Schizophrenia has a devastating effect on all aspects of human thought, emotion, and expression. It is the most common psychotic condition and affects nearly 1% of the earth's population, including more than three million people in the United States. Without adequate treatment, those with schizophrenia and the people who care about them suffer tremendously. Early treatment--shortly after the first symptoms appear--can result in remission rates as high as 85%.

Because the symptoms of schizophrenia arise from various physical processes and vary in how they respond to treatments, some experts classify them into two groups: positive symptoms and negative symptoms. Both types of symptoms can, and frequently do, overlap and interact with each other, so categorizing someone's symptoms as just positive or just negative may be misleading.

While a patient with schizophrenia may have more than one of the following positive and negative symptoms, rarely does someone have all of them.

Positive Symptoms

Positive symptoms manifest as cognitive impairment, also called thought disorder, and psychotic symptoms, e.g., hallucinations and delusions.

Cognitive Impairment

Disordered thought and information processing, lack of attention, an aberrant association between words and sentences, and an impaired ability to abstract. A person's discontinuity between ideas can become so extreme their speech becomes incoherent, a condition commonly referred to as "word salad." Once cognitive impairment symptoms appear, they are usually episodic.

Psychotic Symptoms

Psychotic events, particularly delusions and hallucinations. Schizophrenic delusions can be bizarre (e.g., aliens enter the room via the t.v. screen) or non-bizarre (e.g., the paranoid belief in being watched or persecuted). Schizophrenic hallucinations take the form of hearing and/or seeing things that don't exist. The onset for psychotic symptoms for men is usually between the ages of 17 and 30 and for women between the ages of 20 and 40. After the initial event, the symptoms usually occur episodically, interspersed with varying lengths of remission.

Negative Symptoms

Negative Symptoms are likely due to loss of nerve cells which results in a marked diminished ability to function.

Negative symptoms reflect the diminishment of self--lack of emotions, colorless speaking tone, and an overall disinterest in life--and often co-exist with positive symptoms, usually persisting after positive symptoms have been treated. Negative symptoms also include displays of emotionally inappropriate reactions, e.g., laughing hysterically during a somber event. Negative symptoms can appear early in life; lack of responsiveness and poor sociability have been observed in the childhood of many people who later develop full-blown symptoms of schizophrenia. However, for some people, negative symptoms do not present themselves until after the positive symptoms develop.

Causes

There is no single cause that can fully account for all cases of schizophrenia. One theory is the occurrence of errors in brain development-abnormalities of brain shape and activity, abnormalities of brain circuitry, abnormal brain chemicals--that arise from genetic or environmental factors. Increasingly, researchers are finding that such abnormalities occur in the developing fetus, rather than after birth.

The brain is a complex learning system that responds not only to internal physical mechanisms, but also to external stimuli. People with schizophrenia are extremely responsive to environmental stress which can intensify the already vulnerable neurologic state and often is responsible for triggering and/or exacerbating existing symptoms.

Treatment

While there is not yet a cure for schizophrenia, treatment can reduce the symptoms significantly and reduce the relapse rate by more than 50%. The first course of action should always be seeking help from a physician. The earlier schizophrenia is treated, the better the outcome: Those who receive antipsychotic drugs and therapy during their first episode appear to require less time to fully control symptoms-including fewer hospitalizations during the ensuing five years--than those who do not seek treatment as quickly. One study found that people who received early intervention with monitoring, low-dose medication, and therapy reduced their diagnosis of full-blown schizophrenia by tenfold.

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