WHAT IS IT?
Schizophrenia is a chronic, severe, and disabling brain disease.
Approximately 1 percent of the population develops schizophrenia
during their lifetime – more than 2 million Americans suffer
from the illness in a given year. Although schizophrenia affects
men and women with equal frequency, the disorder often appears
earlier in men, usually in the late teens or early twenties,
than in women, who are generally affected in the twenties to
early thirties. People with schizophrenia often suffer
terrifying symptoms such as hearing internal voices not heard by
others, or believing that other people are reading their minds,
controlling their thoughts, or plotting to harm them. These
symptoms may leave them fearful and withdrawn. Their speech and
behavior can be so disorganized that they may be
incomprehensible or frightening to others. Available treatments
can relieve many symptoms, but most people with schizophrenia
continue to suffer some symptoms throughout their lives; it has
been estimated that no more than one in five individuals
This is a time of hope for people with schizophrenia and their
families. Research is gradually leading to new and safer
medications and unraveling the complex causes of the disease.
Scientists are using many approaches from the study of molecular
genetics to the study of populations to learn about
schizophrenia. Methods of imaging the brain’s structure and
function hold the promise of new insights into the disorder.
Schizophrenia As An Illness:
Schizophrenia is found all over the world. The severity of the
symptoms and long-lasting, chronic pattern of schizophrenia
often cause a high degree of disability. Medications and other
treatments for schizophrenia, when used regularly and as
prescribed, can help reduce and control the distressing symptoms
of the illness. However, some people are not greatly helped by
available treatments or may prematurely discontinue treatment
because of unpleasant side effects or other reasons. Even when
treatment is effective, persisting consequences of the illness –
lost opportunities, stigma, residual symptoms, and medication
side effects – may be very troubling.
The first signs of schizophrenia often appear as confusing, or
even shocking, changes in behavior. Coping with the symptoms of
schizophrenia can be especially difficult for family members who
remember how involved or vivacious a person was before they
became ill. The sudden onset of severe psychotic symptoms is
referred to as an “acute” phase of schizophrenia. “Psychosis,” a
common condition in schizophrenia, is a state of mental
impairment marked by hallucinations, which are disturbances of
sensory perception, and/or delusions, which are false yet
strongly held personal beliefs that result from an inability to
separate real from unreal experiences. Less obvious symptoms,
such as social isolation or withdrawal, or unusual speech,
thinking, or behavior, may precede, be seen along with, or
follow the psychotic symptoms.
Some people have only one such psychotic episode; others have
many episodes during a lifetime, but lead relatively normal
lives during the interim periods. However, the individual with
“chronic” schizophrenia, or a continuous or recurring pattern of
illness, often does not fully recover normal functioning and
typically requires long-term treatment, generally including
medication, to control the symptoms.
It is important to rule out other illnesses, as sometimes people
suffer severe mental symptoms or even psychosis due to
undetected underlying medical conditions. For this reason, a
medical history should be taken and a physical examination and
laboratory tests should be done to rule out other possible
causes of the symptoms before concluding that a person has
schizophrenia. In addition, since commonly abused drugs may
cause symptoms resembling schizophrenia, blood or urine samples
from the person can be tested at hospitals or physicians’
offices for the presence of these drugs.
At times, it is difficult to tell one mental disorder from
another. For instance, some people with symptoms of
schizophrenia exhibit prolonged extremes of elated or depressed
mood, and it is important to determine whether such a patient
has schizophrenia or actually has a manic-depressive (or
bipolar) disorder or major depressive disorder. Persons whose
symptoms cannot be clearly categorized are sometimes diagnosed
as having a “schizoaffective disorder.”
Children over the age of five can develop schizophrenia, but it
is very rare before adolescence. Although some people who later
develop schizophrenia may have seemed different from other
children at an early age, the psychotic symptoms of
schizophrenia – hallucinations and delusions – are extremely
uncommon before adolescence.
The World of
People With Schizophrenia
• Distorted Perceptions of Reality
People with schizophrenia may have perceptions of reality that
are strikingly different from the reality seen and shared by
others around them. Living in a world distorted by
hallucinations and delusions, individuals with schizophrenia may
feel frightened, anxious, and confused.
In part because of the unusual realities they experience, people
with schizophrenia may behave very differently at various times.
Sometimes they may seem distant, detached, or preoccupied and
may even sit as rigidly as a stone, not moving for hours or
uttering a sound. Other times they may move about constantly –
always occupied, appearing wide-awake, vigilant, and alert.
• Hallucinations and Illusions
Hallucinations and illusions are disturbances of perception that
are common in people suffering from schizophrenia.
Hallucinations are perceptions that occur without connection to
an appropriate source. Although hallucinations can occur in any
sensory form – auditory (sound), visual (sight), tactile
(touch), gustatory (taste), and olfactory (smell) – hearing
voices that other people do not hear is the most common type of
hallucination in schizophrenia. Voices may describe the
patient’s activities, carry on a conversation, warn of impending
dangers, or even issue orders to the individual. Illusions, on
the other hand, occur when a sensory stimulus is present but is
incorrectly interpreted by the individual.
Delusions are false personal beliefs that are not subject to
reason or contradictory evidence and are not explained by a
person’s usual cultural concepts. Delusions may take on
different themes. For example, patients suffering from
paranoid-type symptoms – roughly one-third of people with
schizophrenia – often have delusions of persecution, or false
and irrational beliefs that they are being cheated, harassed,
poisoned, or conspired against. These patients may believe that
they, or a member of the family or someone close to them, are
the focus of this persecution. In addition, delusions of
grandeur, in which a person may believe he or she is a famous or
important figure, may occur in schizophrenia. Sometimes the
delusions experienced by people with schizophrenia are quite
bizarre; for instance, believing that a neighbor is controlling
their behavior with magnetic waves; that people on television
are directing special messages to them; or that their thoughts
are being broadcast aloud to others.
Substance abuse is a common concern of the family and friends of
people with schizophrenia. Since some people who abuse drugs may
show symptoms similar to those of schizophrenia, people with
schizophrenia may be mistaken for people "high on drugs.”
Researchers are increasingly showing that some street drugs
(such as Marijuana / cannabis ) can significantly increase the
risk of developing schizophrenia, people who have schizophrenia
also often abuse alcohol and/or drugs, and may have particularly
bad reactions to certain drugs. Substance abuse can reduce the
effectiveness of treatment for schizophrenia. Stimulants (such
as amphetamines or cocaine) may cause major problems for
patients with schizophrenia, as may PCP or marijuana. In fact,
some people experience a worsening of their schizophrenic
symptoms when they are taking such drugs. Substance abuse also
reduces the likelihood that patients will follow the treatment
plans recommended by their doctors.
Schizophrenia and Nicotine
The most common form of substance use disorder in people with
schizophrenia is nicotine dependence due to smoking. While the
prevalence of smoking in the U.S. population is about 25 to 30
percent, the prevalence among people with schizophrenia is
approximately three times as high. Research has shown that the
relationship between smoking and schizophrenia is complex.
Although people with schizophrenia may smoke to self medicate
their symptoms, smoking has been found to interfere with the
response to antipsychotic drugs. Several studies have found that
schizophrenia patients who smoke need higher doses of
antipsychotic medication. Quitting smoking may be especially
difficult for people with schizophrenia, because the symptoms of
nicotine withdrawal may cause a temporary worsening of
schizophrenia symptoms. However, smoking cessation strategies
that include nicotine replacement methods may be effective.
Doctors should carefully monitor medication dosage and response
when patients with schizophrenia either start or stop smoking.
• Disordered Thinking
Schizophrenia often affects a person’s ability to “think
straight.” Thoughts may come and go rapidly; the person may not
be able to concentrate on one thought for very long and may be
easily distracted, unable to focus attention.
People with schizophrenia may not be able to sort out what is
relevant and what is not relevant to a situation. The person may
be unable to connect thoughts into logical sequences, with
thoughts becoming disorganized and fragmented. This lack of
logical continuity of thought, termed “thought disorder,” can
make conversation very difficult and may contribute to social
isolation. If people cannot make sense of what an individual is
saying, they are likely to become uncomfortable and tend to
leave that person alone.
• Emotional Expression :
People with schizophrenia often show “blunted” or “flat” affect.
This refers to a severe reduction in emotional expressiveness. A
person with schizophrenia may not show the signs of normal
emotion, perhaps may speak in a monotonous voice, have
diminished facial expressions, and appear extremely apathetic.
The person may withdraw socially, avoiding contact with others;
and when forced to interact, he or she may have nothing to say,
reflecting “impoverished thought.” Motivation can be greatly
decreased, as can interest in or enjoyment of life. In some
severe cases, a person can spend entire days doing nothing at
all, even neglecting basic hygiene. These problems with
emotional expression and motivation, which may be extremely
troubling to family members and friends, are symptoms of
schizophrenia – not character flaws or personal weaknesses.
• Normal Versus Abnormal :
At times, normal individuals may feel, think, or act in ways
that resemble schizophrenia. Normal people may sometimes be
unable to “think straight.” They may become extremely anxious,
for example, when speaking in front of groups and may feel
confused, be unable to pull their thoughts together, and forget
what they had intended to say. This is not schizophrenia. At the
same time, people with schizophrenia do not always act
abnormally. Indeed, some people with the illness can appear
completely normal and be perfectly responsible, even while they
experience hallucinations or delusions. An individual’s behavior
may change over time, becoming bizarre if medication is stopped
and returning closer to normal when receiving appropriate
Schizophrenia Is Not
There is a common notion that schizophrenia is the same as
"split personality” – a Dr. Jekyll-Mr. Hyde switch in character.
This is not correct.
Are People With Schizophrenia Likely To Be
News and entertainment media tend to link mental illness and
criminal violence; however, studies indicate that except for
those persons with a record of criminal violence before becoming
ill, and those with substance abuse or alcohol problems, people
with schizophrenia are not especially prone to violence. Most
individuals with schizophrenia are not violent; more typically,
they are withdrawn and prefer to be left alone. Most violent
crimes are not committed by persons with schizophrenia, and most
persons with schizophrenia do not commit violent crimes.
Substance abuse significantly raises the rate of violence in
people with schizophrenia but also in people who do not have any
mental illness. People with paranoid and psychotic symptoms,
which can become worse if medications are discontinued, may also
be at higher risk for violent behavior. When violence does
occur, it is most frequently targeted at family members and
friends, and more often takes place at home.
What About Suicide?
Suicide is a serious danger in people who have schizophrenia. If
an individual tries to commit suicide or threatens to do so,
professional help should be sought immediately. People with
schizophrenia have a higher rate of suicide than the general
population. Approximately 10 percent of people with
schizophrenia (especially younger adult males) commit suicide.
Unfortunately, the prediction of suicide in people with
schizophrenia can be especially difficult.
There is no known single cause of schizophrenia. Many diseases,
such as heart disease, result from an interplay of genetic,
behavioral, and other factors; and this may be the case for
schizophrenia as well. Scientists do not yet understand all of
the factors necessary to produce schizophrenia, but all the
tools of modern biomedical research are being used to search for
genes, critical moments in brain development, and other factors
that may lead to the illness.
Is Schizophrenia Inherited?
It has long been known that schizophrenia runs in families.
People who have a close relative with schizophrenia are more
likely to develop the disorder than are people who have no
relatives with the illness. For example, a monozygotic
(identical) twin of a person with schizophrenia has the highest
risk – 40 to 50 percent – of developing the illness. A child
whose parent has schizophrenia has about a 10 percent chance. By
comparison, the risk of schizophrenia in the general population
is about 1 percent.
Scientists are studying genetic factors in schizophrenia. It
appears likely that multiple genes are involved in creating a
predisposition to develop the disorder. In addition, factors
such as prenatal difficulties like intrauterine starvation or
viral infections, perinatal complications, and various
nonspecific stressors, seem to influence the development of
schizophrenia. However, it is not yet understood how the genetic
predisposition is transmitted, and it cannot yet be accurately
predicted whether a given person will or will not develop the
Several regions of the human genome are being investigated to
identify genes that may confer susceptibility for schizophrenia.
The strongest evidence to date leads to chromosomes 13 and 6 but
remains unconfirmed. Identification of specific genes involved
in the development of schizophrenia will provide important clues
into what goes wrong in the brain to produce and sustain the
illness and will guide the development of new and better
Is Schizophrenia Associated With A
Chemical Defect In The Brain?
Basic knowledge about brain chemistry and its link to
schizophrenia is expanding rapidly. Neurotransmitters,
substances that allow communication between nerve cells, have
long been thought to be involved in the development of
schizophrenia. It is likely, although not yet certain, that the
disorder is associated with some imbalance of the complex,
interrelated chemical systems of the brain, perhaps involving
the neurotransmitters dopamine and glutamate. This area of
research is promising.
Is Schizophrenia Caused By A Physical
Abnormality In The Brain?
There have been dramatic advances in neuroimaging technology
that permit scientists to study brain structure and function in
living individuals. Many studies of people with schizophrenia
have found abnormalities in brain structure (for example,
enlargement of the fluid-filled cavities, called the ventricles,
in the interior of the brain, and decreased size of certain
brain regions) or function (for example, decreased metabolic
activity in certain brain regions). It should be emphasized that
these abnormalities are quite subtle and are not characteristic
of all people with schizophrenia, nor do they occur only in
individuals with this illness. Microscopic studies of brain
tissue after death have also shown small changes in distribution
or number of brain cells in people with schizophrenia. It
appears that many (but probably not all) of these changes are
present before an individual becomes ill, and schizophrenia may
be, in part, a disorder in development of the brain.
Developmental neurobiologists funded by the National Institute
of Mental Health (NIMH) have found that schizophrenia may be a
developmental disorder resulting when neurons form inappropriate
connections during fetal development. These errors may lie
dormant until puberty, when changes in the brain that occur
normally during this critical stage of maturation interact
adversely with the faulty connections. This research has spurred
efforts to identify prenatal factors that may have some bearing
on the apparent developmental abnormality.
In other studies, investigators using brain-imaging techniques
have found evidence of early biochemical changes that may
precede the onset of disease symptoms, prompting examination of
the neural circuits that are most likely to be involved in
producing those symptoms. Meanwhile, scientists working at the
molecular level are exploring the genetic basis for
abnormalities in brain development and in the neurotransmitter
systems regulating brain function.
Depression is a it is a mood disorder that frequently co-exists
with schizophrenia and which also needs treatment. Feelings of
depression and hopelessness are also common with caregivers of
the mentally ill. If you or someone you know with schizophrenia
is feeling particularly depressed its important to see the
doctor about the condition.
Famous People and Schizophrenia:
There are relatively few famous people with schizophrenia
because schizophrenia is a brain disorder that typically strikes
people when they are quite young - age 17 to 28. People this age
typically are too young to be famous, they are just starting out
their professional lives after completing high school or
A recent Nobel Laureate in Economics, John Forbes Nash Jr., has
a lifetime history of Schizophrenia but is now doing very well,
as has been well documented in the book "A Beautiful Mind" and
the academy award-winning movie of the same name.
Many "historical diagnoses" are frequently not entirely certain
-- a "good guess" for schizophrenia includes Mary Todd Lincoln,
wife of President Abraham Lincoln. Following is a list of famous
people who have been diagnosed with schizophrenia, or are highly
suspected of suffering (or who had suffered) from schizophrenia.
• Tom Harrell, Jazz Musician
Tom Harrell has been called the John Forbes Nash, Jr. of jazz.
Against considerable odds, Harrell has successfully struggled
with schizophrenia and become one of the most respected
trumpeters and composers of the past 30 years.
• Meera Popkin, Broadway Star
• John Nash - Mathematician/Nobel Prize Winner
• Albert Einstein's son - Eduard Einstein
• Dr. James Watson's son (Dr. Watson is co-discover of DNA and
Nobel Prize winner)
• Alan Alda's Mother (Alan Alda is the famous TV actor from the
• Andy Goram - Scottish Soccer Player/Goal Keeper
• Lionel Aldridge - Superbowl-winning Football Player
• Peter Green, Guitarist for the band Fleetwood Mac
• Syd Barrett of the band Pink Floyd
• Alexander "Skip" Spence and Bob Mosley - both members of the
1960's rock group Moby Grape (and Jefferson Airplane for Skip
• Roger Kynard "Roky" Erickson, of the Austin-based 1960's group
TheThirteenth Floor Elevators
• Joe Meek - 1960's British record producer
• James Beck Gordon (Jim Gordon) - James Gordon had been, quite
simply, one of the greatest drummers of his time
• Charles "Buddy" Bolden - Jazz Musician
• Antoin Artaud - Dramatist, Artist
• Mary Todd Lincoln, wife of Abraham Lincoln (past-President of
the United States)
• Vaclav Nijinsky, Famous Russian Dancer
• Jack Kerouac, Author, was diagnosed with Schizophrenia