As you spend more time discussing goals and challenges with your Talkspace therapist, you may have questions or are interested in learning more about specific mental health topics and conditions. The Talkspace Bookshelf offers up-to-date mental health information directly from our behavioral health team to provide a better understanding of condition origins, diagnoses, various forms a condition may take, and different treatment options. Feel free to use this resource as a starting point to open up a dialogue and pose questions for your Talkspace therapist.

Schizophrenia is a serious mental health condition that affects approximately 1.5% of the American population. It is a chronic and severe condition that often manifests in bizarre behavior and a disconnect with reality. Due to its overt symptom presentation, those with Schizophrenia often find themselves isolated in social and community contexts.

Schizophrenia, while rare, is often a very disabling condition, especially when left untreated. The condition is characterized by a combination of “positive” and “negative” symptoms. This means that those living with the condition may experience additive experiences, such as delusions or hallucinations, which were not present before developing the condition. Alternatively, those living with the condition may also experience negative symptoms, which represent a decline in normal functioning (ex. Losing the ability to express emotions).

While the expression of Schizophrenia differs from person to person, the hallmark criteria are the following:

  • Delusions (believing thoughts that are objectively untrue or unfounded)
  • Hallucinations (experiencing stimuli that is not connected to reality. These may come in the form of hearing voices, seeing shapes, or feeling tactile sensations that actually are not present
  • Very disorganized or distorted speech (incoherence, loosely related ideas)
  • “Flat” or blunted affect (diminished ability to demonstrate natural range of emotions)
  • Abnormal body movements (catatonia) such as being “stuck” in place or fast or unusual movements

In addition, those living with Schizophrenia may also experience cognitive difficulties such as a greater inability to make decisions, trouble understanding information, and difficulties maintaining focus and attention.

As you might imagine, those living with Schizophrenia may have a very difficult time coping with its symptoms. For most, onset is during adolescence or young adulthood. When an individual first develops Schizophrenia, this process is called the “onset” of the diagnosis, psychotic break, or its first episode. This can be a particularly scary experience for both the person themselves and others around them. There is typically a marked decrease in overall functioning as symptoms emerge. In essence, the person living with Schizophrenia may experience a dramatic impact in their social, work, school, or occupational environments. This period of symptomatology must exists for 6 months in order to be diagnosed with Schizophrenia.


Risk Factors

There has been a long and concerted effort to understand the risk factors associated with Schizophrenia. Most research speaks to a strong genetic basis for the condition, noting that there is often a family history of the condition or other serious mental health disorders.

Further research has illuminated the complex variety of risk factors associated in the development and expression of Schizophrenia. In addition to genetic factors, other environmental factors are known to demonstrate greater risk in the development of Schizophrenia. Examples of environmental factors includes: high parental education, low financial stability or poverty, atypical child rearing practices or abuse (particularly from mothers), prenatal malnutrition, urban exposure during childhood, migration, social adversity, and drug misuse.


Treatment

Medication

Medication is, by and large, the predominant treatment for managing symptoms of Schizophrenia. Medications from a category called antipsychotics will help manage the positive symptoms associated with Schizophrenia, such as delusions and hallucinations. Antipsychotics may also help overall cognitive function, which is often present in those living with Schizophrenia. Some examples of antipsychotic medications include: Abilify (generic name: aripiprazole), Geodon (ziprasidone), Haldol (haloperidol), Risperdal (risperidone), Seroquel (quetiapine), Thorazine (chlorpromazine), and Zyprexa (olanzapine).

It should be noted that some medications from the antipsychotic category also display significant side effects and while their use is widespread in the treatment of Schizophrenia, their use is not without concern.

In some cases, those living with Schizophrenia may not believe that they live with a condition that makes them see or hear things that are not there in reality. As such, accepting the condition and accessing treatment can often be quite difficult. In some instances, involuntary commitment and evaluation is necessary given the risks to self or others. As you might imagine, it can also be difficult for those living with Schizophrenia to understand the importance of taking medication regularly to manage the condition. In some instances, where daily medication adherence is a concern, long-acting antipsychotic injections routinely delivered by a licensed medical professional are indicated.

Psychotherapy

Cognitive behavioral  therapy is one of the most often recommended courses of treatment for those living with Schizophrenia. It is a modality recommended by the American Psychiatric Association guidelines.

In individual therapy, a therapist may work with a person living with Schizophrenia to manage positive symptoms associated with the condition, like hallucinations and delusions. For example, if one hears voices, then the therapist may work with the client to lessen the volume of the voices, their tone, or message content.

For those affected by negative symptoms such as flat affect and apathy, a therapist may attempt to assist the person in getting involved with becoming more active and engaged in the community to limit social isolation. Psychosocial clubhouses, when available, may be indicated and are often recommended adjuncts to individual therapy. Additionally, a therapist may attempt to include a person’s family or other loved ones to reinforce connection and limit avoidance and overall social withdrawal.

Additionally, a therapist may work with the person living with Schizophrenia to track their moods, symptoms, and reactions to medications.

Coordinated care and case management

A range of interventions have been found to be helpful in the treatment and management of symptoms for those living with Schizophrenia. In addition to individual talk therapy (psychotherapy), an assortment of services known as coordinated care, or case management, can be quite helpful in those living with the condition.

Often, an individual with Schizophrenia will be offered a range of services including individual therapy, group support, psychosocial services such as a clubhouse, supported education or employment, and psychiatry with medication management. In some instances, some of the services can be home or community based, which has demonstrated success in client satisfaction and adherence to treatment recommendations.


Therapeutic Note

Remember your therapist is here to help you figure out the best way to address your concerns. Therapy works best when it is a collaboration between you and your therapist. It is important to be open, honest, and an active participant in this process. Talk to your therapist about your goals for therapy so that together you can come up with the best plan to achieve your goals.

Questions for my therapist:

  • Does Schizophrenia have a cure?
  • What is the likelihood that I could develop Schizophrenia if my parent had it?
  • What are common reactions to antipsychotic medications?
  • My doctor is advising me (or a family member) to go on an antipsychotic injection.  Can we talk about that?
  • How do I access services like case management?
  • I don’t want to take medication, will therapy still help?


Sources:

American Psychiatric Association. (2013). Schizophrenia Spectrum and Other Psychotic Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Compton, M. T., MD, MPH. (2005, October 13). Risk Factors and Risk Markers for Schizophrenia. Retrieved July 19, 2017, from http://www.medscape.com/viewarticle/512405_1

Dean, K., & Murray, R. M. (2005). Environmental risk factors for psychosis. Dialogues in Clinical Neuroscience, 7(1), 69–80.

Kelly, J., & Murray, R. M. (2000, October). What risk factors tell us about the causes of schizophrenia and related psychoses. Retrieved July17, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/11122984?report=abstract

Lehman, A. F., Dixon, L. B., McGlashan, T. H., Miller, A. L., & Perkins, D. O. (2010). Treatment of Patients with Schizophrenia.

Nemade, R., PhD, & Dombeck, M., PhD. (2009, August 7). Prognosis And Recovery Factors Of Schizophrenia. Retrieved July 19, 2017, from https://www.mentalhelp.net/articles/prognosis-and-recovery-factors-of-schizophrenia/

Schizophrenia.(2016,February).RetrievedJuly19,2017,from https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

Wegmann, J. (2015). Psychopharmacology: straight talk on mental health medications. Eau Claire, WI: PESI Publishing & Media.