Schizophrenia

The first frank episode of psychosis happened when I was around 16, and I suddenly started walking home from school in the middle of the day. I began to feel the houses were getting weird; they were sending me messages: “You are special. You are especially bad. Now walk. Cries and whispers.” There were also some warning signs in college but I didn’t really “officially” break down until graduate school at Oxford.

Schizophrenia was originally known as dementia praecox describing a syndrome that involved an early,  gradual onset yet a progressive deterioration of brain function.  In 1950 Bleuler introduce the term schizophrenia which translates to "split mind" to refer to a split between thought process and emotions or disorganization in thought and behavior.

Keep in mind that this kind of "split mind"is not the same as dissociation reactions of fugue, amnesia, or multiple personality; in these conditions mentioned above the split is between different states of conscious instead of the between thought and emotion.

Even though most cases have an onset in the late teens to mid-thirties, schizophrenia can be diagnosed at any age; yet men tend to show symptoms at an earlier age than women allowing the men to have better outcomes in the end.  Unlike men that show more negative symptoms, women are more likely to suffer from paranoid delusions, mood symptoms, and hallucinations.  Risk of suicide has also increased, up to 40% attempt suicide but about 10% of the schizophrenics have suicide completion.  

There are different subtypes of schizophrenia:

• Paranoid Type
• In this type there are hallucinations or delusions and involve persecution.  Delusions of grandiose or persecution also associated with anger or jealousy.  These individuals have a later onset of symptoms and a better clinical prognosis but may be at greater risk  for suicidal or violent behavior.
• Disorganized Type
• The features consist of incoherent speech, hallucinations, some delusional beliefs, inappropriate responses frequently involving silly laughter, and stereotyped mannerisms and grimaces.  This type of schizophrenia tends to have an earlier onset while the overall disorganization and impairment are severe and it being chronic without significant remissions.
• Catatonic Type
• The most common feature in this type are psychomotor disturbances involving rigid immobility, excessive motor activity, echolalia, echopraxia, and unresponsiveness to environmental stimuli, for long periods of time.  There may be a presence of waxy flexibility, purposeless movements that may appear aggressive and may result in self-injury or injuries to others.  They are extremely negative; they may remain mute or resist all instructions or attempts to be moved.
• Undifferentiated Type
• This type of schizophrenia meets the criteria for schizophrenia but not the criteria for paranoid, disorganized, or catatonic subtypes.  This subtype reflects the fact that schizophrenic symptoms do not conform to the other subtypes mentioned.
• Residual Type
• This residual type is applied to people who have previously experienced episodes of schizophrenia but who at present show no symptoms or psychotic features like, delusions, hallucinations, or disorganized speech or behavior.  At times residual schizophrenia happens between periods of full blown psychotic symptoms and periods of remission but keep in mind that in some cases the residual state can persist for years.  

Unfortunately individuals with schizophrenia have more than twice the death rate than those without the disorder; while almost half of individuals with schizophrenia will suffer from a substance use disorder, like alcohol, marijuana, or others.  But on the brighter side research does show that individuals who suffer from schizophrenia have a better quality of life if their family members are more supportive and less critical.