Schizophrenia

Article updated and reviewed by Christos Ballas, MD, Attenting Psychiatrist, Inpatient and Consult/Liaison Psychiatry, Hospital of the University of Pennsylvania. Editorial review provided by VeriMed Healthcare Network on May 11, 2005.

Schizophrenia is a severe mental disorder characterized by two kinds of symptoms; positive psychotic symptoms - thought disorder, hallucinations, delusions, and paranoia - and negative symptoms – impairment in emotional range, energy, and enjoyment of activities. For a formal diagnosis, these symptoms must persist for at least one month and usually result in severe impairment in job and/or social functioning.

Schizophrenia is a particular form of psychosis, a term encompassing several severe mental disorders that result in the loss of contact with reality along with major personality derangements.

The illness can be described as a collection of particular symptoms that usually fall into four basic categories: formal thought disorder, perception disorder, feeling/emotional disturbance, and behavior disorders.

Formal thought disorder. People with schizophrenia describe strange or unrealistic thoughts. In many instances, their speech is hard to follow due to disordered thinking. Common forms of thought disorder include circumstantiality (talking in circles around the issue), looseness of associations (moving from one topic to the next without any logical connection between them), and tangentiality (moving from one topic to another where the logical connection is visible, but not relevant to the issue at hand).

Many schizophrenics feel they possess extraordinary powers, superhuman strength, or superior insights. They may believe that their thoughts are being controlled by others or are being broadcast over the public airways, or that outside thoughts are being implanted in their heads. When such ideas are persistent, organized, and maintained in spite of evidence to the contrary, they are called delusions.

Perception disorder. Those with schizophrenia regularly report unusual sensory experience, especially when the illness is in an acute stage. Most often these experiences are in the form of hearing voices, or auditory hallucinations.

Persons may hear one or two (and sometimes more) voices making comments on their behavior. They may not know the voice, or they may believe that it is the voice of God, the devil, or a friend or relative. Importantly, these voices are perceived to be either real or from outside the individual, and not as their own voice or conscience. People experiencing these hallucinations often perform behaviors or habits in order to quiet or eliminate the voices. A typical example is turning on the radio or television to static in order to drown out the voices.

Feeling/Emotional Disturbance. People with schizophrenia may exhibit flat or restricted affect. This means that they do not respond emotionally to events which would ordinarily elicit some feeling. For example, they do not display feelings of sadness, happiness, or humor, even though they may be able to understand that these things are supposed to be sad, happy, or funny. Their facial expressions and vocal intonations remain the same regardless of what happens around them. Emotional disturbances frequently result in social withdrawal. People with schizophrenia often avoid contact with friends and lose interest in daily life and events. This withdrawal often leads to significant impairment in the person’s quality of life and can lead to the person being expelled from school or fired from a job.

Behavior disorders. Certain forms of schizophrenia are associated with particular movements or behaviors. Lack of blinking and repetitive movements can be seen. Catatonic behavior, where the person appears frozen and motionless, can also be observed. Though catatonia is a symptom of schizophrenia, it often requires a different class of medications—benzodiazepines—which are not routinely used in schizophrenia.

Researchers suspect a biological (either genetically or environmentally) basis for schizophrenia, possibly an imbalance in brain chemicals that regulate thought and emotion. A sibling or a parent with schizophrenia increases the likelihood that a person will have the disease.

Schizophrenia usually has its onset in late adolescence to the mid-20s in men and late-20s in women.