Schizophrenia is a severe mental disorder that affects thinking, emotions, perception and behaviour. People may hear voices, have false beliefs (delusions) or lose touch with reality. It usually begins in late adolescence or early adulthood. It is a lifelong condition but can be controlled with proper treatment.
Schizophrenia does not mean “split personality.” The term “split mind” actually refers to a disturbance in how thoughts and emotions are connected.
Epidemiology
Schizophrenia affects about 0.3–0.7% of the population. It is slightly more common in men and often begins earlier in males (around 25 years) than females (around 27 years). Childhood and old-age onset are rare.
Types of Schizophrenia
1. Paranoid Type
Dominated by delusions and auditory hallucinations. Thinking and speech remain relatively normal.
2. Disorganized Type
Confused thoughts, inappropriate or flat emotions, silly or childlike behaviour. Daily functioning is affected.
3. Catatonic Type
Physical symptoms dominate: immobility, rigid posture, refusal to move, or repetitive purposeless movements.
4. Undifferentiated Type
Symptoms do not fit clearly into any one subtype.
5. Residual Type
Past history of schizophrenia but current symptoms are mild. Negative symptoms such as blank facial expression, poor motivation, and reduced speech remain.
Causes
The exact cause is unknown but several factors contribute:
- Genetics: runs in families.
- Brain chemistry: imbalance of dopamine, leading to hallucinations and delusions.
- Brain abnormalities: structural changes in some patients.
- Environmental triggers: viral infections, drug abuse (marijuana), or severe stress.
Risk Factors
- Family history of schizophrenia
- Malnutrition or viral exposure in the womb
- Inflammation or autoimmune diseases
- Use of psychoactive drugs during teenage years
Dopamine Theory of Schizophrenia
One of the most accepted theories suggests that schizophrenia is caused by overactivity of dopamine pathways in the brain.
Supporting evidence:
- Drugs that increase dopamine (amphetamine, cocaine) can cause psychosis-like symptoms.
- Patients with Parkinson’s disease taking dopamine-enhancing drugs may develop hallucinations.
- Antipsychotics that block dopamine receptors reduce symptoms.
- Imaging studies show increased dopamine release in schizophrenic patients.
Symptoms
Symptoms usually start in early adulthood. They are grouped into three major categories:
1. Positive Symptoms
- Delusions: false beliefs such as being spied on or having special powers.
- Hallucinations: hearing voices is most common.
- Disordered thinking: jumping between unrelated topics, making up words.
- Disorganized behaviour: strange clothing, poor hygiene, sudden outbursts.
2. Negative Symptoms
- Social withdrawal
- Lack of motivation or interest
- Emotionless or flat expression
- Loss of pleasure
- Reduced speech
- Poor hygiene
3. Disorganized Symptoms
- Incoherent speech
- Confused thinking
- Unpredictable behaviour
Diagnosis
Diagnosis is clinical and made by a psychiatrist. There is no single laboratory test.
A person is diagnosed when:
- Symptoms last for at least six months
- Functioning at work, school or social life is significantly impaired
- Symptoms are not due to drugs or another medical condition
Tests and Screening
To rule out other medical causes:
- Blood tests (CBC, metabolic profile, drug screening)
- Imaging (CT or MRI)
Psychological Evaluation
Includes assessment of mood, thoughts, hallucinations, delusions, behaviour and risk of self-harm.
Treatment
Schizophrenia requires lifelong treatment. A team approach is often used (psychiatrist, psychologist, nurse, social worker).
1. Medications
Second-Generation Antipsychotics (preferred)
Lower risk of neurological side effects.
- Aripiprazole
- Olanzapine
- Risperidone
- Quetiapine
- Clozapine (for resistant cases)
- Lurasidone
- Paliperidone
First-Generation Antipsychotics
Effective but have higher risk of tardive dyskinesia.
- Haloperidol
- Chlorpromazine
- Fluphenazine
- Perphenazine
2. Psychosocial Interventions
- Individual therapy: improves coping skills and recognition of relapse signs.
- Social skills training: helps daily functioning.
- Family therapy: supports caregivers.
- Vocational rehabilitation: helps with employment.
3. Electroconvulsive Therapy (ECT)
Used only when medications fail or when severe depression or catatonia is present.
Complications
If untreated, schizophrenia can lead to:
- Suicide or self-harm
- Depression and anxiety
- Substance abuse
- Social isolation
- Homelessness
- Poor physical health
- Violent behaviour (rare, usually due to lack of treatment)
Prevention
There is no proven way to prevent schizophrenia, but early treatment and adherence to medication can reduce relapses and improve long-term outcomes.
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