What is schizophrenia

Schizophrenia is a mental health condition classified as a psychotic disorder. It involves a significant loss of contact with reality, where individuals may experience distorted perceptions, thoughts, and beliefs. The disorder can disrupt thinking, emotions, and behaviour. Psychotic disorders are often characterised by delusions and disorganised speech or behaviour.

Prevalence and patterns of onset

Schizophrenia affects a portion of the population, with estimates suggesting that between 0.3 and 0.7 per cent of people will develop the condition. While some individuals recover completely after an initial episode, many others experience recurring periods of symptoms throughout their lifetime.

The onset of schizophrenia follows distinct patterns based on age and gender. In males, the disorder is most likely to emerge between the ages of 16 and 25, after which the risk decreases sharply. For females, onset peaks in their twenties, but it declines more gradually, leading to a higher likelihood of developing schizophrenia from age 35 onwards compared to males.

Positive symptoms of schizophrenia

Positive symptoms refer to experiences or behaviours that are added to a person's normal way of functioning, often making reality seem altered or exaggerated. These are typically the most noticeable signs of schizophrenia and can be distressing for the individual. According to classification systems like the DSM-IV-TR and ICD, positive symptoms include hallucinations, delusions, and thought disorders.

Hallucinations

Hallucinations are false perceptions that involve the senses, causing someone to hear, see, smell, taste, or feel things that are not actually present. The most common type is auditory hallucinations, where individuals hear voices in their heads. These voices might give commands, warn of dangers, or even converse with each other. For example, a person might resist attempts to convince them the voices are not real, as the experience feels entirely genuine to them. A helpful approach in treatment is to acknowledge that others do not share these perceptions, framing them as unique to the individual rather than dismissing them outright.

Delusions

Delusions are strongly held false beliefs that are not based on reality and can be easily disproven by others. They often involve misinterpreting everyday events in extreme ways.

Common types of delusions:

• Paranoid delusions - Believing someone, like a government agency, is plotting against them
• Delusions of grandeur - Thinking they are a famous figure or have special powers
• Delusions of control - Feeling that external forces are manipulating their actions or thoughts

To the person experiencing them, these beliefs feel absolutely true, and alternative explanations are often ignored, which can strain relationships with family and friends.

Thought disorders

Thought disorders involve disruptions in the normal flow of thinking. For instance, thought insertion occurs when individuals feel that their thoughts are not their own but have been placed in their mind by an external source, such as another person or entity. They might describe violent or disturbing ideas as being "sent" to them, distinguishing these from their natural thoughts.

Negative symptoms of schizophrenia

In contrast to positive symptoms, negative symptoms involve the loss or reduction of normal emotional and behavioural functions. The DSM-IV-TR and ICD identify negative symptoms such as a flattened emotional response and apathy.

Key negative symptoms

• Loss of emotional responses - This is when individuals show reduced facial expressions, tone of voice, or gestures that typically convey feelings.
• Apathy - This refers to a lack of interest, motivation, or initiative in activities.

Disorganised symptoms and their effects

Schizophrenia often includes disorganised symptoms, which affect speech, thinking, and behaviour.

Disorganised thinking and speech

This becomes noticeable when thoughts jump rapidly between unrelated topics, making conversations hard to follow. Speech might include answers to unasked questions, excessive irrelevant details, or completely jumbled words - a pattern known as word salad, where sentences are grammatically structured but lack any coherent meaning. For instance, someone might start talking about the weather and suddenly shift to an unrelated historical event without any logical connection.

Disorganised behaviour

Actions may appear unpredictable or inappropriate.