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Schizophrenia Spectrum Disorders

Throughout this chapter when making references to beliefs, research results, and conclusions about schizophrenia, it will be useful to understand that I’ve written it from a perspective of the explanations found in some of the mainstream literature, which promote the idea of schizophrenia, and which are typically the only information that the public receives.

With a basic understanding of schizophrenia as it is presented to the public, it will later be easier to conceive how this illness is a complete fabrication and is used by governments to conceal the attacks of their security forces against internal enemies.

Schizophrenia is a mixture of signs and symptoms that include a range of cognitive and emotional dysfunctions, which prevent people from thinking clearly, managing emotions, making decisions, and relating to others.

Its chronic, long-lasting symptoms cause a high degree of disability. Most people with schizophrenia experience hallucinations and delusions. Although many experts believe it is a group of disorders, for now a single term is used for lack of a better alternative. Schizophrenia is not a multiple personality disorder, like dissociative identity disorder.

The symptoms, treatment, and course of schizophrenia also pertain to schizoaffective disorder, schizophreniform disorder, delusional disorder, brief psychotic disorder, shared psychotic disorder, psychotic disorder due to a general medical condition, substance-induced psychotic disorder, and psychotic disorder not otherwise specified.

These disorders are called schizophrenia spectrum disorders. For this study, the term schizophrenia will be used to describe all of these. Closely associated with schizophrenia is manic-depressive disorder (also known as bipolar disorder), which is characterized by episodes of mania and depression.

Although it is primarily a mood disorder, while schizophrenia is a thought disorder, both illnesses have basically the same treatment and prognosis. Also, about 50% of those diagnosed with manic-depression experience hallucinations and delusions. So for the purpose of this study it will be considered a schizophrenia spectrum disorder.


Schizophrenia can be found in about 1% of the population of the world. It affects men and women equally. The 1% does not include those diagnosed with other mental disorders such as manic-depression. Schizophrenia runs in families. Those with parents or siblings with the illness have a 10% chance of developing it. If both parents have it, the chance is 20%. And if an identical twin has it, it increases to 50%.

It seems that people born in the winter or early spring are more likely to develop it. According to the World Health Organization, it is one of the ten most debilitating diseases affecting people worldwide.

The life expectancy of schizophrenics is shorter than that of the general population. One reason for this is that about 10% of the people with the illness commit suicide. Between 20% and 40% will make at least one attempt over the course of the illness.

While both groups are at an increased risk, men successfully complete suicide more often than women. Specific risk factors include men under 45 years old with depressive symptoms, unemployment, and recent discharge from the hospital.

Most people with it are not violent while they’re receiving treatment. Although, as a group people diagnosed with schizophrenia have a higher incidence of violence than the general population, this is attributed to young men with a past history of violence, who are not complying with their medication and are excessively abusing drugs.

Other than people with a history of violence, people with schizophrenia are not prone to violence. However, people with psychotic symptoms may be at a higher risk for violent behavior if they stop taking their medication. When violence does occur, it’s usually directed at a family member or friend, and usually takes place at home.

Schizophrenia can be developed at any age, but about ¾ of those with it developed it between the ages of 16 and 30. Children over the age of 5 can be diagnosed with schizophrenia, although it is uncommon. Women usually have a later onset than men, often between 25 and 35. For men it occurs between 18 and 25. Men rarely develop it after age 35. Although it is rare, it can be develop after age 45, and most of these cases consist of women.


Although the name schizophrenia has only been around for about 100 years, descriptions of the illness allegedly go back several thousand years. Mental illness in general has been mentioned since the beginning of recorded history. These records include descriptions of hallucinations and delusions.

However, it is a debatable issue whether schizophrenia with its characteristic symptoms and course existed in ancient times. The exact time that the illness made its appearance in recorded history is also unknown. Ancient descriptions of these symptoms could have been attributed to head trauma, brain infections, stroke, or some other type of underlying organic reason.

The symptoms that characterize schizophrenia did not appear until the early 1800s. Scholars differ in their explanations of why there is a lapse between descriptions in ancient times and the early 1800s. Some think that it was always present, while others believe it was rare until the 1800s, and then suddenly appeared.

A French researcher named Jean Pierre Falret referred to it as circular madness in 1851. Then over the next 50 years it was defined in slightly different ways and renamed several times. In 1860 a French psychiatrist named Benedict Augustin Morel called it demence praecox. Dr. Ewald Hecker (1843-1909), a German psychiatrist, observed it as hebephrenia in 1871.

In 1874 Hecker’s teacher, Dr. Karl Ludwig Kahlbaum (1828-1899), described it as two diseases, catatonia and paranoia. He published two basic descriptions of psychotic symptoms. One was hebetic paraphrenia which included hallucinations, delusions, and bizarre behavior that began in childhood and progressed to severe deterioration. The other was katatonia (catatonia) which included impaired self will, diminished movement, and dementia. Both Hecker and Kahlbaum believed the illness began in childhood and resulted in an irreversible decline in all mental functions.

Although many different people have contributed to the current understanding of schizophrenia, the two most notable include Emil Kraepelin and Eugen Bleuler. Emil Kraepelin (1856-1926) (pronounced Ey-meel Kre-puh-leen), was a German diagnostician who combined the works of Morel, Hecker, Kahlbaum and others into his own diagnostic system. While recording hundreds of case observations of mental patients, he noticed important similarities.

In 1896 he published the fifth edition of his Textbook of Psychiatry which suggested that all symptoms were part of a single disorder. He called it dementia praecox (pronounced pree-koks), a Latin term for early onset (praecox) and an eventual deterioration in mental functions (dementia). The symptoms included, among others, delusions and hallucinations.1

Kraepelin was the first to recognize it as a single illness composed of multiple symptoms. The diagnostic system that Kraepelin developed formed the system of classification for mental disorders used in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), and the World Health Organization’s International Classification of Diseases (ICD). Modern psychiatry is heavily influenced by his work.

Then in 1911 the term was changed again to schizophrenia by a Swiss psychiatrist named Eugen Bleuler (pronounced Bloy-ler) (1857-1939). In an article called Dementia Praecox or the Group of Schizophrenias published in 1911, he mentioned that he changed the name because his studies revealed that it did not occur in childhood or progress to the complete deterioration of all mental functions (dementia).2 The essential feature of the illness included a split (schizo) with perception in reality that occurred in the mind (phren) of patients.

Unlike Kraepelin, he thought it was a group of diseases rather than one. But, he did agree with Kraepelin’s description of the primary symptoms. He divided the symptoms into two basic categories that included fundamental, which included standard symptoms that he noticed, and accessory symptoms. The accessory symptoms included delusions and hallucinations.


In the DSM-IV symptoms occur in two broad categories including positive and negative. The positive symptoms are manifested by an excess or distortion of normal functions. The negative symptoms are a loss of normal functions. These symptoms are further defined by 5 subcategories.

Categories A1 through A4 contain the positive symptoms, including: A1 (delusions), A2 (hallucinations), A3 (disorganized thought/speech), A4 (grossly disorganized behavior, plus catatonic motor behavior). Category A5 contains the negative symptoms which are defined by limitations in the scope and intensity of emotional expression, productivity of thought and speech, and in goal-directed activities.

Besides the DSM’s method of classification, symptoms can be categorized another way. Other publications include an additional symptom category called cognitive, which corresponds to the DSM’s positive symptom subcategory disordered thought/speech (A3).

These publications also incorporate the DSM’s Social/Occupational Dysfunction (Criterion B) as well as the behavioral disorders (Criterion A4) into their description of negative symptoms. Below I’ve combined the two methods of categorization, using the positive-negative-cognitive format as the general outline, which is broken down further using the DSM’s descriptive criteria.

Positive Symptoms

Positive symptoms (also known as psychotic symptoms) are called positive because they are an addition to regular experiences. They include abnormal behaviors, perceptions, or beliefs that reveal a break from reality and are not shared by people without a mental illness. The most common types of psychotic symptoms are hallucinations and delusions.

To date, the term psychotic has not received a definition that has been universally accepted. In the DSM it varies depending on which illness it refers to. One narrow meaning of the word includes the presence of delusions and hallucinations with an absence of insight into their pathological nature. So for the course of this study the term will usually refer specifically to delusions and hallucinations.

Delusions (Criterion A1)

Delusions are a very common symptom of schizophrenia. A variety of definitions have emerged pertaining to this term. Basically they are false personal beliefs that are not subject to reason or contradictory evidence, are not explained by the person’s typical cultural concepts, and do not change when the person is presented with contradictory evidence.

The two basic categories of delusions include bizarre and nonbizarre. Delusions are considered bizarre if they are clearly implausible, not understandable, and do not originate from an ordinary life experience. What constitutes bizarreness may differ across cultures. The delusional content includes a variety of themes. Some of the most common themes include persecutory, referential, and control.

The most common type is the persecutory delusion, where the person thinks they’re being singled out for harassment by forces or persons. These people believe they’re being stalked, conspired against, and spied on, tormented, tricked, drugged, and poisoned. A variation of the persecutory delusion is the systematized delusion, where an organized system of delusions is logically explained using a single theme.

Those exhibiting persecutory delusions believe there is a government plot to destroy them or drive them crazy. The typical perpetrators are the FBI and the CIA. These individuals may also believe that their family is co-conspiring against them, and therefore, may accuse them as being in on it. Some are convinced that their neighbors are harassing them.

Referential delusions are also common, where the person believes that their environment has been arranged with people, media, and objects that are intended to convey symbolic messages. These symbolic messages are believed to be conveyed using gestures, overheard comments, or other environmental cues, which are usually threatening in nature.

Those suffering such delusions may also believe that people on TV or the radio are conveying these messages, and those newspapers, books, and song lyrics are also being used as a medium for this type of communication.

Examples of delusions of control include people thinking that their thoughts are being read, that thoughts and feelings are being projected into their minds, and that their bodies are being controlled. Some believe that this is being accomplished by an external force, such magnetic waves originating from their neighbors, the CIA, or FBI.

Hallucinations (Criterion A2)

Hallucinations are false sensory perceptions where someone can see, smell, hear, taste, and/or feel something that isn’t there. Auditory hallucinations are the most common, comprising about 70% of all hallucinations, with about 25% being visual.

The auditory hallucinations are experienced as familiar or unfamiliar voices that are perceived as distinct from a person’s own thoughts. These voices may comment on a person’s ongoing activities, carry on a conversation with them, warn them of impending dangers, or issue them orders. Some hear noises such as clicks or other non-word sounds.

Negative Symptoms (Criterion A4 and A5, Criterion B)

Although they are less prominent, much of the morbidity associated with schizophrenia is due to the negative symptoms (also called deficit symptoms), which appear in Criterion A5 of the DSM-IV. These symptoms are manifested by a diminishment in critical functions, such as emotions and behaviors.

In addition to the standard negative symptoms outlined in Criterion A5 of the DSM-IV, many publications include in this criterion symptoms listed elsewhere in the DSM-IV for the same illness. Because all are considered when making an evaluation, this makes no difference in a diagnosis.

It’s just a different method of explaining the symptoms. These additions include: Grossly Disordered Behavior (Criterion A4), Catatonic Behavior (Criterion A4), and Social/Occupational Dysfunction (Criterion B).

Standard Negative Symptoms (Criterion A5)

Problems with emotional expression and motivation are manifested by the presence of symptoms such as affective flattening, alogia, anhedonia, and avolition.

Affective flattening (also called blunted affect) is a common characteristic where a person’s face appears unresponsive, emotionless, and immobile. In addition to diminished facial expressions, there may be a reduction in body language and their speech may be monotone.

Alogia is a poverty of speech which is considered to be the result of thought reduction. The person’s speech may brief and devoid of any content. Anhedonia is a common symptom manifested by a loss of interest or enjoyment in life and activities.

Avolition is lack of motivation to begin or complete tasks, resulting in a person sitting for long periods of time and showing little interest in work or social functions. In some severe cases, schizophrenics can spend an entire day doing nothing at all.

Grossly Disordered Behavior (Criterion A4-1)

Grossly disorganized behavior includes childlike silliness and unpredictable behavior, difficulty with any goal-directed behavior, trouble performing daily living activities such as personal hygiene and preparing meals. The person may appear blatantly messy, may dress in a manner which is not proper for the climate, or exhibit inappropriate sexual behavior. They may also become agitated and begin shouting or swearing for no good reason.

Catatonic Behavior (Criterion A4-2)

Catatonic motor behaviors include a decrease in reactivity to environmental stimuli. This may reach such a point that a person is completely oblivious to their surroundings. They may maintain a rigid posture, a bizarre posture, and may resist efforts to be moved. They may also make unstimulated excessive movements.

Social/Occupational Dysfunction (Criterion B)

Schizophrenia also involves a dysfunction in areas of life such as personal relations, work, education, and self-care. Frequently, the educational process is disrupted and the person is unable to hold a job for a long period of time. Social withdrawal is common. Most people with schizophrenia have little social contact, and have an inability to make or keep friends. About 70% of them don’t marry.

Cognitive Symptoms, Disordered Thought/Speech (Criterion A3)

According to the DSM-IV, disorganized thinking/speech (also called thought disorder) is the single most important component of schizophrenia. Cognitive symptoms include deficits in thinking abilities, such as decision-making, paying attention, and remembering. An example includes absorbing information, interpreting it, and making decisions about it.

Because it’s difficult to arrive at an objective definition of thought disorder, and because speech is an indication of a person’s thoughts, disorganized speech is a method used to gauge thought disorder in the DSM. There are several ways to determine if this symptom exists.

A person may jump from one topic to the next (derailment), may provide answers which are unrelated to the questions that are asked (tangentiality), and sometimes their speech will be so disorganized that it’s incomprehensible.

Included in this category is a symptom called anosognosia which prevents people from understanding that they’re suffering from a mental disorder. It is believed that this lack of insight is a manifestation of the illness rather than denial. This symptom does not improve with medication. Cognitive and negative symptoms may be so similar that they’re difficult to differentiate.


In addition to the positive, negative, and cognitive symptoms, some schizophrenics experience mood disorders such as depression and anxiety resulting in mood swings similar to bipolar disorder.

When mood instability is the primary feature of the illness, it’s called schizoaffective disorder, which means that a combination of schizophrenia and a mood disorder are present. Some believe schizoaffective disorder is just a subtype of schizophrenia, while others think it’s a separate disorder.

Schizophrenia is expressed differently in men and women. Women tend to express more affective symptoms such as delusions, and hallucinations, while men express more negative symptoms such as flat affect, avolition, and social withdrawal. The basic symptoms are the same in children.

Causes and Studies

Schizophrenia is not caused by a lesion in the nervous system or any biochemical disturbances in the body. Its etiology is unknown. There is no medical exam that can diagnose it. Scientists have given many theories to explain the cause of schizophrenia.

The most widely accepted is the dopamine theory, which is based on the idea that it is caused by an imbalance of chemicals in the brain. Specifically, it suggests that there is an imbalance in dopamine neurotransmitters, but this has not yet been confirmed.

The imbalance is thought to be caused by genes, viruses, or problems at birth which impact brain development. It has also been suggested that neurons which formed inappropriate connections during fetal development remain dormant until later in life, when natural changes in the brain influence the underlying faulty connections, which produce the characteristic symptoms. Regions of the human genome are being studied to identify genes that place someone at risk for developing schizophrenia.


While it was easier to describe the symptoms using the positive-negative-cognitive format as the primary structure, for diagnostic purposes we’ll use the standard DSM-IV format. No single symptom can constitute a diagnosis of schizophrenia. In order to diagnose someone with schizophrenia a variety of conditions and symptoms must be met which are detailed in Criteria A through F.

They include the Criterion A symptoms such as delusions (A1), hallucinations (A2), disorganized speech/thought (A3), disorganized behavior (A4), catatonic behavior (A4), and negative symptoms (A5). They also include symptoms pertaining to social and occupational dysfunction (Criterion B), as well as a minimum duration (Criterion C).

Furthermore, other underlying causes must be considered as described in the mood disorder exclusion (Criterion D), substance/general medical condition exclusion (Criterion E), and developmental disorder exclusion (Criterion F).

We’ve already examined the symptoms associated with Criterion A. They include delusions (A1), hallucinations (A2), disorganized speech/thought (A3), disorganized behavior (A4), catatonic behavior (A4), and negative symptoms (A5). At least two of these symptoms must be present for a minimum of one month in order for Criterion A to be met.

Criterion C requires that some signs of the illness described in Criterion A or B must persist for a continuous period of at least 6 months. And that during the 6 month period at least 1 month must include at least two symptoms from Criterion A.

This means that if any two symptoms from Criterion A persist for 6 months then Criterions A, B, and C are met. Therefore, Criterion B, which includes social and occupational dysfunction, is not necessary to make a diagnosis of schizophrenia.

Also, if delusions are judged bizarre, or voices are commenting on a person’s thought pattern or behavior, or if two or more voices are conversing, then only that single symptom is necessary to meet Criterion A. Even if these symptoms subside within a month in response to treatment, then Criterion A will still have been met if the clinician believes they would have persisted absent the medication.

Criterion D is met if the illness is not better accounted for by schizoaffective disorder or mood disorder with psychotic features (bipolar disorder). Other than that, Criterion E and F are just exclusions for drugs or biological disorders that can cause the symptoms.

If the disorder is not attributed to an illegal drug or medication, or an underlying medical condition with a biological origin, then Criterion E is met. If a developmental disorder such as autism is not found, then Criterion F is met.

Other exclusions that do not belong to a specific criterion, but which clinicians should make include cultural differences which may influence beliefs and behavior. For instance, in some cultures sorcery and witchcraft are normal and are not part of a delusional belief system. Likewise, auditory and visual hallucinations may be part of a normal religious experience in some cultures.

Delusions that occur while falling asleep or waking up should not be considered when making a diagnosis. Occasionally hearing one’s name called or humming noises are in the range of normal experiences.

Linguistic differences may account for disorganized speech. In addition, when assessing flat effect, cultural variations resulting in different ways of emotional expression, eye contact, body language, etc. should be considered. Because of these complications, some clinicians have had a tendency to overdiagnose schizophrenia in some racial groups.

Medical disorders with a biological origin can produce symptoms that are consistent with schizophrenia. Therefore, medical exams are done to rule out these possibilities. Some conditions which can cause these symptoms include: brain tumors, AIDS, encephalitis, epilepsy, multiple sclerosis, Alzheimer’s disease, metabolic disorders, thyroid problems, head injury, drugs and alcohol, and nutritional deficiencies.

There is no physical or laboratory test that can diagnose schizophrenia. Instead, a clinician makes the diagnosis based on symptoms. However, these tests are done to rule out the other possible causes as well as for research purposes. They include blood and urine tests, as well as an examination of the fluid surrounding the brain and spinal cord (cerebrospinal fluid). In addition, an MRI, EEG, X-ray, or CT may be done.

The most accurate way to detect schizophrenia is a mental status exam, which is usually performed by a trained clinician during an interview. Clinicians who are qualified to make a diagnosis include all psychiatrists, many psychologists, and some psychiatric social workers and nurses.

The diagnosis is made by asking questions. Some questions pertain to personal background information such as family, friends, living situation, school, work, interests. Others are about the current symptoms and how they’ve changed over the course of the illness, any previous mental or physical disorders, and any family history of mental illness.

The clinician identifies specific symptoms and how long they’ve been present, as well as functional problems in other areas of daily life. They factor in appearance (dress, cleanliness), alertness, and body language including facial expression and tone of voice.v

Because a person who is experiencing psychotic symptoms may have difficulty answering questions, his or her friends and relatives may be present during the interview to help the clinician obtain information. They may be particularly helpful in identifying areas of dysfunction (Criterion B), which are the first symptoms they are likely to notice.

The clinician evaluates the person by matching their symptoms to each criterion in a diagnostic system. A diagnostic system is a set of guidelines containing criteria which is used to make a medical diagnosis. Examples of this include the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), International Classification of Diseases (ICD), Research Diagnostic Criterion (RDC), and Flexible Diagnostic System (FDS).

The two most widely used systems in the world include the DSM, which is used in the US, and the ICD, which is used in most of the rest of the world. The diagnostic criteria are quite similar in both systems.

When making a diagnosis of schizophrenia, subtypes are used for a more accurate description of an individual’s condition. They include: paranoid (295.30), disorganized (295.10), catatonic (295.20), undifferentiated (295.90), and residual (295.60). The most common is paranoid.

The diagnosis of a subtype is based on the most recent evaluation of the patient and may change over time. All subtypes include symptoms of hallucinations and delusions. In addition, schizophrenia can further be broken down into more precise descriptions called specifiers after a period of one year.

Course, Prognosis, Process

The progression of the illness can vary considerably among individuals. But there are several distinct phases including the prodromal phase, the acute (also called active) phase, and the residual phase.

The prodromal phase includes less intense symptoms such as depression, lack of enjoyment in daily activities, and social withdrawal. Early signs also include cognitive problems such as not being able to focus, forgetting things more easily, neglecting personal hygiene, and not making logical connections. The change in behavior which these symptoms produce is often the first sign that friends and family notice.

The onset of psychotic symptoms is called the acute (active) phase which includes hallucinations, delusions, and disordered thinking. It is during this phase that a person suffers a psychotic break and is hospitalized, where they’re evaluated and given treatment (medication). This phase may develop over a period of months or years. Some may experience this phase only once in their lifetime.

The residual phase includes a stabilization of the individual due to a reduction of acute symptoms, which is usually the result of medication. The patient is then released from the hospital or program and must be monitored for the rest of their life.

Residual symptoms include lack of energy, social withdrawal which may last years, or for some, disappear quickly. The residual phase can often last years until interrupted by a relapse into the acute phase. However, with regular medication, relapse can be kept to a minimum.

After the hospital discharge the patient receives intensive outpatient treatment. They attend group therapy sessions to help them resume their lives. They are assigned psychiatrists and nurses to help them with problems regarding their medication.

They may also have a therapist and case manager. Case Managers help schizophrenics find places to live, get benefits, etc. Because there is no cure for schizophrenia, patients must continue to see a psychiatrist or therapist indefinitely. The course of the illness for people who attend psychosocial rehabilitation programs while continuing with their medication is better, according to some research results.

Women have a better prognosis than men as evident by the number of rehospitalizations, lengths of hospital stays, relapse rates, responses to medication, and social functioning. However, even with medication, most people have it chronically or episodically throughout their entire lives.


Medication is said to be the best treatment for schizophrenia. According to some sources most people with the illness show substantial improvement when treated with these drugs. Some are not helped much by the medications, and a few don’t seem to need them.

The drugs used to treat schizophrenia are called antipsychotics, (also called neuroleptics). They help to relive the hallucinations and delusions, and to some extent, cognitive problems. Medication is also associated with a reduction in the number of relapses which result in hospitalization. According to some studies, 70% of those diagnosed with the illness that refuse medication will have a relapse, compared with only 30% of those who take their medication.

Medication does not completely eliminate psychotic symptoms. Instead it reduces them. About 20% to 40% of those who take medication continue to have hallucinations and delusions, but the symptoms are notably reduced.

Scientists think that antipsychotics are effective in correcting an imbalance in the dopamine neurotransmitters, which send nerve impulses across synapses. Some theories suggest that schizophrenics have too much dopamine in the mesolimbic area of the brain, which is involved in imagery, perception, and emotion, and too little in the prefrontal cortex, which is responsible for attention and processing information. Antipsychotics are thought to work by correcting this alleged imbalance.

The most common way of taking antipsychotics is in pill or liquid form, usually between one and three times a day. Some antipsychotics can be taken in fast-acting injections, which are usually used in situations where an individual needs to calm down. Others are available in long-lasting injections which only need to be given every 2-4 weeks. Even if the symptoms are reduced, it is suggested that medication should be continued to prevent a relapse into the acute phase.

The two basic types of antipsychotics include typical (also called conventional or first generation), which are older medications, and atypical (also called novel or second generation), which are relatively new. To describe these kinds of medications, first the generic name will be given, followed by the brand name in parentheses.

Typical antipsychotics were introduced in the 1950s, and all were similar in their ability to relieve the positive symptoms of the illness. They include: chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), thiothixene (Navane), trifluoperazine (Stelazine), perphenazine (Trilafon), loxapine (Loxitane), mesoridazine (Serentil), molindone (Moban), and thioridazine (Mellaril). Haloperidol, perphenazine, and fluphenazine can be administered by injection.

All antipsychotics have side effects which differ depending on the type of drug and dosage. Some can be corrected by lowering the dosage, switching to another medication, or adding a medication. Side effects of typical antipsychotics include a type of restless motion called akathisia, symptoms resembling Parkinson’s disease, stiffness, dry mouth, drowsiness, sedation, blurred vision, and constipation.

Of particular concern is a permanent disorder called tardive dyskinesia (TD) which occurs in about 15 to 20 percent of patients, and is characterized by involuntary movements of the lips, tongue, and sometimes the arms and legs.

Atypical antipsychotics appeared in the early 1990s. All had similar results reducing the positive symptoms of the illness, and were thought to be more effective at reducing some of the negative ones. They include: aripiprazole, (Abilify), clozapine (Clozaril, Fazaclo), olanzapine (Zyprexa, Xydis, Symbyax), quetiapine (Seroquel), risperidone (Risperdal, M-tabs, Consta), and ziprasidone (Geodon).

Atypical antipsychotics cause fewer side effects such as TD, motor side effects (extrapyramidal), restlessness (akathisia), and spontaneous expressiveness (akinesia). All cause metabolic problems that result in weight gain, and increase a person’s chances of developing diabetes, although they may vary in their risk for these conditions. Clozapine, which appears to be more effective than other atypicals, has a possible severe side effect that includes the loss of white blood cells, a condition called agranulocytosis.

In addition to taking medications for psychotic symptoms, schizophrenics may also need to take medication for depression, anxiety, and mood instability. For instance, mood stabilizers may be prescribed, such carbamazepine (tegretol) which is an antiseizure medication. The side effects of it include motor coordination problems, upset stomach, blurred vision, and drowsiness. Valproic acid (depakote) is another mood stabilizer, which has similar side effects. It is common for someone diagnosed with schizophrenia to be taking as many as 5 to 10 medications each day.

Although it is not usually used anymore to treat schizophrenia, electroconvulsive therapy (ECT) may also be used to induce a mild electric shock to a person’s brain, thereby creating a controlled seizure. This is thought to allow the brain circuits to reset themselves, resulting in a calmer attitude.

There are a variety of reasons why a schizophrenic may not comply with treatment. Most are unable to understand that they’re ill, and therefore, don’t believe medication is necessary. Some discontinue their medication because of its side effects or they don’t believe it’s working, or have such disorganized thinking that they can’t remember to take it. Also, family and friends of those suffering from the illness may inappropriately persuade them to stop.

Family members and doctors can work together to construct a schedule with various reminders that will influence the ill person to take their medication. Family members can help the individual make their medication intake part of their daily routine by placing the medication in areas around the house as a reminder for the ill person to take them. In addition, some antipsychotics are available in long-lasting injections which eliminate this problem. More long-lasting injections are currently being developed.

Relatives of those diagnosed with schizophrenia may need to take an even more active role in persuading a family member to take their medication. In some cases, medication can be given to an individual against their will, or they may be required to take their medication as a condition of living in the community.


A variety of therapeutic approaches are available. Some of these may be offered in private mental health agencies, local hospitals, private psychiatrists or therapists. In addition, state-funded community mental health centers (CMHC) are available all across the US to provide therapy for individuals, families, and groups.

The types of programs offered may vary, but some include individual psychotherapy (also called talk therapy), which involves the individual and a mental health specialist such as a psychiatrist, psychologist, social worker, or nurse. With this type of therapy, patients begin to understand their problems by sorting out the real from the unreal.

Another is behavior therapy, which focuses on changing unwanted behavior by developing new behavior patterns and removing maladaptive ones. Cognitive therapy is often used with behavior therapy, and includes correcting inaccurate patterns of thinking, by helping individuals test the validity of some of their beliefs. There is also group therapy that includes a group of people with similar mental disorders that works on issues with the guidance of a therapist.

Family education (psychoeducation) is also useful because schizophrenics are usually released from the hospital in the care of their family. So, it is very important that family members learn about this illness in order to assist the individual. With this type of therapy, families are educated on a variety of skills that will allow for a more effective outcome for the patient. Some of this education includes strategies to improve adherence to medication.

However, psychotherapy is usually reserved for those exhibiting less severe symptoms. Medication is the primary treatment. Therefore, before therapy begins, people are often given medication to reduce their delusions and hallucinations.

Peer groups exist (also called advocacy groups) which offer volunteer programs to help the mentally ill gain work experience, as well as support, and social opportunities. One of these is the National Alliance for the Mentally Ill (NAMI), which provides education, advocacy, and support for individual patients, families, and professionals interested in learning about this illness. Although they may not be led by professional therapists, they offer therapy in the form of mutual support, and serve other functions such as patient advocacy.

Involuntary Commitment (Assisted Treatment)

In a situation where someone who is thought to be mentally ill is exhibiting what are considered to be psychotic symptoms, such as delusions or hallucinations, they can be involuntarily committed. This can be done by family members, guardians, police, licensed physicians, or in most states any common person.

An involuntary commitment process can be initiated by contacting the police, the local mobile crisis team (also called the crisis team, and psychiatric crisis unit), accompanying them to the emergency room, or filing a petition.

Some common signs which constitute a forced commitment include: refusal to take medication; verbally or physically abusive; suicidal ideas; harms self; homeless, which may result in harm to self; refusal to speak with anyone; delusions of grandeur; delusions of persecution; dangerously disorganized; deteriorating health.

Most hospitals have mobile crisis teams which are partnered with the local police. The teams consist of mental health professionals such as master’s level psychologists, social workers, or nurses, who can evaluate a person’s mental health at certain locations.

If the team judges that hospitalization is warranted, they’ll ask the suspected mentally ill person to accompany them to the hospital. If the person refuses, they immediately initiate a legal process for involuntary commitment, which may result in the individual’s eventual commitment. In addition, the police can usually force a person to undergo a psychiatric evaluation.

Commitments can be long or short-term. The initial commitment is a 3-7 day stay at the nearest psychiatric facility, where a doctor performs an evaluation and diagnosis. During this time, a legal proceeding may occur which could result in a long term commitment of about 2 or 3 weeks.

A person may then be released from the hospital under a court order known as an outpatient commitment which requires them to comply with treatment. Another compliance method called a conditional release gives the hospital the authority to judge whether a person is adequately complying with treatment (medication). In either case, if the person is thought to be noncompliant, they may be involuntarily placed back into the hospital.

If a person is diagnosed with schizophrenia and refuses treatment, they can be force medicated at any time. There are other methods which can ensure compliance with medication. They include: assertive case management, representative payee, guardianship, and benevolent coercion.

With assertive case management, teams of mental health professionals called case managers actively seek out those resisting treatment at their homes (or anywhere else in the community), and ensure compliance. An example of this type of team is the Program of Assertive Community Treatment (PACT).

An arrangement called representative payee allows for a psychiatric clinic, case manager, or family member to receive the SSI and VA disability checks of an individual, which are then given to the person only if they’re compliant. Some PACT teams can be designated as payees.

With a guardianship a court appoints someone else to permanently make all treatment decisions for the mentally ill person. If the ill person has been arrested, an option called benevolent coercion can be used which allows them the option of either serving jail time or complying with medical treatment. In housing facilities that are reserved for those with psychiatric disorders, treatment can be enforced by threatening to remove the person if they fail to comply with medication.


1. There are some differences regarding when the term was officially used. The Encyclopedia of Schizophrenia and other Psychotic Disorders, by Richard Noll, PhD, says Kraepelin called it Dementia Praecox in 1893. The book Schizophrenia: Diseases and People, by Jane E. Philips and David P. Ketelsen says he referred to it as Dementia Praecox in 1878. Understanding and Treating Schizophrenia: Contemporary Research, Theory, and Practice, by Glenn D. Shean, PhD, mentions he named it in 1896 when he published the fifth edition of his Textbook of Psychiatry.

2. The Encyclopedia of Schizophrenia and other Psychotic Disorders and Schizophrenia: Diseases and People mention that the term was first used by Bleuler in 1908, while the book Understanding and Treating Schizophrenia says it was first used in 1911 when he first published his work in the article, Dementia Praecox or the Group of Schizophrenias.