Schizophrenia Through The Ages
What does schizophrenia mean?
In 1910, the Swiss psychiatrist Paul Eugen Bleuler coined the term ‘schizophrenia from the Greek words schizo and phren . Bleuler had intended the term to denote a loosening of thoughts and feelings, but, unfortunately, many people read it to mean a split personality.
What does schizophrenia not mean?
Robert Louis Stevensons novel The Strange Case of Dr Jekyll and Mr Hyde did much to popularize the concept of a split personality, which is sometimes also referred to as multiple personality disorder . However, MPD is a vanishingly rare condition that is entirely unrelated to schizophrenia. The vast majority of psychiatrists, myself included, have never seen a case of MPD, and many if not most suspect that such a condition does not exist. Yes, schizophrenia sufferers may hear various voices, or harbour strange beliefs, but this is not the same as having a split personality. Unlike Dr Jekyll, schizophrenia sufferers do not suddenly mutate into a different, unrecognizable person.
Who discovered schizophrenia?
How was schizophrenia thought of in antiquity?
But the spirit of the Lord departed from Saul, and an evil spirit from the Lord troubled him And it came to pass, when the evil spirit from God was upon Saul, that David took an harp, and played with his hand: so Saul was refreshed, and was well, and the evil spirit departed from him.
When did people first start thinking of schizophrenia as an illness?
How did beliefs change?
The Most Common Early Warning Signs Include:
While these warning signs can result from a number of problemsnot just schizophreniathey are cause for concern. When out-of-the-ordinary behavior is causing problems in your life or the life of a loved one, seek medical advice. If schizophrenia or another mental problem is the cause, getting treatment early will help.
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Molecular PsychiatryDiagnostic and Statistical Manual of Mental Disorders, Fifth EditionDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text RevisionIndian Journal of PsychiatryPsychiatric ServicesClinical Child Psychology and PsychiatryPsychiatric TimesFrontiers in PsychiatryPsychiatry ResearchJournal of the American Medical AssociationBritish Journal of PsychiatryAmerican Academy of Social Work and Social WelfareScience DailyClinical NeuropsychiatryCurrent Antipsychotics, Handbook of Experimental Pharmacology, Vol. 212Molecular PsychiatryPsychiatria DanubinaSchizophrenia BulletinBritish Journal of PsychiatryScienceSocial Studies of ScienceThe British Journal of PsychiatryAmerican Journal of PsychiatryPatient CareAm J PsychiatryMen and MasculinitiesHistory of PsychiatrySchizophrenia Research TreatmentGerman Journal of PsychiatryLancetPsychiatric ServicesCurrent Opinion in PsychiatryEpidemiologic ReviewsPsychiatric ServicesNeuropsychopharmacology: The Fifth Generation of Progress, Fifth EdClinical Schizophrenia and Related PsychosesPsychological BulletinSchizophrenia ResearchClinical TherapeuticsHarvard Mental Health LettAmerican Journal of PsychiatryAmerican Journal of PsychiatrySchizophrenia BulletinJournal of PsychopharmacologySchizophrenia BulletinAmerican Journal of PsychiatryPsychiatric TimesSchizophrenia BulletinAutismAmerican Journal of Psychiatry
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Whats So Bad About Schizophrenia
Though schizophrenia isnt as common as other major mental illnesses, it can be the most chronic and disabling. People with schizophrenia often have problems doing well in society, at work, at school, and in relationships. They might feel frightened and withdrawn, and could appear to have lost touch with reality.
What To Do If You See Early Signs Of Schizophrenia In Someone
If you see someone else exhibiting early signs of schizophrenia, you may want to recommend that they get in for proper psychological evaluation. If they do have schizophrenia or some other condition, most professionals will be able to tell what is going on.
Treatment for the condition as soon as possible is associated with better functioning in society and a more favorable prognosis. If the individual has a family history of schizophrenia and they are showing the early warning signs and symptoms, it is likely that they are developing the same condition as there is a genetic link.
Most people with the early warning signs of schizophrenia are not aware of their condition. It typically takes outside intervention for someone to realize that what they are experiencing is in fact a mental illness. This is because all the symptoms that they are experiencing seem so real to them. Although the onset of these symptoms may be sudden or abrupt, the majority of people show a slow, gradual onset of these early signs.
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At What Age Does Onset Of Schizophrenia Usually Occur
The onset of schizophrenia usually occurs between the late teens and the mid-30s. For males, the peak age of onset for the first psychotic episode is in the early to middle 20s for females, it is in the late 20s. The first 510 years of the illness can be stormy, but this initial period is usually followed by decades of relative stability . Positive symptoms are more likely to remit than are cognitive and negative symptoms .
The Age Of Onset In Men And Women
Its hard to pinpoint the exact onset of schizophrenia because people may have cognition problems or trouble in social relationships long before they are officially diagnosed. In general, schizophrenia is diagnosed in late adolescence through the early 30s.
Men are usually diagnosed between the late teens and early 20s, with a peak at 21-25 years of age. Women are diagnosed a few years later, at 25-30 or again after menopause.
The ages are just a guide. No matter when you notice any of the signs or symptoms of schizophrenia in yourself or a loved one, its important to get diagnosed and treated as soon as possible. Symptoms include confusion, disorganized speech, and hallucinations .
At Allied Psychiatry & Mental Health, board-certified psychiatrist Dr. Hadi Estakhri helps his patients live better quality lives through symptom management.
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Can Schizophrenia Appear Even Later In Life
While the majority of cases are diagnosed between a persons late teens to early 30s, schizophrenia can still occur later. This is called late-onset schizophrenia.
While research is still limited, more and more people are being diagnosed with schizophrenia later in life. In fact, its believed that a quarter of people with schizophrenia develop it after age 40.
Many researchers currently believe these later diagnoses happen because the person had untreated cognitive obstacles and a small or poor network of support and camaraderie.
What Causes These Phases
Its unclear why individuals develop schizophrenia. Likewise, its unclear exactly how or why a person moves through the stages at the pace they do.
Researchers believe a combination of factors set off chemical and structural changes in the brain. Ultimately, these changes lead to schizophrenia. Those same factors may influence when or how quickly a person progresses from one phase to another.
Researchers believe these factors may contribute to developing schizophrenia:
- Genetics. If you have a family history of the illness, youre more likely to develop it. However, having a family history doesnt mean you certainly will have the illness.
- Hormonal changes. Researchers believe that hormones and physical changes in the body may be a factor. Symptoms of the illness often begin in young adulthood, during a time of major change. On average, men show first signs in their late teens and early 20s. Women develop the illness later. For them, symptoms typically first appear in their mid 20s to early 30s.
- Biological. Neurotransmitters relay signals between cells in the brain, and chemical changes may damage or impair them. This could lead to the illness.
- Structure. Changes to the shape or structure of the brain could interfere with communication between neurotransmitters and cells, too.
- Environmental. Researchers believe exposure to some viruses at an early age could lead to schizophrenia. Likewise, lifestyle choices may impact risk. These choices can include narcotic use or misuse.
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The Turning Point: Adolescence
An interaction between something in your genes and something in your environment probably causes the disease. Researchers still have a lot to learn about it, but it’s likely that many things play a role. Some, like exposure to a virus or malnutrition , might have happened while you were still in your mother’s womb. For vulnerable individuals, cannabis use can increase the risk of developing psychotic disorders such as schizophrenia.
No one knows exactly why it usually crops up in late adolescence, but there are many theories.
Your brain changes and develops a lot during puberty. These shifts might trigger the disease in people who are at risk for it.
Some scientists believe it has to do with development in an area of the brain called the frontal cortex. Others think it has to do with too many connections between nerve cells being eliminated as the brain matures.
Hormones also play a major role in puberty. One theory is that women get schizophrenia later than men because they go through puberty earlier and the hormone estrogen might somehow protect them. Know how to recognize the signs of schizophrenia in teens.
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.
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How Is Schizophrenia Diagnosed
A diagnosis for schizophrenia is often first made in the active stage. This is when symptoms become most obvious. Other people may recognize the disordered thoughts and behavior patterns for the first time.
At that point, a doctor may work with friends and family members to understand when early symptoms began. Symptoms of the first phase are often not recognized until a person is in the active phase.
Once a diagnosis is made, a doctor will also be able to determine when the active phase is over based on symptoms and behaviors.
Where to Find Help
Advocacy organizations can help you find immediate help. They can also connect you with local resources that can help you find sustained, long-term treatment. These mental health resources include:
Most people with schizophrenia arent diagnosed until the second phase, once symptoms worsen and become more obvious.
At this point, treatment options include:
Where to Seek Emergency Care
If you or a loved one is experiencing suicidal thoughts or dangerous behaviors, seek emergency care:
- Dial 911 or your local emergency number
- Visit a hospital or emergency department
Childhood Schizophrenia Signs And Symptoms
Some children who develop schizophrenia first go through a period called the prodrome or the prodromal phase. They might withdraw from daily life, with more anxiety and less interest in school or friends. Not all children who show these signs will have a psychotic disorder, so itâs important to talk to your doctor if you notice any issues.
Early childhood schizophrenia symptoms
The disorder affects how your child develops. You may notice things like:
- Long periods in which theyâre sluggish or not active
- Floppy arms or legs
- Delays in crawling, walking, or talking
- Odd movements such as rocking or flapping their arms
- A limp or slumped posture
Some of these symptoms show up in children with other problems besides schizophrenia. And some happen in kids without any mental health conditions. Only your child’s doctor can figure out what’s really going on.
Later childhood schizophrenia symptoms
In older kids, you might notice the behavior changes of schizophrenia over time or suddenly, as if out of nowhere. Your child may act withdrawn and clingy, or they may talk about strange and disturbed ideas and fears.
Tell your doctor as soon as you see symptoms of schizophrenia. It’s important to get a diagnosis and start treatment before your youngster shows signs of a break from reality, called psychosis.
Symptoms in older children include:
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Life Challenges For Women With Schizophrenia
Typically, women with schizophrenia function better socially than men, often because a later age of onset indicates a less severe form of mental illness. Women with schizophrenia are likely to experience fewer hospitalizations and shorter visits while in the hospital compared to men. Some researchers believe that this later onset is because hormones like estrogen have a protective effect.4 However, this disparity in the age of onset is not present in all ethnic groups. For example, multiple studies in the country of India have found no difference in the mean age of onset between men and women.5
Development Of The Working Memory
Your prefrontal cortex the part of your brain responsible for storing memories and decision-making finishes developing by . When this happens, your brain has completed the process of determining how you should respond to what happens around you.
Some believe that a variety of outside factors can cause the prefrontal cortex to finish developing differently than it would have, causing a person to develop schizophrenia.
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Begin Treatment Right Away
Doctors diagnose schizophrenia when someone has psychotic episodes that canât be explained by drug abuse or other medical conditions.
Starting an antipsychotic medication immediately offers the best hope of getting symptoms under control.
“The longer a person goes without treatment, the greater the risk of damage to the brain and a poor outcome,â says Steven Jewell, MD, an associate professor of psychiatry at Northeast Ohio Medical University.
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
- For more information, see NIMH NCS-R study page.
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Diagnostic And Statistical Manual Of Mental Disorders
Childhood schizophrenia was not directly added to the DSM until 1968, when it was added to the DSM-II, which set forth diagnostic criteria similar to that of adult schizophrenia. “Schizophrenia, childhood type” was a DSM-II diagnosis with diagnostic code 295.8, equivalent to “schizophrenic reaction, childhood type” in DSM-I . “Schizophrenia, childhood type” was successfully removed from the DSM-III , and in the Appendix C they wrote: “there is currently no way of predicting which children will develop Schizophrenia as adults”. Instead of childhood schizophrenia they proposed to use of “infantile autism” and “childhood onset pervasive developmental disorder” .
In the DSM-III-R , DSM-IV , DSM-IV-TR , DSM-5 there is no “childhood schizophrenia”. The rationale for this approach was that, since the clinical pictures of adult schizophrenia and childhood schizophrenia are identical, childhood schizophrenia should not be a separate disorder. However, the section in schizophrenia’s Development and Course in DSM-5, includes references to childhood-onset schizophrenia.
Treating Women With Schizophrenia
Though treatment for mental illness is not typically separated by gender, clinicians serve women best by considering their unique experience of schizophrenia as well as the unique challenges they face. Because women have later onset of the illness and are less likely to experience affective symptoms, clinicians must be careful to rule out other mental illnesses, such as schizoaffective disorder or bipolar disorder, when giving a diagnosis of schizophrenia.
Treatment for women with schizophrenia should include psychoeducation and support for the needs of mothers with children. Antipsychotic medication can affect the ability to breast feed and the amount of energy a mother has to parent her children.7 Treatment plans tailored for women should include education about physical health as well. Women with schizophrenia are less likely to care for their physical health. This leaves them at risk for untreated breast cancer, osteoporosis, and thyroid conditions. Mental health professionals should also consider creating safety plans for women with schizophrenia who are at increased risk for committing suicide.
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Other Concerns For Men With Schizophrenia
Men with schizophrenia may tend to have lower social functioning and other conditions like substance abuse that complicate their treatment plan and recovery. Dr. Estakhri specializes in both general and addiction psychiatry, so if you have schizophrenia but are also dealing with drug or alcohol abuse, you get the most comprehensive treatment at Allied Psychiatry & Mental Health right here in Orange County, California.
Schizophrenia can be debilitating. Let us help you manage your symptoms and live a better quality of life. Contact us to make an appointment with Dr. Estakhri today.
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