Jerome Levine, MD, is a board-certified psychiatrist whose career has spanned almost 50 years. He is the Deputy Director of the Nathan Kline Institute for Psychiatric Research in Orangeburg, New York. Irene S. Levine, PhD, served as the first Deputy Director of the U.S. Center for Mental Health Services. She is a clinical psychologist and an award-winning freelance journalist and author.

Schizophrenia For Dummies

By Jerome Levine Irene S. Levine

John Wiley & Sons

Copyright © 2009 Jerome Levine and Irene S. Levine
All right reserved.
ISBN: 978-0-470-25927-6

Chapter One

Understanding Schizophrenia: The Big Picture

In This Chapter

* Understanding what schizophrenia is, who gets it, and what the symptoms are

* Looking at how schizophrenia is treated

* Getting the support you need

Schizophrenia. If someone you know has been recently diagnosed with schizophrenia, the very word may evoke a cascade of intense feelings: sadness, fear, confusion, shame, and hopelessness. You may ask yourself, how did this happen? Why did it happen to my loved one? It’s natural to have these emotions. But take a deep breath. You need to know that the diagnosis isn’t as catastrophic as it first appears to be.

Most people know very little about schizophrenia until it hits home, and what they do know is likely to be based on old myths and misperceptions. They need to find out as much accurate information as they can about this complex and misunderstood disease. Knowledge is power – and knowing what schizophrenia is (and isn’t) is the first step toward moving beyond your worst fears.

In this chapter, we give you an overview of the brain disorder known as schizophrenia: what it is, who gets it, and what treatments are available. We dispel some common myths about the disorder and tell you how schizophrenia differs from other mental illnesses. Finally, we tell you the good news about the disorder and why you and your loved one have every reason to remain hopeful that recovery is possible.

Schizophrenia is a serious, long-term, life-altering illness, so it’s natural to be stunned upon hearing the diagnosis. You may even feel paralyzed, not knowing what to do next. But the first step is clear: You need to gather all the information you can to make sure your loved one is getting the best possible treatment and supports available to him.

Defining Schizophrenia

You’re reading this book, which means you probably have a personal interest in schizophrenia – either you or someone close to you has been diagnosed with the disease or you’re worried about someone showing signs or symptoms. In this section, we fill you in on what’s currently known about schizophrenia and the way the disorder affects the people who have it, as well as their loved ones.

What schizophrenia is

Schizophrenia is a brain disorder characterized by a variety of different symptoms, many of which can dramatically affect an individual’s way of thinking and ability to function. Most scientists think that the disorder is due to one or more problems in the development of the brain that results in neurochemical imbalances, although no one fully understands why schizophrenia develops.

People with schizophrenia have trouble distinguishing what’s real from what’s not. They are not able to fully control their emotions or think logically, and they usually have trouble relating to other people. They often suffer from hallucinations; much of their bizarre behavior is usually due to individuals acting in response to something they think is real but is only in their minds.

Unfortunately, because of the way schizophrenia has been inaccurately portrayed in the media over many decades, the illness is one of the most feared and misunderstood of all the physical and mental disorders.

Schizophrenia is a long-term relapsing disorder because it has symptoms that wax and wane, worsen and get better, over time. Similar to many physical illnesses (such as diabetes, asthma, and arthritis), schizophrenia is highly treatable – although it isn’t yet considered curable.

But the long-term outcomes of schizophrenia aren’t as grim as was once believed. Although the disorder can have a course that results in long-term disability, one in five persons recovers completely. Some people have only one psychotic episode, others have repeated episodes with normal periods of functioning in between, and others have continuing problems from which they never fully recover.

Who gets schizophrenia

No group is risk-free when it comes to schizophrenia, but some people are more likely than others to develop the disorder. The following statistics may surprise you:

• Schizophrenia is more common than you might think. About 1 out of 100 people develop schizophrenia over the course of their lifetime. Schizophrenia is twice as common as Alzheimer’s disease or HIV/AIDS, five times as common as multiple sclerosis, and six times as common as Type 1 (insulin-dependent) diabetes.

  REMEMBER Although new cases of schizophrenia are somewhat rare, the number of individuals with the disorder remains relatively high because schizophrenia is a chronic disorder that often lasts for an extended period of time.

  • Schizophrenia affects both sexes equally and is found among people of all races, cultures, and socioeconomic groups around the world.
    • Although schizophrenia is more likely to affect people between the ages of 17 and 35 (the onset tends to be earlier in men than in women), it can begin in children as young as age 5 or have a late onset in a person’s 50s, 60s, or 70s.

      WARNING!

      Childhood-onset schizophrenia is extremely rare, affecting about 1 in 40,000 children. Only 1 in 100 adults now diagnosed with the disorder had symptoms before the age of 13. Because the disorder tends to surface more gradually in children, it often goes unnoticed. Chapter 2 lists some of the early red flags to watch for if you suspect that something may be wrong.

      An earlier onset is often indicative of poorer outcomes because the disorder can interfere with education, development, and social functioning. On the other hand, early recognition can help improve outcomes and minimize disability. What causes schizophrenia

      Schizophrenia is a no-fault, equal-opportunity illness most likely caused by a number of factors, both genetic and environmental. Most scientists now accept a two-hit theory for the cause of schizophrenia, which suggests that the genetic susceptibility is compounded by one or more environmental factors:

      • Genetic susceptibility: Based on family genetic history, some people are more vulnerable to the disorder than other people are.
        • Environmental factors: In someone genetically predisposed, certain environment factors may come into play, such as:

          Physical trauma that occurs to the fetus during childbirth

          Oxygen-deprivation or some psychological or physical problem that occurs to the mother during pregnancy and affects the developing fetus

          Emotional stress, such as the loss of a parent or loved one during young adulthood

          REMEMBER

          Although schizophrenia is genetically influenced, more than genetics is involved in its development. Studies of identical twins show that, if one twin develops schizophrenia, the other twin has only a 40 percent to 50 percent chance of also developing the illness. There’s also an increased risk among fraternal twins when one develops schizophrenia, the other has between a 10 percent and 17 percent chance, far less than that of identical twins. Having a parent with schizophrenia also increases a person’s risk of developing the disease, to about 10 percent. And if you have a sibling with the disorder – not your twin – you have a 6 percent to 9 percent chance of developing the disorder yourself.

          Scientists still don’t know the precise causes of schizophrenia for any particular individual, yet family members and patients themselves tend to dwell on (or even obsess about) finding a “reason” or a “cause” for the illness. Although this instinct is a natural one, finding the precise cause or explanation is impossible, not to mention counterproductive – finding a reason doesn’t help treatment, and it often creates unnecessary and misplaced guilt, with one family member blaming another.

          See Chapter 2 for a full discussion of the possible causes of schizophrenia.

          The Symptoms of Schizophrenia

          There are almost 300 named psychiatric disorders, and schizophrenia is one of them. Although many mental illnesses have symptoms that overlap, schizophrenia has a distinct pattern of symptoms. No two cases of schizophrenia look exactly the same, but most people with schizophrenia display three types of symptoms:

          • Positive symptoms: The term positive symptoms is confusing, because positive symptoms (as the term might suggest) aren’t “good” symptoms at all. They’re symptoms that add to reality, and not in a good way. People with schizophrenia hear things that don’t exist or see things that aren’t there (in what are known as hallucinations). The voices they hear can accuse them of terrible things and can be very jarring (for example, causing them to think that they’ve hurt someone or have been responsible for some cataclysmic world event).

            People with schizophrenia can also have delusions (false beliefs that defy logic or any culturally specific explanation and that cannot be changed by logic or reason). For example, an individual may believe that there is a conspiracy of people driving red cars that follows his every movement. He will use the fact that there are red cars everywhere he goes as evidence that the conspiracy is real.

            • Negative symptoms: These symptoms are a lack of something that should be present; behaviors that would be considered normal are either absent or diminished. For example, people with schizophrenia often lack motivation and appear lazy. They may be much slower to respond than most other people, have little to say when they do speak, and appear as if they have no emotions, or exhibit emotions that are inappropriate to the situation. They may also be unable to get pleasure from the things that most people enjoy or from activities that once brought pleasure to them. Families often get frustrated when a relative with schizophrenia does nothing but sleep or watch TV – they wrongly attribute this behavior to the patient not being willing to assume responsibility or “pull himself up by his bootstraps.”

              REMEMBER

              Negative symptoms are part and parcel of the illness for at least 25 percent of people with schizophrenia.

              • Cognitive symptoms: Most people with the disorder suffer from impairments in memory, learning, concentration, and their ability to make sound decisions. These so-called cognitive symptoms interfere with an individual’s ability to learn new things, remember things they once knew, and use skills they once had. Cognitive symptoms can make it hard for a person to continue working at a job, going to school, or participating in activities she may have enjoyed at one time.

                In addition to the symptoms mentioned above, people with schizophrenia may also have sleep problems, mood swings, and anxiety. They may experience difficulties forming and maintaining social relationships with other people. They may look different enough that other people notice that something is very odd or strange about them and that they don’t quite look “normal.” They may have unusual ways of doing things, have peculiar habits, dress inappropriately (such as wearing a heavy coat or multiple layers of clothes in the summer), and/or be poorly groomed, which can discourage other people from getting involved with them.

                See Chapter 3 for more about the differences in these types of symptoms.

                Dispelling the Myths Associated with Schizophrenia

                People wrongly associate the symptoms of schizophrenia with split or multiple personalities (like Dr. Jekyll and Mr. Hyde), antisocial behavior (similar to what we see in serial killers), and developmental disabilities. Others believe that schizophrenia is a character defect and that the individual could behave normally if he really wanted to.

                Here are a few of the most common misconceptions about schizophrenia:

                • Schizophrenia is the same as a split or multiple personality. Schizophrenia is not the same as multiple personality, which is an exceedingly rare, totally different disorder that is now more commonly called a dissociative identity disorder. (Under stress, people with this disorder often assume different identities, each with different names, voices, characteristics, and personal histories.)
                • People with schizophrenia are violent. People with schizophrenia are more likely to be victims rather than perpetrators of crimes. Many people believe that most people with schizophrenia have a propensity for violence, but the reality is that most people with schizophrenia don’t commit violent crimes, and most violent criminals don’t have schizophrenia.

                  For example, serial killers (people who commit three or more subsequent murders) usually aren’t psychotic (out of touch with reality); they’re likely to be diagnosed with an antisocial personality disorder (a disorder in which people disregard commonly accepted social rules and norms, display impulsive behavior, and are indifferent to the rights and feelings of others).

                  WARNING!

                  However, people with untreated schizophrenia, who refuse to take medication and whose thinking is out of touch with reality are at increased risk of aggressive behavior and self-neglect. The risk of violence also increases if someone with schizophrenia is actively abusing alcohol or illicit drugs. For better or worse, the aggressive behavior is usually directed toward family or friends rather than toward strangers.

                  • Poor parenting causes schizophrenia. For many years, clinicians were taught and actually believed that schizophrenia was caused by parents who were either too permissive or too controlling. The term schizophrenogenic mother was once used to describe such parents – the blame usually fell heavily on mothers because they tended to spend the most time with their offspring. Another outdated theory is the double-bind theory, which suggested that schizophrenia is due to inconsistent parenting, with conflicting messages.

                    REMEMBER

                    These ideas were not based on controlled studies, and these theories no longer have credibility today.

                    Schizophrenia is a no-fault disorder of the brain.

                    • People with schizophrenia are mentally retarded. Some people think that schizophrenia is synonymous with mental retardation (now called developmental disabilities). No. Like the general public, people with schizophrenia have a wide range of intellectual abilities. They may appear less intelligent because of the impaired social skills, odd behaviors, and cognitive impairments that are characteristic of schizophrenia. However, they’re not lacking in intelligence, and schizophrenia is distinct from developmental disabilities (physical and mental deficits that are chronic and severe and that generally begin in childhood).
                      • Schizophrenia is a defect of character. Negative symptoms of schizophrenia give people the mistaken impression that those with the disorder are lazy and could act “normally” if they wanted to. This idea is no more realistic than suggesting that someone could prevent his epileptic seizures if he really wanted to or that someone could “decide” not to have cancer if he ate the right foods. What often appears as character defects are symptoms of schizophrenia.

                        TECHNICAL STUFF

                        When the negative symptoms of schizophrenia are persistent and primarily caused by schizophrenia, they’re referred to as deficit syndrome.

                        • There’s no hope for people diagnosed with schizophrenia. Sixty years ago when people were diagnosed with schizophrenia, they were either kept at home behind closed doors by embarrassed and forlorn families who saw no other alternative, or consigned to long-term stays in distant state hospitals for care that was largely custodial (they weren’t treated – they were just taken care of). Other than using highly sedating drugs, doctors had few tools available to them to relieve the agitation and torment of their patients or to help restore their functioning.

                          (Continues…)

                          
                          Excerpted from Schizophrenia For Dummiesby Jerome Levine Irene S. Levine Copyright © 2009 by Jerome Levine and Irene S. Levine. Excerpted by permission.
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