When the head goes crazy: Initial warnings, causes, and treatment of schizophrenia. Image: pix4U – fotolia
What is schizophrenia?
Schizophrenia is a mental disorder that usually appears in late adolescence or early adulthood, but can break out at any age. Approximately 1% of people will develop such a mental illness in their lifetime. In the following you will learn everything about signs, therapies and causes.
Affects men as well as women, though the disorder appears earlier in men, usually in their late teens or early 20s – unlike women, who usually have their first episode in their 20s or 30s.
When the head goes crazy: Initial warnings, causes and treatment of schizophrenia. (Image: pix4U/fotolia.com)
The term "schizophrenia" describes a split psyche, i.e. someone who wants one thing and its opposite at the same time – not integrated ambivalence. The casual "are you schizophrenic" thrown around in everyday life?" is unfortunate, as it describes multiple personalities or mental disorders in which the personality is fragmented, as in borderline.
However, this does not characterize the disorder in the clinical sense. Indeed, the disease is characterized by a lack of coordination of personality, thinking, memory and perception.
Usually the condition starts with a pre-psychotic phase of increasing negative symptoms such as social withdrawal, neglected hygiene, unusual behavior, outbursts of anger and disinterest in school and professions.
A few months or even years later, the psychotic phase develops, with delusions, hallucinations, bizarre speech out of context, and disorganized behavior.
Individuals who experience onset later in life are first, more often women, and second, have fewer structural brain abnormalities or cognitive impairments. Schizophrenia usually lasts, continuously or in episodes, for a lifetime.
People who suffer from the disorder often hear voices that are not there. Some are convinced that others are reading their minds, controlling how they think, or conspiring against them. They feel invisible forces of "black magic" in their body. This exposes sufferers to extreme stress; they alternately withdraw or react wildly.
Schizophrenia symptoms and early warning signs
In some sufferers, the illness appears suddenly and without warning. But for most, it starts slowly, with subtle warning signs and a gradual loss of function – long before the first serious episode begins.
Families often report doing nothing, even though they noticed their child could not think clearly or withdrew from social situations. They did not consider these early symptoms to be a serious mental illness.
The most important early sign is "weird" behavior that does not make logical sense. However, the prepsychotic episode often breaks out in late adolescence, and even adolescents without the disorder often behave unusually and illogically at that time.
However, schizophrenics in this early phase show a marked decline in their ability to mentally implement experiences compared to normal puberty problems. They can no longer cope with difficulties in everyday life. Failure in school as in life. They also suffer from confusion to a high degree and constantly lose things.
Sufferers usually show signs of depression before schizophrenia develops. They seem emotionless. Deeply desperate.
Even in the early stages, many sufferers turn to narcotics to relieve their psychological pain. Some see this consciously as self-treatment.
At this stage, it is very difficult for lay people to recognize the onset of the disorder. For one thing, various other factors can trigger similar mental states in adolescents: Heartbreak, social ostracism, or a harmful peer coup.
On the other hand, cause and effect are difficult to distinguish: Drugs and their withdrawal symptoms, heroin as well as alcohol, meta-amphetamines, or the "sniffing" of solvents sometimes lead to psychotic symptoms – especially in young people.
Unstable teenagers who fall in love unhappily and drown their sorrows quickly fall into states that fluctuate between depression and psychosis.
In addition, the depressive episodes make one think of clinical depression rather than schizophrenic disorder, and when the hallucinations do not come to the fore, it is difficult even for professionals to separate one from the other.
Many schizophrenia patients suffer from strong hallucinations or delusions. (Image: vchalup/fotolia.com)
Patients appear emotionally numb – as if they do not feel any emotions. They also seem "lost" – like uprooted people. They don't seem to feel happiness or excitement. Their language often lacks expression.
But beware: traumatized people suffer similar things. This includes people suffering from borderline syndrome as well as all disorders of the dissociative type, post-traumatic stress syndrome and clinically depressed people.
However, hallucinations are a hallmark. Although borderliners or post-traumatized persons also suffer from hearing voices as well as other sounds and seeing things that do not in fact exist, the degree to which schizophrenics have hallucinations differs significantly.
Most patients experience auditory hallucinations – these sounds and tones that exist only in their brain are perceived as real. Hallucinations can involve all five senses, but auditory perceptions are the most common, followed by visual perceptions.
The hallucinations of schizophrenics are usually significant for the sufferers. This distinguishes them, for example, from hallucinations, which arise from disturbances in the nervous system but are not pathological in the sense of a mental disorder. For example, someone who regularly has a beeping in their ear is annoyed by it, but they know it is a hallucination.
Borderliners also usually know when the hallucinations subside that they are hallucinations. Schizophrenics, however, not only hear voices that often whisper obscene phrases or give absolute commands, they are also firmly convinced that it is reality in every sense of the word.
Even more, sufferers often develop a system of conspiracy fantasies and irrational models to rationalize these voices: Some believe that ghosts are possessing them, and presumably many of the "demon-possessed" people exorcised by church exorcists are schizophrenics. Others even think they are receiving divine orders to perform world-saving tasks.
The danger of thinking magically is great for those affected. It becomes fatal when in times of crisis – and every schizophrenia that has broken out is a life crisis – they get involved with psychotic cults and/or esoteric healing teachings that confirm them in this magical thinking.
Schizophrenics realize very well that their perception separates them from "the others" as well as their behavior – and they suffer massively from it. Magical thinking then reinforces to them that "normals" are envious of their "supernatural abilities". In this way, the sufferers cement their separation from reality.
They also express inappropriate feelings; for example, they laugh when their loved ones are grieving because a loved one died.
Sufferers often believe that others are talking about them behind their backs. Or they suspect others of secretly poisoning them. Or they accuse others of intruding into their thoughts. They think that burglars are ransacking their home. As "evidence" serve missing objects, which the affected persons themselves have lost.
Paranoid schizophrenics even develop "theories" that are as complex as they are fantastic: secret services, governments, the Mafia and other conspiracy groups have them in their sights. Everywhere the sufferers recognize "secret signs" that confirm their paranoia.
A main characteristic of the disorder is an obsession with religion and the occult. If relatives notice such a new as well as fanatical interest in a young person, they should observe it closely.
In an erupted schizophrenia, personal hygiene goes steeply downhill. For example, sufferers don't shower, they don't comb their hair, and they don't take care of their clothes. This neglect is very different from "slovenly behavior": it is not a matter of someone not washing for three days because they feel like "hanging around"; many schizophrenics smell and look as if they have been living on the streets for months.
Neglect and social isolation is a common consequence. (Image: gstockstudio/fotolia.com)
Sufferers' social relationships break down – schizophrenia makes it hard to form close bonds. Even for confidants who know about the disease and are sensitive to those affected, it is increasingly difficult to find an approach.
Sufferers withdraw from social activity – they isolate themselves from society. They avoid school, work and generally everything that forces them to talk to other people.
Sleep disturbances are part of the disease. Sufferers often stay awake for days, or they sleep for many hours without feeling recovered afterwards.
Patients often harm themselves. On the one hand, they suffer accidents as a result of their behavior – they run in front of a car, break their foot or injure themselves in the household, because their distorted perception of reality does not allow them to behave in a way that is adapted to reality.
On the other hand, they actively attack themselves, cutting themselves with razor blades, for example, to drive the "evil spirits" out of their bodies. Suicide attempts are also among the symptoms.
Causes of schizophrenia
A family history of schizophrenia has been known for a long time. People with close relatives suffering from schizophrenia are more vulnerable than people without such relatives.
A child with schizophrenic parents, develops schizophrenia themselves in 10%. An identical twin has even a 40% to 65% chance to get sick. Second-degree relatives such as uncles, aunts, or grandparents are still at increased risk.
Complications during pregnancy and birth also play a role: heavy physical labor during pregnancy, or low weight of the newborn baby. Viruses and infections in the infant also have an effect.
New studies suggest that children of elderly fathers are at higher risk. One hypothesis was that damaged sperm causes up to 20% of all schizophrenias. Statistically, 1 in 121 children of a 29-year-old father is at risk of developing schizophrenia, but 1 in 47 for a 54-year-old.
However, certain situations promote the risk of developing schizophrenia: Stressful life events are considered the most important social trigger of the disease – from job loss to divorce to abuse.
Substance abuse is also suspected of promoting schizophrenia: Cannabis as well as cocaine, LSD and amphetamines.
Social environment triggers are almost always associated with the development of the illness – but they are not the only cause. Many people suffer the same or worse crises without getting sick – the biological disposition has a decisive meaning.
Schizophrenia can occur in different forms. (Image: eyeQ/fotolia.com)
Different types of schizophrenia
Schizophrenia fans out into five types: The paranoid, the disorganized, the catatonic, the undifferentiated, and the residual. The diagnosis is based on the characteristics that are prominent in the sufferers. These symptoms can change during the course of the illness, and then the diagnosis changes as well.
The paranoid schizophrenia is the most common form and laymen often equate it generally with the disease. Those affected by it suffer in excess from hallucinations, delusions of conspiracy and persecution. They hear voices, they believe they are cursed, and they become ensconced in a horror world where they are surrounded by invisible enemies.
Paranoids can usually function better than other schizophrenics. Your thinking and behavior is less disorganized. For example, they may converse clearly with "normals" about "God and the world" during less psychotic periods.
The "normals" merely wonder, for example, at a certain point in the conversation, why Angela Merkel and the BND, of all people, should be responsible for the fact that the lock on the victim's mailbox is broken.
These "calmer" phases alternate in paranoid schizophrenics, however, with episodes in which the psychoses become overt. Sufferers then yell in public, for example, to drive away the "invisible forces" that are "nesting in their bodies".
They make obscure movements and obscene gestures to "fight the spirits", their arms sometimes twitch, they tear off their clothes or scratch themselves, and they vomit themselves dry.
Some sufferers also rationalize this psychotic behavior, calling themselves action artists and mixing their constructions with memories and quotes from the real outside world.
This behavior is reminiscent of political cults or classic conspiracy theories. People who distrust everything and everyone as much as they blame certain groups working in secret for diffuse fears often suffer from anxiety disorders – but most of them are not schizophrenic. Perhaps, however, the analysis of conspiracy thinking offers approaches to understanding the condition.
Unlike other types, paranoids can usually organize their language. Anger, confusion and extreme anxiety, on the other hand, are shared with other sufferers. The paranoia can even turn into violence – towards things and people.
The dominant symptoms of disorganized schizophrenia revolve around disorganization. Unable to control their behavior, speech and thinking. What they say makes no sense, even to themselves, and their thinking finds no focus.
The affected person cannot organize the simplest things of everyday life. Obscure gestures and surprising behavior are common to. Hallucinations, on the other hand, haunt them less than the paranoid. Disorganization develops gradually. at an earlier age than the symptoms of other sufferers. Washing and dressing is difficult for them; they do not understand why they should care about personal hygiene.
The prognosis for this form of the disease is unfortunately difficult: the symptoms begin in teenagers and slowly increase; to a lesser extent, however, many "normal" pubescents also exhibit this behavior – out of defiance, or because they do not know where they stand in life.
The catatonic schizophrenia characterizes disturbances in motor function. The afflicted reduce their physical actions to the point that arbitrary movements stop abruptly. Or their movements increase without the sufferers being able to arbitrarily draw a line. For example, they row their arms incessantly when talking, or they turn their head to the side in a jerky manner.
They involuntarily mimic the facial expressions and behavior of others and repeat the words others say.
These sufferers come across to others as either clearly disturbed or as provocateurs who make fun of their peers. If the social environment recognizes that "something is wrong" with the affected person, there is still a high risk of misdiagnosis: The catatonic behavior is also shown by clinically depressed people and bipolars – rarely it also occurs in diseases of the central nervous system, for example in Parkinson's disease. The abrupt movements and imitation of other people's facial expressions, gestures and words also points to Tourette's syndrome.
Undifferentiated schizophrenia is the diagnosis when sufferers show various symptoms but do not clearly correspond to one of the four defined types. Hallucinations, disorganized speech, and motor disorders occur.
Symptoms can change: Affected persons behave like paranoids for a time, then more like disorganized persons, and then like catatonics.
Residual schizophrenia Occurs when the active symptoms disappear. For example, those affected no longer have hallucinations. Passive symptoms, however, remain, for example, emotional indifference, or lack of goal-directed interests, then and now the active symptoms reappear in a mild form. This mild form of the disease can last a lifetime or disappear completely.
Hardly any mental disorder can be instrumentalized politically as well as schizophrenia, especially in its paranoid form.
A political critic, for example, whom the intelligence services monitor and whom the government makes life hell for by covert means is not schizophrenic. On the contrary, when he makes the assaults public, he shows facts. Even if he only suspects that the government is monitoring his Internet, bugging his home, or that secret service agents are breaking into his home, this is a reasonable suspicion.
"Outing" him now as sick is a tried and true means of cold-cocking oppositional people. Government abuses then appear to be delusions with no basis in reality.
Ritual practitioners of so-called primitive peoples also viewed European colonizers as mentally ill; shamans were considered schizophrenics. The people who took the advice of these spiritual teachers seriously were therefore spiritually retarded people who followed crazy people.
Although a shaman goes through phases in his career whose behavior is reminiscent of that of paranoid schizophrenics, they hear voices, they see "ghosts", they perform extreme gestures and move in a "different world" from the normals.
Their job, however, is precisely to provide spiritual assistance to their community – from medicine to hunting, the right stand for the camp, weather forecasts and all that the West calls pastoral care.
They are not recognized as teachers until they show success in social matters. Moreover, after the painful phase of irritation, they voluntarily enter extraordinary mental states – unlike schizophrenics.
Family censure as the basis of supposed schizophrenic behavior is mentioned by Paul Watzlawick. When parents reject a child for how the child sees himself, the child eventually distrusts his own senses.
The child becomes insecure; parents now increasingly urge him or her to think "correctly". But if the child keeps his "strange views", the parents call him crazy.
For the child, the parents are vital, therefore it now searches for supposedly hidden contexts of meaning, which seem to be clear to the others, but not to itself – the search for such non-existent orders becomes more and more cranky, the more the parents resist recognizing the child's right to its own perception.
Those who are unaware of this social background to the behavior, but see only the affected person, may mistakenly make the diagnosis.
Schizophrenia in males and females
The disorder is about equally prevalent in males and females, but the sexes differ in the age of onset of the disease. Males usually develop the disease between 15 and 20 years of age, females between 20 and 25.
Men, however, not only develop the disease earlier, but their symptoms are also worse. This is probably because the female hormone estrogen protects women against some aspects of the disorder.
In addition, the age of first onset, the course of the disease, the clinical symptoms and the effect of treatment of people with schizophrenia are different in men than in women. Women develop the first psychotic episode especially when estrogen levels are low, for example during menstruation and menopause. However, the symptoms can also occur just during pregnancy, when their bodies are producing particularly high levels of estrogen.
Men are usually affected earlier by the disease, they have a worse course, fewer affective symptoms, more frequent maternal complications, and a lower familial disposition.
Affected women show more anxiety, illogical thinking, disproportionate affects and bizarre behavior than men, i.e., more affective symptoms. Antisocial behavior, on the other hand, is more common in affected men than in women.
Men often only go to a clinic and are also often only taken seriously when they show severe symptoms. This difference in clinical care demonstrates the stigma of men seeking help.
The social prere on men to be "strong" probably makes it harder for them to seek help.
Women are generally more successful in maintaining close friendships, therefore they can draw on a network of support. Many men lack the ability to form intimate friendships, and therefore lack that support.
In general, it is easier for women who suffer from the disease to deal with the onset of the disease than for men.
Affected people usually die earlier than people without the disease. 40% of them also die an unnatural death – especially suicide. The risk of committing suicide is 4.9% for schizophrenics. Recognizing those at risk is essential for clinical treatment, but uncertain despite all efforts.
Compared to suicide attempts by people without a diagnosis, the suicide attempts by sufferers are very serious and require medical treatment. "Suicide attempts" as cries for help or as blackmail hardly occur in schizophrenics. The urge to take one's own life is generally great, and the methods chosen are more surely fatal than in the general population.
The typical suicide candidate among schizophrenics is young, white, and unmarried; they can still function reasonably well in everyday life; they have had post-psychotic depression and a history of substance abuse; and they have tried to walk away from life a few times.
Thus, the greatest danger of suicide does not occur during acute psychosis, but when affected individuals are again thinking relatively clearly.
Social consequences of the disease, not the symptoms themselves, pose the greatest risk: hopelessness, social isolation, a disease flare-up after a stable phase, lack of support, family stress, professional and psychological instability.
However, the link between substance abuse and suicide in schizophrenics is unclear, and valid studies are scarce. For example, one study showed a link between illicit drug abuse, the disorder, and suicide, but no link to alcoholism. The question of whether it was the chicken or the egg first is hard to answer. If substance abuse is a reaction to the condition, so is suicide?
In any case, alcohol and substance abuse worsen the situation of those affected: Violence, aggression, homelessness are often the result of substance abuse in the first place; psychiatric symptoms worsen as a result of substance abuse; drugs promote comorbidities such as depression and anxiety disorders; sufferers also slip into criminality.
Suicidal thoughts are a great danger for those affected. (Image: marjan4782/fotolia.com)
A higher IQ and education level increases the risk of suicide in sufferers. They are likely to make the sufferers more aware of the feeling of being limited by their illness for the rest of their lives. A strengthened self-perception, a realistic assessment of the illness and the need to seek treatment lead to a higher risk of suicide. This is especially true when self-reflection results in hopelessness.
Cannabis and schizophrenia
Cannabis contains the substance tetrahydrocannabinol (THC). THC travels through the bloodstream into the brain and has a psychoactive effect: users feel relaxed, feel an urge to talk, their perception of space and time is confused, they are sedated, and their ability to concentrate and remember decreases. For some, the use also leads to diffuse fears up to paranoia.
Regular use of cannabis proven to increase risk of developing schizophrenia.
Schizophrenia and culture
Studies show that the number of sufferers is similar in different cultures. The first episode at a young age also coincides.
Some researchers suggest that the disease originates from the human ability to communicate with symbols. Accordingly, it is linked as a disorder to the human peculiarity of using language. While the disease itself exists in many cultures, the way it is dealt with varies considerably.
The core characteristics of the paranoid form, namely hallucinations and the idea of being possessed by invisible forces, mean the loss of the ability to adapt symbols to the social environment and to develop them in communication with other people.
The illness is generally more severe in industrialized countries than in traditional societies. Traditional societies interpret mental disorders as the work of supernatural forces, and thus sufferers are not considered sick individuals. This has the positive side effect for them that they do not suffer from a social stigma like sufferers in industrialized countries – and social isolation is considered to be decisive for the severity of the disease.
Sufferers in traditional societies are firmly integrated into their families, and thus have a source to stabilize themselves. In addition, the lack of specialized jobs makes it more likely for sufferers to find their way back into the community after a psychotic episode.
Behaviors that are considered symptoms in the Western world mark spiritual rapture in traditional societies. A person claiming to be a god on earth would probably run under schizophrenic in the West, but in India he would be considered a human incarnation of a Hindu god.
People who have experienced psychosis are often considered spiritual mediums in traditional societies, and shamans, who serve as intermediaries between the natural and spiritual worlds, are highly respected for their experiences in the "supernatural world". Communicating with ancestors and spirits is not considered a hallucination, but part of cultural heritage.
Mental states resembling temporary psychosis are induced by traditional cultures through drumming, chanting, praying, fasting and meditation. In South America, indigenous people use hallucinogens such as ayahuasca, inviting animal spirits such as the jaguar to enter their souls. In this state, they perform healing rituals for members of their community.
However, people suffering from symptoms diagnosed as schizophrenic disorder in the West are not considered shamans even in indigenous cultures. A shaman is rather just someone who experienced and mastered such states. Unlike schizophrenics, he can distinguish between the material world. Distinguish clearly from the "invisible world". He is not a sick person, but the therapist of his society.
American Indians are familiar with "ghost sickness". With it, they describe symptoms of weakness, emotional coldness, anxiety, hallucinations, confusion, and a loss of appetite. It is possible that those affected are schizophrenics. Against this cultural background, they are regarded as victims of evil spirits.
Patients in industrialized nations differ from those in traditional societies in the course of the disease. In the West, the disease is usually a chronic condition, rather than a sudden onset of symptoms. Psychotic reactions of short duration are common in traditional societies.
These psychotic reactions are characterized by paranoia and hallucinations, accompanied by an intense fear of being persecuted by witches and sorcerers. In contrast to classical schizophrenia with its phases of lack of emotion and withdrawal from reality, psychotic reactions in traditional cultures are expressed by excitement, confusion, and extreme emotions.
Research on whether these psychotic states correspond directly has yet to be conducted. In any case, it is clear that the way society deals with the symptoms has a significant influence on the course of the disease.
It is possible that the emotional coldness and social withdrawal of those affected is not a "biological" symptom, but a reaction to the social stigma of being crazy.
In traditional societies, where these "madnesses" have their place as "working of the spirits," sufferers would consequently find it easier to live with these symptoms.
Treatment of schizophrenia
Schizophrenia is a chronic illness that affects all aspects of the sufferer's life. Treating them therefore requires medical, psychological and psychosocial methods at the same time.
Treating schizophrenics requires an interdisciplinary team: a psychopharmacist, a therapist, a social worker, a nurse, a language coach and a case manager. Clinical pharmacists. Internists also play a role.
Medication is necessary. However, because the drugs for the symptoms can have severe side effects, some sufferers refuse them.
Antipsychotic medications are the most commonly used drugs to treat schizophrenia. They influence the neurotransmitters dopamine and serotonin.
In talk therapy, individuals work with a therapist to learn more about the thoughts, feelings, and behaviors associated with their condition.
Psychosocial treatments should be tailored to individual needs. It is about living with the disorder and enjoying life despite the disease, but also about very practical organization of everyday life.
Those who come to the clinic after a psychotic episode have often lost their homes, have no jobs, have to rebuild a social life first, find meaning in life, build partnerships, maintain friendships, and launch their careers. Your professional helper should not appear as a controller, but should cultivate a relationship with the sufferer based on trust and optimism.
Social skills can be trained in psychosocial treatment, but work support and family therapy are also part of the program.
In individual therapies, patients meet regularly with their therapist to discuss current thoughts, problems, feelings and relationships. Sufferers learn more about their illness as they learn about themselves. Can thus better deal with their specific problems in daily life. The regular meetings are important to help the patient better distinguish what is real and unreal and train them to focus on reality.
Role plays are part of the therapy. Affected individuals act out social interactions while the therapist guides them and gives them positive feedback.
Schizophrenics learn small talk in this way, for example. Indeed, the symptoms get worse the more the sufferers isolate themselves, and since schizophrenics have particular problems matching their inner symbolic worlds to the social environment, small talk helps them to develop their symbolic worlds together with others.
The family should participate in psychosocial treatment as much as possible. Educating affected families about the illness alleviates social stress within the family as well as helping relatives to support the sufferer. Practical life assistance includes money management and job training. (Somayeh Khlaeseh Ranjbar, translated by Dr.