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The diagnosis of any mental health disorder represents a serious condition. Most clinicians consider the most severe of all the psychiatric diagnoses listed by the American Psychiatric Association to be schizophrenia. Schizophrenia is a heterogeneous disorder that consists of a number of very serious symptoms. It is not a disorder of having multiple personalities as still believed by some; that diagnosis was formally termed multiple personality disorder but is now known as a dissociative identity disorder.
Schizophrenia is a psychotic disorder, and it is one of the first categories of mental illnesses to be identified. The actual term schizophrenia comes from the psychiatrist Eugene Bleuler in 1911 who envisioned schizophrenia as the splitting of one’s thinking abilities from their personality.
The diagnosis of schizophrenia or any other mental disorder can only be made by a licensed mental health physician. Schizophrenia is the major form of the psychotic disorders, which are disorders that result in a loss of reality in individuals. The key features associated with psychotic disorders are:
In previous editions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), schizophrenia was diagnosed according to one of five subtypes. Each subtype represented the major symptom associated with the manifestation of the disorder in the person, such as paranoid schizophrenia mainly manifesting paranoid hallucinations and/or delusions, catatonic schizophrenia basically manifesting as catatonic behavior, etc. In the most recent version of the DSM, the DSM-5, these subtypes have been eliminated due to research evidence suggesting that schizophrenia is one disorder that can express a number of different symptoms. Schizophrenia is diagnosed according to the following criteria:
The formal diagnostic criteria specifically lay out a number of other associated conditions indicating whether or not the individual is experiencing a first episode, whether or not the current presentation is acute or chronic, and whether or not there have been multiple episodes. In addition, a number of neurological conditions (e.g., encephalitis), medical conditions (e.g., hepatic encephalopathy), other psychotic disorders, and other mental health disorders (e.g., bipolar disorder) may resemble schizophrenia, and only trained clinicians are qualified to make these distinctions and produce a formal diagnosis.
Schizophrenia is relatively uncommon and occurs over all cultures at a rate of about 1:100 individuals. In general, males and females have equal prevalence rates, although there is some indication that having predominantly negative symptoms may be more common in males. Early conceptualizations of schizophrenia pointed to poor child-rearing and stressful childhood experiences as the causes of the disorder; however, these theories are largely denounced. The general trend is to consider schizophrenia to be a biologically based condition that is a result of:
At the current time, the cause of schizophrenia is unknown. There are probably a number of different interacting causes that result in various different presentations of schizophrenia.
The first line treatment for schizophrenia consists of medications. The first group of medications used in the treatment of schizophrenia was actually discovered to be of use by accident. These medications include major tranquilizers like Thorazine, which also inevitably result in a number of neurological conditions, such as tardive dyskinesia (involuntary movements of the face in other parts of the body), with long-term use.
Other drugs with greater efficacy and fewer side effects have been developed, and these drugs are typically classified as antipsychotic drugs. They include a number of familiar names, such as Risperdal (risperidone), Zyprexa (olanzapine), Seroquel (quetiapine), Abilify (aripiprazole), etc. Newer classes of antipsychotic drugs target combinations of neurotransmitters, such as dopamine and serotonin, and have fewer serious side effects.
Psychotherapy can be used to assist in the treatment of schizophrenia, especially with adjustment issues, teaching living skills, and other forms of psychoeducation; however, it is not generally considered to be the first-line treatment approach for schizophrenia.
Other common co-occurring substance use issues in individuals diagnosed with schizophrenia include:
For many individuals, the image of a person diagnosed with schizophrenia is one of a psychotic killer. Schizophrenia is often vilified in the media, especially in movies where psychotic killers often have schizophrenia-like symptoms. While a very small proportion of individuals with schizophrenia do commit serious crimes including murder, the vast majority of individuals with schizophrenia are not dangerous. Vagrancy as a result of being homeless is the most common crime associated with individuals who are diagnosed with schizophrenia.
Individuals with schizophrenia are at risk to also have co-occurring substance abuse issues. According to APA and other sources, the most common substance use disorder associated with schizophrenia is tobacco use disorder. Individuals with schizophrenia are notorious for being chain smokers. There is research suggesting that nicotine may have a beneficial effect on a number of the symptoms of schizophrenia, and this may be why tobacco abuse is so common in this particular group. Nonetheless, chronic and frequent use of tobacco is associated with a number of serious health effects and the potential to develop serious diseases, such as cancer, heart disease, other cardiovascular disease, etc. As a result, the risks of chronic cigarette smoking far outweigh any advantages it may produce in this group.
The approach to treating an individual with schizophrenia who also has a co-occurring substance use disorder includes the use of antipsychotic medications and a formal substance use disorder treatment program. Individuals with predominantly negative symptoms may require very intensive and targeted interventions. There is evidence that successful treatment of schizophrenia using antipsychotic medications may also result in a decrease in the use of drugs in these individuals; however, the general approach to treating individuals who have co-occurring diagnoses is the use of an integrated treatment program that relies on a multidisciplinary team consisting of physicians (in this case, most likely a psychiatrist and addiction medicine physicians), psychologists, counselors and social workers, and other therapists from different disciplines, including speech therapists, occupational therapists, case managers, etc. The treatment team works together to address treatment issues and to tailor the program to suit the person’s needs and abilities.