Schizophrenia

People with schizophrenia experience phases or episodes of acute psychosis, in which their perception of the world is frequently distorted. For example, they may hear voices or think they are being followed or influenced by other people. Their behavior also changes, and many stop speaking coherently. Some of those affected become almost completely detached from reality.

Acute psychosis is usually temporary and these phases are experienced only once or a small number of times in total. Others have the symptoms permanently, in which case they need a lot of support.

This mistaken view increases prejudices against people with schizophrenia. Although their perception of reality can be severely impaired and their behavior may change during phases of psychosis, their personality does not change or “split”. Schizophrenia also has a wide range of symptoms, causes and progression.

A distinction is made between various types of schizophrenia, based on typical symptoms. The most common types are:

Paranoid schizophrenia

People with paranoid schizophrenia have delusions and hallucinations. For example, they hear voices or think they are being watched and influenced by other people. This is the most common type of schizophrenia. It usually begins between the ages of 25 and 35.

Residual schizophrenia

People with this form of schizophrenia have chronic symptoms that mostly occur after an acute psychotic phase. They are very passive, lethargic and appear depressed. They may also have difficulty concentrating or experience memory problems.

Disorganized (hebephrenic) schizophrenia

This type is characterized by an abnormal emotional life with a mood that barely changes and is often inappropriate to the situation, as well as erratic thinking and inappropriate behavior. Disorganized (hebephrenic) schizophrenia usually begins between the ages of 15 and 25.

Catatonic schizophrenia

This is a very rare form of the illness that affects the way people move. For example, they may become hyperactive for no reason, remain completely immobile or pull faces. It also usually begins between the ages of 15 and 25.

In many cases, indications of an acute psychotic phase or episode occur well in advance. People with schizophrenia themselves and, in most cases, those close to them notice a change in the weeks or months leading up to the episode. People are often tense, restless and have problems sleeping before an acute psychotic episode. They also have difficulty concentrating or memory problems. They may also experience mild hallucinations. They may think they are being watched and influenced by other people.

For more detailed information, for example, about the symptoms of schizophrenia, visit gesundheitsinformation.de.

While the exact causes of schizophrenia are unknown, it is likely that a complex interaction of various factors is at play. It is known that some people have a congenital predisposition to schizophrenia, particularly if a parent or sibling already has it. Around 12% of children who have a parent with schizophrenia go on to develop it too.

There may also be other factors involved that increase the likelihood of developing the illness. These include:

• changes to the brain
• insomnia
• drug abuse
• traumatic experiences
• developmental disorders in the womb or in childhood

A psychosis is often associated with major life changes, such as divorce, moving home or starting work. Schizophrenia is also more likely to occur in a family atmosphere where children are often criticized and constantly told what they can and cannot do.

It is estimated that about 1 in every 100 people will develop schizophrenia at some point in their lives. Slightly more men than women are affected.

Schizophrenia is most statistically likely among people with a low socio-economic status and those who are single. However, loss of social status and loneliness are often consequences of the illness itself.

The first acute episode usually occurs between the ages of 15 and 35. An increase in unexplained symptoms over several years is often an indication of the disease. Potential precursors include, for example, depression, moodiness, restlessness, self-doubt, difficulties concentrating or anxiety. In many cases, there are unexpected problems at school or in college. Many people in the early stages of schizophrenia neglect their appearance or withdraw from their social environment.

On average, the first acute psychotic episode occurs a few years earlier in men than in women. The reason for this is unknown. Schizophrenia very rarely starts in childhood.

Around a quarter of those affected only experience a single acute psychotic episode. Around 60 out of every 100 have a relapse within two years of their first acute psychotic episode. It can take weeks or months for an acute psychosis to subside.

People often continue to experience the effects of an episode of psychosis for a long time, even if they have no symptoms. What they have experienced can unsettle them and affect their feeling of self-worth. However, some are able return to their daily routine and live a normal life after a psychotic phase. Others are permanently affected and need intensive support.

On average, people with schizophrenia die around ten years earlier than the rest of the population. In particular, life expectancy is lower for those who have frequent relapses. There are many reasons for this. For example, they may have addictions and consume more alcohol, nicotine and drugs. They are also more likely to have infections, heart disease or diabetes. These types of physical conditions may be due to their lifestyle but may also be side effects of anti-psychotic medication. If schizophrenia is well treated, life expectancy rises.

Around 5% of those affected take their own life. This is more common in young men having their first acute psychotic episode or people who have had a severe form of the illness for a long period. Critical periods are untreated psychotic phases and the period immediately following discharge from hospital.

Schizophrenia is only diagnosed if the typical symptoms have been present for more than a month. More weight is given to symptoms such as delusions or persistently hearing voices. Signs such as confused speech, becoming hyperactive for no reason or hallucinations other than hearing voices are less important for the diagnosis, as these are less typical of schizophrenia.

Doctors will talk to the person affected and possibly also their loved ones to determine whether they are really suffering from schizophrenia. The person’s behavior is also observed. Physical and neurological examinations are performed to rule out other potential causes of the symptoms. Similar symptoms may be caused, for example, by disorders of the nervous system or alcohol and drug abuse.

Certain symptoms of schizophrenia can also occur under the influence of drugs or in people with other conditions such as depression or anxiety disorders. All of this means that a careful examination by a specialized psychiatrist is a very important part of the diagnostic process.

Treatment for a person with schizophrenia should be centered around their needs. However, this is only possible to a limited extent if they are experiencing their first acute psychotic episode. Designing and planning treatment with the patient based on their individual needs is more likely to succeed once the acute psychosis has subsided. Providing fast, effective treatment increases the chances of a positive outlook for schizophrenia.

The following actions can be taken and support provided:

Support from a person’s social environment

Family, friends and acquaintances can provide emotional support for the person, help them with their everyday routine and ensure they have more stability in their life.

Medication

Anti-psychotic medication can help resolve acute symptoms and make relapses less likely in the long term. However, medication can have distressing side effects.

Psychotherapy

This can reduce symptoms and help the person to better manage their illness. Common forms include cognitive behavioral therapy and family therapy. Psychotherapy can be helpful in all phases of the disease, even during an acute psychosis.

Psychoeducation

This involves training people with schizophrenia and their loved ones in key aspects of the symptoms, treatment and management of the disease. Psychoeducation also provides an opportunity to share experiences with other people who have schizophrenia.

Sociotherapy

This type of therapy can help people to reconnect with their professional and social lives and to live as independently as possible. Sociotherapy can sometimes also alleviate the symptoms.

People with schizophrenia may receive inpatient or outpatient care. Treatment is often provided in a psychiatric hospital during an acute phase. People affected by schizophrenia often do not realize that they are experiencing acute psychosis and may refuse treatment. Compulsory admission to a psychiatric hospital may be the only option in these cases.

People with schizophrenia can sign a treatment contract with doctors to cover this type of situation. This may, for example, specify what action is to be taken if they experience an acute psychosis. This allows them, for example, to agree with doctors how medication is to be administered and how compulsory admission is to be handled if it cannot be avoided. It also allows them to specify what other types of support they want to receive. It may also be advisable to draw up an advance health care directive (“living will”) and a lasting power of attorney for health and welfare to cover this type of situation. This states who is authorized to make decisions if the person affected does not have the capacity to do so.

The “Telefonseelsorge” crisis hotline provides support to people with schizophrenia when they are experiencing acute problems and helps arrange further assistance. Various advisory services are also available for people with schizophrenia.

The Federal Association of Psychotherapists (Bundespsychotherapeutenkammer) provides a therapist search on its website. The appointment service centers of the Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen) help people with schizophrenia make an appointment at a specialist or psychotherapy practice.

The first point of contact is usually the family doctor, even in cases of potential schizophrenia or acute psychosis.