Types, Symptoms, & Treatments

Schizophrenia is one of many mental disorders that include chronic psychotic symptoms, so distinguishing this condition from other psychotic disorders can sometimes be tricky. To make such distinctions, clinicians will often assess whether psychotic symptoms occur together with a mood episode, or whether significant cognitive impairment is present, among recognizing other signs and symptoms.


What Is Schizophrenia Spectrum Disorder?

Schizophrenia spectrum disorder is categorized as a psychotic disorder. Psychotic disorders are mental illnesses that interfere with a person’s ability to accurately perceive and respond to reality. People with psychotic disorders (i.e. schizophrenia or brief psychotic disorder) are unable to differentiate reality from delusions and hallucinations when they’re experiencing symptoms of psychosis. Schizophrenia is a rare but debilitating chronic mental illness. Less than 1% of the US population will develop schizophrenia in their lifetime, and most who do are older teens or younger adults.(FN4) Many experts believe that only people who have a genetic or neurological predisposition can develop schizophrenia, and that certain environmental factors or choices can heighten the risk for those individuals, such as use of illicit substances

Symptoms & Signs of Schizophrenia

For a diagnosis of schizophrenia to be given, the DSM 5 requires a person to exhibit at least two symptoms for a month or more, with at least one of these being a positive symptom, such as hallucinations or delusions.1 Generally, features of schizophrenia are divided into positive symptoms (i.e., the presence of something unusual), negative symptoms (i.e., the absence of something typical) and cognitive symptoms. Cognitive symptoms, like verbal fluency and memory impairment, are not yet necessary for an official diagnosis of schizophrenia. However, expert clinicians use cognitive symptoms to distinguish schizophrenia from other disorders.

How Schizophrenia is Treated

A combination of treatment methods is the best way to manage symptoms of schizophrenia.
Medication treatment is often the first and most effective means of alleviating schizophrenia’s most challenging symptoms, especially psychotic symptoms. However, finding the right medication can be difficult. The positive symptoms of schizophrenia, and the aggressive behaviors they can sometimes trigger, are often best treated with atypical antipsychotics. In rare cases, however, older, typical antipsychotics, like haloperidol, are used. Unfortunately, the most effective medication for the positive symptoms of schizophrenia, Clozapine (Clozaril), can lead to blood disorders, a rare but serious adverse effect. Thus, it is not as often used as it might otherwise be. Other atypical antipsychotics, such as risperidone (Risperdal), olanzapine (Zyprexa), and aripiprazole (Abilify), are less effective, and can come with challenging adverse effects as well, like motor tics (e.g., tardive dyskinesia), weight gain, and additional metabolic problems. However, they still work well to treat both positive and negative symptoms. Beyond antipsychotic medication, some psychiatrists have found that using antidepressants (e.g., Zoloft) to treat the affective symptoms of schizophrenia, along with anti anxiety medications (e.g., Xanax), to curb the panic symptoms, can work well, and without as many of the dangerous adverse effects that result from antipsychotic treatment.
Psychotherapy with individuals who have schizophrenia is generally less effective than it is for individuals with other mental illnesses. A combination of individual therapy—particularly from a behavior therapy (BT) or cognitive behavior therapy (CBT) approach—along with family therapy is most effective. Individual therapy from a BT or CBT perspective often focuses on setting concrete goals, like reality testing of one’s hallucinations and delusions, verbal skills enhancement, maintenance of ADLs, and medication adherence. Family therapy often focuses on the ways an individual’s family system can better prevent the afflicted individual from undue anxiety, frustration or confusion. Therapeutic options for schizophrenia include: Behavior therapy can offer patients concrete rewards for concrete behavior successes, like achieving hygiene goals. Cognitive behavioral therapy can help individuals learn to perform reality testing on their hallucinations and delusions. Family therapy helps family members create an environment of support and positivity that reduces anxiety, anger, and confusion, thus preventing schizophrenia symptoms before they arise. Psychodynamic therapy while not typical for schizophrenia, it can sometimes be helpful with patients who have good insight to recognize how their psychotic symptoms may be related to past traumas that haven’t been fully examined or acknowledged.
Often, the need for hospitalization is the first indication that one’s increasingly aberrant behavior and confusing internal experiences have crossed the line to a psychotic disorder, like schizophrenia. In fortunate situations, a doctor, friend or family member may point out privately that one’s logic or behavior is acutely concerning, thus prompting a trip to a psychiatric ER. In more extreme situations, individuals may behave bizarrely or violently in public, thus leading the police or an EMS team to have a patient involuntarily hospitalized. In either case, hospitalizations can be brief (sometimes just a few days to re-stabilize an individual on the right medication), or they can lead to long term care, where patients may live in community treatment residences for years. Though psychotherapy is provided during hospitalizations for schizophrenia, treatment is very limited and is usually relegated to group therapy, covering only the most superficial aspects of the disorder. Hospitalizatio
Medical Procedures
Aside from medication and psychotherapy, medical procedures, such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS), are sometimes used. When they are, it’s usually to treat the more affective components of the illness, such as depressed mood and negative symptoms.

How to Get Help for Schizophrenia

Finding help for schizophrenia starts with the courage to acknowledge that something is wrong. Many people are afraid for months, even years, to admit that something isn’t right, and valuable time is lost. Schizophrenia can be a progressively degenerative condition if left untreated. As with most medical and mental illnesses, the earlier schizophrenia is treated, the better. Given the fear and uncertainty that schizophrenia can instill, an individual who thinks they could be affected should identify the person they most trust, and tell that person what they are experiencing. That person should, in turn, consider talking to a physician, mental health provider, or a family member to get recommendations regarding how to proceed. If one so chooses, they can take the initiative themselves and find a therapist to start the process of treatment.
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