Schizophrenia

Schizophrenia is a brain disorder affecting approximately 1 percent of the world's population. Schizophrenia has a number of behavioral manifestations, but among the most common are hallucinations, delusions, and deficits in cognitive and social function. These experiences are often frightening and may accompany withdrawal, paranoia, or extreme frustration observed in someone who suffers from schizophrenia. In addition, people with schizophrenia may have disorganized speech and behavior, such that they may not make sense when they speak or may speak in fragments.

The illness affects men and women in equal ratios and occurs at a similar rate in all ethnic groups. Psychotic symptoms (such as hallucinations and delusions) usually emerge in men during their late teens and early 20s and in women during their mid-20s to early 30s.

Schizophrenia seldom occurs after age 50 and only rarely before puberty, although cases of schizophrenia in children as young as 5 have been reported. During the adolescent years, the first signs of schizophrenia can include social withdrawal, a drop in grades, sleep disturbances, and irritability. Many people who develop schizophrenia have difficulty caring for themselves; [Page 1524]therefore, the reliance and subsequent stress on immediate family members is significant.

The symptoms of schizophrenia have been classified into three categories: positive, negative, and cognitive symptoms. Positive symptoms involve unusual thoughts, hallucinations, delusions, and disorders of thought, behavior, and movement. Hallucinations are most commonly auditory, with patients often hearing voices telling them what to think, how to behave, or how to react. Another positive symptom, delusions, are defined as false and irrational personal beliefs, such as believing that people in outer space are sending special messages to them. They may also have delusions of grandeur where they believe they are famous historical or religious figures.

The second category, negative symptoms, manifest as a loss or decreased ability to express emotion, initiate plans, speak, or find pleasure in day-to-day activities. These traits are often challenging to isolate from symptoms of depression, serving to delay proper diagnosis at times. People experiencing these symptoms may neglect basic hygiene and need help with everyday activities that once were second nature.

For adolescents, the first signs of schizophrenia can include social withdrawal, a drop in grades, sleep disturbances, and irritability.

The final category, cognitive symptoms, includes problems with attention, memory, and the executive functions driving advanced planning and organization. Cognitive impairments often interfere with the patient's ability to lead a normal life: maintaining a job, home, friends, and significant other. This deficit can indeed cause a great deal of emotional distress. Overall, positive symptoms are the easiest to diagnose and respond well to medication, whereas negative and cognitive symptoms are often much more insidious.

The underlying etiology of schizophrenia is unclear, although researchers understand that both genetics and environmental influence play a significant role. Schizophrenia is thought to have a strong hereditary component, as first-degree relatives (i.e., parent or sibling) of a patient have a 10 percent chance of developing schizophrenia themselves. The rates of schizophrenia in people with second-degree relatives (i.e., aunts, uncles, grandparents, or cousins) are also higher than that of the general population. Twin studies have contributed to the study of inheritance as well, finding that the identical twin of a person with schizophrenia has a 40 to 65 percent chance of developing the disorder. Ongoing linkage and association studies have now identified a number of polymorphisms that confer risk. All in all, available evidence suggests a major contribution of genetics to schizophrenia susceptibility, although there are clearly environmental influences as well.

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