Schizophrenia: Types, Symptoms, Causes and Complications

Schizophrenia (SZ) is a chronic mental disorder and a complex, heterogeneous, and disabling psychiatric disorder that affects a person's ability to feel, think and behave clearly and impedes cognitive skills and perceptual, emotional, and behavioral functioning.
Schizophrenia is characterized by psychosis, delusions, hallucinations, distorted thoughts and other cognitive difficulties. It usually appears in late adolescence or early adulthood and can often be a lifelong struggle. 
There are different types of schizophrenia, including: Paranoid, hebephrenic, catatonic, undifferentiated, residual, and unspecified.

What is Schizophrenia
Symptoms of schizophrenia.

What is Schizophrenia: Types, Warning Signs, Symptoms, Risk Factors, and Complications

Schizophrenia is a severe mental disorder that generally requires lifelong treatment. It normally occurs in early adulthood or late adolescence in which a person suffers from abnormal changes in thinking, feelings, emotions, and behaviors.  
It is possible that psychosis, which means a person's separation from reality, is one of his symptoms. 

Schizophrenia can also lead to a combination of hallucinations, delusions, disturbed thoughts and many cognitive difficulties that impair daily functioning and can often cause a lifelong conflict and disability. In the past, Dissociative identity disorder (DID) was often misdiagnosed as schizophrenia. 

In this article, we will discuss what schizophrenia is, types, symptoms, causes, and complications of schizophrenia.

What is Schizophrenia?

Schizophrenia is a chronic psychological disorder that adversely affects the thinking and behaviors of the patient, increases the tension, negatively impacts on the social cohesion, causes poor memory, and leads to mental disorientation. 
It is usually associated with psychotic symptoms, such as hearing sounds, delusions, hallucinations, distorted thinking or emotional and behavioral disorders which result in poor daily performance.

Schizophrenia can also be expressed as a set of brain changes associated with increased dopamine activity. 
There are other hypotheses which say that high levels of serotonin or norepinephrine also cause schizophrenia and create a problem in relationships between the patient and the surroundings.

Schizophrenia usually occurs between the ages of 16 and 30, and in men, signs appear at a young age compared to women. 
In many cases, it develops so slowly that the person generally does not know that they had been suffering from it for many ages. 
However, in other cases, this can happen suddenly and develop quickly.

Types of Schizophrenia

• Catatonic schizophrenia: This is a serious psychological or neurological condition in which two types of behaviors are usually displayed: stupor (a state close to unconsciousness) and motor rigidity. 
This type may occur in the form of hyperactivity, total rejection of anything, non-interaction with the surroundings, weird behavior and inability to speak, respond or even move.

• Disorganized Schizophrenia: It is also known as “Hebephrenia” and it is one of the five subtypes of schizophrenia that is considered to be an extreme emotional expression of the disorder syndrome, which is envisaged for one aspect of the three-factor model of symptoms in schizophrenia. 
Other factors include disturbances in reality (involving confusion, hallucinations, and delusions) and psychomotor poverty (lack of spontaneous movement, and lack of speech, etc).  

• Paranoid schizophrenia: In this condition, the impact of biological and genetic factors is less than the impact of the environment; it is mainly characterized by positive symptoms of schizophrenia, which include hallucinations, confusion, and delusions.
These debilitating signs generally blur the line between what is real and what is not, and the personality is integrated with blurred foresight which makes it difficult for a person to live a specific life.

• Residual schizophrenia:  It is a type of schizophrenia where a person often shows the negative symptoms such as irrational thinking, unfamiliar knowledge, emotional inconsistency, showing social withdrawal and extreme behavior, having a lack of interest in the daily activity, being unable to shower, wear clothes, and make food for one's self.

• Undifferentiated schizophrenia: This is a classification of non-specific schizophrenia used when a person shows behaviors commensurate with two or more other subtypes of schizophrenia, including symptoms such as hallucinations, delusions.
In this condition, the patient may exhibit very irregularity in sensation, speech, and behavior, and his feelings are superficial and immature.

Symptoms of Schizophrenia

Symptoms of schizophrenia
Common Symptoms of schizophrenia

The Most Common Symptoms of Schizophrenia
Schizophrenia is associated with a range of psychological, behavioral and emotional changes. 
Signs and symptoms can vary in severity and type - but they usually include delusions, hallucinations, or asymmetrical talk - as they reflect poor functional ability. 
Some of which are present permanently in the affected individuals.

Clear symptoms may appear in some patients, but some patients do not show clear symptoms of schizophrenia, they commonly may look fine until they start to tell what they are really thinking.

Schizophrenia not only affects the patient, but its effects can reach far ahead – society, friends, and family members are also affected.

Symptoms of schizophrenia can vary, depending on the condition of a person; they are commonly classified into 4 major categories:

1. Positive symptoms:  They are also known as psychotic symptoms. For example, behaviors or feelings that are not usually found, such as the belief that what other people are saying is not true (delusions) and seeing, smelling, hearing, tasting or feeling something that other people do not experience (hallucinations).

2. Negative symptoms: They refer to those elements which are taken away from the person. For example, poverty of speech and thought, the absence of facial expressions, reduced social drive, loss of motivation, blunting of effect, lack of social interest, and inattention to cognitive input, apathy, and anhedonia.

3. Emotional symptoms: They are usually considered as negative symptoms.  Emotions are complex systems that have evolved through human evolutionary history so that organisms can be prepared to work in response to many environmental challenges and stimuli. 
Thus, in most circumstances, emotions serve many interpersonal activities and a number of important differences. 
Compared with controls, patients with flat affect were severely impaired on the facial expressions processing tasks, one that is to identify the emotions of happiness and sadness and another who needs to differentiate between the intensity within these emotions.

4. Cognitive symptoms: They generally affect the thoughts process of a person. They can be positive or negative symptoms, for example, disorganized thinking, slow thinking, difficulty understanding, difficulty expressing thoughts, difficulty integrating feelings, thoughts and behavior, poor memory and poor concentration.

The symptoms of schizophrenia usually begin in men from the early twenties to the middle. 
In women, symptoms usually begin in the late twenties. 
Diagnosis of children with schizophrenia is rare and is uncommon in people over the age of 45. Positive, negative and cognitive symptoms are separately classified into a number of categories.

Positive Symptoms of Schizophrenia

Delusions: They are strongly held erroneous assumptions or false beliefs due to incorrect interpretations of perceptions, grandeur or experiences and/or exaggerations or distortions of reasoning. 
The delusions of being watched or followed by others are very common symptoms; as such beliefs send special messages directly to a person’s mind. 
The patient can feel that other people are trying to control them remotely or can think that they have extraordinary abilities and powers.

Hallucinations: They are exaggerations or perversions of perception in any senses, although auditory hallucinations are the most common symptoms followed by visual hallucinations. 
The hearing voices are more common than things like seeing, tasting, feeling or smelling that are not there; However, people suffering from schizophrenia can experience a wide range of hallucinations.

Disorganized speech/thinking: This is also called "thought disorder"; it is a major aspect of schizophrenia. 
The person can jump from one topic to another without any logical reason. Following the speaker can be difficult, erratic or irregular. 
Disorganized thinking is usually done on the basis of the person’s speech. 
Therefore, loosely associated or incompatible speech largely interrupts effective communication which is used by DSM-IV as an indicator of thought disorder.

Gross disorganized behavior: It includes difficulty in target-directed behaviors which can lead to difficulties in daily life activities), unpredictable movement, discomfort, silliness, social disruption, or strange behavior towards the audience. 
Their purposelessness and aimlessness distinguish them from unusual behavior inspired by the beliefs of delusion.

Catatonic behavior: It is characterized by a significant reduction in immediate response to the surrounding environment; sometimes it takes the form of stagnant, motionless and obviously absurd, aimless extra motor activity or rigid, rude or bizarre posture.

Negative Symptoms of Schizophrenia

Affective flattening: It is a decrease in the scope and intensity of emotional expression, including body language, facial expressions, eye contact, and tone of voice.

Poor expression of emotions: In this situation, responses to sad or happy occasions can be inappropriate, lacking or missing.

Alogia: also known as speech poverty, it is a reduction of speech productivity and fluency. It is considered to reflect blocking thoughts or slowing ideas, and often shows short empty responses to questions.

Avolition:  also known as lack of motivation; it is an inability to start and sustain goal-oriented behavior; it is often mistakenly thought to be unclear. 
In this case, the patient loses the drive. Daily procedures, such as washing and cooking, are usually neglected. 
For examples, the patient is no longer interested in meeting with friends, going out and performing tasks that he used to show enthusiasm for, no longer cares much about anything, sitting at home for long hours a day and doing nothing.

Social withdrawal: when a person with schizophrenia wants to be alone and withdraws socially, it is often due to their belief that someone will harm them.

Unawareness of illness:  A number of patients seem to be realistic for hallucinations and delusions, many of them cannot believe that they are really suffering from sickness and illness. 
They can refuse to take medicines, for example, for fear that drug may be poisoned or for fear of side effects.

Cognitive Symptoms of Schizophrenia

Cognitive difficulties:  They affect the person’s ability to focus, remember things, organize his life and plan ahead. 
Communication becomes more difficult in these conditions. In general, the degree of cognitive impairment in schizophrenia is more serious than bipolar or mood disorder and includes more cognitive areas. 
The weakness of perception in schizophrenia is less closely associated with the degree of psychological symptoms, as well as the more “trait-like” and less "state-like”.

The key facts about cognitive symptoms
Social / Occupational dysfunction: For an important part of the time after the beginning of disturbance and unrest, one or more major areas of functioning such as interpersonal relation, work, or self-care, are clearly below the level attained before the beginning.  
Failure to get the expected level of academic, interpersonal or professional achievement can badly hurt childhood or adolescence.

Duration: Signs of continued disturbance remain for at least 6 months. The symptoms of at least 1 month should be included in this 6-month period which meets criterion A and may include residual symptoms. 
During these residual periods, symptoms of disturbances can only be manifested by negative symptoms or two or more signs which are present in Criterion A (e.g., abnormal perceptual experience or odd beliefs).

General medical condition exclusion: Disturbances are not due to the direct physical effects of a substance such as a medication or misuse of drug or a general medical condition.

Mood or Schizoaffective disorder exclusion: Mood disorder and schizoaffective disorder are denied with psychotic characteristics because either (1) none of the major manic, depressive or mixed episodes have concurrently been produced with active-phase symptoms. ; or (2) If the mood-episode occurred during the symptoms of active-phase, then their total duration is concise relative to the periods of active and residual duration.

Relationship to a pervasive developmental disorder: If there is a history of the pervasive developmental disorder or other autistic disorder, then the additional diagnosis of schizophrenia occurs only when the prominent is present.

Symptoms of Schizophrenia in Adolescents

Symptoms of schizophrenia are similar in adolescents to adults, but discrimination may be more difficult. 
This can be partly because some of the early symptoms of schizophrenia in adolescents are common in normal growth such as:
  • Withdrawal from friends and family
  • Deterioration of school performance
  • Difficulty sleeping
  • Feeling depressed or anxious
  • Lack of motivation

Compared to schizophrenia in adults, adolescents can be:
  • Less likely to develop illusions
  • More likely to suffer from visual hallucinations

Causes of Schizophrenia

The causes of schizophrenia are unknown, but researchers believe that a range of genetic, environmental and other brain chemistry factors contribute to the disorder.

The problems of certain chemicals in the brain that occur naturally, including neurotransmitters called dopamine and glutamate, can contribute to schizophrenia. 
Neuroimaging studies show changes in the brain structure and central nervous system of people with schizophrenia. 
The researchers note that schizophrenia in personality is a brain disease, although they are not sure of the importance of these changes.

Risk factors

Although the exact cause of schizophrenia is not known, some factors increase the risk of schizophrenia, including:
  • The family history of schizophrenia
  • Increased immune system activation, such as inflammation or autoimmune diseases
  • Some complications during pregnancy and childbirth such as malnutrition and exposure to toxins and viruses that can affect brain growth
  • Taking drugs that change mood (psychologically active) during adolescence and early puberty

Complications of schizophrenia

If schizophrenia is left untreated, it can lead to serious problems affecting every area of your life. Complications that may be caused by schizophrenia or may be associated with:

When to visit a doctor

People with schizophrenia are often unaware that the difficulties they face are caused by a mental disorder that requires medical attention. 
Most of family members or friends have to ask for help. 
So if you think someone you know may have symptoms of schizophrenia, talk to him about the fears. 

Although you cannot force someone to seek a specialist immediately, you can give them encouragement and support and help your loved ones find a qualified doctor or psychologist.

In some cases, a person may have to enter the hospital in an emergency. The laws related to the compulsory appointments in the mental health hospital are different from the state. 
You can contact community mental health agencies or police stations in your area.

How To Prevent Schizophrenia

There is no sure way to prevent schizophrenia. However, early treatment may help control symptoms before serious complications occur and may help improve the long-term future situation.

Compliance with the treatment plan can help prevent relapse or exacerbate symptoms of schizophrenia. 
In addition, researchers hope that learning more about risk factors for schizophrenia may lead to diagnosis and treatment at the first sign accurately.
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