Rhiannon Freya Lyon
Often misunderstood, schizophrenia is possibly the most stigmatised of mental illnesses. This is largely down to a lack of education on it in the general public, leading to misconceptions that it is some sort of split personality disorder, causing those with it to be violent towards others. The word may conjure up images of padded cells, straight-jackets, and someone who must be kept isolated from society for the good of everyone. The media definitely doesn’t do anything to help with this image.
In reality, this could not be further from the truth. Schizophrenia is complex, made up of many different types of symptoms, and definitely doesn’t cause a person to be any more violent than someone without schizophrenia would be. Although there is currently no cure for schizophrenia, as unfortunately is the trend with mental illnesses, there are many medications and talking therapies that together can work to alleviate an individual’s symptoms, greatly increasing their quality of life.
When one thinks of the symptoms of schizophrenia, the first things that come to mind are things like auditory hallucinations (hearing voices) and delusions (e.g. paranoia). These are known as the ‘positive’ or ‘psychotic symptoms’ of schizophrenia (not positive as in good, but positive as in they are in addition to ‘normal’ experiences). Although auditory hallucinations are the most common, hallucinations of all the other senses can occur too, such as visual hallucinations, the sense of being touched when you are not, and even sensing smells and tastes that are not there. Delusions are beliefs that do not line up with reality, for example those suffering from delusions may feel that they are being followed or plotted against, or that they have committed a terrible crime. These delusions can cause them to feel overwhelmed and act in ways that may seem to not make sense to others. Another positive symptom is disorganised thinking, which may cause the person to talk more quickly or slowly, and jump from topic to topic in with no obvious link.
However positive symptoms are only a part of schizophrenia. There are also ‘negative symptoms’ which are more similar in character to depression, and usually involve a lack of something. They include things like loss of motivation and enjoyment of life, changing sleep patterns, withdrawal from social activities, and memory problems. Negative symptoms are much less dramatic than positive ones, but they generally last longer, and those with schizophrenia often say that they feel the negative symptoms have the biggest impact on their life.
There are a number of forms of schizophrenia, distinguished by their different combinations of various types of positive and negative symptoms. Paranoid schizophrenia is the most common and well known type, often developing in a person’s 20s, and includes prominent hallucinations and delusions. Other types of schizophrenia may be more focused on negative symptoms (simple and residual schizophrenia), or on a specific type of hallucinations, such as experiencing unusual bodily sensations in canasthopathic schizophrenia.
It is not entirely clear what causes schizophrenia, although many risk factors have been identified. Schizophrenia is thought to have some genetic component, as demonstrated by twin studies, but this alone does not cause a person to have schizophrenia, which also requires environmental stressors such as losing a loved one or going through big life changes. Subtle differences in brain structure are also seen in some people with schizophrenia, but not all.
High levels of the neurotransmitter dopamine are associated with hallucinations and delusions. Drugs that lower the levels of dopamine are known to relive some of the positive schizophrenic symptoms – suggesting that those with schizophrenia either have too high levels of this neurotransmitter in the brain, or are somehow overly sensitive to it. Recreational drugs such as amphetamines and cannabis with a high THC content are also associated with the development of schizophrenia, it is unclear whether these directly trigger the disease or if people more likely to develop schizophrenia are also more likely to use these drugs.
There is also evidence that birth complications such as not getting enough oxygen during birth, being born prematurely, or having a low birth weight also increase the risk of developing schizophrenia later in life. This may be due to subtle changes in the brain caused by these complications.
A combination of medication and talking therapies are usually used to combat the symptoms of schizophrenia. The main medications used are antipsychotics, which help alleviate the positive symptoms. There are two main classes of antipsychotics: typical and atypical. Typical antipsychotics used to be used to treat psychosis, but often gave Parkinson’s-like side effects (as Parkinson’s disease involves the death of dopamine-producing neurons), so have more recently been replaced with atypical antipsychotics. Antidepressants can also sometimes be used to help with the negative symptoms.
Cognitive behavioral therapy can be useful in allowing the individual to manage their symptoms more easily, recognising delusions and hallucinations for what they are and making them less overwhelming. Education about the illness and how to spot early signs of a psychotic episode are helpful for both the individual with the illness and those close to them, it’s very important for family and friends of someone with schizophrenia to understand the condition and how to help.