Schizophrenia – A Brain in Trouble

Schizophrenia - A Brain in Trouble. What is real, what is not?
Schizophrenia – A Brain in Trouble. What is real, what is not?

The Good News About Schizophrenia

There really is good news about schizophrenia and its treatment. It might be possible to eliminate schizophrenia altogether, as you’ll read in these pages. The modern medical science in this area is about stopping schizophrenia before it starts. And the medications available to treat existing schizophrenia keep getting better. New approaches with medications seek to treat the positive, the negative, and the cognitive symptoms, not just the psychosis. So take heart that it’s all good and getting better. As always, we remain on your side to praise what works, debunk anything that doesn’t work, and advocate for better medical care and better health outcomes.

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Defining Schizophrenia: It’s a Brain in Trouble

Schizophrenia is a medical condition, a brain disorder. The brain changes caused by schizophrenia change how a person shows emotions, how they think, what they believe, what they hear, and how they behave. It creates a new world that only that one person can fully experience, and it’s scary.

Getting Help for Schizophrenia Is Not a Do It Yourself Project

Schizophrenia is a serious medical condition, a clinical situation that needs the best of medical care. Below we describe symptoms of schizophrenia. It’s not a medical condition that you can identify on your own, by yourself. As with any other medical disorder, you need to see a physician, preferably a physician with good training, a lot of experience with treating it, a good heart, and a good bedside manner. The physician has to be someone who can see the signs of schizophrenia correctly, ask the needed questions, and do the right tests and scans. And then, once all the information is in, offer her opinion on whether this is schizophrenia or some other illness. Then, in discussion, design a person-specific treatment plan.

Beginning at the Beginning – Early Symptoms of Schizophrenia

Early on, that is, when a person’s illness first starts, it might just be that “something” has changed. You might not be able to put your finger on exactly what, but something’s definitely different. It’s hard to get very specific here because the first symptom can appear over a few weeks, or a few months, or a few years. It’s different for each person. It might be something quirky, like coming up with a new belief about something that seems out of character, that makes little sense. (And this change is not the healthy exploration of adolescence.) It’s different. The early signs might be comments on hearing something, but each time, no one else can hear the sound, noise, or voice. The person might seem “deep in thought” too much or too often when they’ve never been like this before.

The Common Symptoms of Schizophrenia

“Positive symptoms” are the easily seen changes of schizophrenia, the fixed false beliefs (believing something that’s clearly not true), hearing voices that no one else hears, and the scattered thinking discussed below. “Negative symptoms”, the things that are missing with schizophrenia, are described below, too. The fixed false beliefs are the delusions. The voices are the hallucinations.

Schizophrenia’s New Onset of Fixed False Beliefs (Delusions)

A person with the early signs of schizophrenia might start believing things or ideas that seem odd and unusual and that don’t make sense. Like believing that their best friend has turned against them, or that the characters on TV are talking to them. Or they might turn enthusiastically religious or might start believing that they have special powers. Special powers like, for example, that they can think their way out of trouble. And you, as a reasonable person, mighty try to explain to them that they’re being unreasonable or unrealistic, or just silly. But they don’t get it and don’t believe you. In response they get angry, or quiet, and it’s clear that they don’t believe you.

Schizophrenia and the Voices That Aren’t There (Hallucinations)

This whole area about hearing voices is a big one. The person hears someone speaking. The speaking is not some faint voice far away and it’s not a voice that they believe might or might not be there. They know it is there. To them it’s a clear voice, one that’s right here, as though someone is standing next to them talking right into their ear. Except, there’s no one there and no one else can hear the voice. And as with the beliefs, if you try to convince them that there is no voice, they won’t believe you, because they can hear the voice. They hear the voice, they know someone is speaking. It’s not just thoughts in their head, it’s absolutely real to them. A very upsetting part, sometimes the voices tell them to do things, “command hallucinations”. Seldom are the commends to do something good.

Schizophrenia’s Foggy-minded Scattered Thinking

This part of the disability of schizophrenia is supposedly new to medical science as of the past twenty-five years or so. Actually, that’s not true.  Dr. Emil Kraepelin described it in the people with schizophrenia that he was treating over a century ago, but medical science “forgot” about it for about seventy-five years, focused on the psychosis. At first the person’s thinking becomes a bit scattered. And since we know how someone is thinking by how they’re speaking, their speech is scattered. We’re not talking about complete gibberish. It’s speaking in a way that’s a bit less well constructed with connected sentences. And for this person that we know, it’s out of character, not the way they usually would have spoken.

closeup color photo of young brunette woman with gray painted fingernails and a serious or worried expression on her face
Photo by Engin Akyurt

Schizophrenia’s Symptoms on What’s Not There – The Negative Symptoms

If you know a person well these will be easy for you to recognize. The individual doesn’t have their usual spark and flash about life. For example, a person doesn’t get excited about a situation or event that usually would really be great for them. For example, if they’ve always been an avid movie buff and not they’re not interested in a great new movie release. Or, they like the person with an upcoming birthday and usually they like parties but are blasé about the party. They’d rather skip it. They just don’t want to do anything active and social. Even fun things. They might not talk about much and might be reluctant to attend social events.

One of our readers asked:                                                                                   

Doesn’t the schizophrenia know he’s sick? How can he not know?

Well, maybe, early on in the start of the changes the person will realize it. But, as the disorder progresses, usually at some point along the way the difference between what’s real and what’s not blurs. Then the person doesn’t know they’re sick. (See our free page on the side effect you can’t tell your doctor.) There’s another concern. What if it’s not schizophrenia? What if it’s just a reaction to a medicine for allergies, like a steroid? What if it’s a thyroid problem? What if it’s a toxic environmental exposure, like an insecticide or herbicide? An experienced physician needs to get the history, talk to the person, run the needed tests, and then make the correct diagnosis. One needs to get thyroid levels, other hormone levels, brain scans and maybe x-rays, a good medical history, and a good physical exam to understand the situation.

Symptoms of Schizophrenia In Women vs. In Men

There’s usually not much difference in the symptoms of schizophrenia between women and men. Maybe one difference is “inappropriate emotions”. This was found in a big study (1526 patients) of women and men with schizophrenia in the U.S. and India. In the study a history of “inappropriate emotions” meant that the person showed emotions that just didn’t fit the situation. And more women than men had a history of showing these inappropriate emotions, but the difference wasn’t large. Forty-two percent of the men and 55% of the women had it, so the difference was actually close to an even 50/50 split.

Angry defensive young man in a dark t-shirt and sweatshirt sitting with arms crossed facing a male doctor in a pink sweater

There Are Other Differences Between Men and Women with Schizophrenia

In this same study done in the U.S. and India there were other gender differences. The study had 395 men and 240 women in the U.S., and 480 men and 403 women in India. One difference was the course of the illness over time. Younger women (pre-menopause) had better course of the illness, meaning a less awful experience, than men. Men with schizophrenia were less likely to be married that the women. And, the women were likely to have more children than the men. Here’s a link to the study report: Women vs. Men – Symptoms of Schizophrenia Research Paper in Psychiatric Investigations.

Schizophrenia Is a Common Medical Condition

Schizophrenia is really common. Worldwide, about 77 million people have schizophrenia. It’s one of those medical conditions that equally crosses all the artificial social divisions that we human beings have constructed, affecting rich and poor, intelligent and challenged, all ethnicities, and any genders. And it’s about equal in men and women. An equal opportunity brain disorder.

Schizophrenia is a Brain-based Condition

Schizophrenia is a medical condition that affects the brain. As is discussed on our page Your Mind & Your Brain, all of the areas of our body are interconnected. So, in addition to the brain, schizophrenia affects many other organ systems like the immune system and the endocrine system (endocrine as in diabetic tendencies).

Schizophrenia is a Medical Condition

While we think this point is clear from the above discussion, we wanted to convince ourselves that we had tried to make it crystal clear: schizophrenia is physical. It’s as physical as a missing arm or leg. It is real, based in brain tissue changes. Here’s the problem. Many people use the word “mental”, as in mental illness, to mean not real. People equate “mental” with the phrase “all in your head” and use this terminology to mean imaginary. This use of the word “mental” is unfortunate and just plain wrong. Schizophrenia is not some vague, hazy thought or emotion just floating about in someone’s mind or head (or brain). It is corrupted brain hardware circuitry, hard wiring and circuits gone wrong in a person’s brain.

We Do Live in our Brain

As we’ve said, schizophrenia is a brain problem. That’s a big problem because we live in our brain. There is such a thing as mild schizophrenia, but it’s rare. (Maybe mild schizophrenia will be more common in the future.) But for now, schizophrenia is usually bad. People with schizophrenia hear voices that others don’t hear. They might view what’s going on around them in a different way. And because of the way their brain’s working they might make social mistakes and anger others. So, after a while, they start avoiding people. Why stay around people when they’re always angry? People with schizophrenia can become nervous, afraid, and upset. They might accidently upset others by making “strange” or nonsensical remarks. There are good medications that will help. It also helps to be in a secure, safe place.

We Need Better Medications for Schizophrenia

Everyone with schizophrenia and their family and friends would agree that we need better medications. Today’s best medications are huge advances over the best medications of 10 years ago. And those medications were better than the ones of 20 years ago. And those 20-years-ago medications were again incredibly better than the ones from 50 years ago. But today’s medications are still not good enough. Most people with schizophrenia never return to the way they were before the illness started. We need to fix that.

The Ongoing Explosive Revolution in Schizophrenia Knowledge and Research

We have to call the current rate of progress an explosive revolution in schizophrenia knowledge and research. For those of us in these research areas it’s really exciting. Physicians can now recognize signs in childhood that indicate the risk for eventual schizophrenia, twenty years before the psychosis starts. There are also newly found symptoms that become obvious just before the beginning of the first psychosis. We have a much better understanding of the way the disorder changes through a person’s life after that first episode. All the new information put together gives us an entirely new view of schizophrenia.

Seeing Schizophrenia Before It Begins

People have early changes in the way they behave for a period of time before the first clear signs of positive symptoms appear. People studying these changes aren’t certain how far before full psychosis the early signs can be seen. It could be that these early signs can be seen years before the obvious positive symptoms hit. As we commented above, it’s even possible that these first early signs can be seen in toddler years or infancy. Scientists are pursuing research all around the world to find out more. Many now believe that if we could tell early enough who is going to get schizophrenia we might be able to prevent it altogether.

Psychosis Is Toxic to the Brain, Making Schizophrenia Worse

The various nerve cell, nerve circuit, and chemical transmitter changes in the brain that result in psychosis are toxic to the brain. It’s like some toxic environmental exposure inside the brain. The changes damage the brain in a way that makes ongoing and worsening psychosis more likely. And, the longer the psychosis continues, the worse the toxic effect gets. The result of this situation is that if early signs of psychosis start and the psychosis is not treated quickly, it gets worse and is harder to treat. And the longer it goes untreated, the worse the condition will become and the more and more difficult it becomes to treat. In such a situation it certainly will likely never go away completely.

young woman with long strawberry blond hair and a serious worried look on her face in front of an out-of-focus purple and lavender background
Image by ThePixelman

Schizophrenia Lasts a Lifetime

Schizophrenia a chronic medical condition. It lasts all through one’s life. In the old days, before we had the better medications we have now, when someone was sent to an residence hospital for schizophrenia they usually stayed in-hospital for the rest of their life. With today’s medications and other treatments the condition can improve to the point of people being almost symptom-free. A sad fact here is that too often people feel so well that they stop their medication and, as a result, their wellbeing falls apart. True, they will improve again when they restart their medication. But each episode of psychosis is toxic to the brain, so the improvement with restarting medication will likely not bring them back to the place they were before they stopped the medication.

Diagnose and Treat Schizophrenia Immediately and It Might Go Away

As we said above, in schizophrenia starting and stopping medication is an real bad idea. (See our free page on Treating Schizophrenia.) It’s likely that the psychosis makes itself worse, that is, psychosis is toxic to the brain and makes it easier for more psychosis to occur. Allowing any psychosis to persist for very long can set up the person for a lifetime of worse illness than need be. This means that if the first early symptoms start and the disorder is quickly treated and treated really well immediately, it might go away. Even if it doesn’t go away completely, the individual is likely to get better and have a milder course throughout his life.

Can We Wipe Out Schizophrenia?

So maybe if we can identify people on the path to develop schizophrenia, jump in with aggressive treatment as soon as the first signs appear, and keep the treatment going, we could wipe out schizophrenia altogether. Eliminating schizophrenia is a goal of everyone close to the condition: physicians, scientists, patients, family members, and friends. And we’re getting close. See our free page on Treating Schizophrenia.

Schizophrenia’s Causes are Complicated and Varied

There are a couple of life situations that greatly increase the risk for schizophrenia. One of these situations is everything a person goes through from the start of pregnancy to today, for example, events during fetal life while Mom is pregnant. The other situation is your ancestors, specifically the genes you inherit. What genetics did you inherit from mom and dad, grandparents, and other ancestors? As all the parts of life’s experiences and genes mix together, you can understand that schizophrenia in one person might be different from schizophrenia in another individual. This means that there is not just one disorder, “schizophrenia”, but many, many similar disorders, the “schizophrenias”, each a bit different. And, while these different schizophrenias might look similar, they are not. Yes, it does get confusing.

The Baby in the Womb and Schizophrenia

We have no control over what happens to us while our mothers are pregnant with us. Many situations that affect the developing baby can occur. Damage to a developing baby is one possible cause of schizophrenia even though the disorder does not appear until teenage years or in young adults. These problem influences on a baby’s well-being include a mother’s temporary diabetes while she is pregnant, any bleeding that she has during pregnancy, and events that can go wrong in labor and delivery like too little oxygen, an emergency C-section, and low birth weight. Another possible problem is infections that a mother has during the middle part of her pregnancy. Or a mother’s high stress levels during this time. These situations might lead to additional problems for the baby. These effects during the middle 3 months on the forming baby could double the risk of developing schizophrenia.

Schizophrenia Does Indeed At Times Run in Families

Schizophrenia can and sometimes does run in families. Families with one family member with schizophrenia are more likely to have other family members with it. Or, consider adopted children born to biological parents with a genetic risk for schizophrenia. They seem to have the same risk for getting schizophrenia in their new, adoptive home as they would have had if they had stayed in the home of their biological parents. So here it’s the genes, not the childhood environment. Schizophrenia also runs in families that have family members with bipolar disorder (manic depression). So, these two conditions are genetically linked in some way.

Helpful links:

NIH, National Institute of Mental Health – The NIH/NIMH on Schizophrenia

National Library of Medicine, MedlinePlus – MedlinePlus on Schizophrenia

The Mayo Clinic on Schizophrenia

American Psychiatric Association on Schizophrenia

National Alliance on Mental Illness on Schizophrenia

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