It’s not what you think…

Schizophrenia IS:

  • A brain disease—the result of physical and biochemical changes in the brain
  • Youth’s greatest disabler—age of onset is usually 15 – 24 years
  • Treatable with medication
  • More common than you think. It afflicts one in 100 people worldwide – that’s about 40,000 of your BC neighbours.

Schizophrenia is NOT:

  • A split personality
  • Caused by childhood trauma, bad parenting, or poverty
  • The result of any actions or personal failures of the individual

Schizophrenia is a devastating mental illness that touches the lives of 1 in 100; that’s more than 47,000 British Columbians, and about 360,000 people in Canada.

Schizophrenia: Basic Facts

View a short documentary about schizophrenia. This is a brief example of a BCSS Partnership Presentation which features a person with lived experience, family member and clinician. If you are interested having a BCSS Partnership Presentation made to your group, call 1-888-888-0029 or email prov@bcss.org:

 

Download our full information booklet on Schizophrenia (updated 2016)

Some Basic Facts

  • Schizophrenia is a disease that strikes young people in their prime.
  • The disease affects the brain and confuses the senses, making it very difficult for the individual to tell what is real from what is not real.
  • Usual age when people start being sick with it is between 16 and 25.
  • Treatment works!
  • Early diagnosis and modern treatment can make a big difference to how well a person with the illness does over time.
  • Schizophrenia is a medical illness. Period.

Schizophrenia is not rare, no one is immune

  • Schizophrenia is found all over the world — in all races, in all cultures and in all social classes
  • It affects 1 in 100 people worldwide. That’s about 40,000 of our B.C. neighbours — or 290,000 fellow Canadians

Men and Women are Equally Likely to Have Schizophrenia

  • For men, the age of first illness with schizophrenia is often ages 16 to 20
  • For women, the age of first illness is sometimes later — ages 20 to 30

We Are All Affected

  • More hospital beds in Canada (8%) are filled by people with schizophrenia than by sufferers of any other medical condition
  • The cost to Canadian society due to hospitalization, disability payments, welfare payments, and lost wages is billions of dollars annually
  • Other costs — such as loss of individual potential, personal suffering, and family difficulties — are impossible to measure.

Outcomes

  • Symptoms of schizophrenia include disordered thinking, changes in emotions, bizarre behaviour, paranoia, hallucinations, delusions, cognitive deficits (damage to short-term memory and executive functioning ? i.e., unable to organize, categorize, prioritize, make decisions). Cognitive impairment is a core feature of the illness, and a reliable predictor of outcomes.
  • Schizophrenia can be a devastating illness. 40-50% of people with schizophrenia attempt suicide. Approximately 12-15% succeed.
  • Early intervention and treatment of symptoms are critical. Evidence indicates that the sooner someone is stabilized on treatment, the better the prognosis for the illness.
  • 8% of hospital beds are presently occupied by people with schizophrenia…more than by sufferers of any other medical condition.
  • Schizophrenia strikes one in 100. That means about 310,000 Canadians will be diagnosed with this illness at some point in their lives. The total cost estimate to Canada for victims of schizophrenia is $6.85 billion per year. Yet research expenditures are lower than for any other major disease.
  • There is as yet no “cure” for schizophrenia. But there is good treatment and there is hope. With new discoveries in brain research and other scientific developments, we are finally on the threshold of an entirely new era of understanding.

Many people with schizophrenia do not receive proper medical treatment and other necessary supports. Severe cognitive deficits and inexplicable perceptions make the person anxious as they struggle to cope with disordered thoughts, internal voices, visual hallucinations or other debilitating symptoms that may cause bizarre behaviours. Without patient education plus support from family, friends and professionals, people in the community may reject someone suffering from schizophrenia because they do not understand the enormous difficulties the person is experiencing.

“Compassion follows understanding.
It is therefore incumbent on us to understand as best we can.
The burden of disease will then become lighter for all.”
— Dr. E. Fuller Torrey

Symptoms

Symptoms of schizophrenia are generally divided into three categories: POSITIVE symptoms, NEGATIVE symptoms, and COGNITIVE symptoms.

Positive Symptoms

“Positive” as used here does not mean “good”. It refers to having symptoms that ordinarily should not be there.

Positive symptoms are sometimes called “psychotic” symptoms since the patient has lost touch with reality in certain important ways.

  • Hallucinations: People with schizophrenia may hear, see, or less commonly, taste, smell or feel things that are not there (see next section, “Stages of Hallucinations”.
  • Delusions: Ideas that are strange and out of touch with reality, often under the categories of:
    • Paranoia – Belief that others can read your thoughts, are plotting against you, or secretly monitoring your activities.
    • Grandiosity – Belief that you can control other people’s minds, or that you are a well-known historical or media figure, or an important and influential personage (writer, artist, musician, inventor, politician, police or military personnel, religious figure, etc.)
  • Anosognosia: a lack of insight, or ability to perceive one’s illness. It is not the same as denial of illness. Anosognosia is caused by physical damage to the brain, and is thus anatomical in origin; denial is psychological in origin. Read more information about anosogosia.

See further information on our site about Psychosis.

Negative Symptoms

  • Affective Flattening: Marked by diminished emotional responsiveness, including: few expressive gestures; changes in facial expression; stilted, forced or artificial gestures; poor eye contact; lack of vocal inflection; decreased spontaneous movements.
  • Alogia: Poverty of speech and of its content; lack of spontaneity and flow of conversation; inability to communicate.
  • Avolition (Apathy) associated with social withdrawal: physical anergia; impaired grooming and hygiene; lack of persistence in performing activities.
  • Anhedonia (Asociality): Few recreational interests/ activities; impaired personal and social relationships; detached, uncommunicative, distant.
  • Inattention: Impaired concentration: social inattentiveness; lack of focus during conversation or interview; poor rapport.

Cognitive Symptoms

  • Disorganized Perceptions: Difficulty making sense of common sights, sounds, and feelings. Perceptions may be distorted so ordinary things seem distracting or frightening. There is extra sensitivity to noises, colours and shapes.
  • Disorganized Thinking and Speech: Trouble understanding language, communicating in coherent sentences, or carrying on a conversation. Odd word associations; “word salad.”
  • Disorganized Behaviour: Loss of short-term memory and organizational skills make planning, prioritizing, and decision-making tasks very difficult, if not impossible.

Cognitive impairment is now recognized as a core feature of schizophrenia. Present in most patients, it is independent of symptoms such as delusions and hallucinations, and a major cause of poor social and vocational outcome. It is also reliably associated with the neurobiology of the disorder.

Stages of Hallucinations

Stage 1: Comforting (correlates with moderate levels of anxiety)

  • The individual experiences anxiety, loneliness, and guilt.
  • Focuses on comforting thoughts to try to relieve anxiety.
  • Individual realises thoughts are one’s own and can control them.

Stage 2: Condemning (correlates with moderate to severe levels of anxiety)

  • If anxiety increases, the individual puts self into a listening state for the hallucination and the hallucination process begins.
  • Individual is unable to control own awareness and may feel terror. Individual becomes afraid others may hear the voices and may begin to withdraw from others.
  • Individual attempts to put distance between self and perceived source(s) of the hallucination.
  • Heart rate, respiration and blood pressure may begin to increase. Attention span begins to narrow.

Stage 3: Controlling (correlates with panic level of anxiety)

  • The voices become threatening if the individual doesn’t follow commands. The hallucination becomes elaborate and may be interwoven with delusions.
  • The hallucination may last for hours or days if there is no therapeutic intervention.
  • Individual may feel suicidal.
  • Individual may become violent or catatonic.

How to help:

  • Follow the direction of the individual and help observe and describe the present and recently past hallucination.
  • You need to find out what the person is seeing, hearing, tasting, touching, or smelling, and begin to discover if a pattern exists.
  • Be patient and LISTEN.

Cognitive Deficits in Schizophrenia

Summary / Overview

    • Neurocognitive deficits are a core feature of schizophrenia.
    • 94% of patients with schizophrenia have cognitive deficits.
    • Cognition problems: reduced attention span, difficulties with memory, reasoning, judgement, problem solving, and decision making are key features of schizophrenia.
    • Memory is particularly impaired.
    • Executive function: the ability to plan, prioritise and implement strategies is also disrupted.
    • Cognitive deficits are probably the most important factor for poor outcome in people with the illness.
    • Research shows that verbal memory, executive functioning and visual vigilance predict functional outcome in schizophrenia.
    • Cognitive abilities are more predictive of functional outcome than psychotic symptoms.
    • Compared to psychotic symptoms, neurocognitive deficits are not as noticeable or odd. But, the deficits are still there and they have an enormous impact on the patient’s life.
    • Little effort is made at present to examine cognitive functioning in people with schizophrenia.
    • Cognitive testing would be of great benefit to patients, clinicians, families and other caregivers.
    • Evaluation of data from neurocognitive testing of patients with schizophrenia would lead to better service planning for all people who suffer from the disease.

Article: Neurocognitive Testing of Patients With Schizophrenia – WHY?

After nearly a century of research it has been firmly established that neurocognitive deficits are a core feature of schizophrenia. Patients with schizophrenia show deficits in areas such as memory, attention and executive functions (Green, 1998). Waldo and colleges (1994) claim that 94% of patients with schizophrenia have neurocognitive deficits compared to non psychiatric controls. However, if you ask professionals who treat schizophrenia what the disorder is, the answer often takes the form of a list of psychotic symptoms.

Sometimes a professional description of the illness is more comprehensive and in-cludes a brief account of “negative” symp-toms. But rarely will neurocognitive deficits be mentioned. Compared to psychotic symptoms, neurocognitive deficits are not as noticeable, not as odd. They are not as yet part of any formal diagnostic system. But, the deficits are still there and they have a great impact on the patient’s life.

Schizophrenia is commonly associated with bizarre thoughts and invisible voices. But it is now clear that problems in cognition–reduced attention span, problems with memory and difficulties in reasoning and problem solving–are also key features of schizophrenia. Cognitive deficits are probably the most important factor for poor outcome in people with the illness. Memory is particularly impaired, and executive function–the ability to plan, prioritise and implement strategies–is also disrupted.

In actively psychotic phases, patients with schizophrenia are often hospitalized. When positive symptoms such as hallucinations and delusions are under control, the patient is usually sent home. However, a majority of patients experience relapses. There could be many reasons for this, but one important issue is that although antipsychotic medications have an impact on symptoms, they do not appear to help neurocognition.

Functional outcome appears to be more closely related to neurocognitive abilities than symptoms. The research of Michael Green (1998) and others has shown that verbal memory, executive functioning and visual vigilance predicts functional outcome in schizophrenia.

Even though it is clear that adults with chronic schizophrenia have cognitive deficits, little effort is made to examine cognitive functioning in people with the illness. There has been an increasing interest in cognitive training programs for this population in recent years, and some programs exist for people with schizophrenia. But much of this training is being done without proper testing to determine who might benefit from what. Before training, it should first be determined in which areas and to what degree individuals experience deficits.

If cognitive testing were performed more regularly it would be of great benefit to people with schizophrenia. Furthermore, an evaluation of collected data could be used to support more appropriate community service planning for all people who suffer from the disease.

– Adapted from Norwegian Social Science Data Services, Dr. Merete , University of Oslo2001 and 01/10/Institute of Psychiatry, King’s College London, 06/01/2003

Other Resources

Information about Cognitive Remediation in Canada

Next Steps: Getting Help

See our How Do I Get Help for my Loved One? page, for more information and contacts for getting your loved one assessed and provided with medical help.

You may also find these pages helpful:

Schizophrenia Information in Different Languages

Find information on schizophrenia in Français / 中文 / ਪੰਜਾਬੀ / हिंदी / বাঙালি / اردو / Español HERE.

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