Schizophrenia and Psychotic States

Classified by mental health clinicians as a psychotic disorder, schizophrenia can distort how an individual thinks, expresses emotions, relates to others and perceives reality. Every year in the United States, roughly 100,000 people are diagnosed with schizophrenia.

Schizophrenia is frequently divided into several subtypes: Paranoid schizophrenia, Disorganized schizophrenia, and Catatonic schizophrenia.

• Paranoid schizophrenia involves hallucinations, delusional thinking and paranoid ideations. This type of schizophrenia often has a later onset in life and may be more difficult to detect due to a lack of overtly disorganized thinking and communicating.
• Disorganized schizophrenia involves disorganized thinking processes with less prominence of hallucinations, delusions and paranoia.
• Catatonic schizophrenia involves disturbances in movement, with a reduction in activity sometimes to the point of immobilization. There are also undifferentiated and residual subtypes.

For many people experiencing schizophrenic symptoms, the world may seem like a jumble of confusing ideas, images, and sounds. The person may feel like he or she has lost touch with reality, especially if they are experiencing hallucinations. Or he or she may feel paranoid and anxious about others trying to “control” their thoughts. If symptoms become more severe, the person may reach a more disorganized state, where he can no longer handle activities of daily living. Severe, untreated schizophrenia may adversely affect a person’s ability to live and function on their own. Many persons with schizophrenia have additional symptoms and conditions that hinder their social and occupational functioning.

People who develop schizophrenia often have difficulties functioning in society. They may develop problems keeping up with normal demands at work or school. They may also experience significant issues in maintaining healthy relationships with other people. However, for most individuals affected by the disorder, especially for those with a “higher functioning” form of the disorder, schizophrenia and schizophrenic symptoms can be successfully controlled when proper treatment is received.

Symptoms of schizophrenia include

• Delusions and paranoia
• Hallucinations
• Disordered thinking and speech
• Flat affect (inability to express emotion)
• Lack of pleasure in everyday life
• Lack of ability to begin and sustain planned activities
• Speaking little, even when forced to interact
• Attention and memory issues
• Social withdrawal
• Disorganization

Schizophrenia affects both men and women. For men, symptoms such as hallucinations and/or paranoid thoughts may emerge for the first time during late adolescence or early adulthood. Women tend to be at highest risk later in life, with onset generally occurring between ages 25 and 40 years old. Though rare, the onset of schizophrenia in children can occur between the ages of 7 to 12 years old.

The clinical presentation of the disorder varies greatly from person to person. Some individuals may experience only a few psychotic episodes over the course of their lifetime. Others may experience recurring symptoms, but still lead relatively normal lives with treatment. Schizophrenic symptoms tend to worsen and improve in cycles known as relapses and remissions. To clear up a long-held misconception, someone who is schizophrenic does not have a “split personality.” Individuals affected by schizophrenia may have auditory hallucinations (hearing voices other people don’t hear), visual or tactile hallucinations, delusions or paranoia (believing that other people are reading their minds, controlling their thoughts, or plotting to harm them). A person with schizophrenia often cannot tell what is real from what is imagined due to hallucinations, delusions or paranoid ideations. For the person affected by the disorder, symptoms can be terrifying, no matter how frequent or infrequent they may be. Individuals with schizophrenia often appear withdrawn or extremely agitated to others. For example, a person with schizophrenia may only reveal their true mental state when they speak, describing experiences which may not make sense to others. Treatment, including the use of medication, can help to eliminate or control many of these symptoms resulting from schizophrenia.

Scientists do not yet fully understand why some people are more likely than others to develop schizophrenia, but do know that genetics, critical moments in brain development, and certain environmental factors can all play a role. In the general population, for example, the risk for developing schizophrenia is about 1 in 100. However, among those with a first-degree family member with the disease (mother, father, sister, brother), the risk rises to about 10 percent. If schizophrenia affects both parents or an identical twin, the risk is even greater. However, heredity and genetics do not explain all cases of schizophrenia; approximately 60 percent of people with schizophrenia have no close relatives with the illness. For these individuals, risk for the disease may be traced back to such experiences as birth complications or childhood trauma. There is also an association between usage of marijuana and an earlier onset of schizophrenia. Marijuana may precipitate schizophrenia or related psychotic disorders in people whose brains are inherently vulnerable to psychosis.

There are no lab tests to detect schizophrenia, so a diagnosis is usually based on clinical history and symptoms. Because symptoms can resemble those of other mental and physical health problems such as bipolar disorder or certain types of brain tumors, it may be necessary to monitor the mental health of the affected individual for a number of months before a final diagnosis of schizophrenia is made. Schizophrenic symptoms can also be mimicked in the effects of illicit drugs, including the use of methamphetamines. According to the DSM-V, the majority of individuals with schizophrenia do not believe they have a psychotic illness. These individuals may be resistant to treatment, including non-compliance with anti-psychotic medications.

Some people experiencing schizophrenia may be reluctant or afraid to seek treatment. Chemical dependency or alcoholism, or co-occurring psychological problems may also be prevalent among persons with the disorder. People with schizophrenia may also experience depression, suicidal thoughts or attempts, and sleep disorders (insomnia, night terrors, and sleepwalking). However, if identified and treated consistently early on, schizophrenia can be managed and the chances of subsequent psychotic episodes are greatly reduced. With earlier treatment and a shorter duration of untreated psychosis there is a lower incidence of relapse and improved clinical outcome. There are effective schizophrenia treatments available to offer the majority of people suffering from this disorder the possibility of living more productive and satisfying lives. Psychotherapy, medications, sleep and stress management, and psycho-education can significantly diminish the frequency and intensity of psychotic episodes. With the proper medications and supportive counseling, the outlook is optimistic for many schizophrenic persons to live and function in society.
Persons with schizophrenia or psychotic issues may isolate themselves from family or loved ones. When a person experiences hallucinations or delusions it can be very confusing and stressful for family members. Persons with psychotic illnesses are often extremely disorganized; they have difficulty maintaining a clean and safe environment for themselves. Thus, it is important to seek help early on in the disease process. Antipsychotic medications can be life-changing for a person experiencing the onset of schizophrenia. One of the greatest challenges for a client taking an antipsychotic medication is medication compliance and understanding the need to continue their medication, even when they are feeling well.

At PCH Treatment Center our treatment team understands the therapeutic demands of those with schizophrenia, such as maintaining compliance with medications, learning to interrelate with other clients, managing activities of daily living and learning to cope with intrusive thoughts. A requirement for admission to PCH is that a person must be able to maintain activities of daily living and be medication compliant. Another important part of our schizophrenia treatment center and program is individual psychotherapy. Clients receive up to five individual sessions per week, coupled with other therapies specifically tailored to clients with schizophrenia and thought disorders, such as skills group, neurofeedback, meditation, art programs and physical activities.

The PCH Psychiatry team emphasizes appropriate medication usage and holistic healing. Each client has their medication regimen evaluated and modified when appropriate, by one of our schizophrenia psychiatrists. Our physicians have extensive backgrounds in working with persons suffering from psychosis and schizophrenic disorders and are experts in managing anti-psychotic and related medications.