What is Schizophrenia and how is it treated?

What is Schizophrenia and how is it treated? May 5, 2013

Schizophrenia is a serious, often highly disabling mental illness. Many get confused and think schizophrenia is a split personality disorder. This is not the case at all. Instead it is characterized by the presence of psychotic symptoms, and the absence of significant mood symptoms.

People can get some psychotic symptoms with the Mood Disorders (Depression and Bipolar Disorder). These should only be present during the mood episodes, and are supposed to be consistent with the mood state rather than bizarre. So, for example, a person who believes he is an alien from another planet sent here on a mission to root out evil is unlikely to have a mood disorder. A person who believes strongly that they are going to die and that their organs are already dead on the inside, may however be suffering from depression.

The distinction between mood disorders and Schizophrenia is not as clear-cut as we might think. As a result, there is also a condition called Schizoaffective disorder, which is diagnosed when patients have episodes which exhibit symptoms normally associated with both Mood Disorders and Schizophrenia.

When people think of Schizophrenia, they tend to think of delusions and hallucinations, which can be bizarre and distressing to relatives. Paranoid delusions, for example that the CIA are bugging your phone, can be disabling. Surprisingly most patients with schizophrenia show what can seem to outsiders like a curious acceptance of their delusions, and minimal to no apparent emotional response. This should not be taken to mean that the illness is not causing suffering. Instead, it is a symptom of the illness itself, which psychiatrists call “affective flattening.” What this means is that patients do not show any of the normal outward signs of emotions, and may indeed be unable to describe how they are feeling even if asked.

Patients who are acutely unwell with schizophrenia will often also exhibit disorganized speech which is hard to follow. In some cases, sentences will disappear altogether , and a highly confusing “word salad” is the result.

Schizophrenia is largely a social condition, and very disorganized behavior is also a prominent sign in many people with an acute episode.

As distressing as all these acute symptoms are, they will usually respond very well to antipsychotics (dopamine receptor blockers). The major issue with schizophrenia is what happens in between episodes. A combination of cognitive, emotional, and motivational symptoms will usually combine to form significant disability. As the DSMIV definition states, in order to get the diagnosis the patient will exhibit such disability that,

“For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset.”

Not everyone who presents with a psychotic episode will turn out to have Schizophrenia. In fact, the diagnosis should not even be made until symptoms of some form have persisted for six months.

Biological Treatment

Medication can be very helpful, especially in treating and preventing the acute episodes. It is important that an expert is involved in working out which treatment regime is best. It can sometimes be hard to determine which symptoms are those from the disease itself and, which may be caused by, for example sedation, which some medications can cause.

Psychological Treatment
Due to the difficulty many patients with Schizophrenia feel in expressing their emotions, traditional psychotherapy has a limited role in this illness, especially in the acute phase. There is some evidence for a role for CBT in residual symptoms and for Family Treatment, which may reduce the risk of relapse

Social Treatment
Helping patients with Schizophrenia cope better at home, feel like they are contributing to society, and have better relationships is very important. To demonstrate the love of God to people with Schizophrenia is surely part of the Church’s task.

Spiritual Treatment
Schizophrenia should be considered in the case of anyone who suddenly seems to develop very strange religious beliefs or experiences. This post is getting too long, so I don’t have time here to explain sufficiently (perhaps this should be a subject for a later post). In my clinical practice, when assessing Christians who had told me about unusual religious experiences for possible schizophrenia, I would sometimes ask them “what do people at your church feel about those experiences you describe?” The answer was almost invariably that church members, or in some cases the pastor had expressed that they were concerned about the experiences to the patient.

In addition, social withdrawal, or an apparent diminishment in the ability to function should lead to a mental health assessment. Sometimes people with schizophrenia may not readily volunteer their symptoms, and so an expert interviewer may uncover the reasons for the person’s change.

In essence with all the mental illnesses I have explored so far, a change in thinking, emotions, or behavior is the trigger to ask for help. I encourage you to refer to two posts in particular to help you detect what may be cases of mental illness in the future:

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  • an

    Nice article and good to see such a subject on a Christian website.
    It appears that the distinctions between schizophrenia,depression,autism etc are even less clear cut than thought,with National Institute of Mental Health just announcing it will no longer support the DSM and it’s methods of boxing separations between schizophrenia,depression etc..
    Science has now shown that the genes between 5 common “mental disorders” are linked and schizophrenia plus autism,for example, share some of the same genes.

    Also,it should be noted that a large portion of people diagnosed with “schizophrenia” don’t respond to the current available treatments and they are left suffering forever or commit suicide to escape their torture.
    There needs to be more emphasis that some can respond very we’ll and give them hope,while at the same time doing more for those who don’t.

    Reality is,the public is under the impression that Schizophrenia is only one disorder but research has shown it’s many.Psychosis can be caused from a vast range of things including b12 deficiency,Graves thyroid disease etc but most Psychiatrists forget all this and the public is kept illinformed.

    Of particular interest,is that some “diagnosed” with Schizophrenia have been found to have evidence of immune system attacking the brain-NMDA receptor antibodies.
    There can be changes to the brain on PET Scans at the medial temporal love areas

    Also,it should be noted

  • an

    Sorry,that should say medial temporal lobe areas.This could easily explain the inability to have social cognition deficits and blunted affect,lack of personality etc.
    Also,post mortem studies of their brains show neuroinflammation and evidence of excitotoxicity.
    Some of genes involved in the “schizophrenias” are genes that are involved in the immune system and autoimmune diseases.
    I propose that in a subset of patients,Schizophrenia is caused by autoimmune attack to the temporal lobes-the area of the brain that governs personality,affect,social cognition,speech organisations etc..
    This attack happens on a background of already genetic vulnerability-a genetically messed up immune system.
    Stress might also cause this vulnerability

    • “some “diagnosed” with Schizophrenia have been found to have evidence of immune system attacking the brain-NMDA receptor antibodies”

      I wrote about ‘brains on fire’, and the uncomfortable questions raised when the contrast is so stark between the biblical narrative and the scientific explanations we are offered, of even a classic case of demonic possession — as the rare encephalitis of the brain you mention, above.
      I have been asking theologians and Christian MHP’s, “How do we reconcile the biblical narrative with the medical accounts”? I have never heard a satisfying explanation of the etiology Jesus names for the diseases in the woman with scoliosis in Luke 13:16, the ‘lunatic’ in Matthew 17:15 — a medical term, stemming from the belief that epileptic seizures were affected by the phases of the moon, a theory as outdated now as the recently discarded ‘chemical imbalance’ explanation for brain disorders –- but, notice Jesus doesn’t use ancient medical terminology, and doesn’t diagnose the young man with a ‘moon imbalance’, but again frees the sufferer of an organic disease from a demonic spirit.
      Then of course, the inflammation of poor Legions’ brain:

      “For when Legion comes, crying piteously and running naked through our graveyards, cutting himself with stones as he demands, “What have you to do with me?”, will we ask him his name? Will we like it better when he answers, ‘Anti-NMDA Receptor Encephalitis’ — so neat and tidily settled!–or when he says, ” Legion!” will we respond like Jesus, with a stern “come out of him!” or do we identify him as a paranoid schizophrenic, a danger to himself who is then forced into emergency treatment with neuroleptics? And a diagnosis of a lifetime disorder hopelessly intractable, and difficult to treat without a course of many different drugs, each responding to the other’s iatrogenic effect?”
      from here, http://thenface2face.wordpress.com/2013/04/24/legions-brain-was-on-fire-or-where-have-all-the-demons-gone/

      • M K

        Karen-do you mean you think “schizophrenia” is demon possession or did I get that confused?
        In my view,there’s been dangers caused by churches trying to “exorcise” people who have delusions/hear voices etc and there’s also been dangers caused by psychiatrists forcing people to take medications (that in certain instances may be ineffective or causes side effects or severe weight gain,Parkinsons etc) and forcing them into involuntary hospitalisation.
        All Christian psychiatrists and all people of good will should treat people with dignity,kindness and respect their liberty and decision making choices at all times possible.Patients should be allowed to have a say regarding their treatment,their opinion on diagnosis,be a part of policy making etc in Psychiatry.
        The brain,like all organs can suffer diseases,neuroinflammation is found in some with”schizophrenia/s” postmortem.
        For others,it might be that severe stress can causes paranoia reactions etc.
        Medications are the answer for some,but not for all.
        Psychiatrys good when it’s a team approach with the patients.
        Psychiatrists causes immense trauma when it’s paternalistic approach,assumptions,fear based thinking etc..
        Where psychiatry + demon possession meet is a good question.
        Perhaps they just look the same but are different?

  • “As distressing as all these acute symptoms are, they will usually respond very well to antipsychotics (dopamine receptor blockers)”

    As distressing as this may be for me to bring up, aren’t you in fact treating this “disease” by inducing another, as your colleague in Britain, Dr. Bruce Charleton interestingly observes here, Adrian?

    “Treating one disease by causing another is actually a pretty mainstream therapeutic strategy in medicine – and especially psychiatry. The idea is to use a milder or temporary disease to treat a more severe or permanent one…Neuroleptics/Antipsychotics create Parkinson’s disease (or, rather, Parkinsonism, which may be reversible) for the treatment of fear, agitation, delusions, hallucinations, and hyperactivity.

    Patients with a range of very distressing psychological and psychotic symptoms were deliberately made to suffer from Parkinson’s disease by giving them dopamine blocking drugs. As well as producing the physical symptoms of Parkinsonism (tremor, stiffness, movement disorders), the drugs produced the psychological symptoms of Parkinsonism – emotional blunting and demotivation. Patients could no longer be bothered to respond to delusions and hallucinations.

    Unfortunately patients could no longer be bothered to do anything else, either and became asocial, withdrawn, idle, and without the ability to experience pleasure. Also, when treatment was sustained, the drugs were found to have a permanent effect (tardive dyskinesia) and to create dependence – such that withdrawal often caused a psychotic breakdown.

    In a recent development neuroleptic/antipsychotic drugs are being given to tens/ hundreds of thousands of over-active children (aka ‘bipolar’). Parkinson’s disease certainly puts a stop to these children’s hyperactivity! – and this is regarded as progress.”
    From his article published here: http://www.madinamerica.com/2013/05/treating-one-disease-by-causing-another/