By: Bhavya Appannagaari
What is schizophrenia?
According to the American Psychiatric Association, schizophrenia is a chronic brain disorder that affects less than one percent of the U.S. population. The National Alliance on Mental Illness describes schizophrenia as a long-term medical illness, that compromises an individual’s ability to think clearly, manage emotions, make decisions, and relate to others. Symptoms of schizophrenia can be managed, yet there is no cure for schizophrenia (National Institute of Mental Health, 2022). Individuals with schizophrenia can experience symptoms such as visual or auditorial hallucinations and may have beliefs that someone is controlling their mind and body (SAMSHA, 2022). Dopamine, glutamate, and GABA neurotransmitters are affected in individuals with schizophrenia, and imbalances contribute to the symptoms they experience (Frontiers, n.d.).
What are the symptoms of schizophrenia?
According to Mayo Clinic, the following symptoms are associated with schizophrenia:
Delusions- false beliefs that are not based on reality.
Hallucinations- seeing and hearing things that are not present.
Disorganized thinking (speech)- impaired communication, putting together words that cannot be understood.
Extremely disorganized or abnormal motor behavior- childlike silliness to unpredictable agitation
Negative symptoms- lack of emotion, neglect of personal hygiene
How is schizophrenia diagnosed?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the following criteria must be met for a diagnosis:
Schizophrenia Diagnostic Criteria 295.90
- Two or more of the following symptoms for a significant portion of time in a one-month period:
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
2. For a significant portion of time since the onset of symptoms, functioning in areas such as work, interpersonal relations, or self-care is markedly below the level achieved prior to the onset of symptoms.
3. Continuous signs of disturbance must persist for a minimum of six months.
4. Conditions such as schizoaffective disorder and depressive or bipolar disorder have been ruled out.
5. Disturbances are not occurring due to substance abuse, prescription medication, or another medical condition.
6. If there is a history of autism spectrum disorder or communication disorder that is child-onset, the diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also persistent for at least one month.
(DSM V, 2013)
What tests are done?
Currently, there are no tests to determine a diagnosis of schizophrenia. Tests will be done to rule out other conditions. The following tests are done:
Imaging tests: Tests such as an MRI or CT Scan can help to rule out brain abnormalities such as tumors, scar tissues, stroke, and other changes to the brain.
Blood, urine, and cerebrospinal fluid (spinal tap) tests: these tests are done to look for chemical changes in the body, and rule out heavy metal toxicity, poisoning, and infections.
Brain activity testing: an electroencephalogram (EEG) can be used to detect any abnormal brain activity and rule out conditions such as epilepsy.
(Cleveland Clinic, 2022)
What treatment options are available?
While there is no cure for schizophrenia, there are treatment options to alleviate symptoms.
Medication:
There are two types of medication that are available for treatment, typical and atypical antipsychotics.
Typical antipsychotics: known as first-generation antipsychotics, these medications block how your brain uses dopamine and cell-to-cell communication.
Atypical antipsychotics: known as second-generation antipsychotics, these block both dopamine and serotonin.
Cognitive behavioral therapy can help in developing coping skills in dealing with the symptoms of schizophrenia as well as the side effects one may experience from their medication. Long-term care can help with other conditions, such as anxiety, depression, and other conditions.
Electroconvulsive therapy (ECT) is often used when medications are not helping to alleviate symptoms and is often used as a last resort. Situations in which ECT will be used are for individuals who are at high risk for suicide.
(Cleveland Clinic, 2022)
What are the risk factors?
The following are risk factors for schizophrenia:
Genetics: genetics can play a key role in someone developing schizophrenia, especially if a parent or sibling has been diagnosed with schizophrenia.
Environment: The environment someone was brought up in can contribute to the risk factor of accumulating schizophrenia. Examples are certain infections, autoimmune diseases, and extreme stress.
Developmental and birth circumstances: Complications of fetal development can increase the chances of developing schizophrenia in life. Examples are gestational diabetes, preeclampsia, malnutrition, or vitamin D deficiency.
Recreational drug use: certain recreational drugs, used in large amounts, has been linked to the development of schizophrenia. Researchers are still debating if it is a direct cause or contributing factor.
(Cleveland Clinic, 2022)
Comorbidities related to schizophrenia
According to the article, Psychiatric Comorbidities and Schizophrenia, anxiety and depression are very common symptoms for someone with schizophrenia to experience. Additional comorbidities are panic disorder (15% affected), posttraumatic disorder (29% affected), and obsessive-compulsive disorder (23% affected). Researchers estimate that around fifty percent of individuals with schizophrenia experience comorbid depression and forty-seven percent of individuals with schizophrenia battle comorbid substance abuse.
How does schizophrenia relate to epilepsy?
According to the article, Schizophrenia and Epilepsy: Is There a Shared Susceptibility?, schizophrenia and epilepsy may share a common pathology of the medial temporal lobe, where complex partial seizures often originate. Some patients who experience complex partial seizures experience interictal psychoses, which can take place during or immediately after having a seizure. According to the article, Interictal psychosis of epilepsy, chronic forms of interictal psychosis closely resemble schizophrenia. Many factors are taken into consideration, such as family medical history, learning disability, age seizure activity began, history of status epilepticus, febrile seizures, and the level of seizure activity. Physicians must use caution when prescribing certain anticonvulsant medications because some can induce psychotic symptoms. Interictal psychosis has been reported at higher levels in patients who were taking zonisamide, topiramate, and levetiracetam, compared to other anticonvulsants.
Conclusion
Schizophrenia is a chronic brain disorder that affects less than one percent of the U.S. population. There are multiple symptoms that someone with schizophrenia may experience. Many things need to be taken into consideration for a proper diagnosis including the time symptoms have been taking place, ruling out other conditions, and the impact it is having on the individuals’ quality of life. While there is no cure, there are multiple treatment options available. The probability that someone will develop schizophrenia depends on the risk factors. Chronic forms of interictal psychosis of epilepsy closely resemble symptoms of schizophrenia. Many factors are taken into consideration and certain anticonvulsant medications should be avoided to prevent any psychotic symptoms during or after seizure activity has taken place.
Resources:
American Psychiatric Association (2013). Schizophrenia, Diagnostic Criteria (295.90). Diagnostic and statistical manual of mental disorders (5th ed.), pg. 99.
American Psychiatric Association (2020). What is Schizophrenia? American Psychiatric Association. Retrieved from: https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia
Buckley, P.F., Miller, B.J., Lehrer, D.S., & Castle, D.J. (2009). Psychiatric Comorbidities and Schizophrenia. Schizophrenia Bulletin, 35(2), 383-402.doi:10.1093/schdul/sbn135
Cascella, N.G., Schretlen, D.J., and Sawa, A. (2009). Schizophrenia and Epilepsy: Is There a Shared Susceptibility? Neuroscience Research, 63(4), 227-335. doi: 10.1016/j.neures.2009.01.002
Cleveland Clinic (2022). Schizophrenia. Cleveland Clinic. Retrieved from: https://my.clevelandclinic.org/health/diseases/4568-schizophrenia
de Toffol, B., Adachi, N., Kanemoto, K., El-Hage, W., & Hingray, C. (2020). Les psychoses épileptiques interictales [Interictal psychosis of epilepsy]. L’Encephale, 46(6), 482–492. https://doi.org/10.1016/j.encep.2020.04.014
Frontiers (n.d.) Mapping the pathophysiology of schizophrenia: interactions between multiple cellular pathways. Frontiers. Retrieved from: https://www.frontiersin.org/research-topics/884/mapping-the-pathophysiology-of-schizophrenia-interactions-between-multiple-cellular-pathways
Mayo Clinic (2020). Schizophrenia, Symptoms and Causes. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443
National Alliance on Mental Illness (2023). Schizophrenia. NAMI. Retrieved from: https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizophrenia
National Institute of Mental Health (2022). Schizophrenia. National Institute of Mental Health. Retrieved from: https://www.nimh.nih.gov/health/topics/schizophrenia
Substance Abuse and Mental Health Services Administration (2022). Living Well with Schizophrenia. SAMHSA. Retrieved from: https://www.samhsa.gov/serious-mental-illness/schizophrenia
