Early Signs Of Schizophrenia In Teenagers And Adults 2024
What is Schizophrenia? Schizophrenia is the most serious disorder that we have in psychiatry. It's much more than hallucinations. It's an illness where the person's main problem is being psychotic. With psychosis, you're not able to tell what's real and what's not real. You can have psychotic symptoms, like hallucinations, for different reasons, like having a reaction to steroid medication, just as an example. But with Schizophrenia, there are several symptoms. And here's how we define the illness using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. You have to have two of the five psychotic symptoms. 
Understanding The Different Types Of Schizophrenia In 2024
Delusions are fixed false beliefs, and the person can not be convinced they're wrong. This is more than believing you're the best at soccer. Because that's subjective. This would be something like your spouse was duplicated from a skin tag taken from the outer quadrant of your calf.
Hallucinations, these can affect any of your five senses. The more common hallucinations though, are auditory, which are hearing things that aren't there, and visual, which are seeing things that aren't there. One important thing to remember is these hallucinations happen when you're completely alert, awake, and clear. This does not include hallucinations that anyone can have when you're falling asleep or waking up.
Disorganized thinking we call this a formal thought disorder. This is usually something that other people notice by the way you talk. You may answer questions in a way that's only slightly related to what the person said. It makes sense in your mind, but the person listening isn't quite sure what you mean. And you may hear people say things like, you're talking in code, and that's because what you say sounds related, but not really. And if you talk for a while, the person listening may not even remember what they asked. Another way you can experience this is by having your thoughts
get derailed such that you're switching from topic to topic. The topics may be loosely connected and make sense to you, but to the person listening, it sounds like you're just trailing way off-topic. We call this tangential thinking when the trail off doesn't get back to the original point. Many people are naturally talkative and include excessive detail in their stories. We call this circumstantial speech or thoughts when you get off topic but you can come back to where you were eventually. Circumstantial speech is not a part of a thought disorder of schizophrenia.
get derailed such that you're switching from topic to topic. The topics may be loosely connected and make sense to you, but to the person listening, it sounds like you're just trailing way off-topic. We call this tangential thinking when the trail off doesn't get back to the original point. Many people are naturally talkative and include excessive detail in their stories. We call this circumstantial speech or thoughts when you get off topic but you can come back to where you were eventually. Circumstantial speech is not a part of a thought disorder of schizophrenia.
A fourth symptom of schizophrenia is disorganized behavior. This is more than having a junky room. These are major levels of internal disorganization that get in the way of daily functioning. I've seen people who are so impaired that they smear feces on the wall. Another way it can look is the person has outbursts of agitation. Sometimes this can look like an outburst of laughing for seemingly no reason. And this is not because you're thinking about a funny video you've watched. You might not be thinking anything and may even feel like your head is completely empty, but you're laughing and disturbing people.
The last manifestation of schizophrenia is negative symptoms. This is not as easy to recognize or understand. The first four symptoms that I mentioned are called positive symptoms.
The best way to think about the negative symptoms is, that you're not responding to your environment in the usual expected way. And it's usually not something that you notice about yourself. What other people will notice is they'll see dramatically decreased facial expressions, or complete lack of eye contact, or failure to initiate movement or speech. So you may sit in a room with very little stimulation around you doing nothing. It's hard for someone without a mental disorder to sit unstimulated for long periods. We need sensory input in any form, someone talking to you, touching you, or having something to read or listen to. But the person with negative symptoms needs much less of this. So you can sit and do nothing and have nothing going on. So those are the five symptoms. You must have two of them going on at the same time for at least a month. And, these symptoms cause serious problems in your social life, work, academic life, or family life. So I don't want you to think, I heard someone call my name last week, does that mean I'm schizophrenic? No, not from that one symptom alone. In fact, schizophrenia is so disabling, that you shouldn't need to think hard to find two of these things that you did some time in the past and question if you have schizophrenia. A couple of features that go along with this are a lack of insight and cognitive problems.
The best way to think about the negative symptoms is, that you're not responding to your environment in the usual expected way. And it's usually not something that you notice about yourself. What other people will notice is they'll see dramatically decreased facial expressions, or complete lack of eye contact, or failure to initiate movement or speech. So you may sit in a room with very little stimulation around you doing nothing. It's hard for someone without a mental disorder to sit unstimulated for long periods. We need sensory input in any form, someone talking to you, touching you, or having something to read or listen to. But the person with negative symptoms needs much less of this. So you can sit and do nothing and have nothing going on. So those are the five symptoms. You must have two of them going on at the same time for at least a month. And, these symptoms cause serious problems in your social life, work, academic life, or family life. So I don't want you to think, I heard someone call my name last week, does that mean I'm schizophrenic? No, not from that one symptom alone. In fact, schizophrenia is so disabling, that you shouldn't need to think hard to find two of these things that you did some time in the past and question if you have schizophrenia. A couple of features that go along with this are a lack of insight and cognitive problems.
When you're delusional, you don't know that you're delusional. It's real to you. You only realize it's a delusion after the symptoms have passed. And they don't pass in a couple of hours. At least not when it's from schizophrenia. When it comes to the hallucinations, some people can experience continual voices talking in the background that they're able to ignore, their ability to ignore it depends on the volume of the voices and what they're saying. I've had some patients who were comforted by the presence of the voices as long as they weren't saying mean things, because with the voices,
they didn't feel alone. That's in contrast to someone who bangs their head because the voices are just so overwhelming for them. Another feature of schizophrenia that sets it apart from other illnesses where psychosis is present, is cognitive deficits. These cognitive deficits are things like memory problems, life planning and organizational problems, and impaired thought processing. This is one of the big differences between someone with bipolar disorder who becomes psychotic and a person with schizophrenia. If you were to look at both people side-by-side while they are in a psychotic state, the person with bipolar disorder will have prominent mood symptoms like depression or mania and the person with schizophrenia will not. A person with bipolar disorder will have delusions that usually match their mood state at the time. If the person is depressed, their delusions may have excessively guilty themes to them, like they don't deserve to live or they've disappointed the world in some way. Whereas the person with schizophrenia will have mood-neutral delusions, that are usually but not always bizarre. A non-bizarre delusion would be that all doctors in the hospital are poisoning you
by putting toxins in your pills. Also, the psychotic person with schizophrenia will have a history of poorer functioning, like serious academic problems inability to keep a job, or serious problems on a job. Whereas the person with bipolar disorder, who's psychotic at the time, will have a functioning level
that was higher before their episode came on.
they didn't feel alone. That's in contrast to someone who bangs their head because the voices are just so overwhelming for them. Another feature of schizophrenia that sets it apart from other illnesses where psychosis is present, is cognitive deficits. These cognitive deficits are things like memory problems, life planning and organizational problems, and impaired thought processing. This is one of the big differences between someone with bipolar disorder who becomes psychotic and a person with schizophrenia. If you were to look at both people side-by-side while they are in a psychotic state, the person with bipolar disorder will have prominent mood symptoms like depression or mania and the person with schizophrenia will not. A person with bipolar disorder will have delusions that usually match their mood state at the time. If the person is depressed, their delusions may have excessively guilty themes to them, like they don't deserve to live or they've disappointed the world in some way. Whereas the person with schizophrenia will have mood-neutral delusions, that are usually but not always bizarre. A non-bizarre delusion would be that all doctors in the hospital are poisoning you
by putting toxins in your pills. Also, the psychotic person with schizophrenia will have a history of poorer functioning, like serious academic problems inability to keep a job, or serious problems on a job. Whereas the person with bipolar disorder, who's psychotic at the time, will have a functioning level
that was higher before their episode came on.
Yes, depression can cause thinking problems like memory problems, but with schizophrenia, you have thinking problems without any depression or mania being present. One last thing to mention when it comes to diagnostic terms, and that's schizoaffective disorder. Think of schizoaffective disorder as a combination of bipolar disorder or unipolar depression plus schizophrenia. So you have these mood episodes, but in between the mood episodes, you still have psychotic symptoms. On that note, schizophrenia is not episodic like depression and bipolar disorder. It's more constant. You can have ups and downs in response to situational stressors, but it's not something where you have these periods of no symptoms at all. So there's a lot that goes into establishing this as a diagnosis. There are lots of nuances here as you can probably see. But this information is not so that you can diagnose yourself, it's just so that you can have more information to understand your illness once you have already been diagnosed.
We don't know exactly what causes schizophrenia.
It can be inherited and run in families. There have been associations linked between birth complications and older paternal age. But we don't have a strong enough link to establish these things as causes. It tends to show up somewhere between late teens and early 30s. However, the peak age of onset is early to mid-20s for men and late 20s for women. We treat schizophrenia with antipsychotic medications. The goal is a complete resolution of symptoms, but that usually doesn't happen, especially when you consider the hit that it takes on your thinking abilities. The medications help keep the positive symptoms like delusions and hallucinations under control. Some of the newer antipsychotic medications can help with the negative symptoms, but in my experience, those usually remain at some level. Social skills training though, can help with some of these things like eye contact and improving your conversation. That's the short version of schizophrenia.