What is Schizophrenia?

Schizophrenia is a chronic mental illness that usually affects young adults. This is why it was previously named as dementia praecox (“precocious madness”) by Dr. Emile Kraepelin. It was later renamed to schizophrenia, as the name was misleading. The word “schizophrenia” comes from the Greek root words schizo (split) and phrene (mind) to describe the fragmented thinking of people with the disorder. This term was not meant to convey the idea of split or multiple personalities – a common misconception. While the term schizophrenia is only about a century old, the disease has been retrospectively found in ancient texts.

Differential diagnosis: Mental illnesses or medical conditions that present similarly to schizophrenia.
Delirium, dementia, substance induced psychosis, bipolar mood disorder, depression, psychotic episode, some personality disorders. Medical conditions like hypothyroidism or hyperthyroidism, pellagra, HIV, syphilis, systemic lupus erythematous and heavy metal toxicity may also present in the same way.

What causes Schizophrenia?

Most psychiatrists subscribe to the multifactorial causation theory as no single specific cause can be identified. Multifactorial means that there are many factors that work together or opposing to determine if a person develops the disease.
Predisposing + precipitating + modulating = illness
Predisposing: Makes person more susceptible – genetic predisposition (aka family history) or other conditions such as autoimmune disease’s
Precipitating: Causes illness to appear – Stressful events, trauma, lack of sleep, autoimmune disease ‘flare-up’, psychoactive drugs
Modulating: Varies or modifies the expression of the illness – age, spousal support

The course of the disease is characterized by remissions & relapsing episodes with residual symptoms in between. Some patients return to normal premorbid functioning, whereas others have a gradual deterioration after each episode.

What are the symptoms of Schizophrenia?

Schizophrenia is diagnosed by impaired functioning (for at least six months) of which at least one month is an active phase. During the active phase, at least two of the following five symptoms are required, of which at least one must be one of the first three listed.
1. Hallucination: False observation that occurs without an external stimulus of a sensory organ. Can affect any sense. Basically seeing/hearing/smelling/feeling/tasting something that isn’t there
2. Delusion: A personal belief that is false, but steadfastly believed (and not part of their culture). Often people will believe that someone is out to get them or that they have magical powers.
3. Thought form disorder: How the person thinks – do they speak incoherently, or illogically. Sometimes they make loose associations between topics that are completely unrelated
4. Disorganized behavior: Bizarre, ‘abnormal’ behaviors, impaired goal-directed activity. Decline in overall daily functioning
5. Negative symptoms: This is a cluster meaning the absence of normal behaviors – presents as a lack of emotional expression, lack of interest or monotone speech.


How is Schizophrenia normally treated?

Biopsychosocial treatment is the standard method of treatment prescribed by psychiatrists for any mental illness

Biological: Medical drugs, namely antipsychotics. This is divided into typical antipsychotics and atypical antipsychotics. Typical antipsychotics are the older generation and treat positive symptoms. They are generally used to terminate acute psychotic episodes or resistant schizophrenia. These are drugs like haloperidol, fluphenazine and clopixol. They unfortunately have serious side effects.
Atypical antipsychotics are the newer generation of medications and are used to treat the negative symptoms of schizophrenia, and have a slower onset of action. These are most often used for maintenance therapy. These are drugs like clozapine, risperidone and olanzapine. These also have their own set of side effects and it is the psychiatrists job to find the right drug for optimal treatment. There is no drug that works on the brain without some side effect.

Psychosocial: This is the non-biological approach, necessary to reduce stressors and prevent relapse

Psych: Education about the disease and its effect. Cognitive behavioral therapy is also used. Occupational therapists work to increase the functioning of the patient in daily life.

Social: Disability grants because they can’t work, family therapy to get sufficient social support and help work through grief stages.

After the first schizophrenic episode, the patient is treated for two year’s, and after the second episode they get treatment for five years.
If the patient is in remission for at least one year and well adapted with good social conditions, then it is possible to slowly withdraw medication. The patient should still attend group sessions.

Hospitalization is avoided as far as reasonably possible – the patient should be treated as an outpatient to let them feel like they are still part of community.
Criteria for hospitalization
• Destructive behavior
• Suicidal behavior
• Pathological family system
• Serious side effects of schizophrenia
• Treatment resistance
• Secondary substance misuse

How does addiction affect Schizophrenia?

Drug addiction complicates an already delicate situation. Comorbid substance abuse in people with a mental illness is often an indicator of poor treatment outcomes. Substance abuse worsens the existing symptoms and addiction sufferers are less likely to follow through with treatment. Substance abuse can often mimic the symptoms of schizophrenia and thus can mask the onset of the disease. In practice, it is very hard to discern which symptoms are caused by the mental illness and which are caused by the drug. Schizophrenia is difficult to diagnose when substances are abused as psychosis can be induced during drug intoxication. In cases where the substance abuse is the sole reason for the psychotic symptoms it is diagnosed as a drug induced psychosis and the symptoms usually pass when the drug use stops.

There is a research that points to a relationship between substance misuse in adolescence and an increased risk for developing schizophrenia. At the moment, there is considerable debate in the mental health field about the relationship between drug abuse and developing schizophrenia. Marijuana is currently being researched due to some States relaxing marijuana consumption laws. It is uncertain if marijuana use is a risk factor for schizophrenia or that schizophrenia patients are more prone to abuse psychoactive drugs. At the moment, there is no conclusive evidence proving or disproving. If you already have a genetic predisposition to the illness, cannabis use may act as a trigger
Other non-biological adverse effects also occur. Substance abuse may severely affect people’s finances. Addiction will distract the person with schizophrenia from everyday problems and reduce their motivation to deal with them – this causes unnecessary stress.

How does Schizophrenia affect Addiction Treatment?

It can be difficult to notice an addiction forming as the symptoms will often be attributed to the mental illness.
Addiction is a serious mental illness but comes secondary to schizophrenia when they occur together. It is a separate illness that requires specialized treatment. It is important to remember the dynamic interaction between the two illnesses. Beating the drug addiction still remains a central part in the treatment of schizophrenia. This is helpful with the beneficial social aspect of keeping down a job and removing unnecessary stressors. It is important to start treatment as soon as possible for any addiction, even more so when occurring with a mental illness.
Peoples with schizophrenia are difficult to treat for addiction. Serious interventions may be required, medication and psychiatric support are a must. Hospitalization is necessary to treat the dual diagnosis.
If you can control the schizophrenia it will be easier to treat the addiction, prevent relapse and vice versa

Special considerations for people with Schizophrenia in treatment / (How to Treat both the addiction and co-occuring disorder).

Schizophrenia is difficult to diagnose at the best of times and drug abuse may hinder a correct diagnosis.
Both illnesses need to be treated concurrently as there is a dynamic relationship between the two.
The antipsychotics used are potent drugs that should not be mixed with other mind-altering substances. Everything from heroin down to nicotine and alcohol has been shown to have a negative effect on treatment outcome.

Mental illness is because of chemical imbalance in the brain. It is the same manner of pathophysiology as other diseases and the stigma should be removed.