Gaba Telepsychiatry

A Deeper Look Into Schizophrenia

Virtual Psychiatrist
Fact Checked by
- Dr. Gundu Reddy
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Schizophrenia is a mental health condition where a person suffering from it, may experience delusions, hallucinations, extreme agitation, limited expressions, and much more. People suffering from schizophrenia also face difficulties in fully exercising their cognitive or thinking skills, which may sometimes lead to irrational decision-making, potentially resulting in harmful or irreversible consequences.

It could also cause psychosis, a condition where a person may lose sense of reality, and experience delusions, and hallucinations; entailing most of the symptoms of schizophrenia. As per psychiatrists at (Gaba Telepsychiatry), One percent of the population worldwide suffers from schizophrenia. Furthermore, more than two out of three people with schizophrenia do not receive specialist mental health care.

It is a sad reality that people suffering from schizophrenia are poorly understood, and more vulnerable to discrimination, and violation of human rights, than a person not suffering from schizophrenia . A lot of stigma and false assumptions surround schizophrenia. People suffering from schizophrenia require care, comprehensive treatment and most importantly, understanding. The first step in helping people with schizophrenia is taking the time to understand the condition and the day-to-day experiences of sufferers.

What are the Symptoms of Schizophrenia?

The symptoms of schizophrenia are put into three categories: Positive symptoms, Negative symptoms, and Cognitive Symptoms.

Positive Symptoms

Some symptoms of schizophrenia include hallucinations, delusions, abnormal physical behavior, and disorganized thinking/ trouble concentrating. These symptoms are categorized as ‘Positive Symptoms’.

The term ‘positive’ refers to the presence, rather than an absence, of additional symptoms that hinder a person’s mental functioning. Positive symptoms include :

  • Hallucinations: Hallucinations occur when a person hears, sees, smells, or feels things that no one else does. These include seeing particular objects, individuals, patterns, or lights, hearing angry, demanding voices, sometimes, in the form of whispers, or murmurs; these voices could be good, but more often than not, these are negative, smelling something that triggers the individual, or feeling like things are moving/ crawling on the individual’s skin.
  • Delusions: Delusions are false thoughts, ideas or conceptions that are far from reality. Delusions lead people to think that their thoughts are the ultimate truth and therefore, lead them to act on their thoughts, resulting in unforeseen outcomes. For instance, people suffering from delusions might think that a catastrophe is about to occur, that their partner is cheating on them, or that certain gestures or comments are being directed at them. Most people with schizophrenia suffer from delusions as well.
  • Abnormal Physical Behavior: Abnormal Physical Behavior refers to a lack of ability to function in regular tasks daily. A person suffering from schizophrenia may not respond to instructions, make peculiar or inappropriate gestures/ postures, not show any emotions, or either portray excessive movements or no movement at all. For example, an individual with schizophrenia may turn around a lot, or sometimes, may not move at all.
  • Disorganized Thinking: Disorganized Thinking is when an individual cannot logically connect thoughts in their mind, may shift from one thought to another without drawing a connection between the two, or may also speak in sentences that are not coherent to others. People with schizophrenia have disorganized thinking which makes it hard for them to get their thoughts/ points across, as their thoughts are jumbled which leads to incoherent speech.

Negative Symptoms

Some other symptoms of schizophrenia include limited emotions, physical inactivity, incoherent speech, withdrawal tendencies, and difficulty in planning or sticking to a plan. These symptoms fall under the category of ‘Negative Symptoms’ of schizophrenia. The term ‘negative’ here, means an absence of/ lack of basic functionalities that are present in most people. These are the symptoms that are either missing or underdeveloped in individuals with schizophrenia. Let’s find out more about these:

  • Limited Emotions: People with schizophrenia may show little to no emotions. There are some terms used to describe this condition; Flat affect: lack of outward expressions or emotions, Anhedonia: reduced experience of pleasure, and Avolition: diminished motivation. All these negative symptoms involve emotion. For instance, an individual with schizophrenia may express no expressions of sorrow after hearing unfortunate news, or on the contrary, may not express excitement after hearing joyous news.
  • Physical inactivity: Schizophrenia leads people suffering from it to lead a sedentary lifestyle. This also leads to low physical activity, for example, lack of exercise, which as a result, may expose the individual to the dangers of a physical illness. For instance, due to the sedentary lifestyle that they live, people with schizophrenia are at a relatively higher risk of developing heart diseases, high blood pressure and diabetes, than people who do not suffer from it.
  • Withdrawal tendencies: Withdrawal tendencies, also referred to as Social Withdrawal, is a lack of socialization with fellow peers. Schizophrenic individuals withdraw from socializing, or isolate themselves from the world. Also, they withdraw from taking up responsibilities. This could occur due to hallucinations, disorganized thinking or an irrational fear of social contacts. Social Withdrawal falls under Anhedonia, a condition where a person experiences reduced/ diminished pleasure, as discussed in the first point.
  • Difficulty in Planning: A person suffering from schizophrenia may experience avolition; a condition in which an individual is not motivated to do something. So, a schizophrenic person, due to a lack of motivation, may not partake in a planning process, or stick to a plan. They have trouble staying on a schedule or sometimes, finishing what they started. For instance, an individual suffering from schizophrenia may not be able to carry out a simple task of grocery shopping, stemming from a lack of motivation.

Cognitive Symptoms

Cognizance is awareness of cognitive processes; awareness, knowledge, perception, and realization. People with schizophrenia face difficulty in dealing with their working memory and show cognitive symptoms. Some of these include cognitive dysfunction for attention, concentration, memory, language, reasoning and problem solving. Let’s delve deeper into these:

  • Cognitive Dysfunction for Attention: Cognitive Dysfunction for Attention, also known as impaired attention, occurs when a person with schizophrenia has trouble focusing on a task. As the name suggests, impaired attention makes it difficult for schizophrenic individuals to pay attention to something as they experience having reduced attention. This is also known as attention deficit.
  • Concentration: Similar to impaired attention, schizophrenic individuals find it hard to concentrate on something. For instance, an individual suffering from schizophrenia may find it hard to concentrate in lectures, classes or meetings.
    Memory: Impaired memory is linked to the lower levels of activity in an area of the brain known as the prefrontal cortex. So, people with schizophrenia have a difficulty in retaining their memory. For example, schizophrenic individuals may not be able to remember a new phone number, do mental math, keep track of a schedule, or remember a short grocery list.
  • Language: Due to a decrease in brain activity in the prefrontal cortex, verbal learning becomes hard for schizophrenic individuals. They have trouble retaining what they recently heard or read, and expressing themselves, which, as we discussed earlier, stems from disorganized thinking, resulting in incoherent speech.
  • Reasoning and problem solving: Reasoning and problem solving are parts of executive functioning. Usually, to solve a problem, we first identify it, analyze it, and then try to find a solution; basically making use of our reasoning and problem solving skills. However, people with schizophrenia find it difficult to perform reasoning tasks because they have decreased brain activity. Also, they perceive their delusions and hallucinations as the truth, which makes it harder for them to reason with rationality, and come to logical conclusions.

Disorganized Symptoms of Schizophrenia

  • Incoherent speech: As covered in the previous section, incoherent speech is the result of disorganized thinking. It is when schizophrenic patients cannot organize their thoughts which results in them speaking in incoherent sentences, which people cannot comprehend. Incoherent speech renders it difficult for people with schizophrenia to communicate properly and get their voices heard.
  • Disorganized thinking: Most individuals with schizophrenia do not show obvious disorganized thinking when taking medication. Previously there were four types of schizophrenia, paranoid schizophrenia being the most common and least severe and disorganized type being the most severe. Although the DSM V has eliminated the subsets, only a subset of individuals with thinking show disorganized symptoms.

What is the Difference Between a Delusion and a Hallucination?

Although used interchangeably, the terms ‘delusion’ and ‘hallucination’ carry very different meanings from one another. Both conditions, however, are symptoms of schizophrenia. Schizophrenic individuals suffer from delusions, as well as hallucinations, which are detrimental to their health. They have one thing in common; they give the person a false sense of reality; both are false but seem very real to the person experiencing them. These hinder a person’s day- to- day activities, giving them a feeling of hopelessness and isolation. So, what is the difference between the two? Let’s take a look:

Delusions

A delusion is a false belief that the person suffering from schizophrenia perceives as the truth. For instance, a person with delusions might think that a certain someone is trying to harm them, or that their partner is cheating on them. Following are some categories of delusions:

  • Grandeur: Delusion of grandeur is when a person starts to believe that they are a prominent personality, or that they are famous. They start to have a false sense of superiority and think that they are either very influential or in a great position of authority. For instance, a person with delusion of grandeur may start to believe that they know an eminent personality, or that they have excessive riches.
  • Persecutory: Persecutory delusion is a common form of delusion. It occurs when a person suffering from it feels that they are being stalked, spied upon, conspired against, or harassed by either individuals or a group of people. For example, a person with persecutory delusion may constantly feel that their food is being poisoned, or that their peers are conspiring against them.
  • Jealousy: Delusion of jealousy occurs when a person starts to think that their partner is being unfaithful without any proof. These doubts may be unwarranted which might severely affect their relationship with the person. The person with the delusion of jealousy could sometimes go to extreme lengths to prove their false claims, which again, could be extremely damaging.
  • Erotomania: Erotomania, or delusion of love occurs when a person starts to think that a certain individual is in love with them. They become fixated on that person, show inappropriate forms of jealousy, and take inimical steps when the other person is seen with their partner. This condition is also known as De Clerambault’s Syndrome.
  • Somatic: Somatic delusions occur when a person feels that there is something wrong with them. Consequently, they visit multiple doctors, surgeons, and physicians for consultations. This condition is harmful as it could lead the person to consider ending their life. Sometimes, they also feel that things are crawling on their skin. This is called monosymptomatic hypochondriacal psychosis and is a part of somatic delusional disorder.
  • Folie a’deux: Folie a’deux, or induced delusions occur when two people who are in a close relationship, share the same beliefs of grandeur or persecution, despite being culturally or physically separated. Usually, the dominant personality (inducer) influences the other person and convinces them to believe their delusions.
  • Bizarre: Bizarre delusions occur when a person starts to believe that an event (that is implausible or bizarre) is about to happen. For instance, a person suffering from bizarre delusions may believe that the world is about to end, or that there is going to be an alien invasion.
  • Non- bizarre: Non- bizarre delusions involve situations that could happen in real life, such as being followed, being deceived or being cheated on. However, these claims may either be untrue or exceedingly exaggerated. For example, a person with this condition might have a false belief that their partner is being unfaithful to them, when in reality, that might not be the case.

Delusions are things that you think or believe but you do not taste, smell, touch or hear delusions.

Hallucinations

Hallucinations are false perceptions of events or objects that involve our senses. People who suffer from hallucinations may not necessarily suffer from schizophrenia. There are other causes of hallucinations like, Parkinson’s disease, epilepsy, brain tumors, migraines, and more. These are perceptions of things that are not present/ there, hence, calling them false perceptions. For instance, a person suffering from this condition may see a certain pattern repeatedly, hear voices in their head, or smell a certain smell. Following are some categories of hallucinations:

  • Visual: As the name suggests, Visual hallucinations occur when a person sees things other people do not. They either see things in a way others do not, like wrong shapes, things moving in different directions, or things that others around them do not see. This category involves another condition called ‘occipital’ in which an individual sees brightly colored shapes or spots. For instance, an individual may see a ‘STOP’ sign repeatedly, despite it not being there, or as mentioned, see bright lights flashing.
  • Auditory: Auditory hallucinations occur when people start to hear voices no one else can hear. They hear these voices in their heads, more often than not, instructing them to do something. As mentioned above, these voices could sometimes be good, but are usually condescending and angrily demanding in the form of whispers or murmurs, but could be loud too. For instance, people with schizophrenia have claimed that the voices in their heads often tell them negative things about themselves, which results in low self- esteem and self- confidence.
  • Olfactory: Olfactory hallucinations are when an individual smells an odour around them that is not there or smells an odor from their bodies. For instance, a person might smell smoke and think there is a fire somewhere around, when in reality, that might not be the case.
  • Gustatory: Gustatory hallucinations occur when an individual tastes something odd while drinking or eating, when in reality, there is nothing wrong with what they are consuming. They have a lingering feeling that something is wrong with their food or drink because they keep tasting something odd. For instance, the most common tastes people taste are bitter, rusty, salty and metallic tastes.
  • Somatic: Somatic hallucinations are when a person feels like something is either crawling on their skin, or that they’re being touched, when no one is around. For instance, people with somatic hallucinations feel that they’re being tickled, there’s a bug crawling on their hand, or they’re being hit with blasts of hot air on the face, when all of this is not real. These are also called tactile hallucinations.

These days, the trend of ‘delulu’ is taking the internet by storm. Gen Z is using the term ‘delulu’ online, to casually explain their dating experiences, disregarding the real meaning behind the word.

What Types of Hallucinations Happen in Schizophrenia?

To give you a rundown of above- mentioned symptoms, hallucinations are false perceptions of things that involve our five senses, that people with schizophrenia experience. There are five types of hallucinations:

  • Visual: Visual hallucinations occur when a person sees things other people do not, like wrong shapes or things moving in different directions. This category involves another condition called ‘occipital’ in which an individual sees brightly colored shapes or spots.
  • Auditory: Auditory hallucinations occur when people start to hear voices no one else can hear. They hear these voices in their heads, more often than not, instructing them to do something. It is common in schizophrenia to hear multiple voices talking to each other, talking to you or commenting on your actions (walking commentary).
  • Olfactory: Olfactory hallucinations are when an individual smells an odor around them that is not there or smells an odor from their bodies.
  • Gustatory: Gustatory hallucinations occur when an individual tastes something odd while drinking or eating, when there is nothing wrong with what they are consuming. They have a lingering feeling that something is wrong with their food or drink because they keep tasting something odd.
  • Somatic: Somatic hallucinations are when a person feels like something is either crawling on their skin, or that they’re being touched, when no one is around. These are also called tactile hallucinations.

What Does it Feel Like to Have Schizophrenia?

Most people with schizophrenia experience life quite differently from people who do not suffer from it. Most people report after the first psychotic break even if symptoms respond to medication life is never quite the same again.

Every Day is a Battle

There are battles people with schizophrenia secretly fight every single day. The daily battle is ‘not to give up’.

One woman posted her experience with schizophrenia on the Internet. She told the readers how she was diagnosed with schizophrenia at the age of eleven, when she did not even understand the concept of a mental illness. She stated that she heard voices in her head, particularly of a man, telling her to hurt herself and those around her. She also told the readers how she saw shadowy figures around her at all times, and thought they were coming to take her. It was when her parents took her to the doctors that she came to know of schizophrenia. She was put on some anti- psychotics to curb her hallucinations. She remembers how she felt like an outsider and experienced social withdrawal, which resulted in her isolating herself.

Now that she is an adult, she looks back at her childhood days, and tells the readers that if she could go back and say one thing to her younger self, she would call her younger self a ‘warrior’ and would tell her to not give up.

A Feeling of Vulnerability

Even when medication starts working and delusions and hallucinations resolve, people with schizophrenia may appear completely ‘normal’ to everyone else. However, most experience a feeling of vulnerability, not being absolutely sure if and when they will relapse and how they are perceived by others.

Never Being Quite Sure

Most of us can state with certainty what we have seen or not seen, heard or not heard. A person with schizophrenia even when not experiencing delusions or hallucinations, may feel that they cannot say with absolute certainty what is real or not real.

Stigma

The person constantly feels like they are in their head, while simultaneously tolerating hearing other voices in their head, telling them all kinds of negative things. They see, hear, smell, taste, and feel things others do not, which gives them a sense of inferiority; they feel as if the people around them would not understand them, which further drives them away, resulting in them completely distancing themselves from their peers. The term schizophrenia is often used as a derogatory term, and most schizophrenics have heard the term being used with negative connotations.

Some TV series outrageously portray the concept of hallucinations in bad taste. This is not only ungracious, but also disrespectful to those who suffer from these conditions in reality, as these are very much real- life problems people go through.

A Feeling of Alienation

Schizophrenia further discourages a person from communicating with others as they cannot put into words what they are feeling or thinking as their thoughts are disorganized, which results in unintelligible speech. They also cannot remember things that would be easy for other people to remember, like addresses, schedules, etc. Schizophrenia may seem like a quagmire to the person going through it. It’s like an inescapable trap that follows them no matter where or how far they go.

Paranoia

It is hard to imagine living in a world where you think everyone is lying to you; your partner is being unfaithful to you; someone is stalking/ following you; and you see brightly colored patterns at random times of day. People with schizophrenia go through these experiences every day. They live their lives with these experiences, with a false perception that all of this is real.

This is also called Paranoia. It is a feeling that makes individuals feel that they are being threatened, or that they are in imminent danger. It could also be that they feel others are out to ‘get them’. This is an irrational fear, which leads people to mistrust others, and they always stay hyper- alert. People with schizophrenia sometimes become paranoid because their delusions or hallucinations lead them to suspect anything and everything.

Loss of Fine Cognitive Skills

A person with schizophrenia often experiences mild problems with memory , executive functioning and problem solving. This may not be apparent to others, as individuals with schizophrenia may have above average intelligence. However individuals with schizophrenia are often painfully aware that they cannot perform to the same academic level as before . They also may be restricted with regards to career options, and often cannot perform consistently in jobs which involve a lot of multitasking, high stress or a fast paced environment.

Feelings of Loss

Individuals with schizophrenia often feel a sense of loss. They often feel they have to change their career aspirations, and life goals. They often question if they can marry or have children. Although all of these things are possible, a person with schizophrenia cannot take things for granted like before. Ultimately, what is lost after a person has their first psychotic break is their
‘youth’. Loss of youth in the case of schizophrenia, means no longer being able to take things for granted, or believing that anything is possible.

Lakshmi, a 25 year old medical student, had her first psychotic break during her first clinical rotation. She started medication and symptoms resolved. Believing that she was better she stopped medication and she once again started hearing voices, and had delusions that colleagues were placing ‘pubic hair’ in the petri dishes to confuse her. She once again started medication, but it was several months before the right combination was found and symptoms resolved.

This time she was told she could not return to medical school. Lakshmi turned to her friends who were also medical students to speak to the Dean on her behalf, but they looked embarrassed and many of them had started to avoid her. Lakshmi had been married for two years after a whirlwind romance. Her husband Krishna, a doctor from the same medical school, had pursued her aggressively after meeting through friends, told her she was his soulmate and proposed after six months. Krishna accepted a job office on the other side of the country. He had not told her yet that he was leaving, but intimacy was stopped and he now spent most of his time studying, working on his research project or at the gym.

Although Lakshi had a much less severe form of schizophrenia the effects were still devastating. Ultimately, Lakshmi had to accept that her old life was over as she knew it and she had to work towards picking up the pieces and rebuilding.

Medication Side Effects

Some people who have schizophrenia have experienced unpleasant side effects to medication, which can be distressing or even frightening.

How to Help Someone with Schizophrenia?

It is painful to watch your loved one, or someone close to you, suffer from schizophrenia. You think about ways you could help them, or at the very least, be there for them in their hard times. It is a helpless feeling when you cannot do anything for someone who is suffering in silence. But, there are ways in which you could be a helping hand for the person you care about and want to watch live their life peacefully. Following are some ways to help someone with schizophrenia:

  • Encourage them to seek help: Schizophrenia requires professional help. Medical professionals could prescribe the person suffering from schizophrenia some medications to curb their schizophrenic episodes. You could encourage your loved one to seek professional help and make them understand that it’s for their betterment. After receiving professional help, people tend to lead a more improved life than before. If you want what’s best for your loved one, seek professional help for them.
  • Keep a note of their appointments: An important step towards the betterment of their treatment, would be to make notes of their appointments. Not only this, but also, keep a track of their symptoms, medications, any other medical conditions they have, and make sure to bring these up in the next appointment with their doctor. This could not only help keep track of their medical history, but also help the doctor check which medications suit them and determine what course of action to follow in the future.
  • Encourage them to join support groups: Support groups are communities of people who share the same experiences and therefore, provide comfort, support and advice to each other. People with schizophrenia are encouraged to join support groups as there are other people who share their experiences, making others in the group feel that their feelings and thoughts are validated, and that they’re not alone. They also acknowledge that they need help, encourage each other to seek help, and build each other up. One of the many positive things to come out of these support groups is the feeling of solidarity.
  • Ask them how they are feeling: Sometimes, a simple “How are you”, or “How are you feeling” could make a huge difference. Hearing these words, the person/ your loved one could open up about their struggles, which is a positive sign that they trust you. Try to enquire about their feelings, ask them how they are holding up, and as mentioned above, keep a note of their symptoms. Sometimes, people struggle in silence as they feel detached from the rest of the world. However, someone asking them about their mental headspace could bring them comfort and reduce the feeling of isolation.
  • Lend them your ears: Instead of trying to explain to your loved one their own feelings, listen to what they have to say. It is not you who’s going through the struggles, but them. The most disappointing aspect would be that a schizophrenic person who’s trying to open up to the person they trust the most, is not heeding to their concerns, is taking their conditions lightly, or just ignoring them. The most important part of support is active listening.
  • Empathize, not sympathize: Sometimes, people with schizophrenia are well aware of their condition and know that their delusions and hallucinations are not real. So, instead of lecturing them on their feelings, try to comprehend what they’re trying to convey. Put yourself in their shoes and try walking a mile to truly comprehend what they’re going through. These little efforts could turn out to be a ray of hope in the dark tunnel they’re trapped in. Also, do not pity them; try to understand their feelings, show them that their thoughts matter and tell them that what they’re feeling is valid.
  • Check up on your loved ones: It is well said that you never know what someone’s going through. Check up on your loved ones every once in a while and see how they’re doing. Sometimes people suffer in silence and do not let anyone know about their internal struggles. However, this only makes the battle harder to deal with. So, stay connected to your loved ones and keep a check on them.
  • Do not resent them: If your loved one says anything that hurts you or does something that makes you feel unimportant, don’t let it get to you. Remember, it’s their schizophrenia that’s making them act that way. Do not resent their actions, rather, try to understand why they’re doing what they’re doing and ask them to seek professional help. Foster an environment in which your loved one does not feel pressured to act a certain way to hide their symptoms, and encourage open conversations.
  • Know the early signs of suicide: Sometimes, the person suffering from schizophrenia is not a threat to others, but a threat to themselves. They may try to end their life to escape from their sufferings. Although you cannot see it coming, it is always better to keep a check on your loved ones. Take a closer look at what they’re writing down, ask them about their feelings, and validate their symptoms. Tell them that help is always there if they need it. It’s always better to be safe than sorry.
  • Educate yourself on the topic: The most important part of any improvement process is knowledge. Educate yourself on schizophrenia and familiarize yourself with the condition. Read about different methods to help your loved one, and research about different symptoms. It’s imperative for us to destigmatize schizophrenia so that people suffering from it do not hesitate to reach out for help.

You could be a huge helping hand in the path of improvement for your loved one, by talking to them about their struggles, validating their thoughts, offering them your help with anything they need, keeping up with their regular appointments, keeping a track of their schedules, regularly checking up on them, or simply, by just being there for them in their trying times.

What is the Differential Diagnosis for Schizophrenia?

Conditions that must be ruled out in order to correctly diagnose someone with schizophrenia are:

  • Schizoaffective Disorder
  • Bipolar Disorder
  • Major Depression with Psychosis
  • Substance- induced Psychosis
  • Brief Psychotic Disorder
  • Psychotic Disorder Secondary to General Medical Condition

Let’s take a look at each of them in detail:

Schizoaffective Disorder

Schizophrenic Disorder shares some symptoms of schizophrenia as well as mood disorder like bipolar disorder, or depression. In this condition, there are alternating symptoms of depressive episodes and episodes of improvement, like hallucinations, delusions, depression, and mood swings. Sometimes, the person suffering from Schizoaffective Disorder may experience bouts of high energy and then, return to feeling depressed. Schizoaffective Disorder could be treated with the help of medication as well as therapy or counseling.

Bipolar Disorder

Bipolar Disorder is a condition in which a person experiences extreme emotions of the two ends of the spectrum. These are called mood swings. The individual may either feel extremely happy one minute, and extremely depressed the next. These are called highs and lows; mania/ hypomania and depression, respectively. Bipolar Disorder could be treated by medication, supportive therapy, or psychotherapy.

Major Depression with Psychosis

Major Depression with Psychosis or simply, Psychotic Depression, is a condition that is a combination of symptoms of Depression, Psychosis, and Schizophrenia. Individuals with this experience episodes of depression, as well as delusions, hallucinations. According to the National Institutes of Health (NIH), symptoms of psychosis occur in almost 18.5% of individuals who are suffering from Major Depressive Disorder. Psychotic Depression is usually treated with medication. A second option however, is Electroconvulsive Therapy.

Substance- induced Psychosis

Substance- induced Psychosis is a condition with symptoms of psychotic disorder and schizophrenia. This condition usually arises when a person either starts to consume alcohol/ any other drug (intoxication), or has started to withdraw from it (withdrawal). Some symptoms include hallucinations, delusions, and lack of emotional expressions. Treatments for this condition are medication, therapy, and supportive therapy.

Brief Psychotic Disorder

Brief Psychotic Disorder is a condition in which a person all of a sudden, portrays symptoms of psychotic disorder/ exhibits psychotic behavior for a short while/ a short period of time. This usually happens during a traumatic or stressful event. This condition shares symptoms of schizophrenia and psychotic disorder. What sets Brief Psychotic Disorder apart from Schizophrenia is the duration; according to DSM-5, it usually lasts less than a month, with subsequent remission but with a possibility of future relapses. Antipsychotic medication and talk therapy are two treatment options.

Psychotic Disorder Secondary to General Medical Condition

Psychotic Disorder Secondary to General Medical Condition is a condition that occurs when a person experiences psychosis due to a medical condition. The severity of the disorder depends on the medical condition; as time goes on, the disorder may get as severe as the medical condition, or may even settle with the improvement of the condition. Just like the above mentioned conditions, this disorder shares symptoms of schizophrenia as well as psychotic disorder. This condition could only be improved with an appropriate treatment of the medical condition. However, to curb the symptoms of psychosis, the person could be put on medications like benzodiazepines, antipsychotics or antidepressants.

Have I Been Wrongly Diagnosed with Schizophrenia?

It is common for people to question their diagnoses. However, it is imperative to not take your symptoms lightly, and seek professional evaluation the moment you doubt your symptoms/ experience some other symptoms, because chances are, what you are experiencing is not schizophrenia, but some other mental condition. Following are some conditions that could be present, instead of schizophrenia:

  • Bipolar Disorder
  • Post- Traumatic Stress Disorder
  • Brief Psychotic Disorder
  • Schizophrenic Disorder
  • Psychotic Depression
  • Major Depressive Disorder with Psychotic Features
  • Substance- induced Psychosis
  • Delusional Disorder
  • Schizophreniform Disorder
  • Some other underlying medical condition

If you think you’ve been wrongly diagnosed with schizophrenia, you should:

  • Seek professional evaluation: You could go for another evaluation/ revaluation if you think you do not have schizophrenia. It is never a bad idea to seek a second opinion. You could consult multiple professionals to ensure that you are correctly diagnosed.
  • Research: Apart from consulting professionals, you could help yourself by researching schizophrenia, reach out to people who have schizophrenia and ask them about their symptoms. You could also keep a track of your symptoms, along with your medical history, medications, or any other previous evaluations you’ve gone through.
  • Read up on other conditions: If you are unsure about your diagnosis it is fine to read up on other conditions like schizoaffective disorder, and bipolar disorder. However rather than diagnosing yourself, it is better to discuss symptoms with your doctor and see which condition best suits you.
  • Foster an environment of open communication: Ideally you should feel comfortable sharing your feelings about your condition with your doctor. A strong therapeutic rapport leads to better treatment outcomes . It is important that you do not feel judged and are able to form a ‘therapeutic alliance’ with your doctor.
  • Focus on the symptoms and treatment rather than the condition: The symptoms and treatment of any condition is just as important as the diagnosis of the condition itself. While you should focus on the correct diagnosis, it is equally important that you consult professionals to seek ways to alleviate symptoms. Ultimately regardless of the diagnosis, relief of symptoms is essential to restore quality of life.

What Should I Do if I Think I Have Schizophrenia?

If you think you have schizophrenia, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5), you must have the following symptoms:

  • Delusions (false beliefs not based in reality)
  • Hallucinations (perceiving things that are not there)
  • Disorganized speech
  • Grossly disorganized or catatonic behavior (unusual motor behaviors)
  • Negative symptoms (lack of normal emotional expression or motivation)

If you’re experiencing the above mentioned symptoms, you should:

  • Consult a professional: The first step towards the betterment of schizophrenia is getting it diagnosed correctly. If you start to experience the above mentioned symptoms, do not hesitate to seek professional help right away, as any delay could contribute to aggravating the condition.
  • Research on the topic: Educate yourself on the topic of schizophrenia because the more knowledge you have, the easier it would be for you to seek help. Study about different types of schizophrenia, its symptoms, causes, and treatment options. Prior knowledge about the condition would help you discern schizophrenia from other conditions.
  • Support groups: Approach support groups. Support groups are a huge help to people with different conditions. These allow you to listen to others’ experiences and share yours. They provide support and advice to each member of the group which gives every single person the strength to keep going.
  • Share with someone: You should share your thoughts, feelings and symptoms with someone you trust. Doing so, would lessen the burden of struggle. Your loved one would in turn, be aware of your condition and help you with anything you may require. Sharing about your condition with someone would also encourage you to seek professional help for the better.
  • Keep a track of your symptoms: Take down your everyday experiences in a journal for future references. These could include symptoms, frequencies of hallucinations and delusions, durations, and your thoughts. This is an important step which you should not skip as having a record of your symptoms could be helpful to your healthcare provider for assessing your condition.
  • Treatment Recommendations: After your doctor has laid out treatment methods for you, make sure to stick by them for improvement. Taking prescribed medications on time, attending regular therapy sessions, and showing up for support group sessions, are some ways you could cope with schizophrenia and be on a path of betterment.
  • Be Honest: Do not hide anything from your doctor in the evaluation sessions. Be honest about what you’re experiencing and what thoughts you’re having. You should show them the journal you maintain and openly communicate with them. You should also talk about any other medical conditions that you might have in order for them to accurately diagnose and treat you.
  • Self- care: It is absolutely imperative that you take care of yourself during trying times. You should not give up on things you like just because you’re suffering from schizophrenia. Focus on things that bring you joy. Following are some things you should follow for self- care:
  • Practice Yoga
  • Balanced Diet
  • Adequate Sleep
  • Exercise
  • Regular Walks
  • Stress Management Techniques
  • Say NO to Substance- Abuse
  • Outdoor Activities
  • Take up your favorite activity (for example, singing, painting, playing badminton)
  • Mindful Breathing

What Causes Schizophrenia?

There are many things that could cause schizophrenia. From stressful situations to the condition being hereditary, the causes of schizophrenia vary from person to person. Let’s take a look at every one of them:

  • Stress
  • Substance- Abuse
  • Hereditary
  • Pregnancy or birth complications
  • Social Isolation
  • Depression & Anxiety
  • Obsessive- Compulsive Disorder (OCD)
  • Health problems/ any other medical condition
  • Suicidal Thoughts
  • Neurotransmitters

Stress

Stress is not considered a direct source of schizophrenia. However, it could trigger a schizophrenic episode in an already vulnerable person. Childhood trauma is a strong cause for schizophrenia. People who went through any kind of emotional, mental, physical or sexual abuse in their childhood are three times more likely to suffer from schizophrenia, according to a Meta- Analysis Study by Oxford Academic. Stress affects the physical changes of the developing brain of the person and hence, changes the ways in which the person reacts to things.

Substance- Abuse

Just like stress, there is no direct link between substance- abuse and schizophrenia. However, constant consumption of said substances could result in frequent episodes of psychosis, leading the person to suffer from delusions and hallucinations. Drugs like amphetamines, LSD, cannabis and other hallucinogens could potentially trigger an episode of schizophrenia, even though the person might not have a history of any mental illness. These symptoms, however, are temporary, which sometimes are also called the side- effects of the consumed drug.

Hereditary

While everyone has a 1% chance of developing schizophrenia in their lifetime, having a schizophrenic parent increases that percentage to 10%. Schizophrenia could be hereditary, but no single gene is proven to be responsible for causing schizophrenia. Multiple combinations of different genes make people more prone to schizophrenia. However, it is not important that a person born to schizophrenic parents or having schizophrenic siblings will 100%, with a certainty, develop schizophrenia. It is interesting to note that the lifetime risk of schizophrenia in monozygotic twins is more than 40%, according to the National Institutes of Health (NIH).

Pregnancy or birth complications

Pregnancy or birth complications (obstetric complications) could lead to schizophrenia. Women are vulnerable to the following conditions during the time of their delivery which could result in the development of schizophrenia:

  • Preeclampsia: Preeclampsia is a blood pressure condition that causes blood pressure levels to rise and increases levels of protein in the urine.
  • Rhesus Incompatibility: When both the parents of the unborn baby do not have the same Rh factor (i.e., one parent has a positive Rh factor, while the other has a negative Rh factor), this could result in a rhesus incompatibility.

It is observed that some individuals with schizophrenia experienced hypoxia at birth; a condition where sufficient amounts of oxygen is not available at tissue level to maintain suitable homeostasis. Hypoxia is also responsible for developing brain abnormalities among people with schizophrenia. Newborns are also susceptible to schizophrenia if exposed to infections.

Social Isolation

Social Isolation, although an aspect of schizophrenia, is also one of the causes of the condition. Social isolation stems from anxiety disorder, social withdrawal, and feelings of alienation from childhood. Social isolation/ disconnection could lead people to forget the meaning of human connection as there is little to no communication, resulting in them developing delusions and hallucinations of all sorts. Social Isolation, while not directly linked to schizophrenia, surely harms the mental health of people, discouraging them to form connections.

Depression & Anxiety

Here’s where again, social isolation comes into play. The stress of isolation in people with depression and anxiety may trigger schizophrenia. We’ve heard of Psychotic Depression; it’s where the person suffers from episodes of psychosis (a symptom of schizophrenia) as well as depression. While it is not necessary that people with depression have schizophrenia, it is observed that schizophrenic individuals have depression. So, sometimes, factors like social isolation, depression, disorganized thinking, play a role in developing schizophrenia.

Obsessive- Compulsive Disorder (OCD)

Obsessive- Compulsive Disorder is when unreasonable or obstructive obsessions and thoughts lead to compulsive behaviors. The relationship between OCD and schizophrenia is unclear, however, there is a risk of later development of schizophrenia in individuals who suffer from OCD. People with OCD may sometimes experience episodes of psychosis during which they cannot organize their thoughts, which could result in a brief schizophrenic episode. According to a study published by Psychiatry Online, between 1% and 16% of people suffering from OCD, later developed schizophrenia.

Health Problems/ Any Other Medical Condition

Conditions like autoimmune disorders, thyroid disorders, brain trauma, neurological conditions, or metabolic disorders could lead to people developing schizophrenia. While a specific cause for schizophrenia is unknown, these pre- existing conditions could exacerbate the symptoms and cause the person to slowly develop the condition later. These serve as severe risk factors that could worsen the condition.

Suicidal Thoughts

People with suicidal thoughts who already deal with social isolation, delusions and hallucinations, are vulnerable to schizophrenia as they may start to have false beliefs and unreasonable thoughts of things that do not exist. Although two distinct mental health issues, schizophrenic individuals may have suicidal thoughts and people with suicidal thoughts may develop schizophrenia (they may start to hear voices coaxing them to take drastic steps). While there is no link established between the two, they’re indirectly linked.

Neurotransmitters

Neurotransmitters are chemical signals sent to the brain. Some neurotransmitters play a role in the development of schizophrenia. These are:

  • Dopamine: Extreme dopamine activity plays a role in exacerbating the positive symptoms of schizophrenia, which are delusions, hallucinations, disorganized thinking, and abnormal physical activity.
  • Serotonin: Serotonin abnormalities are found in individuals with schizophrenia. Serotonin is responsible for mood regulation, perception and cognition. A slight dysregulation of serotonin could aggravate the symptoms of the condition.
  • Glutamate: Glutamate neurotransmitters are responsible for cognitive activities. However, a dysfunction in the glutamatergic system, particularly NMDA receptors (which are responsible for memory formation) could result in the development of schizophrenia or could intensify the existing symptoms.
  • Acetylcholine: Acetylcholine neurotransmitters are involved in cognitive activities/ processes. Abnormal functioning of these could result in cognitive impairment; a symptom of schizophrenia.

Should I Take Medication for Schizophrenia?

If you observe some symptoms of schizophrenia in yourself/ your loved one, or notice the symptoms getting worse, make sure to reach out to professional help to get on the path of improvement. While the treatment for schizophrenia involves regular medication, there are other methods as well, that doctors recommend so that the person does not solely rely on medications.
Some of the treatment options for schizophrenia are listed below:

  • Cognitive Behavioral Therapy (CBD)
  • Supportive Care
  • Supported Employment (Supported Housing, Supported Medical Care)
  • Therapy Animal
  • Yoga
  • Meditation
  • Arts Therapy
  • Family Psychoeducation
  • Hospitalization
  • Medication

Cognitive Behavioral Therapy (CBD)

Cognitive Behavioral Therapy, also known as Psychotherapy (Talk Therapy) is a type of therapy that allows the patient to have an open conversation with their therapist in an organized way. The number of therapy sessions are limited. The therapist encourages the person to introspect and observe all negative and unreasonable thoughts so that they view the challenges in their life more clearly and make more sound decisions. CBD is used to treat many mental conditions, including schizophrenia. CBD helps the person acknowledge their symptoms and break the stigma surrounding the condition.

Supportive Care

Contrary to CBD, supportive care (or therapy) is general care that is provided to people with schizophrenia by mental health services. While CBD depends on talk therapy, supportive therapy ensures overall well-being of the person and provides basic assistance to facilitate daily living. It has been observed that people, no matter what mental illness they have, prefer supportive care over any other kind of therapy.

Supported Employment (Supported Housing, Supported Medical Care)

Mental health proponents advocate for job placements for people suffering from schizophrenia. Along with this, they also advocate for housing and medical care facilities to be provided to those with the condition. It has not been hidden that people who struggle with their mental health face difficulties in finding jobs, housing and medical care. Since, all of these aspects signify normal living, it is important that people with schizophrenia be provided all these facilities for better integration into society. Assistance in all of these would increase the chances of recovery of a schizophrenic person.

Therapy Animal

Therapy animal (companion animal) provides companionship, emotional support and comfort to those struggling with their mental health. There are dogs that are trained for assisting individuals with schizophrenia; they are called ‘Schizophrenia Service Dogs’. Along with providing emotional support, comfort, and companionship, they detect hallucinations and symptoms, and interrupt negative thinking or disruptive behaviors of the schizophrenic person. This therapy is also known as Animal- Assisted Therapy.

Yoga

Although suggested for every person, Yoga, especially for people with schizophrenia is quite advantageous as it could alleviate some of the symptoms. It helps them sleep calmly as schizophrenia disrupts their sleeping schedule. It also helps them respond to medications greatly. Yoga helps to ameliorate GABA brain chemicals that are involved in schizophrenia. If practiced regularly, it could also help people get rid of their sedentary lifestyle which is a result of schizophrenia.

Meditation

Meditation is useful for people suffering from schizophrenia as it involves practicing mindfulness. It encourages them to pay attention to their environment and observe their negative thoughts. It helps alleviate stress, negative and disorganized thinking. Meditation could also affect the brain structure of the person in a positive manner and encourage the person to practice mindfulness on a daily basis.

Arts Therapy

Arts therapy is the type of therapy that allows individuals to explore their thoughts, emotions and feelings, through their chosen mode of medium. Some types of art therapies are: dance therapy, painting therapy, music therapy, drama therapy, clay therapy, poetry therapy, Mandala therapy, and much more. Art therapy could be a beneficial option for those with schizophrenia as it allows them to explore their thoughts in the form of their favorite activity/ medium and allows the person to acknowledge their condition which makes them determined to improve it.

Family Psychoeducation

Family Psychoeducation is a unique approach to help out families of schizophrenic individuals. It provides comfort, understanding and a helping hand to them. It also educates the families on schizophrenia and encourages them to converse about the condition openly and without any hesitations. Family Psychoeducation provides information on schizophrenia, communication skills, crisis management, problem- solving skills, social support, and stress management skills.

Hospitalization

Hospitalization is considered an option when a schizophrenic individual is at a risk of either harming themselves or those around them. Sometimes hospitalization is also an option when the health of the person is deteriorating because of the condition, or also, when the symptoms are intensifying. Usually people are admitted to hospitals when they’re experiencing a psychotic episode and threatening to harm either themselves or others. Sometimes, hospitalization is a necessary option so that frequent psychotic episodes or critical situations could be avoided.

Medication

Medication is a crucial treatment option for every mental illness. Doctors, according to their medical history and prior mental health conditions, prescribe different medications to different individuals. However, some of the most common medications for schizophrenia are Aripiprazole, Cariprazine, Paliperidone, Fluphenazine, Chlorpromazine, Risperidone, and Brexpiprazole. So, while individuals could opt for any above mentioned treatment options, they cannot skip getting prescribed medications. Medication goes hand- in- hand with other treatment options. For instance, a person could go for arts therapy, however, they would also be required to take their medication regularly, without fail.

In conclusion, schizophrenia is a complex mental health issue that affects people and families worldwide. It is a condition that should not be taken lightly. It is imperative for people to consider the difficulties faced by schizophrenic individuals, and educate themselves on the condition. Schizophrenia requires care, empathy, and understanding. While it may sound like a debilitating condition, we should remember that there’s help and support available. Schizophrenia is treatable and once people opt for some treatment options, their journey to recovery will commence.

So, let’s educate ourselves on schizophrenia, break the stigma that surrounds the condition, and uplift those who need our help, support and understanding.

What is the difference between an Emotional Support Animal and a Service Animal?

Unlike emotional support animals, service animals are individually trained to assist their owners so that they can lead a normal life. Service animals have permission to go everywhere with their humans, including places like restaurants, shopping malls, and even airlines, according to the Air Carrier Access Act.

According to the ADA, animals that provide only emotional support do not qualify as service animals. While emotional support animals would react to situations instinctively, service animals have been given special training and have passed ophthalmic or orthopedic exams to respond to difficult situations and extend their support to help their owners.

Should I get an Emotional Support Animal?

If you are going through a mental health condition and feel that the presence of a loving, non-judgmental, and loyal companion can make you feel better, you should consider the thought of getting an emotional support animal.

In some cases, your mental health professional might suggest you pet an ESA, considering its therapeutic benefits for your mental health.

While some people embrace an innate connection with animals and love their company, others may be new to the concept of living with an animal. No matter what, getting an emotional support animal brings along the significant responsibility of managing a living being, who is also an individual with needs and emotions.

Before making a decision, find answers to these questions:

  • Do you have enough resources to feed, accommodate, and handle an animal?
  • Are you capable of arranging medical aid for the animal, if need be?
  • Do you understand that this is a long-term responsibility?
  • Will you be able to spend enough time with the animal?
  • If you wish to discontinue companionship, would you find alternate homes for the animal, by asking friends, relatives, neighbors, or acquaintances?

If you can answer most or all of these questions affirmatively, you may be ready to take on the responsibility of owning an emotional support animal. In the journey of healing yourself with the support of your ESA, it is necessary to acknowledge its needs and wants. Support and companionship are two-way forces!

How to Qualify for an Emotional Support Animal?

If you have a mental or emotional disability enlisted in the Diagnostics and Statistics Manual (DSM), and closeness to an emotional support animal can help you with your symptoms, you are legally qualified to get one.

Emotional support animals can be helpful for individuals suffering from:

Amongst other psychiatric disorders.

They can also be helpful for the elderly, and those suffering from isolation due to immobility or physical disability.

To learn more about our services and seek help, visit www.gabapsychiatrist.com.

Schizophrenia FAQs

Can I work if I have schizophrenia?

People with schizophrenia can work, however, it will be difficult for them to function in a regular office- setting as work requires multitasking, and some jobs are quite fast- paced. They are suggested to communicate with experienced career counselors who could give them advice on which career paths they would be most likely to excel, and experience the least amount of stress.

Can I get married if I have schizophrenia?

Yes, people with schizophrenia could get married. However, it is crucial that they inform their partner about their condition so that their partner could come up with techniques to facilitate their daily living and support them through their illness. Some people themselves are not emotionally equipped or not motivated to support a spouse with schizophrenia . It is especially important to choose a life partner who is loving , understanding and supportive if you have schizophrenia.

Can I have children if I have schizophrenia?

Yes, people with schizophrenia can and do become parents. They should however, before conceiving, it is important to ensure that you have the appropriate support system , and crisis plan. It is important to discuss plans to conceive with your psychiatrist and therapist.

Is schizophrenia hereditary?

Yes, schizophrenia is hereditary. Schizophrenic people could inherit schizophrenia from their parents. They could also inherit it from their siblings.

Are people with schizophrenia violent?

No. It is a misconception that people with schizophrenia are violent. People who constantly abuse drugs, do not have access to appropriate treatment methods and have a history of violence, are considered to be a danger to society.

What is the best medicine for schizophrenia?

Medical professionals prescribe different medications to different people, according to their medical history. However, some of the most commonly used medications are Paliperidone, Fluphenazine, Chlorpromazine, Risperidone, and Brexpiprazole.

References

Virtual Psychiatrist
Fact Checked by
- Dr. Gundu Reddy
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