Disorganized speech is a result of fragmented thinking and can be seen by the way a person speaks. They may answer with unrelated comments, change topics in mid sentence, speak without making sense, or saying illogical things.

Common signs of disorganized speech:

·         Rapidly shifting between topics, with no connection between them called Loose associations.

·         Using made-up words or phrases called Neologisms that only have meaning to the patient.

·         Repeating words and statements by saying the same thing over and over called Perseveration.

·         Meaningless use of rhyming words called Clang such as “The meat eat the sheet and greet feet or neat".

Disorganized behavior interferes with simple goals and activities causing problems with taking care of themselves, working and interacting with others. We can see it by:

·         A decline in overall daily functioning and self care

·         Unpredictable or inappropriate emotional responses

·         Behaviors that appear bizarre and have no purpose

·         Lack of inhibition and impulse control

The symptoms of schizophrenia fall into two kinds of categories "positive" and "negative" symptoms. Positive symptoms are sometimes called psychotic symptoms like those listed above such as delusions and hallucinations and refer to symptoms that appear or are added to the individual. 

Negative symptoms refer to elements that are taken away from a person such as.

·         Lack of emotional expression and blank or restricted facial expressions, a flat monotone voice and lack of eye contact.

·         Lack of interest or enthusiasm such as problems with motivation and a lack of self-care.

·         Lack of interest in the world and a noticeable lack of awareness of the environment and social withdrawal.

·         Speech difficulties and abnormalities include an inability to carry a conversation with short and disconnected replies.

Substance Abuse

                     People with schizophrenia can be mistaken for people who are affected by drugs because the symptoms of drug abuse are similar to those of schizophrenia. Most researchers do not believe that substance abuse causes schizophrenia, but substance abuse is the most common secondary problem associated with people who have schizophrenia as they are much more likely to engage in substance abuse than the average person.

                     In addition, an addiction to nicotine is the most common form of substance abuse in people with schizophrenia as they are addicted at three times the rate of the general population. People with schizophrenia seem to be driven to smoke but trying to quit smoking can be very difficult because nicotine withdrawal process may cause their psychotic symptoms to worsen.

Types of schizophrenia

There are three major subtypes of schizophrenia, each classified by their most recognized symptom:

·         Paranoid schizophrenia

·         Disorganized schizophrenia

·         Catatonic schizophrenia

Paranoid schizophrenia is characterized by bizarre or suspicious ideas and beliefs. These ideas usually center on a rational, organized theme or story that remains consistent over time. Delusions of persecution are the most frequent themes however delusions of grandeur are also common.

People with paranoid schizophrenia show a history of increasing paranoia and difficulties in their relationships. They tend to function better than individuals with other schizophrenic subtypes. In contrast, their thinking and behavior is less disordered and their long-term prognosis is better.

Disorganized schizophrenia generally appears at an earlier age than other types of schizophrenia. It begins gradual with the person slowly retreating into their fantasies. It can be distinguishing from other types due to the disorganized speech, disorganized behavior, and dulled or inappropriate emotions. People with disorganized schizophrenia also have trouble taking care of themselves, and may be unable to perform simple tasks such as bathing or feeding themselves.

People with disorganized schizophrenia sometimes suffer from hallucinations and delusions, but unlike the paranoid subtype, their fantasies aren’t consistent or organized.

Catatonic schizophrenia characteristic trait is a disturbance in movement: either a decrease in body movement, seen as a stuporous state, or an increase in body movement, seen as an excited state.

·         The stuporous state reflects a dramatic reduction in activity. The person often ceases all voluntary movement and speech, and may be extremely resistant to any change in his or her position, even to the point of holding an awkward, uncomfortable position for hours.

·         In the Excited state sometimes people with catatonic schizophrenia pass suddenly from a state of stupor to a state of extreme excitement. During this frenzied episode, they may shout, talk rapidly, pace back and forth, or act out in violence either toward themselves or others.

People with catatonic schizophrenia can be highly suggestible. They may automatically obey commands, imitate the actions of others, or mimic what others say.

Other Schizophrenic Subtypes

Schizoaffective disorder is a mental condition that causes both a loss of contact with reality (psychosis) and mood problems. To be diagnosed with schizoaffective disorder, you must have psychotic symptoms during a period of normal mood for at least 2 weeks.

Schizoaffective disorder is believed to be less common than schizophrenia and mood disorders. Women may have the condition more often than men but it tends to be rare in children.

Schizoid personality disorder is a psychiatric condition where a person has a lifelong pattern of indifference to others and social isolation. The causes of schizoid personality disorder are unknown and may be related to schizophrenia and it shares many of the same risk factors. However, schizoid personality disorder is not as disabling as schizophrenia. It does not cause hallucinations, delusions, or the complete disconnection from reality that occurs in untreated (or treatment-resistant) schizophrenia.

How is schizophrenia treated?

Recovery from schizophrenia is a lifelong process. Successful treatment for schizophrenia aims to relieve current symptoms, prevent future psychotic episodes, and restore your ability to function and enjoy a meaningful life. A treatment plan that combines medication with supportive services and therapy is the most effective approach.

There is no known way to prevent schizophrenia and there are no medical tests to diagnose it. A psychiatrist should examine the patient to make the diagnosis based on a thorough interview of the person and family members. Brain scans (such as CT or MRI) and blood tests may help to rule out other disorders that have similar symptoms to schizophrenia.

MEDICATIONS

Antipsychotic medications are the most effective treatment for schizophrenia but it takes time for the antipsychotic medications to take full effect. These medications help by lessening hallucinations and delusions and helping to maintain logical thoughts but because of the serious side effects many people do not want to take the medications and will often relapse. These side effects can include restlessness and pacing, extremely slow movements, tremors, painful muscle stiffness or temporary paralysis, muscle spasms of the neck, eyes, or trunk, loss of motivation, drowsiness, weight gain, sexual dysfunction and nervousness.

One of the long-term risks of antipsychotic medications is a movement disorder called Tardive Dyskinesia which causes repeated movements that you cannot control, especially around the mouth.

Since many people with schizophrenia require medication for extended periods of time, sometimes for life, the goal is to find a medication regimen that keeps the symptoms of the illness under control with the fewest side effects and it is a trial and error process.

Symptoms of schizophrenia will return if a person does not take their medication but people with schizophrenia often resist treatment. They may not think they need help because they believe their delusions or hallucinations are real. In these cases, family and friends may need to take action to keep their loved one safe.

SUPPORT PROGRAMS AND THERAPIES

Psychological and social interventions include counseling, communication skills, self-care, work, and forming and keeping relationships. 

Family members of a person with schizophrenia should be educated about the disease and offered support. Programs that emphasize outreach and community support services can help people who lack family and social support. Family members and caregivers are often encouraged to help people with schizophrenia stick to their treatment. Support makes an immense difference in the outlook for schizophrenia especially the support of family and close friends.

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.