Statistical Methods And Measurement Caveats
The prevalence rate of schizophrenia and related psychotic disorders is difficult to estimate using typical household survey methods alone. Accurate assessment of schizophrenia is best achieved using clinicians trained in the diagnosis of mental illnesses. The U.S. prevalence studies cited here were selected based on their use of U.S. population samples and use of methods that involved clinical diagnosis, either via clinical reappraisal studies or clinical record studies.3,4,5
Individuals with schizophrenia and other psychotic disorders may be under-counted in prevalence estimation studies. These individuals may be under-represented in household surveys because they may reside in prisons, other institutions, or may lack a permanent address. Similarly, some people with schizophrenia and other psychotic disorders may not be fully reflected in medical records data because they may not have a documented diagnosis, and/or may receive little or no health care.
Information on statistical methods and measurement caveats can be found in the papers cited on this page and listed in the reference section. Below we provide additional background information for large datasets used in two studies cited on this page.3,5
National Comorbidity Survey Replication
What Are The Types Of Schizophrenia
There are different types of schizophrenia. The International Classification of Diseases manual describes them as below.
- Pranks, giggling and health complaints.
- Usually diagnosed in adolescents or young adults.
- Unusual movements, often switching between being very active and very still.
- You may not talk at all.
- Negative symptoms are prominent early and get worse quickly.
- Positive symptoms are rare.
Your diagnosis may have some signs of paranoid, hebephrenic or catatonic schizophrenia, but doesnt obviously fit into one of these types alone.
This type of schizophrenia is diagnosed in the later stages of schizophrenia. You may be diagnosed with this if you have a history of schizophrenia but only continue to experience negative symptoms.
There are other types of schizophrenia according to the ICD-10, such as.
- Cenesthopathic schizophrenia. This is where people experience unusual bodily sensations.
- Schizophreniform. Schizophreniform disorder is a type of psychotic illness with symptoms similar to those of schizophrenia. But symptoms last for a short period.
Symptoms meet the general conditions for a diagnosis, but do not fit in to any of the above categories.
Schizophrenia Diagnosis: Rule Out Other Conditions
A diagnosis involves what someone is experiencing as well as what he is not. Some disorders have some features or symptoms that are shared with schizophrenia therefore, doctors check to see if something else fits better than schizophrenia. Some of the conditions that, according to criteria in the DSM-5, have some similarities with schizophrenia are
- Mood disorders with psychotic features
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What Are The Early Signs Of Schizophrenia
The most common early signs of schizophrenia may include social withdrawal, depression, hostility, oversleeping or insomnia, inability to cry or express joy, and deterioration of personal hygiene. The early stage of the schizophrenia is called the prodromal phase. It is difficult to diagnose schizophrenia during this early stage, as these symptoms could result from a number of other problems.
The Signs And Symptoms Of Schizophrenia
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
The symptoms of schizophrenia can seem peculiar to people who observe them. However, when people are experiencing symptoms, they may have little or no insight that their thoughts or behaviors are strange. The lack of insight can make schizophrenia very frustrating and frightening for loved ones.
Verywell / Cindy Chung
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Medical Expenditure Panel Survey
- The MEPS collect data from community-dwelling people in the U.S. It does not include patients living in group homes, supported living arrangements, prisons, and institutions. In addition, homeless people and undocumented immigrants are excluded. These groups may have a higher prevalence of schizophrenia. MEPS survey responses were obtained from a single respondent for all the members of the family, therefore some recall bias may be associated with the responses.
- Patients for the schizophrenia study were selected based on ICD-9 codes only. Due to the stigma associated with the condition, physicians are known to give patients an interim non-schizophrenia diagnosis when uncertain about schizophrenia until it can be confirmed. To capture patients who may be given an interim non-schizophrenia diagnosis, researchers used the ICD-9 code for non-organic psychoses in addition to that for schizophrenic disorder in their study.5 MEPS collects information about conditions through patient interviews and some miscoding may occur as the household participants describe their conditions during the interviews and the coders record the ICD-9 codes for the diagnosis.
Are People With Schizophrenia Dangerous
Popular books and movies often depict people with schizophrenia and other mental illnesses as dangerous and violent. This usually isnât true. Most people with schizophrenia are not violent. More typically, they prefer to withdraw and be left alone. When people with mental illness do take part in dangerous or violent behaviors, itâs generally a result of their psychosis and the fear that theyâre being threatened in some way by their surroundings. Drug or alcohol use can make it worse.
On the other hand, people with schizophrenia can be a danger to themselves. Suicide is the top cause of premature death among people with schizophrenia.
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Can Schizophrenia Be Treated
Yes. The main types of treatment are counseling and medicines to lessen or stop psychotic symptoms. Medicines will control psychotic symptoms in most people. In milder cases of schizophrenia, medications may not be needed. Medicines can:
- Lessen or stop hallucinations
- Help the person tell the difference between hallucinations and the real world
- Lessen or stop false beliefs
- Lessen feelings of confusion
- Help the person think more clearly
Lessening of these symptoms can help the person resume his or her normal lifestyle and activities. Medicines for schizophrenia need to be taken regularly, even after symptoms are gone. Some people with schizophrenia will stop taking their medicine because they believe the medicine is no longer needed, or they dislike the medication’s side effects. Psychotic symptoms often return when medication is stopped. Do not stop taking medicine without the advice of your healthcare provider.
Discuss any concerns you have about side effects with your healthcare provider.
Moving Into Adulthood: A Turning Point
Schizophrenia is typically diagnosed after age 18, most often in a persons 20s or early 30s.
It may be fairly well-controlled early in life, but moving from home to college and encountering new rules, or no rules exposes vulnerable young people to things theyre not prepared to deal with, says Dr. Bowers.
Living with a college roommate can prove difficult. It may seem easier to avoid talking or eating with others. You tend to isolate yourself and seem preoccupied with your own world, she says.
Increased exposure to alcohol or drug use is also a trigger.
Among 50 college students who smoke pot, a few may get a drug-induced psychosis that clears in weeks, says Dr. Bowers. But one may go on to develop a serious mental health disorder.
Exposure to disturbing news events or potentially false information on the internet and social media can provoke extreme reactions in the vulnerable.
They misperceive whats happening in the environment and develop delusions, she says. They may not make sense or become too aggressive.
Its easy to become so distracted by thoughts that schoolwork and jobs get neglected.
If someone constantly plays video games or focuses only on personal interests, and offers an irrational explanation for avoiding studies or work, thats a warning sign, says Dr. Bowers.
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Here Are Some Things You Can Do To Help Your Loved One:
- Help them get treatment and encourage them to stay in treatment
- Remember that their beliefs or hallucinations seem very real to them
- Tell them that you acknowledge that everyone has the right to see things their way
- Be respectful, supportive, and kind without tolerating dangerous or inappropriate behavior
- Check to see if there are any support groups in your area
Some symptoms require immediate emergency care. If your loved one is thinking about harming themselves or others or attempting suicide, seek help right away:
- Call the National Suicide Prevention Lifeline at 1-800-273-TALK or text the Crisis Text Line .
How Is The Diagnosis Made
Some of the symptoms that occur in schizophrenia also occur in other mental health conditions such as depression, mania, and dissociative identity disorder, or after taking some street drugs. Therefore, the diagnosis may not be clear at first. As a rule, the symptoms need to be present for several weeks before a doctor will make a firm diagnosis of schizophrenia.
Not all symptoms are present in all cases. Different forms of schizophrenia occur depending upon the main symptoms that develop. For example, people with paranoid schizophrenia mainly have positive symptoms which include delusions that people are trying to harm them. In contrast, some people mainly have negative symptoms and this is classed as simple schizophrenia. In many cases there is a mix of positive and negative symptoms.
Sometimes symptoms develop quickly over a few weeks or so. Family and friends may recognise that the person has a mental health problem. Sometimes symptoms develop slowly over months and the person may gradually become withdrawn, lose friends, jobs, etc, before the condition is recognised.
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What Kind Of Symptoms Might People With Schizophrenia Have
People with schizophrenia may have a number of psychotic symptoms. These symptoms can come and go in phases, or they can happen only once or twice in a lifetime. When the illness begins, psychotic symptoms are usually sudden and severe.
During psychotic phases, the person may still understand parts of reality. He or she may lead a somewhat normal life, doing basic activities such as eating, working and getting around. In other cases, the person may be unable to function. Symptoms during psychotic phases include:
- Seeing, hearing, feeling or smelling things that are not real .
- Having strange beliefs that are not based on facts . For example, the person may believe that people can hear his or her thoughts, that he or she is God or the devil, or that people are putting thoughts into his or her head.
- Thinking in a confused way, being unable to make order out of the world, shifting quickly from one thought to the next.
- Having emotions, thoughts and moods that do not fit with events.
People with schizophrenia also may:
- Have a lot of energy or be overly active, or become “catatonic,” a state in which the body becomes rigid and cannot be moved.
- Talk in sentences that do not make sense.
- Not wash or groom.
- Cut themselves off from family, friends and the outside world.
- Be unable to function in school, work, or other activities.
- Lose interest in life.
- Be very sad or have mood swings.
- Have dulled emotions.
Its Easy To Live In Denial
Even though your loved one isnt functioning well, isnt meeting their own expectations in life, and is using alcohol or drugs to cope, they may not see theres a problem.
Because of the natural urge to protect those you love, families can stay in denial, as well.
Its often the college that sends a young adult to the hospital for the first time because of erratic behavior or an overdose. The parents get involved only because the college requests their child be evaluated by a psychiatrist.
Families often dont seek help on their own, says Dr. Bowers.
They may continue to struggle try to understand their loved ones symptoms. Or ignore those symptoms until they escalate, sometimes into violent behavior.
But early, continuous treatment is critical, she stresses. Without help, a young adults problems will continue especially if they use drugs or alcohol.
If you find them up all hours of the night, or painting their room black, or too irritable without their meds, or scaring their little sister, call the doctor, she says. And encourage them to keep their appointments.
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What Is Schizoaffective Disorder
People with schizoaffective disorder typically show symptoms of a mood disorder, such as mania or depression, alongside schizophrenia symptoms.
In the past, the process of diagnosing schizoaffective disorder may have been imprecise. Today, there is a distinction between having schizophrenia and mood episodes and having schizoaffective disorder.
Because the symptoms can overlap, it is not always clear whether a person has bipolar disorder or depression with psychotic features, post-traumatic stress disorder , or a schizophrenia-like illness, such as schizophrenia or schizoaffective disorder.
Diagnosing Schizophrenia Using Symptoms And Features
Professionals use specific diagnostic features in the DSM-5 to help determine whether someone meets the criteria for schizophrenia. The DSM-5 delineates five main criteria. Paraphrased:
A. Two or more of
B. Level of functioning has declinedC. The symptoms in Criterion A have persisted for at least 6 monthsD. Schizoaffective disorder, major depression, and bipolar disorder have been ruled outE. Substance use/abuse has been ruled out as a cause
In order for someone to be diagnosed with schizophrenia, he must experience a group of these symptoms and features. One or two are not enough.
To receive a schizophrenia diagnosis, someone can have any of the symptoms and features, but he must have the following:
- At least two symptoms from Criteria A
- One of those two must be delusions, hallucinations, or disorganized speech.
- These must have been present for at least one month.
The symptoms must impair ones life and get in the way of her ability to work , have positive relationships , and practice self-care. The problems in these areas must be new, a decline in the previous status.
Duration of the symptoms is also important for a schizophrenia diagnosis. Someone must have been experiencing steady symptoms for at least one month. Symptoms must be present some of the time for six consecutive months.
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Is Schizophrenia Good Or Bad
Though not as frequent as other serious mental diseases, schizophrenia can be the most persistent and severe. People with schizophrenia frequently struggle to function properly in society, at job, at school, and in relationships. They may appear to be fearful and withdrawn, as if they have lost contact with reality. Otherwise healthy young people can develop schizophrenia. Older adults who have lived through many of their friends are diagnosed with the disease more often than not.
It is more common in those of European descent patients are about twice as likely to be male as female. The illness tends to run in families, so researchers look for genetic factors that might cause it. Schizophrenia seems to involve problems with brain cell communication processes, but scientists don’t know what causes these problems to occur repeatedly in similar areas of the brain. The symptoms typically come on gradually, although there are cases of schizophrenia breaking into episodes years at a time without any clear signs of recovery between them.
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According To National Data Of Canadians Aged 10+: Footnote 3
- 1 out of 100 were living with diagnosed schizophrenia:
- 56% were men
- 44% were women
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What If I Am A Carer Friend Or Relative
It can be distressing if you are a carer, friend or relative of someone who has schizophrenia. You can get support.
How can I get support for myself?
You can do the following.
- Speak to your GP about medication and talking therapies for yourself.
- Speak to your relatives care team about family intervention. For more information about family intervention see the further up this page.
- Speak to your relatives care team about a carers assessment.
- Ask for a carers assessment.
- Join a carers service. They are free and available in most areas.
- Join a carers support group for emotional and practical support. Or set up your own.
What is a carers assessment?NICE guidelines state that you should be given your own assessment through the community mental health team to work out what effect your caring role is having on your health. And what support you need. Such as practical support and emergency support.
The CMHT should tell you about your right to have a carers assessment through your local authority. To get a carers assessment you need to contact your local authority.
How do I get support from my peers?You can get peer support through carer support services or carers groups. You can search for local groups in your area by using a search engine such as Google. Or you can call our advice service on 0808 801 0525. They will search for you.
How can I support the person I care for?
You can do the following.
There is no definition for what high risk means. It could include:
What Are The Early Symptoms Of Schizophrenia
The condition usually shows its first signs in men in their late teens or early 20s. It mostly affects women in their early 20s and 30s. The period when symptoms first start and before full psychosis is called the prodromal period. It can last days, weeks, or even years. It can be hard to spot because thereâs usually no specific trigger. You might only notice subtle behavioral changes, especially in teens. This includes:
- A change in grades
- Difficulty sleeping
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