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Thought Disorders/Schizophrenia

Psychosis is characterized by episodes in which people may have trouble distinguishing between what is real and not real. This can include unusual thoughts and beliefs, paranoia, unusual behavior, trouble with thought processes, delusions, and hallucinations (seeing or hearing things that may not be there). While psychosis can be troubling to those experiencing those symptoms as well as to family or friends of those having that experience, there are many effective treatments that can reduce and even eliminate those symptoms.

There can be many different problems that can trigger psychotic thoughts including medical or neurological illness that are often treatable, substance abuse, stress, medications, depression, and a number of psychiatric illnesses including depression, anxiety, manic-depression (bipolar disorder), and schizophrenia. It is not always easy to tell what the cause of the psychoses is immediately and making an accurate psychiatric diagnosis can sometimes take weeks or months of getting to know the individual and follow them over time. The main immediate goal of treatment is to identify and treat any medical cause including substance abuse and often medicines are needed to eliminate the psychotic symptoms. The longer-term goals is to find ways of preventing future episodes which may include stress reduction, counseling, medication, and avoiding situation that may increase the risk of these symptoms returning.

Schizophrenia and schizoaffective disorders are psychiatric illnesses  in which psychotic symptoms are a main presenting symptom for which there are no other medical or psychiatric cause and may not fully respond to treatment.  

While there is no cure for schizophrenia or schizoaffective disorder, research is leading to new, safer treatments and with currently available therapies many people can lead very productive, satisfying, and meaningful lives. Experts also are unraveling the causes of the disease by studying genetics, conducting behavioral research, and using advanced imaging to look at the brain’s structure and function. These approaches hold the promise of new, more effective therapies.

The complexity of schizophrenia may help explain why there are misconceptions about the disease. Schizophrenia does not mean split personality or multiple-personality. Most people with schizophrenia are not dangerous or violent. They also are not homeless nor do they live in hospitals. Most people with schizophrenia live with family, in group homes or on their own.

When the disease is active, it can be characterized by episodes in which the patient is unable to distinguish between real and unreal experiences. As with any illness, the severity, duration and frequency of symptoms can vary; however, in persons with schizophrenia, the incidence of severe psychotic symptoms often decreases during a patient’s lifetime. Not taking medications as prescribed, use of alcohol or illicit drugs, and stressful situations tend to increase symptoms. Symptoms fall into several categories:

    • Positive psychotic symptoms: Hallucinations, such as hearing voices, paranoid delusions and exaggerated or distorted perceptions, beliefs and behaviors.
    • Negative symptoms: A loss or a decrease in the ability to initiate plans, speak, express emotion or find pleasure.
    • Disorganization symptoms: Confused and disordered thinking and speech, trouble with logical thinking and sometimes bizarre behavior or abnormal movements.
    • Impaired cognition: Problems with attention, concentration, memory and declining educational performance.

Researchers believe that a number of genetic and environmental factors contribute to causation, and life stressors may play a role in the disorder’s onset and course. Since multiple factors may contribute, scientists cannot yet be specific about the exact cause in individual cases. Since the term schizophrenia embraces several different disorders, variation in cause between cases is expected.

Treatment can help many people with schizophrenia lead highly productive and rewarding lives. As with other chronic illnesses, some patients do extremely well while others continue to be symptomatic and need support and assistance.

Therapy and supports can help people learn social skills, cope with stress, identify early warning signs of relapse and prolong periods of remission. Because schizophrenia typically strikes in early adulthood, individuals with the disorder often benefit from rehabilitation to help develop life-management skills, complete vocational or educational training, and hold a job. For example, supported-employment programs have been found to help persons with schizophrenia obtain self-sufficiency. These programs provide people with severe mental illness with competitive jobs in the community.

Optimism is important and patients and their family members need to be mindful that many patients have a favorable course of illness, that challenges can often be addressed, and that patients have many personal strengths that can be recognized and supported. We can help provide you with a variety of resources to make sure that you have all tools available to maximize treatment response, reduce risk of symptom reoccurrence, and function at the highest level possible.  


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