schizo means split
and frenia in this case refers to the
mind
even though schizophrenia can be
interpreted to mean splitting of the
mind
it does not refer to a split personality
like some media sources might portray
but rather schizophrenia describes a
scattered or fragmented pattern of
thinking
schizophrenia is actually a syndrome
meaning there are all sorts of symptoms
that might be associated with it
and different patients might experience
different symptoms
although the symptoms can be broadly
categorized into three major areas
positive symptoms negative symptoms and
cognitive symptoms
alright taking a step back most human
symptoms from any illness are extreme
versions of a normal physiologic process
for example everyone has a heartbeat
right and tachycardia is a fast
heartbeat
in the same way everyone has a normal
body temperature but during a fever that
temperature is higher
in schizophrenia patients have positive
symptoms which aren't positive in the
sense that they're helpful
but positive in the sense that there's
some new feature that doesn't have any
normal or
physiologic counterpart these are the
psychotic symptoms
so delusions hallucinations disorganized
speech
and disorganized or catatonic behavior
none of which occur physiologically
delusions are false beliefs that the
person might feel very strongly about
so much so that they won't change their
mind even if you give them evidence
against it
there are all sorts of different
delusions like for example a delusion of
control where somebody thinks that
some outside force or person or thing is
controlling their actions
they could also be delusions of
reference where someone might think that
insignificant remarks are directed at
them like a newscaster is speaking
directly to them through the tv
hallucinations are a second type of
positive symptom and can be any kind of
sensation that's not actually there
including visual but also including
auditory sensations like hearing voices
or commands
a third type is disorganized speech an
example being something like a word
salad which seems like just a random
jumbling of words or phrases
like pencil dog hat coffee blue
disorganized behavior on the other hand
could be like if they exhibit some
bizarre or silly behavior
that's out of context and doesn't seem
to have much of a purpose
like for example wearing multiple layers
of jackets on a hot summer day
also sometimes their behavior is
described as catatonic which has to do
with their movements
posture and responsiveness so like they
might be
super resistant to moving or being an
unresponsive stupor
negative symptoms are like when there's
this reduction or removal of normal
processes
and this is like a decrease in emotions
that they can express
or a loss in interest in things that
they once found interesting
one type of negative symptom is called
flat effect where they don't respond
with an emotion or reaction
that would seem appropriate like if they
saw something very unexpected like a
small monkey playing in their living
room
they might simply sit and watch idly as
if nothing was happening
another type is eloja or poverty of
speech
which is a lack of content in their
speech so like if somebody asked them
do you have any children they might
respond with yes
instead of yeah one boy and two girls
a third type of negative symptom is
abolition which is this decrease in
motivation to complete certain goals
so someone might stay home for long
periods of time without trying to reach
out to friends or find work
cognitive symptoms are like not being
able to remember things
learn new things or understand others
easily
these symptoms are more subtle though
and are more difficult to notice and
might only be detected if they have
really specific tests performed an
example might be somebody not being able
to keep track of several things at once
like a phone number and an address
people with schizophrenia seem to cycle
through three phases
typically in order during the prodromal
phase
patients might become withdrawn and
spend most of their time alone
and a lot of times this seems similar to
other mental disorders like depression
or anxiety disorders
during the active phase patients
experience more severe symptoms like
delusions hallucinations
disorganized speech disorganized
behavior or catatonic behavior
following an active phase patients often
enter into a residual phase where they
might exhibit cognitive symptoms like
not being able to concentrate or
becoming withdrawn again
as with the prodromal phase
for an official diagnosis of
schizophrenia patients need to be
diagnosed with two of the following
symptoms
delusions hallucinations disorganized
speech
disorganized behavior or catatonic
behavior
or negative symptoms and at least one of
them has to be either delusions
hallucinations or disorganized speech so
basically they couldn't have just
disorganized behavior and negative
symptoms
even though some patients have cognitive
symptoms as well they aren't
specifically needed for a diagnosis
also though for a diagnosis signs of
these disturbances must be ongoing for
at least six months
meaning that they're likely in one phase
or another for a period of six months
but there must be at least one month of
active phase symptoms
and finally those symptoms can't be
attributable to another condition like
substance abuse
now that we've diagnosed it why does it
even happen in the first place
what causes schizophrenia well we don't
really know
since it seems like the signs and
symptoms of schizophrenia are pretty
unique to humans
or at least they're hard to imagine or
notice in animal models like mice or
rats
one clue is that the majority of
antipsychotic medication that
improves schizophrenia symptoms block
the dopamine receptor d2
which reduces dopamine levels in neurons
this suggests that maybe schizophrenia
has something to do with increased
levels of dopamine
these medications though are neither
universally nor completely effective
and don't work for everyone with
schizophrenia which adds to the
confusion and means there's probably
more to it than just the d2 receptors
interestingly one of the most effective
antipsychotic drugs
clozapine is a weak d2 antagonist
suggesting that other neurotransmitter
systems like norepinephrine
serotonin and gaba are involved
studies have shown support for a genetic
basis as well
even though there haven't been any
specific genes conclusively linked to
schizophrenia yet
also environmental factors like earlier
prenatal exposure to infection
and certain autoimmune disorders like
celiac disease have been linked with
schizophrenia
finally another important set of clues
involves the epidemiology
schizophrenia seems to happen slightly
more in men than in women
with onset in the mid-20s for men but
late 20s for women
and the clinical signs for schizophrenia
are often less severe
some studies suggest this difference
might be due to estrogen regulation of
dopamine systems
there doesn't however seem to be any
difference among race
now treating schizophrenia can be really
tricky and antipsychotic medications are
often used but it's super important to
combine the efforts of several
clinicians and health professionals
including professionals in therapy or
counseling medicine
and psychopharmacology antipsychotics
can be very effective at reducing
symptoms
but they often come with a lot of
additional considerations to keep in
mind
like cost and the potential for unwanted
side effects like tolerance
dependence and withdrawal
you