Recognizing and Managing Schizophrenia
The symptoms of schizophrenia can make it difficult to participate in usual, everyday activities, but effective treatments are available, allowing many people to maintain their independence, and personal relationships.
Although some of the signs may seem similar, schizophrenia is not dissociative identity disorder (formerly called multiple personality disorder or split personality). People with dissociative identity disorder have two or more distinct identities that are present and that alternately take control of them.
Schizophrenia can occur at any age, although the average age of onset tends to be in the late teens to the early 20s for men, and the late 20s to early 30s for women. It is uncommon for schizophrenia to be diagnosed in a person younger than 12 or older than 40.
Symptoms
It’s important to recognize the symptoms of schizophrenia and seek help as early as possible, especially after a first psychotic episode. Starting treatment as soon as possible following the first episode of psychosis is an important step toward recovery.
Schizophrenia symptoms can differ from person to person, but they generally fall into three main categories: psychotic, negative, and cognitive.
Psychotic symptoms include changes in the way a person thinks, acts, and experiences the world. People may lose a shared sense of reality with others and experience the world in a distorted way. Receiving treatment as soon as possible for these symptom is important, as repeated or continued periods of psychosis can damage the brain. These symptoms include:
Hallucinations: When a person sees, hears, smells, tastes, or feels things that are not actually there. Hearing voices is common for people with schizophrenia. Hallucinations are very real to the person experiencing it and may be very confusing for a loved one to witness.
Delusions. These are false beliefs that don’t change even when the person who holds them is presented with new ideas or facts. People who have delusions often have problems concentrating, confused thinking, or the sense that their thoughts are blocked. They may believe that they are in danger or that others are trying to hurt them.
Thought disorder: People with thought disorder may have trouble organizing their thoughts and speech. Sometimes a person will stop talking in the middle of a thought, jump from topic to topic, or make up words that have no meaning.
Movement disorder: When a person exhibits abnormal body movements. People with movement disorder may repeat certain motions over and over.
Negative symptoms diminish a person’s abilities and are sometimes confused with clinical depression. This includes being emotionally flat or speaking in a dull, disconnected way. They may find it difficult to start or follow through with activities or sustain relationships. They may show little interest in life.
Cognitive issues/disorganized thinking. People with the cognitive symptoms of schizophrenia often struggle to remember things, organize their thoughts, or complete tasks. Commonly, people with schizophrenia have anosognosia or “lack of insight.” This means the person is unaware that they have the illness, which can make treating or working with them much more challenging.
Treatment
Current treatments for schizophrenia focus on helping people manage their symptoms, improve day-to-day functioning, and achieve personal life goals, such as completing education, pursuing a career, and having fulfilling relationships. With medication, psychotherapy, self-management strategies, and family support, the symptoms of schizophrenia can be reduced and controlled.
Medication
Antipsychotic medications
Antipsychotics can help relieve symptoms of psychosis, such as delusions and hallucinations. These medications can be taken daily. Some are given as injections once or twice a month, which can be helpful with patients who lack insight into their own illness.
Many people taking antipsychotic medications experience side effects such as weight gain, dry mouth, restlessness, and drowsiness. Some of these side effects may go away over time, while others may last.
Psychotherapy
We know that psychotherapy is essential in helping people cope with schizophrenia. Here are some of the more common approaches:
Cognitive behavioral therapy (CBT) is an effective treatment for some people with affective disorders. With more serious conditions, including those with psychosis, additional cognitive therapy (CBTp) may be added, helping people develop coping strategies for persistent symptoms that do not respond to medicine.
Supportive psychotherapy is used to help a person process his experience and to support him in coping while living with schizophrenia. It is not designed to uncover childhood experiences or activate traumatic experiences. It is focused on the here and now.
Cognitive Enhancement Therapy works to promote cognitive functioning and confidence in one’s mental ability, and involves a combination of computer-based brain training and group sessions.
Psychosocial Treatments These help people manage symptoms and find solutions to everyday challenges while attending school, working, and forming relationships. People who participate in regular psychosocial treatment are less likely to have symptoms reoccur or to be hospitalized.
Coordinated specialty care: A recovery-focused approach for people with a first episode psychosis and early-stage schizophrenia. Healthcare providers and specialists work as a team to provide psychotherapy, medication, case management, employment and education support, and family education and support.
Self-help
Here are some ways to help manage the illness.
Manage Stress. Stress can trigger psychosis and make the symptoms of schizophrenia worse, so keeping it under control is extremely important. Knowing personal limitations, both at home and at work or school is critical.
Try to get plenty of sleep. When on medication, more sleep than the standard eight hours may be needed. Many people with schizophrenia have trouble with sleep, but lifestyle changes such as getting regular exercise and avoiding caffeine can help.
Avoid alcohol and drugs. Substance use affects the benefits of medication and worsens symptoms. Seek help for substance use.
Maintain connections. Having friends and family involved in the treatment plan is important. People living with schizophrenia often have a difficult time in social situations, so being surrounded by people who understand this can make the transition back into daily social life smoother.
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