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Can Schizophrenia Develop Over Time

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What Myths Are There About Schizophrenia

How Schizophrenia Starts – My Experience with the Prodromal Phase

There are some myths or mistaken beliefs about schizophrenia which come from the media. For example,

  • Schizophrenia means someone has a split personality

This is not the case. The mistake may come from the fact that the name schizophrenia comes from two Greek words meaning split and mind.

  • Schizophrenia causes people to be violent

Research shows that only a small number of people with the illness may become violent. The same way as a small minority of the general public may become violent.

People with schizophrenia are far more likely to be harmed by other people than other people are to be harmed by them. But as these incidents can be shocking, the media often report them in a way which emphasises the mental health diagnosis. This can create fear and stigma in the general public.

How Do We Treat Schizophrenia

Schizophrenia is a major psychiatric illness that calls for careful, often complex, and lifelong treatment. A combination of therapies is usually necessary to effectively manage the disease.

Since there is no known cure for schizophrenia, treatment is aimed at reducing the severity of the disorder’s impact on early life and helping the child manage symptoms. Treatment is most successful when symptoms are addressed early on.

As one of the largest pediatric psychiatric services in New England, Boston Children’s has an experienced team of expert psychiatrists, psychologists, and social workers ready to help you, your child, and your family cope. Your clinician will prescribe treatment methods that may include medication, psychotherapy, specialized educational or activity programs, and support groups.

Causes Of Death In Individuals With Schizophrenia

    Schizophrenia affects approximately 1% of the US population. This serious psychiatric illness is characterized by psychotic symptoms , cognitive symptoms , and negative symptoms .

    Although there is no cure for schizophrenia, treatment can decrease symptoms. Currently, these treatments include medications and psychosocial interventions. Many individuals with schizophrenia can work, live independently or with limited assistance, and enjoy life. Unfortunately, some individuals have symptoms that do not respond to treatment and interfere with their ability to lead independent lives and comply with treatment.

    Persons with schizophrenia have a greatly diminished life span. In general, people with this disorder die more than 25 years earlier than the general population. In other words, these individuals can only expect to live about 70% of the normal life span. Why do they die early?

    In a paper recently published in JAMA Psychiatry, Mark Olfson and colleagues set out to answer this question. They examined reasons for premature mortality in a group of over 1 million people with schizophrenia covered by Medicaid, the largest insurance provider for persons suffering from schizophrenia in the U.S. They identified causes of death for over 65,500 of the 74,000 people who died during the study period and found that individuals with schizophrenia had an increased rate of death across all ages and all demographic groups when compared to the general population.

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    What Are The Symptoms Of Schizophrenia And How Is It Diagnosed

    How is schizophrenia diagnosed?

    Only a psychiatrist can diagnose you with schizophrenia after a full psychiatric assessment. You may have to see the psychiatrist a few times before they diagnose you. This is because they need to see how often you are experiencing symptoms.

    There are currently no blood tests or scans that can prove if you have schizophrenia. So, psychiatrists use manuals to diagnose schizophrenia and other mental illnesses.

    The 2 main manuals used by medical professionals are the:

    • International Classification of Diseases which is produced by the World Health Organisation , or
    • Diagnostic and Statistical Manual which is produced by the American Psychiatric Association .

    NHS doctors use the ICD-10.

    The manuals explain which symptoms should be present, and for how long for you to receive a diagnosis. For example, according to the NHS you need to be hearing voices for at least 1 month before you can be diagnosed. Mental health professionals may say you have psychosis before they diagnose you with schizophrenia.

    What is the future of diagnosis in schizophrenia?There are many research studies being conducted across the world on how to better diagnose schizophrenia. For example, a recent study found through looking at images of the brain, there may be different sub-types of schizophrenia.

    What are the symptoms of schizophrenia?

    The symptoms of schizophrenia are commonly described as positive symptoms or negative symptoms. This doesnt mean that they are good or bad.

    Schizophrenia: A Brief History

    Schizophrenia Symptoms In Adults / Schizophrenia Causes Symptoms And ...

    Early references to schizophrenia

    Schizophrenia has been around for a long time. References to people who are clearly insane appear in classical writings and the bible, for instance in Mark 5 we hear of the Gerasene Demoniac who, All day and all night among the tombs and in the mountains he would howl and gash himself with stones. In fact the oldest recorded description of an illness like schizophrenia dates back to the Ebers Papyrus of 1550BC from Egypt.1

    Descriptions of episodes of madness involving hearing voices, seeing visions and erratic and unruly behaviour start to appear in the literature from the 17th century. It is interesting to note that even then madness was seen as a medical problem rather than some possession by evil spirits although they were denied the effective remedies that we have today.7

    First Breakthroughs

    Dr Emil Kraepelin who first described schizophrenia in 1896.

    Schizophrenia was first described by Dr Emil Krapelin in the 19th century. He was director of the psychiatric clinic at the university in Estonia. He first used the term Dementia Praecox or premature dementia and he believed that the condition always had a steadily worsening course or if there was any improvement over time it would only be partial.

    Although Krapelins understanding of schizophrenia was still incomplete his work was pioneering in the way that he distinguished the condition from the other psychotic disorders such as bipolar disorder.5

    The Victorian Asylums

    Talking Therapy

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    Does Schizophrenia Get Worse With Age

    Schizophrenia is a chronic disorder that may wax and wane in severity, but it does not typically worsen with age. For some people, the symptoms of schizophrenia will improve over time while for others the symptoms will stay the same or get worse.

    Can You Recover From Schizophrenia

    Is schizophrenia a life sentence or was Krapelin wrong?

    When Emil Krapelin first described schizophrenia in 1898 he called it dementia praecox or premature dementia because he thought that it involved a progressive deterioration of the patients functioning over time. This view persisted for many years into the 20th century.

    Dr Emil Kraepelin who first described schizophrenia in 1896.

    We now know that this is not the case and that the receipt of a diagnosis of schizophrenia is not a life sentence to an existence of low achievement. 1 Many people who have suffered an episode of schizophrenia or even multiple episodes go on to recover a very high level of functioning and often to be able to re-join mainstream society.2

    Rule of thirds and rule of quarters

    For much of the 20th century psychiatrists thought of recovery rates from schizophrenia in terms of what was known as the rule of thirds. According to this rule of thumb about one third of those diagnosed with schizophrenia would recovery completely, a further third would be improved over time, leaving the remaining third who would not show any improvement.

    With improvements in treatment methods and newer medications, this model was seen to be unrepresentative and doctors now tend to use another rule of thumb which they call the rule of quarters and which suggests the outcomes after 10 years from diagnosis.

    Disparity between clinical and social outcomes in schizophrenia

    Factors affecting the outcome in schizophrenia

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    What Is Schizophrenia In Children

    Schizophrenia is a serious mental illness. It is a long-lasting and disabling problem of the brain. A child with this disorder has unusual behavior and strange feelings. He or she may suddenly start to have psychotic symptoms. Psychotic means having strange ideas, thoughts, or feelings that are not based in reality.

    Schizophrenia is not often found in children younger than age 12. Itâs also hard to spot in the early stages. Often, the psychotic symptoms start in the middle to late teen years. Slightly more boys develop it in childhood. But by the teen years it affects both boys and girls equally.

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    Economic And Social Impacts

    Are Schizophrenia Simulations Accurate?

    Not all consequences of untreated schizophrenia take place inside the persons body and mind. This serious disorder can affect the patients relationships, financial security, and social standing. People with schizophrenia are more likely to:

    • Social withdrawal: One of the symptoms of schizophrenia is isolating oneself from others. Without a concentrated effort from loved ones, it can be impossible for people with schizophrenia to maintain healthy, meaningful relationships.
    • Become a victim: Although many people believe that those with schizophrenia are more likely to perpetrate violent crime, the opposite is true. While some people with the disorder act out in violence, they are much more likely to become the victims of violent crime than the general population.
    • Experience homelessness: Several schizophrenia symptoms can make it hard to get and keep a job. As such, people with the disorder often find it difficult to pay their bills and can end up without a home of their own. Some such people stay with friends and family. However, others end up living in homeless shelters or on the streets.
    • Abuse alcohol and drugs: Schizophrenia can be difficult to live with, even when a person is on medication and seeking treatment. Without this help, patients may try to self-medicate and use substances to drown out the symptoms. This can lead to dependence on alcohol and illicit substances.

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    The Search For Progressive Brain Changes

    Researchers have sought to identify structural brain changes in schizophrenia since the time of Kraepelin.2 Postmortem33 and pneumoencephalographic studies34,35 provided support for the presence of atrophic brain changes in some patients with chronic schizophrenia. However, the opportunity to systematically investigate brain structure emerged in the 1970s and 1980s. Computed tomography revealed that patients with schizophrenia on average had larger intracranial cerebrospinal fluid volumes, including larger lateral ventricles36,37 and cortical sulci.38,39 Subsequent MRI studies demonstrated widespread deficits in gray matter volumes40,41 and white matter volumes.42 The magnitude of these group differences was observed to be greater for more chronically ill patients.43 From the outset, both CT and MRI studies sought to demonstrate associations between illness duration and the magnitude of CSF and gray matter volumes, but with little success.40,44

    The Public Health Challenge

    A recent, report by Bartcls and colleagues examined the annual health care costs for adults with schizophrenia, depression, dementia, or physical illnesses in one small US state .2 In general, except, for dementia, costs of care increased with the age of patients, with those over 85 incurring the greatest per-capita expense. Among people aged 65 or over, annual per-person care for those with schizophrenia, $40 000 or more, was the most, costly: . The patients with schizophrenia incurred higher annual costs in all age-groups compared with depression or medical conditions. The cost-by-age data were different for patients with dementia, where younger patients incurred higher costs. However, among patients over age 65, the cost of care was higher for the patients with schizophrenia compared with those with dementia.

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    Are You Affected By This

    • Samaritans provides emotional support, 24 hours a day for people who are experiencing feelings of distress or thoughts of suicide
    • Its number is 116 123 and is free to call and will not appear on a phone bill
    • Rethink Mental Illness has more than 200 mental health services and 150 support groups across England.
    • Its number is 0300 5000 927

    âMental health disorders are not about a single gene but about a collection of genes. We need to start thinking about this as a cumulative loading of genetics.â

    The work at KCL is still in its early stages. But it has been found there are 108 genes with changes in people with schizophrenia. Now, nine genes have been found across those with depression, and 20 in people who have bipolar disorder. There are almost certainly many more still to find and scientists say many of these genes will be shared across the different conditions.

    Making sense of my genetic legacy is important, because it allows me to break away from the feelings of inevitability that depression gives you. Is this meant to happen? Am I meant to get over this? Is this bigger than me?

    âEvidence from the last few years also suggests that many mental disorders share common genetic risk factors â for instance, genetic variation associated with schizophrenia overlaps with both depression and bipolar disorder,â says Lewis.

    Siblings can have very different outcomes. Twins Lucy and Jonny have a bipolar mother. Jonny has also suffered from the condition, while Lucy has not.

    Longitudinal Studies And The Effects Of Antipsychotic Medication

    Schizophrenia Symptoms : Set Icons Schizophrenia Symptoms Fears ...

    Longitudinal MRI studies have now shown that brain tissue volumes decrease and CSF volumes increase over time to a greater degree in patients with schizophrenia than control subjects.47,55,56 However, there is now compelling evidence that antipsychotic medications have an important role in contributing to these progressive changes.57,58 Lieberman et al59 followed patients treated with either olanzapine or haloperidol for a FEP for 2 years patients treated with haloperidol but not olanzapine had worsening deficits in gray matter volumes that were already apparent after 12 weeks of treatment. It was unclear whether the relative volume reductions seen in the haloperidol-treated group reflected a disease process that was ameliorated by olanzapine but not haloperidol, a drug effect caused by haloperidol but not olanzapine, an increase in relative tissue volume related to the weight gain and metabolic effects associated with olanzapine, or a statistical artifact caused by sample attrition.60

    Ho et al61 have now demonstrated an association between antipsychotic treatment and brain volume reductions in patients ascertained with a FES who were scanned longitudinally over an average of 7.2 years. Antipsychotics were associated with decreases in gray- and white matter volumes with higher doses resulting in greater decreases.61

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    Positive And Negative Symptoms

    What psychiatrists call the positive symptoms of schizophrenia are more obvious:

    • Abnormal thinking and inappropriate emotions.
    • Hallucinations, delusions and odd communication.

    What they call the negative symptoms are more subtle and can last longer:

    • Not talking much.
    • Blunted feelings/little facial expression.
    • Staying in bed to avoid people.

    Whether their symptoms are positive or negative, people with schizophrenia dont seem to interact with the world in a healthy way, says Dr. Bowers.

    Chances For People To Develop A Psychosis

    Psychosis is common. Schizophrenia affects about 1% of the general population, bipolar disorder affects about 1-2% of the general population and major depression affects about 5-10% of the general population.

    However, studies show that the chances for developing many types of psychosis are higher for family members of people with a psychosis.

    The following statistics show the chances of a person who has a brother, sister, or parent with one of the following disorders, developing these disorders themselves.

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    Side Effects Of Atypical Antipsychotics In Elderly Patients

    The safety and adverse events profile of atypical antipsychotics in elderly patients treated is mixed. On the positive side, there is a significantly lower incidence of tardive dyskinesia among older patients taking atypical antipsychotics compared with the older typical antipsychotics. There is widespread concern regarding the effect of atypical antipsychotics on cardiovascular and metabolic function, diabetes, and lipid levels, with resultant warnings issued by various regulatory and professional organizations. It is beyond the scope of this paper to review the substantial body of literature in these areas.

    It remains unclear whether these concerns arc specific to older patients with dementias or whether they are generalizable to atypical antipsychotic use in all older patients. With funding from the National Institutes of Health, we have initiated a comprehensive prospective study of a large sample of older persons in whom an atypical antipsychotic is identified as a treatment of choice. Patients are randomized to one of four medications , and assessed every 3 months for at least 2 years. The protocol includes complete physical examinations, periodic questionnaires and standardized rating scales, and a variety of metabolic measures and markers of vascular inflammation and endothelial dysfunction. This study provides the opportunity to address the many questions that are emerging about the use of atypical antipsychotic medications in the older patient.

    Risk Factors For Schizophrenia

    What is schizophrenia? – Anees Bahji

    Different factors combine to heighten the risk of schizophrenia, says Dr. Bowers:

    • Genetics: Having a relative with schizophrenia or one who displays schizophrenic behaviors increases risk.
    • Life stressors: Extreme poverty homelessness traumatic events early in life early isolation or deprivation or a constant fight for survival heighten risk.
    • Hallucinogens: The use of crystal meth, LSD, PCP or psilocybin mushrooms increases risk in the vulnerable.

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    What Is The Average Life Expectancy Of Someone With Schizophrenia

    Schizophrenia is a debilitating disorder that can make it difficult for people to live their lives. It can also be extremely stressful for family members who are close to someone who has schizophrenia.

    The good news is that schizophrenia is a treatable condition and people with the illness can live long and productive lives.

    The average life expectancy of someone with schizophrenia may depend on several factors such as how soon the person was diagnosed, the severity of their symptoms, and whether or not they take their medication as they are supposed to.

    People who have been diagnosed with schizophrenia at a younger age tend to have poorer outcomes overall than those who do not develop schizophrenia until they are older.

    The average life expectancy of a person diagnosed with schizophrenia is about 16 to 18 years shorter than the average life expectancy of someone who does not have the illness. The average life expectancy of a person with schizophrenia is around 64 years old. By comparison, the average life expectancy of the general population in the United States is around 77 years old.

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