Schizophrenia is the common term for a group of serious psychiatric conditions called the schizophrenic disorders. Although they strike only about one percent of the population, these disorders are so disabling they are considered among the most important of psychiatric illnesses.
Schizophrenic disorders are generally characterized by hallucinations and delusions. Experts have struggled to agree on precise definitions and terms for the various disorders, but most concur that the schizophrenic disorders may be broadly assigned to one of two categories—good prognosis and poor prognosis. Good prognosis cases are believed to be somewhat more common than poor prognosis cases.
Good prognosis (expected outcome) forms of the disease are as follows:
- acute schizophrenia
- reactive schizophrenia
- schizoaffective disorder
- remitting schizophrenia
Conditions with poor prognosis are as follows:
- chronic schizophrenia
- process schizophrenia
- nuclear schizophrenia
- nonremitting schizophrenia
Most forms of schizophrenia are marked by at least intermittent episodes of hallucinations and delusions, despite the absence of any gross physical defects in the relevant sensory apparatus. Auditory hallucinations (hearing voices, for example) tend to be the most common, although visual hallucinations are also common. Less frequently, patients suffer olfactory hallucinations (usually consisting of unpleasant smells) and even imaginary tactile sensations (insects crawling on or under the skin is a classic example).
Mood changes and other affective symptoms—such as inability to sleep, weight loss, loss of appetite (anorexia), suicidal thoughts and depression—may also appear during the course of the illness.
Other symptoms may include odd or inappropriate or bizarre behavior, an inability to make logical associations among ideas, and episodes of paranoia. Physical behavior may devolve into a dysfunctional state known as catatonia. Although this is often portrayed in the media as a sort of waking coma, catatonia may involve episodes of great excitement or profound confusion and usually entails muscle rigidity and apparent stupor.
Who’s at Risk?
Men are more likely to be stricken at an earlier age—often in early adulthood—than women, and male patients’ prognoses tend to be worse. It is apparent that there is a genetic component in some cases, amounting to a greater predisposition among some individuals from families with a history of the disorder. But it is still unknown who will succumb to the disease or precisely what might trigger it.
Treatments have included electroconvulsive therapy (ECT), sometimes called “shock treatment,” and, beginning in the mid-20th century, tranquilizing antipsychotic medications, such as the phenothiazines (e.g. Thorazine) and more recently, a new generation of medications (known as atypical antipsychotics; e.g. Geodon, Zyprexa), which tend to have fewer side effects than older medications.
Written by: Dale Kiefer
Medically reviewed by Jennifer Monti, MD, MPH