Schizophrenia Spectrum Disorders
Worldwide, about 24 million people are on the schizophrenia spectrum. Among adults, the rate is roughly one in 222 people. The disorder typically begins during the late teens or early 20s and is more common in males.
Less than a decade ago, people with a schizophrenia spectrum disorder would have their condition labeled simply as “schizophrenia.” In 2013, the American Psychiatric Association changed the name of the disorder class to reflect that people express symptoms in different ways and varying degrees.
The APA’s fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-V) formally implemented the change, classifying it as “schizophrenia spectrum and other psychotic disorders.” Today schizophrenia exists as a single condition and as part of a spectrum of conditions related to a larger group of psychotic disorders.
Are There Different Types of Schizophrenia?
Concepts are still evolving, but you should understand that before the DSM-V update, psychologists classified five subtypes of schizophrenia classified by different symptoms. These consisted of the following:
However, we no longer use those clinical classifications because, at its core, schizophrenia produces an altered sense of reality. However, how people express that skewed sense of reality differs from person to person and can change at different times in the same person. In other words, the “five subtypes” can manifest in the same underlying disorder.
What are the Symptoms of Schizophrenia?
The main symptoms of schizophrenia spectrum disorder remain the same as before, despite the DSM-V change. To meet the definition of being on the schizophrenia spectrum, a person must experience at least two of the following symptoms for six months or longer. These symptoms include:
- Delusions: beliefs that do not align with reality
- Disorganized speech or thinking: jumps from topic to topic with no clear direction
- Grossly disorganized or abnormal behavior: peculiar and inappropriate acts or the inability to carry out daily functions
- Hallucinations: Seeing and hearing things or voices that other people don’t
- Withdrawn symptoms: a diminished or absence of normal behaviors related to motivation, interest, and self-expression
The main categories of schizophrenia symptoms and associated disorders are:
An individual can display symptoms from each category, though symptoms often show up in similar groups.
Positive symptoms include hallucinations, delusions, and abnormal beliefs and behaviors. A person talking to themselves or seemingly seeing things that aren’t there may be experiencing positive symptoms of schizophrenia.
Negative symptoms refer to a decline in or absence of typical characteristics and actions. These symptoms might include emotional inability, a lack of motivation, or disinterest in social situations. A person with negative symptoms of schizophrenia may withdraw from their goals, friends, family, work, hobbies, or school.
These symptoms often appear as confused thinking, disordered speech, or strange movements. Someone with disorganized symptoms might reply to questions with nonsensical answers or jump from topic to topic in a scattered fashion.
What Other Conditions Occur on the Schizophrenia Spectrum?
Schizophrenia is only one disorder on a broad spectrum. Other related conditions may look like schizophrenia, but a trained mental health professional can distinguish between them. Here’s a brief synopsis:
Brief Psychotic Disorder
The DSM-V characterizes this condition with one or more of the following:
- Disorganized speech
It may also include grossly disorganized or catatonic behavior. The syndrome typically lasts no more than a month, and antipsychotic medications are the first-line treatment.
People experience at least one delusion for a month or more with this condition. Other than having one or more delusions, they function and behave more or less normally. If mood disorders occur alongside the delusions, they’re typically fleeting.
People with schizoaffective disorder have a combination of psychotic symptoms alongside depression (major depressive disorder) or bipolar disorder. They may swing between very low or high energy or have heightened irritability. Those with schizoaffective disorder will sometimes have psychotic symptoms, even if their mood feels okay.
While schizophreniform disorder shares many similarities with schizophrenia, its main difference is symptom duration. If a person experiences psychosis, delusions, disordered thinking, and inappropriate behaviors for more than a month but less than six months, the diagnosis is likely to be schizophreniform disorder.
What Causes Schizophrenia Spectrum Disorders?
There is no single cause of schizophrenia, but researchers now know that genetics can play a role. Experts believe the combination of genetics, brain chemistry, and environmental factors contribute to the disorder’s development.
Problems with specific naturally occurring brain chemicals, including neurotransmitters like dopamine and glutamate, may also contribute.
Neuroimaging studies show differences in the central nervous system and brain structure of people with schizophrenia. We’re still uncertain of the change’s significance, but they indicate brain disease.
Although the precise cause of schizophrenia remains unknown, certain factors seem to increase risk. These include:
- A family history of schizophrenia
- Pregnancy and birth complications (malnutrition or exposure to toxins/viruses that impact brain development)
- The use of mind-altering (psychotropic or psychoactive) drugs during teen years and young adulthood
How are Schizophrenia Spectrum Disorders Treated?
Even when symptoms have subsided, schizophrenia requires lifelong treatment. Treatment with medications and psychosocial therapy help manage the condition. Inpatient stays are common for initial treatment as they provide a safe environment for therapy and medication adjustments.
Medications are the cornerstone of schizophrenia treatment, with antipsychotic medications being the most commonly prescribed. They help control symptoms by affecting the brain’s neurotransmitters. However, other medications also help, including antidepressants and anti-anxiety drugs.
The treatment goal with antipsychotic medications is to manage signs and symptoms at the lowest possible dose. Therefore, the psychiatrist may try different drugs, dosages, or combinations over time to achieve the desired result. It can take several weeks to notice an improvement in symptoms.
While schizophrenia is a chronic condition, our understanding of the illness is evolving. Research in the field has exploded in the past half-century, so there is a reason for hope. Better treatments with fewer side effects are on the horizon and will target symptoms beyond psychosis.
Psychosis is a disorder that damages gray and white matter in the brain. When left untreated, schizophrenia can result in serious complications that affect everyday life. Schizophrenia may cause or be associated with the following challenges:
- Abuse of alcohol or other drugs
- Aggressive behavior (although very uncommon)
- Financial problems and homelessness
- Health and medical problems
- Inability to maintain a job or attend school
- Obsessive-compulsive disorder (OCD)
- Social isolation
- Suicide and suicidal ideation
Each of these disorders or challenges can be treated or addressed alongside schizophrenia spectrum disorders.
Living with Schizophrenia Spectrum Disorders
One of the reasons mental health practitioners embraced the 2013 change that recast schizophrenia as a spectrum disorder is because people adapt differently to their conditions. It acknowledges that people at the lower end of the schizophrenia spectrum might experience milder forms of the disorder. At the same time, those at the higher level may have their daily functioning impacted.
The change also leaves room for questions about the difficulty a person may experience in their professional and personal life. For someone with a milder expression of schizophrenia, the condition may not feel like a hardship because they perform at work and engage in relationships without much trouble.
Additionally, treatment might be less intensive than it would be for someone more severely impacted. Evaluating individual needs allows providers to avoid a one-size-fits-all treatment plan that would unlikely work for all clients.
Undoing the Stigmas of Schizophrenia
The recognition that schizophrenia occurs on a continuum might even help reduce the social stigmas of the disorder. Stigma cuts across all psychiatric disorders, but schizophrenia and psychotic disorders suffer more intensely due to how the media portrays affected people as violent potential killers.
This stereotype is false, as people living with schizophrenia spectrum disorders are no more likely to kill than others. On the contrary, schizophrenia increases the likelihood of being the victim of crime or exploitation. The majority of patients with schizophrenia will never be violent. Out of every patient who commits a homicide, 100 will commit suicide.
Psychoeducation that psychosis is a treatable brain disorder helps reduce stereotypes that limit people from finding supportive and caring networks. A better knowledge of the disorder spectrum can improve the critical and responsive treatment our patients should receive.
Helping Those on the Schizophrenia Spectrum
If you believe you, or someone you know, may have symptoms of schizophrenia, talk to a qualified doctor or mental health professional about your concerns. Remember, we can’t force someone to seek professional help, but we can offer support and encouragement.
If you find that you or your loved one poses a threat to themselves or others or cannot provide their own clothing, food, or shelter—you may need to call an emergency responder for help.
At Sequoia Behavioral Health, our compassionate team of therapists helps treat trauma, mental health, and addiction. We also have medical and dietary professionals on staff to offer the full spectrum of holistic care. Here, you’ll be seen, listened to, and welcomed into a community that understands you. Reach out to learn more about our program.