scizophenia

8/3/2019 scizophenia

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History of Schizophrenia

The word "schizophrenia" is less than 100 years old. However the disease was first identified as a discrete

mental illness by Dr. Emile Kraepelin in the 1887 and the illness itself is generally believed to have

accompanied mankind through its history.

Written documents that identify Schizophrenia can be traced to the old Pharaonic Egypt, as far back as the

second millennium before Christ. Depression, dementia, as well as thought disturbances that are typical in

schizophrenia are described in detail in the Book of Hearts. The Heart and the mind seem to have been

synonymous in ancient Egypt. The physical illnesses were regarded as symptoms of the heart and the

uterus and originating from the blood vessels or from purulence, fecal matter, a poison or demons.

A recent study into the ancient Greek and Roman literature showed that although the general population

probably had an awareness of psychotic disorders, there was no condition that would meet the moderndiagnostic criteria for schizophrenia in these societies.

At one point, all people who were considered "abnormal," whether due to mental illness, mental

retardation, or physical deformities, were largely treated the same. Early theories supposed that mental

disorders were caused by evil possession of the body, and the appropriate treatment was then exorcising

these demons, through various means, ranging from innocuous treatments, such as exposing the patient

to certain types of music, to dangerous and sometimes deadly means, such as releasing the evil spirits by

drilling holes in the patient's skull.

One of the first to classify the mental disorders into different categories was the German physician, Emile

Kraepelin. Dr. Kraepelin used the term "dementia praecox" for individuals who had symptoms that we

now associate with schizophrenia.

The nonspecific concept of madness has been around for many thousands of years and schizophrenia was

only classified as a distinct mental disorder by Kraepelin in 1887. He was the first to make a distinction in

the psychotic disorders between what he called dementia praecox and manic depression. Kraepelin

believed that dementia praecox was primarily a disease of the brain, and particularly a form of dementia.

Kraepelin named the disorder 'dementia praecox' (early dementia) to distinguish it from other forms of

dementia (such as Alzheimer's disease) which typically occur late in life. He used this term because his

studies focused on young adults with dementia.

The Swiss psychiatrist, Eugen Bleuler, coined the term, "schizophrenia" in 1911. He was also the first to

describe the symptoms as "positive" or "negative." Bleuler changed the name to schizophrenia as it was

obvious that Krapelin's name was misleading as the illness was not a dementia (it did not always lead to

mental deterioration) and could sometimes occur late as well as early in life.

The word "schizophrenia" comes from the Greek roots schizo (split) and phrene (mind) to describe the

fragmented thinking of people with the disorder. His term was not meant to convey the idea of split or


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multiple personality, a common misunderstanding by the public at large. Since Bleuler's time, the

definition of schizophrenia has continued to change, as scientists attempt to more accurately delineate the

different types of mental diseases. Without knowing the exact causes of these diseases, scientists can only

base their classifications on the observation that some symptoms tend to occur together.

Both Bleuler and Kraepelin subdivided schizophrenia into categories, based on prominent symptoms and

prognoses. Over the years, those working in this field have continued to attempt to classify types of

schizophrenia. Five types were delineated in the DSM-III: disorganized, catatonic, paranoid, residual, and

undifferentiated. The first three categories were originally proposed by Kraepelin.

These classifications, while still employed in DSM-IV, have not shown to be helpful in predicting outcome

of the disorder, and the types are not reliably diagnosed. Many researchers are using other systems to

classify types of the disorder, based on the preponderance of "positive" vs "negative" symptoms, the

progression of the disorder in terms of type and severity of symptoms over time, and the co-occurrence of

other mental disorders and syndromes. It is hoped that differentiating types of schizophrenia based on

clinical symptoms will help to determine different etiologies or causes of the disorder.

The evidence that schizophrenia is a biologically-based disease of the brain has accumulated rapidly

during the past two decades. Recently this evidence has been also been supported with dynamic brain

imaging systems that show very precisely the wave of tissue distruction that takes place in the brain that

is suffering from schizophrenia.

With the rapid advances in the genetics of human desease now taking place, the future looks bright that

greatly more effective therapies and eventually cures - will be identified.

First Aid for Schizophrenia

A group that is a leader in the identification, treatment and prevention of schizophrenia (ORYGEN Research

Centre, Department of Psychiatry, University of Melbourne, Australia) has recently come out with a list of

"First Aid" actions to be taken by parents and family members, counselors, police officers, etc. for people who

are beginning to experience psychosis (loss of touch with reality) and schizophrenia.

First aid recommendations for psychosis and schizophrenia

Schizophrenia as well as Psychosis (a description of a key symptom of schizophrenia) is the mental state

when a person experiences hallucinations, unusual beliefs, paranoia, mixed emotions, muddled thoughts,

unusual or puzzling behaviors. If someone seems distressed or impaired by their experiences, even if they're

quite subtle at first, it's best not to ignore them and hope they'll go away. It's good to give the person theopportunity to discuss the situation.

You should realize that although warning signs and/or symptoms of psychosis are often not very dramatic

on their own, taken together they may suggest that something is not quite right.

You should not ignore or dismiss warning signs and/or symptoms if they appear gradually and are unclear.


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You should not assume that the person exhibiting warning signs and/or symptoms is just going through a

phase or misusing substances.

You should not assume that the warning signs and/or symptoms of psychosis will go away on their own.

You should be aware that the warning signs and/or symptoms of psychosis may vary from person to person

and can change over time.

You should take into consideration the spiritual and/or cultural context of the persons behaviors.

You should be understand that people developing a psychotic disorder will often not reach out for help. If the

first aider is concerned about someone, they should approach the person in a caring and nonjudgmental

manner to discuss their concerns.

You should understand that someone who is experiencing profound and frightening changes such as

psychotic symptoms will often try to keep them a secret. The first aider should be aware that the person they

are trying to help might not trust them or might be afraid of being perceived as different and, therefore,

may not be open with them.

You should make sure to approach the person privately about their experiences, in a place that is free of

distractions.

You should try to tailor your approach and interaction to the way the person is behaving (eg if the person is

suspicious and is avoiding eye contact, the first aider should be sensitive to this and give the person the

space they need).

You should not touch the person without their permission. The first aider should state, in specific behavioral

terms, why she/he is concerned about the person and should not speculate about their diagnosis. (Forexample - "I'm concerned about you not being able to get out of the house and do the things you want to do")

You should allow the person to talk about their experiences and beliefs if they want to.

As far as possible, you should let the person set the pace and style of the interaction.

You should recognize that the person may be frightened by their thoughts and feelings.

You should ask the person about what will help them to feel safe and in control.

You should reassure the person that she/he is there to help the person and wants to keep them safe.

You should let the person know that she/he is there to support them.

You should allow the person to stay in control by offering choices of how she/he can help them where

possible.


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You should convey a message of hope to the person by assuring them that help is available and things can get

better.

If the person is unwilling to talk with the first aider, the first aider should not try to force them to talk about

their experiences.

If the person is unwilling to talk, you should let them know that she/he will be available if they would like totalk in the future.

How the first aider can be supportive

You should always treat the person with respect.

You should try to empathize with how the person feels about their beliefs and experiences, without stating

any judgments about the content of those beliefs and experiences.

You should understand that the person may be behaving and talking differently due to psychotic symptoms.

You should recognize that the person who may be experiencing psychosis may find it difficult to tell what is

real from what is not real.

You should avoid confronting the person and should not criticize or blame them.

You should understand the symptoms for what they are and should try not to take them personally.

You should not use sarcasm when interacting with a person who may be experiencing psychosis.

You should avoid using patronizing statements when interacting with a person who may be experiencingpsychosis.

You should be honest when interacting with the person and should not make them any promises that cannot

be kept.

How the first aider should deal with delusions (false beliefs) and hallucinations (perceiving things

that are not real)

You should recognize that the delusions and/or hallucinations are very real to the person.

You should not dismiss, minimize, or argue with the person about their delusions and/or hallucinations.

You should not act alarmed, horrified, or embarrassed by the persons hallucinations or delusions.

You should not laugh at the persons symptoms of psychosis.

If the person exhibits paranoid behavior, the first aider should not encourage or inflame the persons

paranoia.


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How the first aider should deal with communication difficulties

People experiencing symptoms of psychosis are often unable to think clearly. You should respond to

disorganized speech by communicating in an uncomplicated and succinct manner and should repeat things if

necessary.

After you speak, you should be patient and allow plenty of time for the person to digest the information andrespond.

If the person is showing a limited range of feelings, You should be aware that it does not mean that the

person is not feeling anything.

You should not assume that the person cannot understand what they are saying, even if the persons

response is limited.

Whether the first aider should encourage the person to seek professional help

You should ask the person if they have felt this way before, and if so, what they have done in the past that has

been helpful.

You should try to find out what type of assistance the person believes will help them.

You should try to determine whether the person has a supportive social network and if they do, the first

aider should encourage them to utilize these supports.

If the person decides to seek professional help, you should make sure that the person is supported both

emotionally and practically in accessing services.

If either the person experiencing psychosis or the first aider lacks confidence in the medical advice they have

received, they should seek a second opinion from another medical or mental health professional.

What the first aider should do if the person does not want help

You should recognize that even if the person does realize that they are unwell, their confusion and fear about

what is happening to them may lead them to deny that there is anything wrong.

If the person refuses to seek help, the you should encourage them to talk to someone they trust.

You should be aware that the person who is experiencing psychotic symptoms may lack insight that they are

unwell.

If the person does lack insight, you should be aware that they might actively resist the first aiders attempts

to encourage them to seek help.

When someone who is experiencing symptoms of psychosis denies that they are unwell, the first aiders

course of action should depend on the type and severity of the persons symptoms.


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You need to understand that unless a person with psychosis meets the criteria for involuntary committal

procedures, they cannot be forced into treatment.

You should remain patient, as people experiencing psychosis often need time to develop insight regarding

their illness.

You should never threaten the person with the mental health act or hospitalization.

If the person refuses to get help, You should remain friendly and open to the possibility that they may want

the first aiders help in the future.

What the first aider should do in a crisis situation when the person has become acutely unwell

It is very rare that people with even severe psychosis become aggressive. They are much more likely to be a

risk to themselves. The exception is if the person is abusing drugs or alcohol, or has a history of violence - in

this case the risk that the person will be violent is higher.

In the event of a crisis, when the person experiencing psychosis has become acutely unwell:

You should try to remain as calm as possible.

You should evaluate the situation by assessing the risks involved (eg whether there is any risk that the

person will harm themselves or others).

You should assess whether the person is at risk of suicide.

If the person has an advance directive/relapse prevention plan, You should follow the guidelines set out in

the plan.

You should try to find out if the person has anyone s/he still trusts (eg close friends, family) and should try to

enlist their help.

You should assess whether it is safe for the person to be alone and if not, should ensure that someone stays

with the person.

You should communicate in a clear and concise manner and use short, simple sentences.

You should use a moderate, nonthreatening tone of voice.

You should speak quietly at a moderate pace and should answer all the persons questions calmly.

You should comply with requests that are not endangering or unreasonable. This gives the person the

opportunity to feel somewhat in control.

You should be aware that the person might act upon a hallucination or delusion.


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You should remember that their primary task is to de-escalate the situation and therefore should not do

anything to further agitate the person.

You should try to maintain safety and protect the person, themselves, and others around them from harm.

the first aider should have access to an exit.

the first aider should remain aware that they may not be able to de-escalate the situation, and if this is the

case, they should be prepared to call for assistance.

If the person is a danger to themselves or others, the first aider should make sure they are evaluated by a

medical or mental health professional immediately.

if the first aiders concerns about the person are dismissed by the services they contact, they should

persevere in trying to seek support for the person.

if crisis staff arrive, the first aider should convey specific, concise observations about the severity of the

persons behavior and symptoms to the crisis staff.

if other people arrive, the first aider should explain to the person experiencing psychosis who the people are,

that they are there to help, and how they are going to help.

What the first aider should do if the person becomes aggressive

The first aider should be aware that people with psychosis are not usually aggressive and are at a much

higher risk of harming themselves than others.

You need to recognize that certain symptoms of psychosis (eg, visual or auditory hallucinations) can cause

people to become aggressive.

You should know how to de-escalate the situation if the person they are trying to help becomes aggressive.

You should not respond in a hostile, disciplinary, or challenging manner to the person who is being

aggressive.

You should not threaten the person as this may increase fear or prompt aggressive behavior.

If the person is showing aggression, the first aider should avoid raising their voice and should not talk too

fast.

If the person is showing aggression, the first aider should stay calm and avoid nervous behavior (eg, shuffling

their feet, fidgeting, making abrupt movements).

You should not try to restrict the persons movement (eg, if the person wants to pace up and down the

room).


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If the person becomes aggressive, the first aider should remain aware that the persons symptoms or fear

causing the aggression may be exacerbated by the first aider taking certain steps (eg, involving the police).

You should take any threats or warnings seriously, particularly if the person believes they are being

persecuted.

If the first aider is frightened, they should seek outside help immediately as they should never putthemselves at risk.

If the persons aggression escalates out of control at any time, the first aider should remove themselves from

the situation and call the crisis team.

When contacting the appropriate service, the first aider should not assume the person is experiencing a

psychotic episode but should outline any symptoms and immediate concerns.

If the police are called, the first aider should tell them that the person is experiencing a psychotic episode

and that the first aider needs the help of the police to obtain medical treatment and to control the persons

aggressive behavior.

The first aider should let the police know whether or not the person is armed.

Schizophrenia Symptoms and Diagnosis

There is currently no physical or lab test that can absolutely diagnose schizophrenia - a psychiatrist usually

comes to the diagnosis based on clinical symptoms. What physical testing can do is rule out a lot of other

conditions (seizure disorders, metabolic disorders, thyroid disfunction, brain tumor, street drug use, etc)

that sometimes have similar symptoms.

Current research is evaluating possible physical diagnostic tests (such as a blood test for schizophrenia,

special IQ tests for identifying schizophrenia, eye-tracking, brain imaging, 'smell tests', etc), but these are still

in trial stages at only a few universities and companies and are not yet widely used. It will likely be a few

years before these on the market, and adopted by hospitals, etc.

People diagnosed with schizophrenia usually experience a combination of positive (i.e. hallucinations,

delusions, racing thoughts), negative (i.e. apathy, lack of emotion, poor or nonexistant social functioning),

and cognitive (disorganized thoughts, difficulty concentrating and/or following instructions, difficulty

completing tasks, memory problems). Please refer to the information available on this page (see below) for

common signs and symptoms, as well as consumer/family stories of how they identified schizophrenia intheir own experiences. However, only a psychiatrist can make a diagnosis and start a treatment program. If

you are experiencing symptoms are bothersome, debilitating, or harmful, please we recommend you try the

on-line Screening test for identification of early schizophrenia symptoms (click here to go to the test) that we

offer on this web site. The on-line test is also available in an "off-line version" for print-out (valuable for

testing a family member who is not on-line, or who may not like the site of a schizophrenia-focused web site)

- and the responses can then be entered into the on-line version of the test for scoring. If you test positive

you may want to go to to an early psychosis diagnosis and treatment center or make an appointment with

your doctor and/or a psychiatrist.


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The First Steps Towards Proper Diagnosis

The first step in getting treatment for schizophrenia is getting a correct diagnosis. This is important to do

quickly because research has shown that the sooner you get diagnosed and treated, the better the long-term

outcome (which is the same for all serious illnesses). This can be a more difficult than it might seem, because

the symptoms of schizophrenia can be similar at times to other major brain disorders, such as bipolar

disorder (manic-epression) or even major depression. Another issue is that a person with schizophrenia maybe paranoid or believe that nothing is wrong with them, and therefore may not want to go to see a doctor.

Because many regular family doctors may not be very familiar with schizophrenia, it is important to see a

good psychiatrist that is experienced in the diagnosis and treatment of schizophrenia.

The best place for proper diagnosis of psychosis (hallucinations & delusions) and schizophrenia - are at the

increasing number of centers focused on early diagnosis and treatment of psychosis and schizophrenia.

Another way to do find a good psychiatrist is to contact a local support group that deals with brain disorders

such as schizophrenia, and talk to the other members that already have experience with the local

psychiatrists.

If you have a family history of schizophrenia, psychiatric illness, or other serious conditions in your family, it

can be a great help to the doctor if you create a Health Family Tree that tracks such diseases through family

generations. Having a family health history in front of them can help providers decide which diagnostic and

screening tests are most appropriate for you or your loved one. Create your own Health Family Tree with

this free, web-based software (provided by the Health and Human Services Dept).

As with most serious illnesses, its important to get diagnosis and treatment as quickly as possible. Getting

treatment early can significantly improve an individual's chances at a partial or complete recovery by

preventing further brain damage or other damage caused by the disease symptoms. More information on the

importance of early diagnosis and treatment

Symptoms of Schizophrenia

Schizophrenia is characterized by profound disruption in cognition and emotion, affecting the most

fundamental human attributes: language, thought, perception, affect, and sense of self. The array of

symptoms, while wide ranging, frequently includes psychotic manifestations, such as hearing

internal voices or experiencing other sensations not connected to an obvious source (hallucinations)

and assigning unusual significance or meaning to normal events or holding fixed false personal

beliefs (delusions). No single symptom is definitive for diagnosis; rather, the diagnosis encompasses

a pattern of signs and symptoms, in conjunction with impaired occupational or social functioning(Source: DSM-IV -available for purchase on Amazon.com Diagnostic and Statistical Manual of Mental

Disorders DSM-IV-TR).

Symptoms are typically divided into positive and negative symptoms because of their impact on

diagnosis and treatment. Positive symptoms are those that appear to reflect an excess or distortion of

normal functions. The diagnosis of schizophrenia, according to DSM-IV, requires at least 1-month

duration of two or more positive symptoms, unless hallucinations or delusions are especially bizarre,


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in which case one alone suffices for diagnosis. Negative symptoms are those that appear to reflect a

diminution or loss of normal functions. These often persist in the lives of people with schizophrenia

during periods of low (or absent) positive symptoms. Negative symptoms are difficult to evaluate

because they are not as grossly abnormal as positives ones and may be caused by a variety of other

factors as well (e.g., as an adaptation to a persecutory delusion). However, advancements in

diagnostic assessment tools are being made.

Diagnosis is complicated by early treatment of schizophrenias positive symptoms. Antipsychotic

medications, particularly the traditional ones, often produce side effects that closely resemble the

negative symptoms of affective flattening and avolition. In addition, other negative symptoms are

sometimes present in schizophrenia but not often enough to satisfy diagnostic criteria (DSM-IV): loss

of usual interests or pleasures (anhedonia); disturbances of sleep and eating; dysphoric mood

(depressed, anxious, irritable, or angry mood); and difficulty concentrating or focusing attention.

The Causes of Schizopherenia

Introduction

Experts now agree that schizophrenia develops as a result of interplay between biological predisposition

(for example, inheriting certain genes) and the kind of environment a person is exposed to. These lines of

research are converging: brain development disruption is now known to be the result of genetic

predisposition and environmental stressors early in development (during pregnancy or early childhood),

leading to subtle alterations in the brain that make a person susceptible to developing schizophrenia.Environmental factors later in life (during early childhood and adolescence) can either damage the brain

further and thereby increase the risk of schizophrenia, or lessen the expression of genetic or

neurodevelopmental defects and decrease the risk of schizophrenia. In fact experts now say that

schizophrenia (and all other mental illness) is caused by a combination of biological, psychological and

social factors, and this understanding of mental illness is called the bio-psycho-social model.

Neither the biological nor the environmental (psycho-social) categories is completely determinant, and

there is no specified amount of input that will ensure someone will or will not develop schizophrenia.

Moreover, risk factors may be different for different individuals - while one person may develop

schizophrenia due largely to a strong family history of mental illness (e.g. a high level of genetic risk),

someone else with much less genetic vulnerability may also develop the disease due to a more significant

combination of prepregnancy factors, pregnancy stress, other prenatal factors, social stress, family stress

or environmental factors that they experience during their childhood, teen or early adult years. The exact

process by which environmental factors and stress gets translated into brain changes and ultimately

psychosis or schizophrenia is increasingly thought to be a result of epigenetics, and recent research

suggests exactly how stress might trigger these brain changes.


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Research has now shown that children's and teen's brains are very sensitive to stress (up to 5 to 10 times

more sensitive than adult brains) and can be damaged by frequent or ongoing stress. What seems like

mild to moderate stress for an adult, may be very severe stress for a child. This stress-related brain

damage can greatly increase risk for many types of mental illness later in life. (see diagram below that

provides an example of how schizophrenia might develop in a person)

This means that there is always hope, and there are many things you can do to reduce your own or your

childrens' risk of developing schizophrenia. Recent scientific research on the causes of schizophrenia is

increasingly suggesting that it may be possible to prevent many cases of schizophrenia through actions

taken during pregnancy (before a person is born) as well as by actions throughout early childhood and

later in life. Such prevention factors can be especially important for people who know they have a family

history of any type of serious mental illness (depression, bipolar disorder, schizophrenia, OCD, anxiety,

etc.). Follow this link to learn more aboutschizophrenia prevention.

How Genes Contribute to Schizophrenia:

There is no doubt a strong genetic component to schizophrenia - those who have immediate relatives witha history of this or other psychiatric diseases (for example, schizoaffective disorder, bipolar disorder,

depression, etc) have a significantly increased risk for developing schizophrenia over that of the general

population. However, twin studies have shown that simple genetic transmission is far from the whole

story - if one identical twin has schizophrenia, the risk for the other twin (who has the exact same genes as

his/her sibling) is only about 50%. This indicates a complexity of genetics and environment that is not yet

well understood, rather than a case of single or multiple gene presence in the body automatically

conferring a certain risk for developing schizophrenia.

Similarly with schizophrenia it is becoming increasingly evident that having the gene(s) associated with

schizophrenia is just a starting point. If you have the genes, but don't experience the environmentalcontributing factors or "triggers" for schizophrenia - then evidence suggests that you'll never get

schizophrenia. However, if you are exposed to certain environmental factors - then the chances seem to

increase (and the more environmental factors a person experiences, the higher the risk) that the person

will ultimately get schizophrenia.

An example of this theory with regard to schizophrenia is a recent research study that indicated that

people who had multiple copies of a version of the COMT gene and who smoked marijuana had a 1,000%

increase in their risk of developing schizophrenia. (source: Biol Psychiatry. 2005 May). This research may

partly explain the increased risk of developing schizophrenia for people who smoke cannabis / marijuana.

Another recent study done in Finland indicated that adopted children that had a high genetic/biological

risk of schizophrenia (their mother had schizophrenia) - had an 86% lower rate of developing

schizophrenia when brought up in a healthy family vs. a dysfunctional family. In the healthy family only

6% of the children developed schizophrenia, whereas approximately 37% of the children of dysfunctional

families developed schizophrenia (read full report on study here - A Healthy Family Social Environment

May Reduce Schizophrenia Risk by 86% in High Risk Groups).

Some of the genetic factors that are being researched right now are multiple genes contributing to the


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disease (there are about a dozen genes that are leading candidates), and the possibility of epigenetic

interactions (that is, certain genes and other biological molecules that determine whether and when

certain genes present in the body are turned on or off) is being investigated and has gained considerable

research support during the past five years.

How Environment Contributes to Schizophrenia:

First of all - its important to understand that when schizophrenia researchers talk about "environment"

they have a very broad definition that basically includes everything other than "genes" or genetic factors.

So, whereas the typical person might think of their "environment" as their house, or their neighborhood -

scientists trying to understand the factors that influence the development of schizophrenia define

environment to include everything from the social, nutritional, hormonal and chemical environment in the

womb of the mother during pregnancy, up to the social dynamics and stress a person experiences, to

street drug use, education, virus exposure, vitamin use, and much, much more. So, when you see the word

"environment" used when talking about the causes of schizophrenia - another way to think of it is

"everything other than genes". Its basically the same as when people talk about "nature vs. nuture" - what

they are saying is "genes vs. environment".

y Pregnancy-related Schizophrenia RiskFactors (and Risk Reduction Approaches)o Maternal infections and Flu during pregnancy are associated with increased risk of

Schizophrenia

o Pregnancy and baby delivery complications are associated with increased risk ofschizophrenia

o Genital/ reproductive infections (including sexually transmitted diseases, STDs) aroundthe time of conception or in the first few weeks of pregnancy are linked to a 500% higherrisk of schizophrenia for the child.

o Having Genital Herpes (for a mother) during pregnancy is associated with increased riskfor the child of developing schizophrenia

o Pregnant women's exposure to Cats who have the Taxoplasmosis Gondii parasite mayincrease risk of the child getting schizophrenia later in life

o Maternal-fetal Rh blood incompatibility associated with 100% Increased Risk ofDeveloping Schizophrenia for Offspring

o Lead, Alcohol and other Toxic Exposures to Pregnant Women may Triple Risk ofSchizophrenia for Child

o Use of Painkillers (e.g. Aspirin) during Pregnancy have been linked to 500% higher risk ofSchizophrenia

o Maternal stress during pregnancy is associated with a higher risk of schizophrenia for the


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children

o Breast Feeding Your Baby may Reduce Risk for Schizophreniao Excess Body Weight of Mother during pregnancy (above normal healthy pregnancy levels)

is associated with a higher risk of child's development of schizophrenia in later life.

o Low Birth Weight Infants May Have Increased Risk for Schizophreniao Season of Birth - Mother's Low Sunlight Exposure/Lack of Vitamin D is associated with

higher risk of schizophrenia in child.

o Older Age of Father increases risk of Schizophrenia in child.o Celiac Disease (wheat allergy) May Slightly Increase Schizophrenia Risk for Certain

Individuals - reducing early exposure to wheat may reduce a child's chances of developing

allergic reaction

o Choline Supplementation During Pregnancy May Improve Brain Function and ReduceSchizophrenia Risk

o Low Folic Acid levels during pregnancy may increase risk of schizophrenia in childo X-ray Radiation During Pregnancy (from medicalX-rays, Intercontinental Flights, etc.) may

increase risk of schizophrenia for child

y Child and Adult Schizophrenia RiskFactors (and Risk Reduction Approaches)o Lower Level of Stress for Child while growing up May Significantly Lower Schizophrenia

Risk

o Marijuana /Cannabis (and other street drugs) are Linked to Increased Risk of gettingSchizophrenia

o Social Stress associated with immigration may Increase Risk of schizophreniao Social Adversity during childhood linked to Increased Schizophrenia Risko Social isolation during childhood, teen, and early adult years is linked to increased

Schizophrenia Risk

o Country & Rural living (vs. City living) between ages 0 and 15 years, is linked to lowerschizophrenia risk

o Enriched Educational, Nutrition and Social EnvironmentsLower the Risk of Schizophreniao Child Abuse (physical, sexual and emotional abuse, and emotional neglect) have been


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linked with many psychiatric disorders, and some psychologists are suggesting it may be a

significant causal factor in schizophrenia

o Breast Fed Babies may have a Reduced Risk for Schizophreniao Vitamin D supplementation in boys during first year of life is associated with a lower risk

of schizophrenia.

o Essential fatty acid (EFA) deficiency and resulting lipid membrane abnormalities mayincrease risk of schizophrenia

o Childhood Exposure to Cats with the the T. Gondi parasite may increase schizophrenia risk.o Celiac Disease ("wheat allergy") May Slightly Increase Risk of Schizophrenia for Certain

Individuals - those affected may alleviate their symptoms with a gluten-free diet.

o Nicotine Use by Younger Adults May Reduce Schizophrenia Risk later in lifeo Exposure to X-ray Radiation During Early Childhood (under age 5) may result in higher

risk of schizophrenia for child

o Antioxidant Intake may reduce risks of schizophrenia and decrease side effects ofmedications

o Head Injury Linked to Increased Risk of Schizophrenia


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Preventing Schizophrenia - Tactics and Risk Reduction Strategies

Research conducted in the past decade indicates that schizophrenia is due to a genetic predisposition

and environmental stressors early in a child's development (during pregnancy and birth, and/or

early childhood) which lead to subtle alterations in the brain that make a person susceptible to

developing schizophrenia. Additional environmental factors and stresses later in life (during

childhood, adolescence and young adulthood) can either damage the already vulnerable brain

further and trigger schizophrenia or lessen the expression of neurodevelopmental defects and

decrease the risk of schizophrenia. In fact experts now say that schizophrenia (and all other

mental illness) is caused by a combination of biological, psychological and social factors, and this

understanding of mental illness is called the bio-psycho-social model.

While the precise mechanisms that underlie the development of schizophrenia are just starting to be

understood research does suggest many important actions that individuals and families can take

(or avoid) to lower the risk of schizophrenia and other mental illnesses. In this document we've

identified the specific actions that research suggests are most likely to reduce your, or your child's,

risk of mental illness.

Scientists now know that genes are not destiny. While a person may have some of the genes that are

associated with increased risk of mental illness - research suggests that only if a person is exposedto specific environmental factors and perceived stresses do the genes become active and thereby

further increase the risk for, or trigger, the illness. There is no specific amount of genetic or

environmental input that has been identified that will ensure someone will or will not develop

schizophrenia so it is never to late or too early to begin planning for your mental health and that of

your children. Research now shows that in mental health the biology, psychology and social

/emotional environment are closely interdependent - so factors in each of these areas are

important to address. Please note that the following information is targeted at optimizing


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children's mental health in general, not just avoidance of schizophrenia.

Before going into the specific risk reduction strategies its important to know the initial risks that a

person may face of getting schizophrenia. In the general population, for someone who has no

family history of mental illness, the average risk is estimated at approximately 1% (and therefore a

99% probability that the person will not get schizophrenia). If someone who is genetically related

to a person in the extended family that does have schizophrenia, then the risk is higher - and the

chart below provides a rough estimate of that risk. If, for example, you have an aunt or uncle who

developed schizophrenia, then your risk (on average) is estimated at approximately 3% (and

therefore there is a 97% probability you won't get schizophrenia). Even for the situation where

one parent has schizophrenia the risk is estimated at 13% for a child, which means there is an

87% probability that the person will not develop schizophrenia. If a family has a history of more

than one person developing schizophrenia then the risk goes up. People who have a strong history

of mental illness in their family may want to consider genetic counseling in addition to the

schizophrenia prevention tactics identified below.

Its also important to keep in mind as you read about the risk factors, that most of these risk factors areassociated with approximately a doubling of risk (also called the "Odds Ratio") - which might

sound high, but that means that overall for someone with no family history of schizophrenia, that

the risk goes from about 1% to 2% (with risk of not getting schizophrenia declining from 99% to

98%). Therefore, for the average person with no family history of schizophrenia or mental illness

most of these risk factors may not make a significant difference in terms of total risk of

schizophrenia which remains low. At the same time good healthcare, nutrition and a positive

emotional environment for women during pregnancy are always important factors for the health

of a baby and always recommended by doctors. Research also suggests that nurturing, sensitive

child care is also important for the healthy emotional development of children.

The factors listed below matter most significantly for people who have a history of schizophrenia or

other mental illness in their family which suggests that a person may have some of the genes,

psychological issues or social environmental factors that are associated with schizophrenia risk. At

this time little is known about exactly how the environmental exposures identified below increase

risk in those with some sort of genetic vulnerability - so don't get too worried if you have in the

past experienced a given environmental factor, as its impossible to know for sure how that

environmental factor might impact you or your child. Focus on the environmental factors that you

still have some influence over.

The take home message is that if you have a family history of mental illness it would likely be

beneficial to take some reasonable steps to reduce or avoid exposure to the risk factors --

especially those factors involved in pregnancy, prenatal care and early child care. For teens

interested in lowering their risk of schizophrenia, the avoidance of street drugs, maintenance of

healthy friendships, and early treatment for any depression, sadness and anxiety/fear is likely to

be valuable. At the same time, all of the actions below are likely to help the mental health of any

child or person - so the more steps you can take, the better your (or your child's) mental health is

likely to be.


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- Schizophrenia Prevention tactics:

y Information for Teens: How toLower Your Risk for Schizophreniao Don't use street drugs, and moderate any use of alcoholo Make an ongoing effort to develop your social skills as much as you cano Avoid social isolationo Make an ongoing effort to maintain friendships with adultso Make an extra effort to learn positive perspectives on the worldo Make extra effort to learn how to deal with stress and anxietyo Seek Help from Qualified Psychologists and Psychiatrists if you have problems coping

y Information for Parents: How to Lower Your Child's Risk for Schizophrenia

o Relationship & Family Environment Factors Build a relationship, or marry, a person with whom you can have a stable, loving

and (mostly) low-stress relationship

Make an extra effort to resolve differences. Learn good relationship skills Maximize your own mental health, learn to lower stress, and eliminate anxiety and

depression

o Pre-Pregnancy Planning for Children's Mental Health Begin prenatal planning at least three months prior to pregnancy Plan your pregnancy; Have a child when you want one, and don't have a child if you

don't want one

Take a multivitamin daily for 1 to 3 months prior to conception Make sure that any sexually transmitted diseases (eg. Herpes, Chlamydia, etc.) have

been treated by a medical professional prior to pregnancy

Make an extra effort to be at a healthy weight prior to pregnancy Make extra efforts to avoid alcohol and lead exposure prior to, and during

Pregnancy

Men should try to plan to have children when they are younger, rather than older Consider having a longer (greater than 27 months) interval between pregnancies,

to maximize mental health of children

o Stress and Pregnancy; Lower Stress Results in Healthier Brain Development Learn how to Maintain Lower Levels of Physical, Social and Emotional Stress &

Anxiety (worry) Immediately before, and during pregnancy

How to Lower Stress, Anxiety, Worry and Depression Before Pregnancyo Activites To Take During Pregnancy to Maximize Children's Mental Health

During pregnancy be sure to get enough of the key vitamins for the child's healthybrain development

Do not smoke cigarettes or use other tobacco products during pregnancy Avoid all medications (unless doctor prescribed) during the pregnancy


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Avoid Dry Cleaning chemicals during the pregnancy (and keep young childrenaway from recently dry cleaned clothes)

It may be good for the baby's brain for the mother to continue moderate exerciseafter start of pregnancy

Test for risk of RH blood incompatibility between mother and child immediatelyafter birth

Consider taking extra precautions to avoid getting the flu, during flu season Eat a healthy diet with a lot of vegetables and the recommended amount of fish

with omega 3 fatty acids

Consider taking extra precautions to minimize risk of baby delivery complications Consider minimizing your exposure to cats during your pregnancy After Birth - Make sure the mental health of the mother is good Breast feed the baby for at least 6 months, unless otherwise directed by a doctor Provide vitamin D supplementation to your child during the first year of life Consider having, and raising, your child outside of an urban environment

o Childhood Mental Health Maximizing Activities Learn as much as you can about the important new lessons that psychology and

neuroscience research is revealing about how to raise children for maximum

mental health

Teach your children (and yourself) a "Growth Mindset" on life's challenges, toreduce stress and maximize a child's ability to effectively cope with difficulties in

life.

During the first year of life, the baby should be held by a caring human for 4 hoursor more a day

Try to moderate the stress that children experience and coach them on how tomost effectively and positively deal with the stress they do experience

Parents should minimize"Expressed Emotion" (yelling, shouting, arguing, or over-involvement & controlling behavior)

Learn from the latest research into child development and practice sensitive,nurturing, low-stress parenting

Teach your children a positive, optimistic view on life and life's events Encourage the development of good social skills and friendships for your children A family may want to work on providing an enriched educational, nutritional and

social environment for their children

If a family emmigrates to a different country, the family should make extra effortsto make sure that the child integrates well in the new country and learns how to

strong friendships

Try to minimize risk of traumatic events in a child's life Encourage the development of good "reality testing" skills Encourage good head and brain safety practices in children Get early screening and treatment for mental health problems in children


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Schizophrenia Treatment

Treating Schizophrenia with Medications

y Treating Schizophrenia with Complementary Therapiesy New Psychiatric Treatment Guidelines for Schizophrenia (Canada, Nov. 2005)y Frequently Asked Questions Regarding Schizophrenia Treatments

o What to expect after going on an antipsychotic medicationo What if I can't afford my prescriptions?o Working with a psychiatristo Hospitalization - when and why it might be necessaryo What to do when a loved one refuses treatment

Medications work successfully to control symptoms in the majority of patients (approximately 70% of

patients will improve to some degree, according to research - but we've also seen research that suggests

the chances of any one drug working for a person may be only 50% or so. People frequently have to try

more than one drug to partially or completely control the positive symptoms - hallucinations, delusions,

paranoia, racing thoughts, etc). They are not as effective in controlling negative symptoms, and may cause

side-effects of their own. However, second-generation antipsychotics (also called atypical antipsychotics)

have shown more success with some patient population in treating negative and cognitive symptoms.

There are also a wealth of new, and hopefully better, schizophrenia medications currently in development.

See our Medications area for information on commonly prescribed antipsychotic medications - how they

work, how effective they are, what side-effects they cause - as well as additional info on research studies

and medications in clinical trials.

Although an important element, medication is far from the only treatment used for schizophrenia patients.

Many patients and their families choose supplemental therapies (these can include psychosocial or


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cognitive therapy, rehabilitation day programs, peer support groups, nutritional supplements, etc) to use

in conjunction with their medications. In certain severe cases, some patients also respond to

electroconvulsive therapy (which has been shown to be safe and effective) or transcranial magnetic

stimulation (TMS). These additional treatments can be essential for a full recovery - although medications

are the best tool right now for controlling symptoms (particularly positive ones), other treatments and

therapies are what can help a person manage depression, social interactions, school, work, and the

components for a full life. The most promising complementary treatments to try in conjunction with

medication that we have seen thus far, based on scientific literature and patient experiences, include

personal therapy (there are many types), certain amino acids and antioxidant vitamins such as glycine or

sarcosine supplements, and a healthy diet.In the case of therapy, some research has shown that

psychotherapy and medication can be more effective than medication alone (however, the same study

noted that psycotherapy alone was NOT a substitute for medication). The three main types of psychosocial

therapy are: behavioral therapy (focuses on current behaviors) cognitive therapy (focuses on thoughts

and thinking patterns) and interpersonal therapy (focuses on current relationships). For schizophrenia,

cognitive-behavioral therapy has shown the most promise in conjunction with medication.

scizophenia

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