Schizophrenia is a chronic severe mental disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behaviour that impairs daily functioning, and can be disabling. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.
1% of the population or about 300,000 Malaysians are estimated to have schizophrenia.
WHAT IS SCHIZOPHRENIA?
The symptoms of schizophrenia fall into three categories: positive, negative, and cognitive.
“Positive” symptoms are psychotic behaviours not generally seen in healthy people. People with positive symptoms may “lose touch” with some aspects of reality. Symptoms include:
These usually involve seeing or hearing things that don't exist. Yet for the person with schizophrenia, they have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.
These are false beliefs that are not based in reality. For example, you think that you're being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you; or a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.
- Disorganized speech
This is evident in incoherence or frequent derailment of thought. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad.
- Extremely disorganised or abnormal motor behavior
This may show in a number of ways, from childlike silliness to unpredictable agitation. Behaviour isn't focused on a goal, so it's hard to do tasks. It can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
“Negative” symptoms are associated with disruptions to normal emotions and behaviours and refers to reduced or lack of ability to function normally.
- “Flat affect” (reduced expression of emotions via facial expression or voice tone)
- Reduced feelings of pleasure in everyday life
- Difficulty beginning and sustaining activities
- Reduced speaking
Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present.
To Receive a Diagnosis of Schizophrenia
There must be significant interference in functioning in major life areas such as work, self-care or interpersonal relations.
There are continuous signs of the disturbance at least of 6 months. The symptoms may include active-phase symptoms and also prodromal or residual symptoms (attenuated or only negative symptoms). The prodromal stage refers to the “pre-active phrase”. During the active phase, there is a clear presence of delusions, hallucinations or disorganised speech. During the prodromal stage, there are often mild or subthreshold signs. For instance, the individual may hold unusual or odd beliefs; may have unusual perceptual experiences; understandable but vague speech; and unusual but not seriously disorganised behaviour.
Anxiety and depression are common among people with schizophrenia. Some people with schizophrenia may also display inappropriate emotions, depersonalization or derealization.
Sometimes, there is a genuine lack of awareness of the disorder and the symptoms experienced. This is part of the illness, rather than a deliberate denial of the disorder.
Hostility and aggression can be associated with schizophrenia. However, the majority of people with schizophrenia are not aggressive, and they are often more likely to be victims of aggression rather than to be aggressive towards others.
Suicidal thoughts and behaviour are common among people with schizophrenia. If you have a loved one who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with that person. Call 999 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.
In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It's uncommon for children to be diagnosed with schizophrenia and rare for those older than age 45.
The onset may be sudden, but there are often prodromal (“pre-phrase”) symptoms of schizophrenia for most people. Many will experience depressive symptoms and show some changes in beliefs and thought patterns.
Although a small percentage of people have experienced complete recovery from schizophrenia, many people with schizophrenia require formal or informal daily living supports. Positive symptoms tend to diminish over time with age, but negative symptoms tend to be the most persistent. Cognitive deficits associated with schizophrenia may not improve.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.