Schizophrenia

To be diagnosed with schizophrenia, an individual must demonstrate a six-month period of marginal functioning accompanied by a mixture of psychotic symptoms (delusions and hallucinations), disordered speech, disorganized behavior, emotional disturbance, and motivational impairment. Hallmark delusions (false beliefs) involve the conviction that individuals are conspiring to harm the patient and bizarre beliefs such as that one's thoughts are being broadcast or controlled by an external force. Auditory hallucinations (false sensory experiences) such as hearing voices are typical, but unusual bodily sensations (e.g., the perception that one is being touched) and visions (e.g., the image of the Virgin Mary) are also possible. Speech may be vague and difficult to follow, at times becoming incomprehensible. Normal variation in facial expressions may be restricted with the patient seldom smiling or displaying appropriate anger. Reduced ability to experience pleasure, a lack of drive and initiative, an absence of close friends, neglect of personal hygiene, and inappropriate behavior—such as public masturbation or childlike silliness—also comprise the symptom picture (American Psychiatric Association 1994). No one individual is likely to have all or even most of these symptoms, thus complicating diagnosis and leading to great heterogeneity in the clinical picture.

People with schizophrenia often have other problems as well. Despite the debilitation accompanying schizophrenia, many patients lack insight that they have a problem or are so mistrustful that they will not seek treatment. Depression often accompanies schizophrenia, with approximately 10 percent of patients committing suicide. Substance abuse, including nicotine addiction and alcoholism, is common. Medical conditions can result from poor self-care and chronic substance use. Unfortunately, the most effective drugs used to treat schizophrenia sometimes have deleterious health consequences, including excessive weight gain, diabetes, and an irreversible, involuntary movement disorder called tardive dyskinesia.

Schizophrenia afflicts slightly less than one out of every 100 people. Studies conducted with the sponsorship of the World Health Organization (WHO) suggest that when uniform diagnostic criteria are used to identify cases, the prevalence of schizophrenia varies little across cultures as diverse as the United States, Japan, and India ( Jablensky et al. 1992). However, the content of delusions may vary across countries, emphasizing regionally popular themes. There may be some cultures where the prevalence varies slightly from the averaged estimate. For instance, African Caribbeans in the United Kingdom appear to have higher rates of schizophrenia than other inhabitants of this European country.

Schizophrenia typically begins during adolescence or early adulthood, with females lagging behind the average age of onset in males by about five years. Although the disorder can begin abruptly, most individuals experience an extended period of impairment characterized by mild symptom expression and a decline in social, educational, or occupational functioning. The course is variable, with a minority of individuals recovering whereas most experience recurrent episodes interspersed with periods of partial remission or a chronic course characterized by incoherence, unwavering delusions, and recurring hallucinations. Although the prevalence of schizophrenia in men and women is believed to be the same, men appear to experience a more chronic course and are thus more likely to be hospitalized and included in research investigations. The course and outcome of schizophrenia may be more favorable in developing than developed nations, perhaps because the cultures of developing countries are characterized by more intact families and community networks, fewer job related demands, and greater acceptance of the unconventional beliefs and behavior characteristic of affected individuals.