Schizophrenia is a mental illness. It is serious, but in many cases, it is easy to treat. More about symptoms, diagnosis and therapy
- Early detection
- Consulting expert
In a nutshell: what is schizophrenia?
Schizophrenia is a mental illness that can manifest itself in very different ways. It influences thinking, perception, action and feelings. Affected people perceive reality in a different way.
There are a variety of possible symptoms. In acute phases, for example, some patients hear voices, develop delusional ideas or perceive their own thoughts as alien. It is wrong to believe that those affected have a split personality.
Schizophrenias are common all over the world. They occur in poor and rich countries and different cultures. The risk of developing some form of schizophrenia once in a lifetime is around one percent. The disease can occur at any age, most commonly it begins in early adulthood before the age of 35.
Schizophrenias can develop in different ways. Sometimes it remains an acute episode, more often a more wavy or chronic course. Usually, medication and psychotherapy help in the treatment of schizophrenia.
Schizophrenia: early detection is important
Schizophrenia may appear before the first acute phase occurs. The symptoms in this preliminary stage are often unspecific.
Possible early symptoms include:
- Disturbance of perception and thought processes
- Restlessness, fears, tense or depressed mood
- Difficulty concentrating
- Retreat from friends and family
- The symptoms mentioned can also have other causes.
Experts believe that starting therapy early improves the prognosis of schizophrenia. Therefore, early detection centers were set up. They advise – also anonymously.
The offers are aimed in particular at young adults. Anyone who notices changes in themselves – such as concentration problems, sudden distrust of other people or uncanny perceptions – can be advised and examined by specialists there.
Symptoms: Other possible signs of schizophrenia
The following symptoms can indicate schizophrenia – but do not have to be. Other diseases are also possible causes. Individual symptoms sometimes show up in healthy people without the need for therapy:
Thought disorders: concentration and attention are difficult. Thoughts get stuck again and again and abruptly break off. Individual thoughts slide in, disturb the flow of thoughts.
Hallucinations: In the acute episode of the illness, sufferers may experience hallucinations. For example, they hear noises or voices that are not actually there, such as the voices of their loved ones. Often these voices comment or criticize, and they may be perceived as threatening. Other types of hallucinations can occur as well.
Delusional ideas: Affected people construct delusions that have no real basis, but seem to them to be conclusive. For example, they think they are being bugged or followed. Others mistakenly refer to impressions in their environment. For example, they believe they see a hidden message addressed to them in the television program. There are also delusions of grandeur and religious delusions.
Ego disorder: those affected experience some areas of their own world of thought as alien, not belonging to themselves. They have the impression that strange thoughts are given to them from outside or that their own thoughts are being withdrawn from them.
Drive disorders: Some people affected appear powerless and apathetic, lose interest in their environment and withdraw. In severe cases, those affected can neglect daily eating and personal hygiene.
Change in mood: Those affected may no longer show or feel any pronounced emotions. Your mood may be irritable or suspicious. Or they feel incompatible feelings side by side – anger and happiness, love and hate.
Movement disorders: Experts refer to conspicuous motor disorders as catatonic symptoms, which have become rare with today’s treatment options. For example, patients appear frozen in phases and show no facial expressions (so-called stupor). Such episodes can alternate with phases of severe agitation.
The symptoms described do not have to be present in schizophrenia. They can vary over the course of the disease and from patient to patient.
What are positive and negative symptoms?
Experts differentiate between positive symptoms and negative symptoms – but not in the sense of a rating.
Positive symptoms: There is something added that cannot be determined in healthy people – for example, delusions or hallucinations.
Negative symptoms: Something is missing that would normally be there – for example, drive or facial expressions.
There are also so-called cognitive symptoms. They affect thinking – such as the inability to concentrate on facts or to think thoughts through to the end in an orderly manner.
Various sub-forms of schizophrenic diseases include:
Paranoid-hallucinatory schizophrenia: Dominant symptoms are delusions and hallucinations
Hebephrenic schizophrenia: It typically begins in teenagers. Above all, thinking, drive and emotional disorders are in the foreground
Catatonic schizophrenia: The main characteristic of catatonic schizophrenia are movement disorders (catatonic symptoms, see above)
However, the various forms are not stable over time. They can alternate with one another, and according to the current state of knowledge, no definable causes can be differentiated.
Some symptoms overlap with those of other mental illnesses, such as mania or severe depression. Then a safe demarcation can be difficult.
Statistically speaking, people with schizophrenia are more likely to suffer from other mental illnesses such as depression and from alcohol or drug addiction.
What are the causes of schizophrenia?
Exactly how schizophrenia develops is not clear. As far as we know today, different factors work together. Presumably, some people already have a certain “susceptibility” to the disease. The following points can play a role:
There is a certain familial predisposition to schizophrenia. This is supported by observations on twins, for example, Identical twins are genetically identical. If one of them becomes ill with schizophrenia, the risk for the second increases more clearly than would be the case with genetically different siblings.
However, the risk of disease is not based on a single gene. It is more likely that many different genes work together. The fact that the predisposition is present does not in any way mean that the disease has to occur. So schizophrenia is not simply “inherited” directly.
Changes in the brain?
Presumably, there is a change in certain brain messenger substances and a change in information processing. For example, harmful influences before or after the birth are discussed as a possible cause. Researchers are also trying to find out whether and which abnormalities can be identified in the brain of sick people – for example by comparing brain images of healthy people and those affected. There are no final results on this yet.
External influences can possibly contribute to the disease in people at risk, for example very stressful experiences or severe stress. The use of some drugs, such as hashish or marijuana, can potentially cause schizophrenia to break out earlier if predisposed.
The first point of contact may be the family doctor. If he suspects that it is schizophrenia, he will usually be referred to a specialist in psychiatry and psychotherapy.
The doctor will speak to the patient to get an idea of their symptoms. Communication can be difficult in the acute episode of illness. Due to illness, those affected cannot always be convinced that they are ill and that therapy is advisable.
In a conversation with the patient – and if possible also with his relatives – the expert tries to differentiate between other mental illnesses. Psychological tests help assess the patient’s memory function or attention.
In order to rule out physical illnesses as the cause, the doctor may take pictures of the brain – for example using magnetic resonance imaging (MRI).
Therapy treatment for schizophrenia
A treatment essentially consists of three components:
- Medicines (primarily antipsychotics, formerly known as neuroleptics)
- Psychoeducation and psychotherapy
- Socio-therapy (concrete help in everyday life)
In many cases, treatment is initially provided in a psychiatric clinic or day clinic, with milder courses on an outpatient basis.
Medicines are usually used in an acute episode. Above all, they have a beneficial effect on psychotic symptoms such as delusions and hallucinations. Negative symptoms and cognitive disorders are often less responsive to them.
Which drug is selected must be decided on an individual basis. It is not possible to predict with certainty whether it will help in individual cases or whether it will be necessary to switch to another drug.
Acute psychotic episodes can last for several weeks. If the disease is relapsing, there are often months or years between the acute episodes. During this time, symptoms can disappear completely or partially persist. However, the disease can also be more continuous.
Psychoeducation and psychotherapy
It is important that those affected – and, if possible, their relatives – receive as well-founded information as possible about the disease. This so-called psychoeducation should enable patients, among other things, to better understand the disease, to recognize signs of relapse at an early stage and to react quickly to it. The aim is always to trust cooperation between those affected and therapists in order to promote self-responsible dealing with the disease and to support those affected and their relatives in coping with the disease.
Overall, psychotherapeutic methods are gaining in importance in the treatment of schizophrenia. For example, they help those affected to cope better with stress and conflicts in their everyday lives, to develop workable solutions to problems and to train social skills.
Therapists are also trying out new techniques that guide patients, for example, in assessing their own thinking. In the best-case scenario, those affected recognize problematic thought traps and can learn, for example, to jump to conclusions less due to illness. In addition to improving the symptoms, psychotherapy can support those affected in their abilities to participate in social activities and to do satisfactory work.
Socio-therapy and rehabilitation
Socio-therapeutic methods help patients back into a life that is as independent as possible. Supervisors and therapists motivate those affected, for example, to structure their daily routine sensibly, to do all the necessary everyday tasks such as shopping and cooking. They help patients to actively shape their free time, not to isolate themselves, but to make contacts – for example in meeting places.
Another important goal is that patients also use suitable offers of help in the long term. As far as possible, those affected should find their way back to work. Occupational rehabilitation measures can be helpful here.