SCHIZOPHRENIA

The standard book that mental health experts use, called The Diagnostic and Statistical Manual of Mental Disorders, shows how schizophrenia is classified.

Schizophrenia Spectrum

This illness is a group of related mental disorders that share some symptoms. They affect your sense of what’s real. They change how you think, feel, and act.

The main disorder is schizophrenia. It includes all the previous subtypes: catatonic, disorganized, paranoid, residual, and undifferentiated.

It’s a psychosis — what seems real to you isn’t. It can look like:

Hallucinations: Seeing or hearing things that aren’t there

Delusions: Mistaken but firmly held beliefs that are easy to prove wrong, like thinking you have superpowers, are another famous person, or people are out to get you

Disorganized speech: Using words and sentences that don’t make sense to others

Strange behavior: Acting in an odd or repetitive way, like walking in circles or writing all the time, or sitting perfectly still and quiet for hours on end

Withdrawn and lifeless: Showing no feelings or motivation, or lacking interest in normal daily activities

You may have different symptoms at different times, and they may get worse or better — and it’s still schizophrenia.

Doctors may still categorize your schizophrenia according to its predominant symptom, to make a diagnosis clearer. But rather than saying you have “paranoid schizophrenia,” they would say you have “schizophrenia with paranoia.”

Here are the subtypes of schizophrenia

Disorganized schizophrenia. This includes:

• Persistently erratic speech and behavior
• Inappropriate emotional expressions

Paranoid schizophrenia. The patient has:

• Preoccupation with delusions that other people want to harm them
• Frequent auditory hallucinations (hearing things that aren’t there)
• Undifferentiated schizophrenia. The patient doesn’t meet the specific criteria of the above subtypes.

Residual schizophrenia. Symptoms have greatly improved but the patient still has mild symptoms or only symptoms such as:

• Apathy
• Lack of energy and motivation
• Minimal facial expressions
• Poor grooming habits

DIAGNOSIS

A schizophrenia diagnosis can be made when all of the following are true about a person:

• Schizophrenia symptoms have been present for at least six months.
• The person is significantly impaired by the symptoms; for example, he/she has serious difficulty working or with social relationships, compared to the period before symptoms began.
• The symptoms can’t be explained by another diagnosis, such as drug use or another mental illness.

Diagnosing Schizophrenia by Symptoms

Other mental illnesses and medical conditions sometimes include symptoms that are similar to schizophrenia. A doctor needs to be sure that a patient doesn’t have other conditions that are causing the symptoms. Conditions that can potentially create confusion around a schizophrenia diagnosis include:

• Bipolar disorder.
• Major depression.
• Drug use.
• Schizoaffective disorder.

People with schizophrenia may also have depression or abuse drugs. These problems can make the schizophrenia diagnosis unclear. The only way for a psychiatrist to reliably make a schizophrenia diagnosis in these cases is by watching and interviewing a person over time.

People with schizophrenia commonly also have:

• A decline in reasoning and memory abilities
• Anxiety
• Depression
• Thoughts of suicide or suicidal behaviors

Many other mental illnesses and medical conditions may also share these symptoms. This makes these symptoms less helpful in making a schizophrenia diagnosis.

Subtypes of Schizophrenia

After making a schizophrenia diagnosis, a psychiatrist may classify a patient according to subtypes of schizophrenia through its symptoms.

Paranoid schizophrenia tends to have a better prognosis than other subtypes.

RECOMMENDED MEDICATIONS

Antipsychotic medications are used in treating acute psychosis and reducing the risk of future psychotic episodes in schizophrenia. The treatment of schizophrenia thus has two main phases: an acute phase, when higher doses might be necessary in order to treat psychotic symptoms, followed by a maintenance phase, which is usually life-long. During the maintenance phase, dosage is often gradually reduced to the minimum required to prevent further episodes and control inter-episode symptoms. If symptoms reappear or worsen on a lower dosage, an increase in dosage may be necessary to help prevent further relapse.

Some patients, however, do not respond to medications, and a few may seem not to need them.

It is important to have long-term follow-up, so that the treatment can be adjusted and any problems addressed promptly, since it is difficult to predict which patients will fall into what groups.

Antipsychotics do not cure the illness, they greatly reduce the symptoms and allow the patient to function better, have better quality of life, and enjoy an improved outlook.

The doctor will choose which of these antipsychotic drugs will be appropriate for you:

• chlorpromazine (Thorazine)
• fluphenazine (Prolixin)
• haloperidol (Haldol)
• loxapine (Loxapine)
• perphenazine (Trilafon)
• thioridazine (Mellaril)
• thiothixene (Navane)
• trifluoperazine (Stelazine)
• clozapine (Clozaril)
• aripiprazole (Abilify)
• asenapine (Saphris)
• brexpiprazole (Rexulti)
• cariprazine (Vraylar)
• lurasidone (Latuda)
• paliperidone (Invega Sustenna)
• paliperidone palmitate (Invega Trinza)
• quetiapine (Seroquel)
• risperidone (Risperdal)
• olanzapine (Zyprexa)
• ziprasidone (Geodon)
  iloperidone (Fanapt)