Anxiety Disorder Causes
Causes
An interaction between biophysical factors and traumatic situations may cause anxiety disorders. Neurotransmitters of the central nervous system like norepinephrine and serotonin, peptides like corticotropin-releasing factor are the major mediators for the cause of anxiety disorder.
Biological
Low levels of GABA, a neurotransmitter that reduces activity in the central nervous system, contribute to anxiety. A number of anxiolytics achieve their effect by modulating the GABA receptors.[22][23][24]
Selective serotonin reuptake inhibitors, the drugs most commonly used to treat depression, are frequently considered as a first line treatment for anxiety disorders.[25] A 2004 study using functional brain imaging techniques suggests …show more content…
that the effects of SSRIs in alleviating anxiety may result from a direct action on GABA neurons rather than as a secondary consequence of mood improvement.[26]
Severe anxiety and depression can be induced by sustained alcohol abuse which in most cases abates with prolonged abstinence. Even moderate, sustained alcohol use may increase anxiety and depression levels in some individuals.[27] Caffeine, alcohol and benzodiazepine dependence can worsen or cause anxiety and panic attacks.[28] Anxiety commonly occurs during the acute withdrawal phase of alcohol and can persist for up to 2 years as part of a post-acute withdrawal syndrome, in about a quarter of people recovering from alcoholism.[29] In one study in 1988–1990, illness in approximately half of patients attending mental health services at one British hospital psychiatric clinic, for conditions including anxiety disorders such as panic disorder or social phobia, was determined to be the result of alcohol or benzodiazepine dependence. In these patients, an initial increase in anxiety occurred during the withdrawal period followed by a cessation of their anxiety symptoms.[30]
There is evidence that chronic exposure to organic solvents in the work environment can be associated with anxiety disorders. Painting, varnishing and carpet-laying are some of the jobs in which significant exposure to organic solvents may occur.[31]
People with obsessive-compulsive disorder (sometimes considered an anxiety disorder), evince increased grey matter volumes in bilateral lenticular nuclei, extending to the caudate nuclei, while decreased grey matter volumes in bilateral dorsal medial frontal/anterior cingulate gyri.[32][33] These findings contrast with those in people with other anxiety disorders, who evince decreased (rather than increased) grey matter volumes in bilateral lenticular/caudate nuclei, while also decreased grey matter volumes in bilateral dorsal medial frontal/anterior cingulate gyri.[33]
Ingestion of caffeine may cause or exacerbate anxiety disorders.[34][35] A number of clinical studies have shown a positive association between caffeine and anxiogenic effects and/or panic disorder.[36][37][38] Anxiety sufferers can have high caffeine sensitivity.[39][40][41][42][43]
Amygdala
The amygdala is central to the processing of fear and anxiety, and its function may be disrupted in anxiety disorders.[44] Sensory information enters the amygdala through the nuclei of the basolateral complex (consisting of lateral, basal, and accessory basal nuclei). The basolateral complex processes sensory-related fear memories and communicates their threat importance to memory and sensory processing elsewhere in the brain, such as the medial prefrontal cortex and sensory cortices.
Another important area is the adjacent central nucleus of the amygdala, which controls species-specific fear responses, via connections to the brainstem, hypothalamus, and cerebellum areas. In those with general anxiety disorder, these connections functionally seem to be less distinct, with greater gray matter in the central nucleus. Another difference is that the amygdala areas have decreased connectivity with the insula and cingulate areas that control general stimulus salience, while having greater connectivity with the parietal cortex and prefrontal cortex circuits that underlie executive functions.[44]
The latter suggests a compensation strategy for dysfunctional amygdala processing of anxiety. Researchers have noted "Amygdalofrontoparietal coupling in generalized anxiety disorder patients may ... reflect the habitual engagement of a cognitive control system to regulate excessive anxiety."[44] This is consistent with cognitive theories that suggest the use in this disorder of attempts to reduce the involvement of emotions with compensatory cognitive strategies.
Clinical and animal studies suggest a correlation between anxiety disorders and difficulty in maintaining balance.[45][46][47][48] A possible mechanism is malfunction in the parabrachial area, a brain structure that, among other functions, coordinates signals from the amygdala with input concerning balance.[49]
Anxiety processing in the basolateral amygdala has been implicated with dendritic arborization of the amygdaloid neurons. SK2 potassium channels mediate inhibitory influence on action potentials and reduce arborization. By overexpressing SK2 in the basolateral amygdala, anxiety in experimental animals can be reduced together with general levels of stress-induced corticosterone secretion.[50]
Stress
Anxiety disorders can arise in response to life stresses such as financial worries or chronic physical illness. Somewhere between 4% and 10% of older adults are diagnosed with anxiety disorder, a figure that is probably an underestimate due to the tendency of adults to minimize psychiatric problems or to focus on their physical manifestations.[citation needed] Anxiety is also common among older people who have dementia. On the other hand, anxiety disorder is sometimes misdiagnosed among older adults when doctors misinterpret symptoms of a physical ailment (for instance, racing heartbeat due to cardiac arrhythmia) as signs of anxiety.[4]
Emotional Symptoms of Anxiety • Persistent state of apprehension or fear. • Feelings of dread without valid cause. • Concentration problems. • Inner tension and nervousness. • Catastrophic thinking. • Irritability or edginess. • Restlessness and sleeping problems. • Hyper-vigilance towards signs of danger. • Absentmindedness and mind blanks. • Intense/sudden feelings of panic or doom. • Fear of losing control or going crazy. • Feelings of detachment and unreality.
Physical Symptoms of Anxiety
• Pounding heart/rapid heartbeat • Excessive sweating • Choking sensations • Stomach cramps • Dizziness and vertigo • Frequent urination or diarrhea • Shortness of breath • Hyperventilation • Hot flashes or chills • Lightheadedness • Tremors and twitches • Muscle tension • Headaches • Fatigue • Insomnia • Nausea
General symptoms of a personality disorder
Personality disorder symptoms include: • Frequent mood swings • Stormy relationships • Social isolation • Angry outbursts • Suspicion and mistrust of others • Difficulty making friends • A need for instant gratification • Poor impulse control • Alcohol or substance abuse
Causes
By Mayo Clinic staff
Personality is the combination of thoughts, emotions and behaviors that makes you unique. It's the way you view, understand and relate to the outside world, as well as how you see yourself. Personality forms during childhood, shaped through an interaction of two factors: • Inherited tendencies, or your genes. These are aspects of your personality passed on to you by your parents, such as shyness or having a happy outlook. This is sometimes called your temperament. It's the "nature" part of the nature vs. nurture debate. • Environment, or your life situations. This is the surroundings you grew up in, events that occurred, and relationships with family members and others. It includes such things as the type of parenting you had, whether loving or abusive. This is the "nurture" part of the nature vs. nurture debate.
Personality disorders are thought to be caused by a combination of these genetic and environmental influences. You may have a genetic vulnerability to developing a personality disorder and your life situation may trigger the actual development of a personality disorder.
MOOD DISORDER
What are the symptoms of mood disorders?
Symptoms of mood disorders are related to your feelings. Often, mood disorders will start out as mild feelings of sadness or inadequacy. Mild negative feelings are normal, but if these feelings continue for a long time or are very intense, you may have a mood disorder.
Common symptoms of mood disorders
You may experience mood disorder symptoms daily or just once in a while. At times any of these mood disorder symptoms can be severe: • Body aches • Changes in appetite • Difficulty concentrating • Difficulty sleeping • Fatigue • Feelings of sadness, hopelessness, helplessness or inadequacy • Guilt • Hostility or aggression • Irritability and mood changes • Loss of interest in daily life • Problems interacting with loved ones • Unexplained weight gain or loss
Symptoms of heightened mood that may accompany mood disorders
• Mania is the presence of an abnormally elevated mood, and hypomania is a term used to refer to this condition when present to a lesser extent. Symptoms of mania include: • Abnormally high energy level • Decreased sleep • Feelings of omnipotence • Impulsive behaviors such as spending sprees • Poor judgment • Racing thoughts • Talking fast or switching conversational topics rapidly
Serious symptoms that might indicate a life-threatening condition
In some cases, mood disorders can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including: • Being a danger to yourself or others, including threatening, irrational or suicidal behavior • Feelings of wanting to die • Hearing voices or seeing things that do not exist • Inability to care for your basic needs • Suicidal thoughts or expression of suicidal thoughts
What causes mood disorders?
The exact cause of many mood disorders is not known. Most mood disorders are linked to chemicals in the brain, called neurotransmitters, which regulate moods, feelings and behavior. It is thought that changes in the levels of these neurotransmitters can lead to mood disorders. In some cases, it appears that heredity may contribute to mood disorders, though environment also plays a major role.
Often, mood disorders can be triggered by a traumatic event or stress in your daily life. While it is normal to have changes in mood due to life events, usually you are able to recover from stressors. When you have a mood disorder, your ability to cope with stress is decreased, leading to many of the symptoms of mood disorders.
Causes of mood disorders
Although there is no concrete evidence to nail the cause of mood disorders, genetics, imbalance in brains chemicals (neurotransmitters), hormonal imbalances and the environment in which an individual lives can be causative factors of the problem.
Symptoms
Although each individual may experience symptoms differently, some of the most common symptoms of mood disorders include: • Loss of appetite or overeating. • Sleeplessness or sleeping excessively. • Loss of energy, feeling tired all the time. • Loss of interest in things that you once enjoyed. • Headache, irritability and hostility. • Aggressive behavior.
What causes mood disorders in children is not well known. There are chemicals in the brain that are responsible for positive moods. Other chemicals in the brain, called neurotransmitters, regulate the brain chemicals that affect mood. Most likely, depression (and other mood disorders) is caused by a chemical imbalance in the brain. Life events (such as unwanted changes in life) may also help cause this chemical imbalance.
Affective disorders aggregate in families and are considered to be multifactorially inherited. Multifactorial inheritance means that "many factors" are involved. The factors are usually both genetic and environmental, where a combination of genes from both parents, in addition to environmental factors, produce the trait or condition. Often one gender (either males or females) is affected more frequently than the other in multifactorial traits. There appears to be a different threshold of expression, which means that one gender is more likely to show the problem, over the other gender.
What are the symptoms of mood disorders? [pic]Children, depending upon their age and the type of mood disorder present, may exhibit different symptoms of depression. The following are the most common symptoms of a mood disorder. However, each child and adolescent may experience symptoms differently. Symptoms may include: [pic] • Persistent feelings of sadness. • Feeling hopeless or helpless. • Having low self-esteem. • Feeling inadequate. • Excessive guilt. • Feelings of wanting to die. • Loss of interest in usual activities or activities once enjoyed. • Difficulty with relationships. • Sleep disturbances (i.e., insomnia, hypersomnia). • Changes in appetite or weight. • Decreased energy. • Difficulty concentrating. • A decrease in the ability to make decisions. • Suicidal thoughts or attempts. • Frequent physical complaints (i.e., headache, stomach ache, fatigue). • Running away or threats of running away from home. • Hypersensitivity to failure or rejection. • Irritability, hostility, aggression.
[pic]
In mood disorders, these feelings appear more intense than adolescents normally feel from time to time. It is also of concern if these feelings continue over a period of time or interfere with an adolescent's interest in being with friends or taking part in daily activities at home or school. Any adolescent who expresses thoughts of suicide should be evaluated immediately.
[pic]Other signs of possible mood disorders in adolescents may include: [pic] • Difficulty achieving in school. • Constant anger. • Rebellious behaviors. • Trouble with family. • Difficulty with friends and peers.
[pic]
The symptoms of mood disorders may resemble other conditions or psychiatric problems. Always consult your child's physician for a diagnosis.
Schizophrenia – Symptoms
An in-depth report on the causes, diagnosis, and treatment of schizophrenia
Symptoms:
Research indicates that symptoms in childhood strongly predict disease in adulthood.
In one long-term study, over 40% of people with schizophrenia who developed the disease in young adulthood had reported psychotic symptoms by age 11. For children with a family history of schizophrenia, the following inherited traits may be warning signs: • Deficits in working (short-term) and verbal memory • Impairments in gross motor skills (the child's ability to control different parts of the body) • Attention deficits • A decline in verbal memory, IQ, and other mental functions
Any signs of hallucinations or delusions must be differentiated from normal childhood fantasies.
Most often, early warning signs go unnoticed, and schizophrenia usually becomes evident for the first time in late adolescence or early adulthood. Schizophrenia that starts in childhood or adolescence tends to be severe. It should be strongly noted that the traits discussed above, even combinations of them, can be present without schizophrenia.
Negative Symptoms
A person with schizophrenia may have the following negative symptoms: • Lack of self confidence • Lack of emotions • Colorless speaking …show more content…
tones • Inappropriate reactions to events (such as laughing hysterically over a loss) • A general loss of interest in life and the ability to experience pleasure
Lack of responsiveness and poor sociability often appear in childhood as the first indications of schizophrenia. Certain imaging techniques suggest that these findings are based on biologic changes in specific parts of the brain. In many patients, however, negative symptoms do not appear until after positive symptoms develop. Negative symptoms tend to be more common than positive symptoms in older patients and typically persist after positive symptoms have been treated.
Psychotic Symptoms
Psychotic symptoms, particularly delusions and hallucinations, are the most widely recognized manifestations of schizophrenia. • Hallucinations. A hallucination is the experience of seeing, hearing, tasting, smelling, or feeling something that doesn't really exist. Auditory hallucinations are false senses of sound such as hearing voices that go unheard by others. They are the most common psychotic symptoms, affecting about 70% of patients. • Delusions. A delusion is a fixed, false belief. It can be bizarre (such as invisible aliens have entered the room through an electric socket) or nonbizarre (such as unwarranted jealousy or the paranoid belief in being persecuted or watched).
Psychotic symptoms usually occur every now and then, alternating with periods of remission. They typically occur in men ages 17 - 30 and in women ages 20 - 40.
Cognitive Impairment (Disordered Thinking)
The symptoms of cognitive impairment and disordered thinking may occur before other symptoms of schizophrenia. They include: • A lack of attention. • Impaired information processing and an aberrant association between words and ideas. Sometimes this condition is so extreme that speech becomes incoherent and is referred to as "word salad." Patients may connect words because of similarity of sound, rather than by meaning, a condition known as "clang associations." • Memory impairment. In keeping with other aspects of disordered thinking, memory impairment in schizophrenia is likely to involve the inability to connect an event with its source into a complete and whole memory. For instance, a patient may recall and even feel a familiarity with a specific event but be unable to remember where, when, or how it took place. • Backward masking dysfunction. This is a trait in which a distraction causes a person to forget a preceding event. It might be an important symptom and a marker of schizophrenia even in people with normal working memories.
People with schizophrenia do poorly on mental tasks requiring conscious awareness, such as verbal fluency, short-term and working memory, and processing speed. However, they are no worse than the general population in underlying (implicit) learning, such as grammar skills, vocabulary, and spatial skills (such as map reading). Some experts believe that impaired verbal memory in schizophrenia is a consequence of depression and slowness, but not a result of the disease process.
Other Symptoms
People with schizophrenia may experience other symptoms, such as intolerance of heat (often associated with antipsychotic medications) and a reduced sense of smell.
Symptoms of Progression to Full-Blown Schizophrenia
The course of the disease varies from one patient to the next. Symptoms of psychosis can become gradually or suddenly evident. • In up to a third of patients, the disease is unrelenting and progresses from the first episode onward. • In others, schizophrenia follows a fluctuating course with psychotic flare-ups, followed by remissions. • In one study, a third of patients experienced a complete remission of symptoms within 3 years after one or more episodes. Women are more likely to go into remission, possibly because of some protective effect of estrogen on the brain.
Typically, patients develop considerable cognitive dysfunction (disordered thinking) within the first 4 - 5 years of the onset of psychotic symptoms.
Some evidence indicates that the physical disease process in schizophrenia is progressive, as with Alzheimer's and Parkinson's disease. However, schizophrenia does not progress in the same way as those two diseases. Unlike Parkinson's and Alzheimer's, cognitive function usually eventually stabilizes. Psychosis, disorganized thought, and negative symptoms often improve over time, although, even in such cases, deficits in verbal memory usually persist. (Thought disorder often improves along with improvements in negative symptoms.)
Causes:
No single cause can account for schizophrenia. Rather, it appears to be the result of multiple causes such as genetic factors, environmental and psychological assaults, and possible hormonal changes that alter the brain's chemistry.
Abnormalities in Brain Structure, Circuitry, and Chemicals
Brain scans using magnetic resonance imaging (MRI) have shown a number of abnormalities in the brain's structure associated with schizophrenia. Such problems can cause nerve damage and disconnections in the pathways that carry brain
chemicals.
Because these problems tend to show up on brain scans of people with chronic schizophrenia rather than newly diagnosed patients, some doctors believe they may be a result of the disease and its treatments rather than a cause. (Medications used for schizophrenia can also cause brain shrinkage over time.)
Abnormal Brain Chemicals. Schizophrenia is associated with an unusual imbalance of neurotransmitters (chemical messengers between nerve cells) and other brain chemicals, such as dopamine overactivity, glutamate, reelin, and others. Whether any changes in these chemicals in the brain is a cause or a consequence of schizophrenia remains unclear.
Abnormal Circuitry. Abnormalities in brain structure are also reflected in the disrupted connections between nerve cells that are observed in schizophrenia. Such miswiring could impair information processing and coordination of mental functions. For example, auditory hallucinations may be due to miswiring in the circuits that govern speech processing. Strong evidence suggests that schizophrenia involves decreased communication between the left and right sides of the brain.
Genetic Factors
Schizophrenia undoubtedly has a genetic component. The risk for inheriting schizophrenia is 10% in those who have one immediate family member with the disease and about 40% if the disease affects both parents or an identical twin. Family members of patients also appear to have higher risks for the specific symptoms (negative or positive) of the relative with schizophrenia.
Researchers are seeking the specific genetic factors that may be responsible for schizophrenia in such cases. Current evidence suggests that there are a multitude of genetic abnormalities involved in schizophrenia, possibly originating from one or two changes in genetic expression. Scientists are beginning to discover the ways in which specific genes affect particular brain functions and cause specific symptoms. Genes that have been studied include the neuregulin-1 gene, the OLIG2 gene, and the COMT gene.
Heredity does not explain all cases of the disease. About 60% of people with schizophrenia have no close relatives with the illness.
Infectious Factors
The case for viruses as a cause of schizophrenia rests mainly on circumstantial evidence, such as living in crowded conditions. The risk is higher for people who are born in cities than in the country. The longer one lives in the city, the higher the risk. The following are some studies suggesting an association: • Winter and Spring Births. The risk for schizophrenia worldwide is 5 - 8% higher for those born during winter and spring, when colds and viruses are more prevalent. • Large Families. The risk for schizophrenia is also greater in large families in which there are short intervals between siblings (2 or fewer years). Such observations suggest that exposure to infection early in infancy may help set the stage for later development of the disease. • Pregnant Mother's Exposure to Viruses. The mother's exposure to viral infections such as rubella, measles, chicken pox, or others while the infant is in the womb has also been associated with a higher risk for schizophrenia in her child. • Researchers are trying to identify specific viruses that may be responsible for some cases. Of particular interest is research finding evidence of a virus that belongs to the HERV-W retrovirus family in 30% of people with acute schizophrenia.
Some research has found an association between some cases of schizophrenia and toxoplasmosis, a parasite carried by cats and other domestic animals. Several studies suggest that patients with schizophrenia have an increased prevalence of antibodies to toxoplasmosis. Toxoplasmosis can lie dormant in the nervous system and migrate to the brain over many years.
Psychologic Factors
Although parental influence is no longer believed to play a major role in the development of schizophrenia, it would be irresponsible to ignore outside pressures and influences that may exacerbate or trigger symptoms. The prefrontal lobes of the brain, the brain areas often thought to lead to this disease, are extremely responsive to environmental stress. Given the fact that schizophrenic symptoms naturally elicit negative responses from the patient's circle of family and acquaintances, negative feedback may intensify deficits in a vulnerable brain and perhaps even trigger and exacerbate existing symptoms.
Early warning signs of schizophrenia
In some people, schizophrenia appears suddenly and without warning. But for most, it comes on slowly, with subtle warning signs and a gradual decline in functioning long before the first severe episode. Many friends and family members of people with schizophrenia report knowing early on that something was wrong with their loved one, they just didn’t know what.
In this early phase, people with schizophrenia often seem eccentric, unmotivated, emotionless, and reclusive. They isolate themselves, start neglecting their appearance, say peculiar things, and show a general indifference to life. They may abandon hobbies and activities, and their performance at work or school deteriorates.
The most common early warning signs of schizophrenia include:
• Social withdrawal • Hostility or suspiciousness • Deterioration of personal hygiene • Flat, expressionless gaze • Inability to cry or express joy • Inappropriate laughter or crying • Depression • Oversleeping or insomnia • Odd or irrational statements • Forgetful; unable to concentrate • Extreme reaction to criticism • Strange use of words or way of speaking
While these warning signs can result from a number of problems—not just schizophrenia—they are cause for concern. When out-of-the-ordinary behavior is causing problems in your life or the life of a loved one, seek medical advice. If schizophrenia or another mental problem is the cause, treatment will help.
Signs and symptoms of schizophrenia
There are five types of symptoms characteristic of schizophrenia: delusions, hallucinations, disorganized speech, disorganized behavior, and the so-called “negative” symptoms. However, the signs and symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all symptoms, and the symptoms of schizophrenia may also change over time.
Delusions
A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies. Common schizophrenic delusions include: • Delusions of persecution – Belief that others, often a vague “they,” are out to get him or her. These persecutory delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water”). • Delusions of reference – A neutral environmental event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a person on TV is sending a message meant specifically for them. • Delusions of grandeur – Belief that one is a famous or important figure, such as Jesus Christ or Napolean. Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one else has (e.g. the ability to fly). • Delusions of control – Belief that one’s thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”).
Hallucinations
Hallucinations are sounds or other sensations experienced as real when they exist only in the person's mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia. Visual hallucinations are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.
Schizophrenic hallucinations are usually meaningful to the person experiencing them. Many times, the voices are those of someone they know. Most commonly, the voices are critical, vulgar, or abusive. Hallucinations also tend to be worse when the person is alone.
Disorganized speech
Fragmented thinking is characteristic of schizophrenia. Externally, it can be observed in the way a person speaks. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. They may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.
Common signs of disorganized speech in schizophrenia include: • Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next. • Neologisms – Made-up words or phrases that only have meaning to the patient. • Perseveration – Repetition of words and statements; saying the same thing over and over. • Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head").
Disorganized behavior
Schizophrenia disrupts goal-directed activity, causing impairments in a person’s ability to take care of him or herself, work, and interact with others. Disorganized behavior appears as: • A decline in overall daily functioning • Unpredictable or inappropriate emotional responses • Behaviors that appear bizarre and have no purpose • Lack of inhibition and impulse control
Negative symptoms (absence of normal behaviors)
The so-called “negative” symptoms of schizophrenia refer to the absence of normal behaviors found in healthy individuals. Common negative symptoms of schizophrenia include: • Lack of emotional expression –Inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions. • Lack of interest or enthusiasm – Problems with motivation; lack of self-care. • Seeming lack of interest in the world – Apparent unawareness of the environment; social withdrawal. • Speech difficulties and abnormalities – Inability to carry a conversation; short and sometimes disconnected replies to questions; speaking in monotone
Early warning signs of schizophrenia
In some people, schizophrenia appears suddenly and without warning. But for most, it comes on slowly, with subtle warning signs and a gradual decline in functioning long before the first severe episode. Many friends and family members of people with schizophrenia report knowing early on that something was wrong with their loved one, they just didn’t know what.
In this early phase, people with schizophrenia often seem eccentric, unmotivated, emotionless, and reclusive. They isolate themselves, start neglecting their appearance, say peculiar things, and show a general indifference to life. They may abandon hobbies and activities, and their performance at work or school deteriorates.
The most common early warning signs of schizophrenia include:
• Social withdrawal • Hostility or suspiciousness • Deterioration of personal hygiene • Flat, expressionless gaze • Inability to cry or express joy • Inappropriate laughter or crying • Depression • Oversleeping or insomnia • Odd or irrational statements • Forgetful; unable to concentrate • Extreme reaction to criticism • Strange use of words or way of speaking
While these warning signs can result from a number of problems—not just schizophrenia—they are cause for concern. When out-of-the-ordinary behavior is causing problems in your life or the life of a loved one, seek medical advice. If schizophrenia or another mental problem is the cause, treatment will help.
Daniel’s story
Daniel is 21-years-old. Six months ago, he was doing well in college and holding down a part-time job in the stockroom of a local electronics store. But then he began to change, becoming increasingly paranoid and acting out in bizarre ways. First, he became convinced that his professors were “out to get him” since they didn’t appreciate his confusing, off-topic classroom rants. Then he told his roommate that the other students were “in on the conspiracy.” Soon after, he dropped out of school.
From there, things just got worse. Daniel stopped bathing, shaving, and washing his clothes. At work, he became convinced that his boss was watching him through surveillance bugs planted in the store’s television sets. Then he started hearing voices telling him to find the bugs and deactivate them. Things came to a head when he acted on the voices, smashing several TVs and screaming that he wasn’t going to put up with the “illegal spying” any more. His frightened boss called the police, and Daniel was hospitalized.
Signs and symptoms of schizophrenia
There are five types of symptoms characteristic of schizophrenia: delusions, hallucinations, disorganized speech, disorganized behavior, and the so-called “negative” symptoms. However, the signs and symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all symptoms, and the symptoms of schizophrenia may also change over time.
Delusions
A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies. Common schizophrenic delusions include: • Delusions of persecution – Belief that others, often a vague “they,” are out to get him or her. These persecutory delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water”). • Delusions of reference – A neutral environmental event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a person on TV is sending a message meant specifically for them. • Delusions of grandeur – Belief that one is a famous or important figure, such as Jesus Christ or Napolean. Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one else has (e.g. the ability to fly). • Delusions of control – Belief that one’s thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”).
Hallucinations
Hallucinations are sounds or other sensations experienced as real when they exist only in the person's mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia. Visual hallucinations are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.
Schizophrenic hallucinations are usually meaningful to the person experiencing them. Many times, the voices are those of someone they know. Most commonly, the voices are critical, vulgar, or abusive. Hallucinations also tend to be worse when the person is alone.
Disorganized speech
Fragmented thinking is characteristic of schizophrenia. Externally, it can be observed in the way a person speaks. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. They may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.
Common signs of disorganized speech in schizophrenia include: • Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next. • Neologisms – Made-up words or phrases that only have meaning to the patient. • Perseveration – Repetition of words and statements; saying the same thing over and over. • Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head").
Disorganized behavior
Schizophrenia disrupts goal-directed activity, causing impairments in a person’s ability to take care of him or herself, work, and interact with others. Disorganized behavior appears as: • A decline in overall daily functioning • Unpredictable or inappropriate emotional responses • Behaviors that appear bizarre and have no purpose • Lack of inhibition and impulse control
Negative symptoms (absence of normal behaviors)
The so-called “negative” symptoms of schizophrenia refer to the absence of normal behaviors found in healthy individuals. Common negative symptoms of schizophrenia include: • Lack of emotional expression –Inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions. • Lack of interest or enthusiasm – Problems with motivation; lack of self-care. • Seeming lack of interest in the world – Apparent unawareness of the environment; social withdrawal. • Speech difficulties and abnormalities – Inability to carry a conversation; short and sometimes disconnected replies to questions; speaking in monotone
Early warning signs of schizophrenia
In some people, schizophrenia appears suddenly and without warning. But for most, it comes on slowly, with subtle warning signs and a gradual decline in functioning long before the first severe episode. Many friends and family members of people with schizophrenia report knowing early on that something was wrong with their loved one, they just didn’t know what.
In this early phase, people with schizophrenia often seem eccentric, unmotivated, emotionless, and reclusive. They isolate themselves, start neglecting their appearance, say peculiar things, and show a general indifference to life. They may abandon hobbies and activities, and their performance at work or school deteriorates.
The most common early warning signs of schizophrenia include:
• Social withdrawal • Hostility or suspiciousness • Deterioration of personal hygiene • Flat, expressionless gaze • Inability to cry or express joy • Inappropriate laughter or crying • Depression • Oversleeping or insomnia • Odd or irrational statements • Forgetful; unable to concentrate • Extreme reaction to criticism • Strange use of words or way of speaking
While these warning signs can result from a number of problems—not just schizophrenia—they are cause for concern. When out-of-the-ordinary behavior is causing problems in your life or the life of a loved one, seek medical advice. If schizophrenia or another mental problem is the cause, treatment will help.
Daniel’s story
Daniel is 21-years-old. Six months ago, he was doing well in college and holding down a part-time job in the stockroom of a local electronics store. But then he began to change, becoming increasingly paranoid and acting out in bizarre ways. First, he became convinced that his professors were “out to get him” since they didn’t appreciate his confusing, off-topic classroom rants. Then he told his roommate that the other students were “in on the conspiracy.” Soon after, he dropped out of school.
From there, things just got worse. Daniel stopped bathing, shaving, and washing his clothes. At work, he became convinced that his boss was watching him through surveillance bugs planted in the store’s television sets. Then he started hearing voices telling him to find the bugs and deactivate them. Things came to a head when he acted on the voices, smashing several TVs and screaming that he wasn’t going to put up with the “illegal spying” any more. His frightened boss called the police, and Daniel was hospitalized.
Signs and symptoms of schizophrenia
There are five types of symptoms characteristic of schizophrenia: delusions, hallucinations, disorganized speech, disorganized behavior, and the so-called “negative” symptoms. However, the signs and symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all symptoms, and the symptoms of schizophrenia may also change over time.
Delusions
A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies. Common schizophrenic delusions include: • Delusions of persecution – Belief that others, often a vague “they,” are out to get him or her. These persecutory delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water”). • Delusions of reference – A neutral environmental event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a person on TV is sending a message meant specifically for them. • Delusions of grandeur – Belief that one is a famous or important figure, such as Jesus Christ or Napolean. Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one else has (e.g. the ability to fly). • Delusions of control – Belief that one’s thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”).
Hallucinations
Hallucinations are sounds or other sensations experienced as real when they exist only in the person's mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia. Visual hallucinations are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.
Schizophrenic hallucinations are usually meaningful to the person experiencing them. Many times, the voices are those of someone they know. Most commonly, the voices are critical, vulgar, or abusive. Hallucinations also tend to be worse when the person is alone.
Disorganized speech
Fragmented thinking is characteristic of schizophrenia. Externally, it can be observed in the way a person speaks. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. They may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.
Common signs of disorganized speech in schizophrenia include: • Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next. • Neologisms – Made-up words or phrases that only have meaning to the patient. • Perseveration – Repetition of words and statements; saying the same thing over and over. • Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head").
Disorganized behavior
Schizophrenia disrupts goal-directed activity, causing impairments in a person’s ability to take care of him or herself, work, and interact with others. Disorganized behavior appears as: • A decline in overall daily functioning • Unpredictable or inappropriate emotional responses • Behaviors that appear bizarre and have no purpose • Lack of inhibition and impulse control
Negative symptoms (absence of normal behaviors)
The so-called “negative” symptoms of schizophrenia refer to the absence of normal behaviors found in healthy individuals. Common negative symptoms of schizophrenia include: • Lack of emotional expression –Inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions. • Lack of interest or enthusiasm – Problems with motivation; lack of self-care. • Seeming lack of interest in the world – Apparent unawareness of the environment; social withdrawal. • Speech difficulties and abnormalities – Inability to carry a conversation; short and sometimes disconnected replies to questions; speaking in monotone
An interaction between biophysical factors and traumatic situations may cause anxiety disorders. Neurotransmitters of the central nervous system like norepinephrine and serotonin, peptides like corticotropin-releasing factor are the major mediators for the cause of anxiety disorder.
Biological
Low levels of GABA, a neurotransmitter that reduces activity in the central nervous system, contribute to anxiety. A number of anxiolytics achieve their effect by modulating the GABA receptors.[22][23][24]
Selective serotonin reuptake inhibitors, the drugs most commonly used to treat depression, are frequently considered as a first line treatment for anxiety disorders.[25] A 2004 study using functional brain imaging techniques suggests …show more content…
that the effects of SSRIs in alleviating anxiety may result from a direct action on GABA neurons rather than as a secondary consequence of mood improvement.[26]
Severe anxiety and depression can be induced by sustained alcohol abuse which in most cases abates with prolonged abstinence. Even moderate, sustained alcohol use may increase anxiety and depression levels in some individuals.[27] Caffeine, alcohol and benzodiazepine dependence can worsen or cause anxiety and panic attacks.[28] Anxiety commonly occurs during the acute withdrawal phase of alcohol and can persist for up to 2 years as part of a post-acute withdrawal syndrome, in about a quarter of people recovering from alcoholism.[29] In one study in 1988–1990, illness in approximately half of patients attending mental health services at one British hospital psychiatric clinic, for conditions including anxiety disorders such as panic disorder or social phobia, was determined to be the result of alcohol or benzodiazepine dependence. In these patients, an initial increase in anxiety occurred during the withdrawal period followed by a cessation of their anxiety symptoms.[30]
There is evidence that chronic exposure to organic solvents in the work environment can be associated with anxiety disorders. Painting, varnishing and carpet-laying are some of the jobs in which significant exposure to organic solvents may occur.[31]
People with obsessive-compulsive disorder (sometimes considered an anxiety disorder), evince increased grey matter volumes in bilateral lenticular nuclei, extending to the caudate nuclei, while decreased grey matter volumes in bilateral dorsal medial frontal/anterior cingulate gyri.[32][33] These findings contrast with those in people with other anxiety disorders, who evince decreased (rather than increased) grey matter volumes in bilateral lenticular/caudate nuclei, while also decreased grey matter volumes in bilateral dorsal medial frontal/anterior cingulate gyri.[33]
Ingestion of caffeine may cause or exacerbate anxiety disorders.[34][35] A number of clinical studies have shown a positive association between caffeine and anxiogenic effects and/or panic disorder.[36][37][38] Anxiety sufferers can have high caffeine sensitivity.[39][40][41][42][43]
Amygdala
The amygdala is central to the processing of fear and anxiety, and its function may be disrupted in anxiety disorders.[44] Sensory information enters the amygdala through the nuclei of the basolateral complex (consisting of lateral, basal, and accessory basal nuclei). The basolateral complex processes sensory-related fear memories and communicates their threat importance to memory and sensory processing elsewhere in the brain, such as the medial prefrontal cortex and sensory cortices.
Another important area is the adjacent central nucleus of the amygdala, which controls species-specific fear responses, via connections to the brainstem, hypothalamus, and cerebellum areas. In those with general anxiety disorder, these connections functionally seem to be less distinct, with greater gray matter in the central nucleus. Another difference is that the amygdala areas have decreased connectivity with the insula and cingulate areas that control general stimulus salience, while having greater connectivity with the parietal cortex and prefrontal cortex circuits that underlie executive functions.[44]
The latter suggests a compensation strategy for dysfunctional amygdala processing of anxiety. Researchers have noted "Amygdalofrontoparietal coupling in generalized anxiety disorder patients may ... reflect the habitual engagement of a cognitive control system to regulate excessive anxiety."[44] This is consistent with cognitive theories that suggest the use in this disorder of attempts to reduce the involvement of emotions with compensatory cognitive strategies.
Clinical and animal studies suggest a correlation between anxiety disorders and difficulty in maintaining balance.[45][46][47][48] A possible mechanism is malfunction in the parabrachial area, a brain structure that, among other functions, coordinates signals from the amygdala with input concerning balance.[49]
Anxiety processing in the basolateral amygdala has been implicated with dendritic arborization of the amygdaloid neurons. SK2 potassium channels mediate inhibitory influence on action potentials and reduce arborization. By overexpressing SK2 in the basolateral amygdala, anxiety in experimental animals can be reduced together with general levels of stress-induced corticosterone secretion.[50]
Stress
Anxiety disorders can arise in response to life stresses such as financial worries or chronic physical illness. Somewhere between 4% and 10% of older adults are diagnosed with anxiety disorder, a figure that is probably an underestimate due to the tendency of adults to minimize psychiatric problems or to focus on their physical manifestations.[citation needed] Anxiety is also common among older people who have dementia. On the other hand, anxiety disorder is sometimes misdiagnosed among older adults when doctors misinterpret symptoms of a physical ailment (for instance, racing heartbeat due to cardiac arrhythmia) as signs of anxiety.[4]
Emotional Symptoms of Anxiety • Persistent state of apprehension or fear. • Feelings of dread without valid cause. • Concentration problems. • Inner tension and nervousness. • Catastrophic thinking. • Irritability or edginess. • Restlessness and sleeping problems. • Hyper-vigilance towards signs of danger. • Absentmindedness and mind blanks. • Intense/sudden feelings of panic or doom. • Fear of losing control or going crazy. • Feelings of detachment and unreality.
Physical Symptoms of Anxiety
• Pounding heart/rapid heartbeat • Excessive sweating • Choking sensations • Stomach cramps • Dizziness and vertigo • Frequent urination or diarrhea • Shortness of breath • Hyperventilation • Hot flashes or chills • Lightheadedness • Tremors and twitches • Muscle tension • Headaches • Fatigue • Insomnia • Nausea
General symptoms of a personality disorder
Personality disorder symptoms include: • Frequent mood swings • Stormy relationships • Social isolation • Angry outbursts • Suspicion and mistrust of others • Difficulty making friends • A need for instant gratification • Poor impulse control • Alcohol or substance abuse
Causes
By Mayo Clinic staff
Personality is the combination of thoughts, emotions and behaviors that makes you unique. It's the way you view, understand and relate to the outside world, as well as how you see yourself. Personality forms during childhood, shaped through an interaction of two factors: • Inherited tendencies, or your genes. These are aspects of your personality passed on to you by your parents, such as shyness or having a happy outlook. This is sometimes called your temperament. It's the "nature" part of the nature vs. nurture debate. • Environment, or your life situations. This is the surroundings you grew up in, events that occurred, and relationships with family members and others. It includes such things as the type of parenting you had, whether loving or abusive. This is the "nurture" part of the nature vs. nurture debate.
Personality disorders are thought to be caused by a combination of these genetic and environmental influences. You may have a genetic vulnerability to developing a personality disorder and your life situation may trigger the actual development of a personality disorder.
MOOD DISORDER
What are the symptoms of mood disorders?
Symptoms of mood disorders are related to your feelings. Often, mood disorders will start out as mild feelings of sadness or inadequacy. Mild negative feelings are normal, but if these feelings continue for a long time or are very intense, you may have a mood disorder.
Common symptoms of mood disorders
You may experience mood disorder symptoms daily or just once in a while. At times any of these mood disorder symptoms can be severe: • Body aches • Changes in appetite • Difficulty concentrating • Difficulty sleeping • Fatigue • Feelings of sadness, hopelessness, helplessness or inadequacy • Guilt • Hostility or aggression • Irritability and mood changes • Loss of interest in daily life • Problems interacting with loved ones • Unexplained weight gain or loss
Symptoms of heightened mood that may accompany mood disorders
• Mania is the presence of an abnormally elevated mood, and hypomania is a term used to refer to this condition when present to a lesser extent. Symptoms of mania include: • Abnormally high energy level • Decreased sleep • Feelings of omnipotence • Impulsive behaviors such as spending sprees • Poor judgment • Racing thoughts • Talking fast or switching conversational topics rapidly
Serious symptoms that might indicate a life-threatening condition
In some cases, mood disorders can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including: • Being a danger to yourself or others, including threatening, irrational or suicidal behavior • Feelings of wanting to die • Hearing voices or seeing things that do not exist • Inability to care for your basic needs • Suicidal thoughts or expression of suicidal thoughts
What causes mood disorders?
The exact cause of many mood disorders is not known. Most mood disorders are linked to chemicals in the brain, called neurotransmitters, which regulate moods, feelings and behavior. It is thought that changes in the levels of these neurotransmitters can lead to mood disorders. In some cases, it appears that heredity may contribute to mood disorders, though environment also plays a major role.
Often, mood disorders can be triggered by a traumatic event or stress in your daily life. While it is normal to have changes in mood due to life events, usually you are able to recover from stressors. When you have a mood disorder, your ability to cope with stress is decreased, leading to many of the symptoms of mood disorders.
Causes of mood disorders
Although there is no concrete evidence to nail the cause of mood disorders, genetics, imbalance in brains chemicals (neurotransmitters), hormonal imbalances and the environment in which an individual lives can be causative factors of the problem.
Symptoms
Although each individual may experience symptoms differently, some of the most common symptoms of mood disorders include: • Loss of appetite or overeating. • Sleeplessness or sleeping excessively. • Loss of energy, feeling tired all the time. • Loss of interest in things that you once enjoyed. • Headache, irritability and hostility. • Aggressive behavior.
What causes mood disorders in children is not well known. There are chemicals in the brain that are responsible for positive moods. Other chemicals in the brain, called neurotransmitters, regulate the brain chemicals that affect mood. Most likely, depression (and other mood disorders) is caused by a chemical imbalance in the brain. Life events (such as unwanted changes in life) may also help cause this chemical imbalance.
Affective disorders aggregate in families and are considered to be multifactorially inherited. Multifactorial inheritance means that "many factors" are involved. The factors are usually both genetic and environmental, where a combination of genes from both parents, in addition to environmental factors, produce the trait or condition. Often one gender (either males or females) is affected more frequently than the other in multifactorial traits. There appears to be a different threshold of expression, which means that one gender is more likely to show the problem, over the other gender.
What are the symptoms of mood disorders? [pic]Children, depending upon their age and the type of mood disorder present, may exhibit different symptoms of depression. The following are the most common symptoms of a mood disorder. However, each child and adolescent may experience symptoms differently. Symptoms may include: [pic] • Persistent feelings of sadness. • Feeling hopeless or helpless. • Having low self-esteem. • Feeling inadequate. • Excessive guilt. • Feelings of wanting to die. • Loss of interest in usual activities or activities once enjoyed. • Difficulty with relationships. • Sleep disturbances (i.e., insomnia, hypersomnia). • Changes in appetite or weight. • Decreased energy. • Difficulty concentrating. • A decrease in the ability to make decisions. • Suicidal thoughts or attempts. • Frequent physical complaints (i.e., headache, stomach ache, fatigue). • Running away or threats of running away from home. • Hypersensitivity to failure or rejection. • Irritability, hostility, aggression.
[pic]
In mood disorders, these feelings appear more intense than adolescents normally feel from time to time. It is also of concern if these feelings continue over a period of time or interfere with an adolescent's interest in being with friends or taking part in daily activities at home or school. Any adolescent who expresses thoughts of suicide should be evaluated immediately.
[pic]Other signs of possible mood disorders in adolescents may include: [pic] • Difficulty achieving in school. • Constant anger. • Rebellious behaviors. • Trouble with family. • Difficulty with friends and peers.
[pic]
The symptoms of mood disorders may resemble other conditions or psychiatric problems. Always consult your child's physician for a diagnosis.
Schizophrenia – Symptoms
An in-depth report on the causes, diagnosis, and treatment of schizophrenia
Symptoms:
Research indicates that symptoms in childhood strongly predict disease in adulthood.
In one long-term study, over 40% of people with schizophrenia who developed the disease in young adulthood had reported psychotic symptoms by age 11. For children with a family history of schizophrenia, the following inherited traits may be warning signs: • Deficits in working (short-term) and verbal memory • Impairments in gross motor skills (the child's ability to control different parts of the body) • Attention deficits • A decline in verbal memory, IQ, and other mental functions
Any signs of hallucinations or delusions must be differentiated from normal childhood fantasies.
Most often, early warning signs go unnoticed, and schizophrenia usually becomes evident for the first time in late adolescence or early adulthood. Schizophrenia that starts in childhood or adolescence tends to be severe. It should be strongly noted that the traits discussed above, even combinations of them, can be present without schizophrenia.
Negative Symptoms
A person with schizophrenia may have the following negative symptoms: • Lack of self confidence • Lack of emotions • Colorless speaking …show more content…
tones • Inappropriate reactions to events (such as laughing hysterically over a loss) • A general loss of interest in life and the ability to experience pleasure
Lack of responsiveness and poor sociability often appear in childhood as the first indications of schizophrenia. Certain imaging techniques suggest that these findings are based on biologic changes in specific parts of the brain. In many patients, however, negative symptoms do not appear until after positive symptoms develop. Negative symptoms tend to be more common than positive symptoms in older patients and typically persist after positive symptoms have been treated.
Psychotic Symptoms
Psychotic symptoms, particularly delusions and hallucinations, are the most widely recognized manifestations of schizophrenia. • Hallucinations. A hallucination is the experience of seeing, hearing, tasting, smelling, or feeling something that doesn't really exist. Auditory hallucinations are false senses of sound such as hearing voices that go unheard by others. They are the most common psychotic symptoms, affecting about 70% of patients. • Delusions. A delusion is a fixed, false belief. It can be bizarre (such as invisible aliens have entered the room through an electric socket) or nonbizarre (such as unwarranted jealousy or the paranoid belief in being persecuted or watched).
Psychotic symptoms usually occur every now and then, alternating with periods of remission. They typically occur in men ages 17 - 30 and in women ages 20 - 40.
Cognitive Impairment (Disordered Thinking)
The symptoms of cognitive impairment and disordered thinking may occur before other symptoms of schizophrenia. They include: • A lack of attention. • Impaired information processing and an aberrant association between words and ideas. Sometimes this condition is so extreme that speech becomes incoherent and is referred to as "word salad." Patients may connect words because of similarity of sound, rather than by meaning, a condition known as "clang associations." • Memory impairment. In keeping with other aspects of disordered thinking, memory impairment in schizophrenia is likely to involve the inability to connect an event with its source into a complete and whole memory. For instance, a patient may recall and even feel a familiarity with a specific event but be unable to remember where, when, or how it took place. • Backward masking dysfunction. This is a trait in which a distraction causes a person to forget a preceding event. It might be an important symptom and a marker of schizophrenia even in people with normal working memories.
People with schizophrenia do poorly on mental tasks requiring conscious awareness, such as verbal fluency, short-term and working memory, and processing speed. However, they are no worse than the general population in underlying (implicit) learning, such as grammar skills, vocabulary, and spatial skills (such as map reading). Some experts believe that impaired verbal memory in schizophrenia is a consequence of depression and slowness, but not a result of the disease process.
Other Symptoms
People with schizophrenia may experience other symptoms, such as intolerance of heat (often associated with antipsychotic medications) and a reduced sense of smell.
Symptoms of Progression to Full-Blown Schizophrenia
The course of the disease varies from one patient to the next. Symptoms of psychosis can become gradually or suddenly evident. • In up to a third of patients, the disease is unrelenting and progresses from the first episode onward. • In others, schizophrenia follows a fluctuating course with psychotic flare-ups, followed by remissions. • In one study, a third of patients experienced a complete remission of symptoms within 3 years after one or more episodes. Women are more likely to go into remission, possibly because of some protective effect of estrogen on the brain.
Typically, patients develop considerable cognitive dysfunction (disordered thinking) within the first 4 - 5 years of the onset of psychotic symptoms.
Some evidence indicates that the physical disease process in schizophrenia is progressive, as with Alzheimer's and Parkinson's disease. However, schizophrenia does not progress in the same way as those two diseases. Unlike Parkinson's and Alzheimer's, cognitive function usually eventually stabilizes. Psychosis, disorganized thought, and negative symptoms often improve over time, although, even in such cases, deficits in verbal memory usually persist. (Thought disorder often improves along with improvements in negative symptoms.)
Causes:
No single cause can account for schizophrenia. Rather, it appears to be the result of multiple causes such as genetic factors, environmental and psychological assaults, and possible hormonal changes that alter the brain's chemistry.
Abnormalities in Brain Structure, Circuitry, and Chemicals
Brain scans using magnetic resonance imaging (MRI) have shown a number of abnormalities in the brain's structure associated with schizophrenia. Such problems can cause nerve damage and disconnections in the pathways that carry brain
chemicals.
Because these problems tend to show up on brain scans of people with chronic schizophrenia rather than newly diagnosed patients, some doctors believe they may be a result of the disease and its treatments rather than a cause. (Medications used for schizophrenia can also cause brain shrinkage over time.)
Abnormal Brain Chemicals. Schizophrenia is associated with an unusual imbalance of neurotransmitters (chemical messengers between nerve cells) and other brain chemicals, such as dopamine overactivity, glutamate, reelin, and others. Whether any changes in these chemicals in the brain is a cause or a consequence of schizophrenia remains unclear.
Abnormal Circuitry. Abnormalities in brain structure are also reflected in the disrupted connections between nerve cells that are observed in schizophrenia. Such miswiring could impair information processing and coordination of mental functions. For example, auditory hallucinations may be due to miswiring in the circuits that govern speech processing. Strong evidence suggests that schizophrenia involves decreased communication between the left and right sides of the brain.
Genetic Factors
Schizophrenia undoubtedly has a genetic component. The risk for inheriting schizophrenia is 10% in those who have one immediate family member with the disease and about 40% if the disease affects both parents or an identical twin. Family members of patients also appear to have higher risks for the specific symptoms (negative or positive) of the relative with schizophrenia.
Researchers are seeking the specific genetic factors that may be responsible for schizophrenia in such cases. Current evidence suggests that there are a multitude of genetic abnormalities involved in schizophrenia, possibly originating from one or two changes in genetic expression. Scientists are beginning to discover the ways in which specific genes affect particular brain functions and cause specific symptoms. Genes that have been studied include the neuregulin-1 gene, the OLIG2 gene, and the COMT gene.
Heredity does not explain all cases of the disease. About 60% of people with schizophrenia have no close relatives with the illness.
Infectious Factors
The case for viruses as a cause of schizophrenia rests mainly on circumstantial evidence, such as living in crowded conditions. The risk is higher for people who are born in cities than in the country. The longer one lives in the city, the higher the risk. The following are some studies suggesting an association: • Winter and Spring Births. The risk for schizophrenia worldwide is 5 - 8% higher for those born during winter and spring, when colds and viruses are more prevalent. • Large Families. The risk for schizophrenia is also greater in large families in which there are short intervals between siblings (2 or fewer years). Such observations suggest that exposure to infection early in infancy may help set the stage for later development of the disease. • Pregnant Mother's Exposure to Viruses. The mother's exposure to viral infections such as rubella, measles, chicken pox, or others while the infant is in the womb has also been associated with a higher risk for schizophrenia in her child. • Researchers are trying to identify specific viruses that may be responsible for some cases. Of particular interest is research finding evidence of a virus that belongs to the HERV-W retrovirus family in 30% of people with acute schizophrenia.
Some research has found an association between some cases of schizophrenia and toxoplasmosis, a parasite carried by cats and other domestic animals. Several studies suggest that patients with schizophrenia have an increased prevalence of antibodies to toxoplasmosis. Toxoplasmosis can lie dormant in the nervous system and migrate to the brain over many years.
Psychologic Factors
Although parental influence is no longer believed to play a major role in the development of schizophrenia, it would be irresponsible to ignore outside pressures and influences that may exacerbate or trigger symptoms. The prefrontal lobes of the brain, the brain areas often thought to lead to this disease, are extremely responsive to environmental stress. Given the fact that schizophrenic symptoms naturally elicit negative responses from the patient's circle of family and acquaintances, negative feedback may intensify deficits in a vulnerable brain and perhaps even trigger and exacerbate existing symptoms.
Early warning signs of schizophrenia
In some people, schizophrenia appears suddenly and without warning. But for most, it comes on slowly, with subtle warning signs and a gradual decline in functioning long before the first severe episode. Many friends and family members of people with schizophrenia report knowing early on that something was wrong with their loved one, they just didn’t know what.
In this early phase, people with schizophrenia often seem eccentric, unmotivated, emotionless, and reclusive. They isolate themselves, start neglecting their appearance, say peculiar things, and show a general indifference to life. They may abandon hobbies and activities, and their performance at work or school deteriorates.
The most common early warning signs of schizophrenia include:
• Social withdrawal • Hostility or suspiciousness • Deterioration of personal hygiene • Flat, expressionless gaze • Inability to cry or express joy • Inappropriate laughter or crying • Depression • Oversleeping or insomnia • Odd or irrational statements • Forgetful; unable to concentrate • Extreme reaction to criticism • Strange use of words or way of speaking
While these warning signs can result from a number of problems—not just schizophrenia—they are cause for concern. When out-of-the-ordinary behavior is causing problems in your life or the life of a loved one, seek medical advice. If schizophrenia or another mental problem is the cause, treatment will help.
Signs and symptoms of schizophrenia
There are five types of symptoms characteristic of schizophrenia: delusions, hallucinations, disorganized speech, disorganized behavior, and the so-called “negative” symptoms. However, the signs and symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all symptoms, and the symptoms of schizophrenia may also change over time.
Delusions
A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies. Common schizophrenic delusions include: • Delusions of persecution – Belief that others, often a vague “they,” are out to get him or her. These persecutory delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water”). • Delusions of reference – A neutral environmental event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a person on TV is sending a message meant specifically for them. • Delusions of grandeur – Belief that one is a famous or important figure, such as Jesus Christ or Napolean. Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one else has (e.g. the ability to fly). • Delusions of control – Belief that one’s thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”).
Hallucinations
Hallucinations are sounds or other sensations experienced as real when they exist only in the person's mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia. Visual hallucinations are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.
Schizophrenic hallucinations are usually meaningful to the person experiencing them. Many times, the voices are those of someone they know. Most commonly, the voices are critical, vulgar, or abusive. Hallucinations also tend to be worse when the person is alone.
Disorganized speech
Fragmented thinking is characteristic of schizophrenia. Externally, it can be observed in the way a person speaks. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. They may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.
Common signs of disorganized speech in schizophrenia include: • Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next. • Neologisms – Made-up words or phrases that only have meaning to the patient. • Perseveration – Repetition of words and statements; saying the same thing over and over. • Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head").
Disorganized behavior
Schizophrenia disrupts goal-directed activity, causing impairments in a person’s ability to take care of him or herself, work, and interact with others. Disorganized behavior appears as: • A decline in overall daily functioning • Unpredictable or inappropriate emotional responses • Behaviors that appear bizarre and have no purpose • Lack of inhibition and impulse control
Negative symptoms (absence of normal behaviors)
The so-called “negative” symptoms of schizophrenia refer to the absence of normal behaviors found in healthy individuals. Common negative symptoms of schizophrenia include: • Lack of emotional expression –Inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions. • Lack of interest or enthusiasm – Problems with motivation; lack of self-care. • Seeming lack of interest in the world – Apparent unawareness of the environment; social withdrawal. • Speech difficulties and abnormalities – Inability to carry a conversation; short and sometimes disconnected replies to questions; speaking in monotone
Early warning signs of schizophrenia
In some people, schizophrenia appears suddenly and without warning. But for most, it comes on slowly, with subtle warning signs and a gradual decline in functioning long before the first severe episode. Many friends and family members of people with schizophrenia report knowing early on that something was wrong with their loved one, they just didn’t know what.
In this early phase, people with schizophrenia often seem eccentric, unmotivated, emotionless, and reclusive. They isolate themselves, start neglecting their appearance, say peculiar things, and show a general indifference to life. They may abandon hobbies and activities, and their performance at work or school deteriorates.
The most common early warning signs of schizophrenia include:
• Social withdrawal • Hostility or suspiciousness • Deterioration of personal hygiene • Flat, expressionless gaze • Inability to cry or express joy • Inappropriate laughter or crying • Depression • Oversleeping or insomnia • Odd or irrational statements • Forgetful; unable to concentrate • Extreme reaction to criticism • Strange use of words or way of speaking
While these warning signs can result from a number of problems—not just schizophrenia—they are cause for concern. When out-of-the-ordinary behavior is causing problems in your life or the life of a loved one, seek medical advice. If schizophrenia or another mental problem is the cause, treatment will help.
Daniel’s story
Daniel is 21-years-old. Six months ago, he was doing well in college and holding down a part-time job in the stockroom of a local electronics store. But then he began to change, becoming increasingly paranoid and acting out in bizarre ways. First, he became convinced that his professors were “out to get him” since they didn’t appreciate his confusing, off-topic classroom rants. Then he told his roommate that the other students were “in on the conspiracy.” Soon after, he dropped out of school.
From there, things just got worse. Daniel stopped bathing, shaving, and washing his clothes. At work, he became convinced that his boss was watching him through surveillance bugs planted in the store’s television sets. Then he started hearing voices telling him to find the bugs and deactivate them. Things came to a head when he acted on the voices, smashing several TVs and screaming that he wasn’t going to put up with the “illegal spying” any more. His frightened boss called the police, and Daniel was hospitalized.
Signs and symptoms of schizophrenia
There are five types of symptoms characteristic of schizophrenia: delusions, hallucinations, disorganized speech, disorganized behavior, and the so-called “negative” symptoms. However, the signs and symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all symptoms, and the symptoms of schizophrenia may also change over time.
Delusions
A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies. Common schizophrenic delusions include: • Delusions of persecution – Belief that others, often a vague “they,” are out to get him or her. These persecutory delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water”). • Delusions of reference – A neutral environmental event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a person on TV is sending a message meant specifically for them. • Delusions of grandeur – Belief that one is a famous or important figure, such as Jesus Christ or Napolean. Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one else has (e.g. the ability to fly). • Delusions of control – Belief that one’s thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”).
Hallucinations
Hallucinations are sounds or other sensations experienced as real when they exist only in the person's mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia. Visual hallucinations are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.
Schizophrenic hallucinations are usually meaningful to the person experiencing them. Many times, the voices are those of someone they know. Most commonly, the voices are critical, vulgar, or abusive. Hallucinations also tend to be worse when the person is alone.
Disorganized speech
Fragmented thinking is characteristic of schizophrenia. Externally, it can be observed in the way a person speaks. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. They may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.
Common signs of disorganized speech in schizophrenia include: • Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next. • Neologisms – Made-up words or phrases that only have meaning to the patient. • Perseveration – Repetition of words and statements; saying the same thing over and over. • Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head").
Disorganized behavior
Schizophrenia disrupts goal-directed activity, causing impairments in a person’s ability to take care of him or herself, work, and interact with others. Disorganized behavior appears as: • A decline in overall daily functioning • Unpredictable or inappropriate emotional responses • Behaviors that appear bizarre and have no purpose • Lack of inhibition and impulse control
Negative symptoms (absence of normal behaviors)
The so-called “negative” symptoms of schizophrenia refer to the absence of normal behaviors found in healthy individuals. Common negative symptoms of schizophrenia include: • Lack of emotional expression –Inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions. • Lack of interest or enthusiasm – Problems with motivation; lack of self-care. • Seeming lack of interest in the world – Apparent unawareness of the environment; social withdrawal. • Speech difficulties and abnormalities – Inability to carry a conversation; short and sometimes disconnected replies to questions; speaking in monotone
Early warning signs of schizophrenia
In some people, schizophrenia appears suddenly and without warning. But for most, it comes on slowly, with subtle warning signs and a gradual decline in functioning long before the first severe episode. Many friends and family members of people with schizophrenia report knowing early on that something was wrong with their loved one, they just didn’t know what.
In this early phase, people with schizophrenia often seem eccentric, unmotivated, emotionless, and reclusive. They isolate themselves, start neglecting their appearance, say peculiar things, and show a general indifference to life. They may abandon hobbies and activities, and their performance at work or school deteriorates.
The most common early warning signs of schizophrenia include:
• Social withdrawal • Hostility or suspiciousness • Deterioration of personal hygiene • Flat, expressionless gaze • Inability to cry or express joy • Inappropriate laughter or crying • Depression • Oversleeping or insomnia • Odd or irrational statements • Forgetful; unable to concentrate • Extreme reaction to criticism • Strange use of words or way of speaking
While these warning signs can result from a number of problems—not just schizophrenia—they are cause for concern. When out-of-the-ordinary behavior is causing problems in your life or the life of a loved one, seek medical advice. If schizophrenia or another mental problem is the cause, treatment will help.
Daniel’s story
Daniel is 21-years-old. Six months ago, he was doing well in college and holding down a part-time job in the stockroom of a local electronics store. But then he began to change, becoming increasingly paranoid and acting out in bizarre ways. First, he became convinced that his professors were “out to get him” since they didn’t appreciate his confusing, off-topic classroom rants. Then he told his roommate that the other students were “in on the conspiracy.” Soon after, he dropped out of school.
From there, things just got worse. Daniel stopped bathing, shaving, and washing his clothes. At work, he became convinced that his boss was watching him through surveillance bugs planted in the store’s television sets. Then he started hearing voices telling him to find the bugs and deactivate them. Things came to a head when he acted on the voices, smashing several TVs and screaming that he wasn’t going to put up with the “illegal spying” any more. His frightened boss called the police, and Daniel was hospitalized.
Signs and symptoms of schizophrenia
There are five types of symptoms characteristic of schizophrenia: delusions, hallucinations, disorganized speech, disorganized behavior, and the so-called “negative” symptoms. However, the signs and symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all symptoms, and the symptoms of schizophrenia may also change over time.
Delusions
A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies. Common schizophrenic delusions include: • Delusions of persecution – Belief that others, often a vague “they,” are out to get him or her. These persecutory delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water”). • Delusions of reference – A neutral environmental event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a person on TV is sending a message meant specifically for them. • Delusions of grandeur – Belief that one is a famous or important figure, such as Jesus Christ or Napolean. Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one else has (e.g. the ability to fly). • Delusions of control – Belief that one’s thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”).
Hallucinations
Hallucinations are sounds or other sensations experienced as real when they exist only in the person's mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia. Visual hallucinations are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.
Schizophrenic hallucinations are usually meaningful to the person experiencing them. Many times, the voices are those of someone they know. Most commonly, the voices are critical, vulgar, or abusive. Hallucinations also tend to be worse when the person is alone.
Disorganized speech
Fragmented thinking is characteristic of schizophrenia. Externally, it can be observed in the way a person speaks. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. They may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.
Common signs of disorganized speech in schizophrenia include: • Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next. • Neologisms – Made-up words or phrases that only have meaning to the patient. • Perseveration – Repetition of words and statements; saying the same thing over and over. • Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head").
Disorganized behavior
Schizophrenia disrupts goal-directed activity, causing impairments in a person’s ability to take care of him or herself, work, and interact with others. Disorganized behavior appears as: • A decline in overall daily functioning • Unpredictable or inappropriate emotional responses • Behaviors that appear bizarre and have no purpose • Lack of inhibition and impulse control
Negative symptoms (absence of normal behaviors)
The so-called “negative” symptoms of schizophrenia refer to the absence of normal behaviors found in healthy individuals. Common negative symptoms of schizophrenia include: • Lack of emotional expression –Inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions. • Lack of interest or enthusiasm – Problems with motivation; lack of self-care. • Seeming lack of interest in the world – Apparent unawareness of the environment; social withdrawal. • Speech difficulties and abnormalities – Inability to carry a conversation; short and sometimes disconnected replies to questions; speaking in monotone