Schizophrenia is defined as a loss of contact with reality.
Schizophrenia is an illness of the brain that manifests itself in the disturbance of certain mental functions. It is not an illness of the soul, a lack of will, or multiple personalities; rather, it is a “fault” in certain neural circuits in the brain that results in a disability, a handicap and, unfortunately, in stigman due to public misunderstanding.
Cognitive disorders are often the first symptoms to appear and they are the early warning signs of schizophrenia. They are also called precursor symptoms. These are the disorders that lead to socializing difficulties in people affected by schizophrenia.
Attention disorders, lack of concentration and effort tolerance
The person takes time to answer questions, to react to situations that call for a rapid response; they are unable to sustain attention on a task and no longer able to continue their studies or concentrate on a film.
The person forgets to perform daily tasks (homework, following a schedule). They have difficulty relating what they are reading, remembering what others say, or following a conversation. Their autobiographical memory is affected: they forget events in personal history. Their impaired working memory means that they cannot do several tasks at the same time since they cannot remember how far they have progressed on each task.
Executive function disorders
Executive functions are essential to all directed, autonomous and adapted behaviours, such as preparing a meal. The person has difficulty conceptualizing the actions needed to accomplish a task or anticipate the consequences: they cannot plan and organize the series of steps needed to reach a goal; they also lack flexibility, discernment, verification, and the ability to correct themself.
Cognitive disorders occur first, as precursor symptoms, but they persist long after the positive symptoms have diminished.
The appearance of acute (positive) symptoms is usually in early adulthood, between ages 17 and 23 in men, and between ages 21 and 27 in women. They are called “positive” because they are manifestations that are added to normal mental functioning. It is their presence that is abnormal.
These are disturbances in perceptions, most often auditive (the person hears a voice that utters insults and threats), but sometimes they can also be visual, olfactory or tactile.
These are errors in logical judgment, beliefs not grounded on reality.The person imagines that someone looking at them on the bus, or someone they pass in the street is there to spy on them; the person feels watched, persecuted, in danger;they believe the television is sending them messages; they are convinced they have the power to influence world events; that they are controlled by a force; that others can read their thoughts, etc.
- Incoherent language
The person says things that are incoherent or incomprehensible and invents words.
- Bizarre acts
The person closes the blinds of the house for fear of being spied on; collects empty water bottles; walks nude in the street; shows an unusual interest in religions and occult sciences, etc.
- Compulsive need to write; writes incoherent texts with handwriting similar to that of a child
Negative symptoms usually follow positive symptoms. They can be seen in a lack or absence of expected, spontaneous behaviours. Negative symptoms are often wrongly attributed to the effects of medication.
- Isolation, social withdrawal, indifference to the outside world
The person loses pleasure in recreational activities. They abandon friends, withdraw to their room, even become irritable if someone tries to approach them. Little by little they cut themselves off from reality. Their interpersonal relationships deteriorate.
- Alogia or difficulty conversing
They search for their words, give brief and evasive answers and are no longer able to communicate ideas or emotions. They use unusual expressions or sentence structures.
- Apathy, loss of energy
The person spends days in front of the TV without being able to follow what is happening. They neglect personal hygiene and appearance and lack interest and persistence in beginning and completing routine tasks (studies, work, housework). Their attitude gives the impression of carelessness, negligence, of laziness, of a lack of will.
- Reduced expression of emotions
The face of the person affected becomes blank, vocal inflections diminish (they always speak in a monotone), movements are less spontaneous, actions less demonstrative. They have a fixed stare, along with an absence of blinking or, alternatively, incessant blinking.
- Sleep disorders, periods of wakefulness at unusual hours, confusion of night and day
- Hyperactivity or inactivity or alternating between the two states
- Hostility, distrust and terror
- Exaggerated reactions when faced with disapproval from friends, colleagues and family members and unusual emotional reactions
- Hypersensitivity to sound and light
- Alterations in taste and smell
This illness cannot be explained by one simple cause. Some individuals are predisposed (neurophysiological vulnerability) to develop schizophrenia when stress factors appear in their life.
Environmental stress factors
Drugs (marijuana, PCP, ecstasy, etc.) frequently act as trigger factors in schizophrenia. Strong emotions (hostility, criticism, intense and intimate relationships), social tensions, work or study pressures, changes in routine (relocation, changing schools, etc.) are also stress situations that may provoke schizophrenic relapses.
Heredity is a risk factor, and the risk increases as genetic baggage mounts. A newborn’s risk increases by:
- 5% if he or she has a relative (uncle, aunt, cousin) who suffers from schizophrenia;
- 10% if he or she has a family member (father, mother, brother, sister) who suffers from schizophrenia;
- 10% if he or she has a non-identical twin who suffers from schizophrenia;
- 40% if he or she is the child of two parents who suffer from schizophrenia;
- 50% if he or she has an identical twin who suffers from schizophrenia.
It is estimated that 50% of cases of schizophrenia result from a genetic anomaly that affects brain development.
Other incidents during pregnancy, such as having the flu, taking drugs, or suffering a famine, may affect the cerebral development of the fetus.
Several cerebral regions are affected by schizophrenia:
- The hippocampus, an area in the brain that in particular helps modulate emotions and stores working memory
- The frontal lobes, which are the command centre for social and planning skills, function slower (hypofrontality) in the affected person’s brain
- The temporal lobes, which are activated by hearing, but also by auditive hallucinations
Some neurotransmitters (dopamine, serotonin, glutamate), which establish connections between nerve cells, are defective.
Who is at risk?
Schizophrenia affects 1% of the population worldwide.
(Source : Société québécoise de la schizophrénie www.schizophrénie.qc.ca)
Generally, schizophrenia appears between the ages of 15 and 30, but it can appear later, sometimes affecting people over 40 years of age.
Prevention and care
This complex illness, which affects the patient and disrupts the family, calls for a multi-disciplinary team effort approach in order to offer a multi-level treatment plan.
Antipsychotics (Risperdal, Seroquel, Zyprexa, Clozaril and, soon, Ziprasidone, Aripiprazole) are modern pharmaceutical treatments. These medications can alleviate acute symptoms (hallucinations, delusions, bizarre behaviour, incoherent speech). These new antipsychotics rarely cause the trembling and sedation seen with earlier medications (Haldol, Moditen, Largactil, etc.). On the other hand, they often lead to weight gain, which can lead to complications such as diabetes or to an increase in the level of lipids.
Treatment by medication is accompanied by rehabilitation (teaching social, communication and problem-solving skills, etc.) which begins during hospitalization and continues later, becoming more diverse, depending on the patient’s rate of progress. A concerted effort to give the person support, encouragement and gradual stimulation is needed to help them fight the persistent symptoms that handicap and undermine their motivation. Encouraging the person to participate regularly in their rehabilitation program will help them learn to take care of themselves and return to fulfilling activities at work and/or school.
It is essential to offer the patient and his or her family current information about the illness, its evolution and treatments. We need to learn to pay attention to precursor symptoms of a relapse and to avoid stress (drugs, strong emotions, etc.) that may aggravate the illness. Also, one must establish a new lifestyle that will enable the patient to become as functional as possible while protecting their vulnerability, surmounting their handicaps and offering support to their family.
Often unprepared to confront new or complex situations, patients will need help in resolving everyday problems (lodging, eating, socializing, working). This is not a dependency need; rather, a need for assistance in the planning and carrying out of activities that are part of a day-to-day routine.
There are many mutual aid groups operating throughout Québec that can offer information and support to a family affected by this illness.
Société québécoise de la schizophrénie
514 251-4000, poste 3400 ou 1 866 888-2323
Fédération des familles et amis de la personne atteinte de maladie mentale
418 687-0474 ou 1 800 323-0474
You can also consult our directory to see all the resources available to you.