About

Schizophrenia is a group of psychotic disorders that interfere with thinking and responsiveness. It is a disease of the brain, just like Alzheimer's and Parkinson's diseases. The term schizophrenia, which means "split mind," was first used in 1911 by Swiss psychiatrist Eugen Bleuler to categorize patients whose thought processes and emotional responses seemed disconnected. Despite its name, the condition does not cause a split personality.

Schizophrenia is characterized by the following symptoms:

• Delusions
• Hallucinations
• Disordered thinking
• Emotional unresponsiveness

Because symptoms of schizophrenia arise from various physical processes and respond differently to treatments, some experts recommend classifying the disease based on the presence of the following symptom groups:

• Negative symptoms (including apathy and social withdrawal)
• Psychotic symptoms
• Disordered thinking

Some experts group psychotic and disordered thinking into a single category called positive symptoms.

The disease is complicated by the fact that although a schizophrenic patient may have more than one symptom, he or she rarely has all of them. Symptoms also often go into remission.

Negative Symptoms

A person with schizophrenia may have the following negative symptoms:

• Lack of self confidence
• Lack of emotions
• Colorless speaking tones
• Inappropriate reactions to events (such as laughing hysterically over a loss)
• A general loss of interest in life and the ability to experience pleasure

Lack of responsiveness and poor sociability often appear in childhood as the first indications of schizophrenia. Certain imaging techniques suggest that these findings are based on biologic changes in specific parts of the brain. In many patients, however, negative symptoms do not appear until after positive symptoms develop. Negative symptoms tend to be more common than positive symptoms in older patients and typically persist after positive symptoms have been treated.

Psychotic Symptoms

Psychotic symptoms, particularly delusions and hallucinations, are the most widely recognized manifestations of schizophrenia.

• Hallucinations. A hallucination is the experience of seeing, hearing, tasting, smelling, or feeling something that doesn't really exist. Auditory hallucinations are false senses of sound such as hearing voices that go unheard by others. They are the most common psychotic symptoms, affecting about 70% of patients. One study reported that schizophrenic patients who had been profoundly deaf since birth were able to describe convincing experiences of hearing voices. Patients describe the voices as occurring all about them and that they are impossible to filter out or ignore.
• Delusions. A delusion is a fixed, false belief. It can be bizarre (such as invisible aliens have entered the room through an electric socket) or nonbizarre (such as unwarranted jealousy or the paranoid belief in being persecuted or watched).

Psychotic symptoms usually occur every now and then with periods of remission. They typically occur in men between the ages of 17 - 30 and in women between the ages of 20 - 40.

Cognitive Impairment (Disordered Thinking)

The symptoms of cognitive impairment and disordered thinking may occur before other symptoms of schizophrenia. They include:

• A lack of attention
• Impaired information processing and an aberrant association between words and ideas. Sometimes this condition is so extreme that speech becomes incoherent and is referred to as "word salad." Patients may connect words because of similarity of sound, rather than by meaning, a condition known as "clang associations."
• Memory impairment. In keeping with other aspects of disordered thinking, memory impairment in schizophrenia is likely to involve the inability to connect an event with its source into a complete and whole memory. For instance, a patient may recall and even feel a familiarity with a specific event but be unable to remember where, when, or how it took place.
• Backward masking dysfunction. This is a trait in which a distraction causes a person to forget a preceding event. It might be an important symptom and a marker of schizophrenia even in people with normal working memories. One test to diagnose this trait uses four letters on a computer screen. The screen goes blank, and another image, called a masking stimulus, appears (such as four broken letter fragments). After viewing the images, the patient is asked to type in the original letters. Both symptomatic and presymptomatic patients commonly have problems with this particular exercise.

In summary, people with schizophrenia do poorly on mental tasks requiring conscious awareness such as verbal fluency, short-term and working memory, and processing speed. However, they are no worse than the general population in underlying (implicit) learning such as grammar skills, vocabulary, and spatial skills (such as map reading). Some experts believe that impaired verbal memory in schizophrenia is a consequence of depression and slowness, but not a result of the disease process.

Other Symptoms

People with schizophrenia may experience other symptoms such as intolerance of heat (often associated with antipsychotic medications) and a reduced sense of smell.