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Schizophrenia Patient Education

Schizophrenia Overview

Schizophrenia is a complex, severe, and disabling brain disorder that alters how a person perceives the world, marked by a disconnection from reality. Confusion and fear may cause withdrawal or abnormal behavior.

This disorder usually presents between a person’s late teens or early twenties, but it can occur in children or later adulthood. One percent of the American population will be diagnosed with this condition during their lifetime, which represents 2 million people. Read more in this Schizophrenia patient education guide.

Common early warning signs include:

Paranoia, suspiciousness, hostility
Inappropriate emotional display with crying or laughing
Lack of expression of happiness or sorrow
Depression
Sleep disorders (insomnia or sleeping throughout the day)
Irrational or inappropriate statements
Loss of memory, lack of focus
Withdrawal from friends, family and society
Lack of personal hygiene
Flat gaze
Decline of mental acuity, increased confusion
Inability to take criticism (reacting with hostility)

Five symptoms typical of schizophrenia:

Hallucinations – experiencing something that is real although it is not. It can involve any of the senses, such as hearing noises or seeing visual images that are not really there.
Delusions – occur in 90% of patients. This is a set idea that the individual has despite facts that show it isn’t valid. This takes the form of fantasies or illogical and bizarre ideas. Common forms of delusion involve ideas of persecution or grandeur, control issues, or events possessing some special meaning.
Muddled speech – responding inappropriately to questions or having no connection between sentences or words. This is due to lack of focus and the inability to maintain specific thoughts. Patterns of rhyming words, free association, perseveration, and made-up words are common.
Unpredictable behavior - bizarre, non-purposeful actions. This behavior may be impulsive and show a lack of daily functions.
Flat affect - the absence or near absence of emotional response to a situation that normally elicits emotion

There are 3 subtypes of schizophrenia:

Paranoid schizophrenia – includes delusions of persecution or feelings of grandeur. The thoughts often follow an organized theme or story
Disorganized schizophrenia – includes odd reactions or facial expressions, possible infantile speech and behavior, and impaired speech and communication skills
Catatonic schizophrenia – includes a behavior of stupor or excited motor signs with pacing and acting out violently

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Doctors Who Treat Schizophrenia

As your schizophrenia disorder is diagnosed, treated and managed, you may encounter the following team of doctors and specialists.

Psychiatrists - (medical doctor) specializes in the diagnosis and treatment of mental disorders using both therapy and medications
Family Therapists - (psychologist) educates families and lends support in dealing with schizophrenia
Case Managers - helps to find housing, employment, crisis management and self-help groups in the patient’s community
Occupational Therapists - treats patients with disabilities or conditions by helping them improve or deliver the skills needed to work and function daily in society

How to Prepare for Your Schizophrenia Doctor Visit

Having made your appointment with a healthcare provider, there are certain actions you can take to maximize the benefit of your doctor visit. Read more in this schizophrenia patient education guide.

For the initial evaluation, it is important to bring the following to the physician’s office:

A list of your medications, including any herbal and vitamin supplements
A list of any allergies you have
A list of any medical problems
A list of your symptoms and the times they occurred

If blood tests are going to be done at the visit, fasting may be necessary. In that case, no food or drink should be consumed after midnight prior to the exam.

Questions to Ask Your Doctor About Schizophrenia

From your initial diagnosis throughout your treatment and care, you will have questions about your schizophrenia disorder. Below is a list of questions to discuss with your doctor so you can make informed decisions about your condition and your care.

Questions About My Diagnosis

Is there another medical condition/illness that may mimic my symptoms of schizophrenia?
Is there another condition that may be making me worse?
Are there allergies that can aggravate or mimic my symptoms?
What signs would signal an oncoming relapse of symptoms?

Questions About My Treatment

Will I always have to take medication?
How long will it take for the drugs to work?
What side-effects are associated with the medication?
Will I need therapy in addition to drugs?
Are there alternative therapies to taking drugs?
Can I nurse my baby with the medications?

Questions About My Lifestyle & Family

Can I still work at my current job?
Can I still drive?
Can I still take care of my children?
Is this hereditary? What should my family look for?
What should I tell my family, friends and boss about my illness?
What types of services am I eligible for?
What types of services would help me?

Common Tests or Labs to Diagnose Schizophrenia

Prior to diagnosing schizophrenia, a physician must rule out medical conditions that may cause changes to behavior. A complete physical examination is performed by a physician including a drug screen to rule out usage, which can mimic the symptoms of schizophrenia, and alcohol level, to ensure that the patient is not exhibiting signs of withdrawal.

The complete history and list of medications are also reviewed. Read more below in this schizophrenia patient education guide.

Test	Why Test?	What Happens?	Normal Result
Thyroid panel	Thyroid dysfunction can manifest with a decrease in alertness, confusion, and memory loss.	After a tourniquet is applied to the upper arm, the puncture site of skin is swabbed with alcohol pads and a needle punctures the skin. Blood is then drawn into a syringe for analysis.	TSH = .25-4.3 microunits/ml Free T3=2.3-4.2 pg/ml Serum T3=70-200 ng/dl Free T4=.5-2.1 ng/dl Serum T4=4-12 mcg/dl
Lumbar puncture (spinal tap)	Purpose is to: -Find symptoms caused by infection (e.g. meningitis), cancer or hemorrhage -Measure pressure surrounding the spinal cord -Diagnose conditions of the nervous system (e.g. multiple sclerosis or Guillain-Barre syndrome) -Inject pain medication into the spinal cord -Inject therapeutic drugs to treat cancer and leukemia	You will lie on the bed in a fetal position, or lean forward while sitting on a chair with head and chest tucked in toward your knees. The back is cleaned with alcohol and draped with sterile pads or towels. Local pain medication is injected into the site for puncture. A long (spinal) needle is inserted into the spinal canal and, once in place, the solid core of the needle is withdrawn. If no spinal fluid is obtained, another puncture site may be used. A device called a manometer attached to the needle measures the cerebrospinal fluid (CSF). After fluid samples are obtained, the needle is removed and the site is cleansed and bandaged.	Color: Clear Pressure: 90-180 mm Organisms: None RBCs: None WBCs: 0-5/mm cubed Protein: 15-45 mg/dL Glucose: 60% of blood glucose
Magnetic resonance imaging (MRI)	Looks for: -Hydrocephaly (water on the brain) -Tumors -Abscess -Pituitary gland problems -Symptoms of head injury -Aneurysms -Blood flow, clots, or active bleeding in the brain -Signs of stroke	You will be asked to remove all jewelry, dentures, clips, artificial limbs, braces, hairpins, and hearing aids. You will then lie on the table (possibly having received sedation), which slides into a tunnel-like space. Earplugs or headphones with music may be given to mask the tapping noises during the scan. If needed, contrast material may be given in the IV line inserted into a vein.	No visualization of growths, tumors or bleeding. No signs of inflammation. No abnormalities of the brain, nerves, and surrounding areas.
Computed tomography scan (CT)	Looks for: -Brain tumors -Ruptured aneurysms -Abnormalities of sinuses -Fractures	You will be asked to remove jewelry, hearing aids, and glasses. You will lie on a table and straps will be applied to your head to keep it steady. Sedation may be given. The table slides into a round opening of the scanner which then moves around your body, taking pictures. Buzzing can be heard during this process. If contrast material is needed, it will be inserted into an IV in a vein (of the arm or hand). The test takes 30 minutes.	Images show no bleeding, tumors, or growths. The skull, face, joints, and jaw are normal in shape, size and position.
Body temperature	Hyperthermia (heat stroke) or hypothermia (body is too cold) can both cause changes In mental acuity.	A rectal thermometer is inserted while the patient is lying on his/her side with knees bent upward toward the chest.	Normal range is 97.5F (36.4C) to 99.7F (37.6C).
White blood cell count (WBC) with differential	Elevation in white blood count is usually indicative of an infection in the body. This test often takes place as part of a complete blood count (CBC) test.	After a tourniquet is applied to the upper arm, the puncture site of skin is swabbed with alcohol pads and a needle punctures the skin. Blood is then drawn into a syringe and sent to the lab for analysis. The needle is removed and a pressure bandage is applied to the puncture site.	4,500-10,000 cells/ml Segmented neutrophils = 54-62% Lymphocytes = 24-44 Eosinophils =0-3 Monocytes =3-6 Basophils = 0-1
Urine analysis	Severe urine infections can cause disorientation.	After washing the urogenital area with an antiseptic swab, the patient voids into a sterile cup which is then sent for analysis.	No red blood cells, white blood cells, casts, bacteria or viruses found.
Blood gases	For those patients who have respiratory difficulties, a lack of oxygen can cause a decline in alertness and mental acuity.	After a tourniquet is applied, the puncture site of skin is swabbed with alcohol pads and a needle punctures the skin (the needle enters an artery instead of the usual venous puncture). Blood is drawn into a syringe and sent to the lab for analysis. The needle is removed and a pressure bandage is applied to the puncture site with additional manual pressure applied for the first few minutes.	pH = 7.35-7.45 pCO₂ = 35-45 pO₂ = 70-100 HCO₃ = 19-25 O₂ Saturation 90-95%
Electrocardiogram (EKG)	Cardiac problems can reduce blood flow to the brain causing confusion, delirium, and decreased alertness.	After lying on your back on the examination table, adhesives are applied along the torso and limbs through which leads are attached. The EKG machine is turned on and, after getting a reading, the leads are removed. This is a painless test that takes 5-10 minutes.	A normal EKG is a pattern with a P wave followed by a QRS wave, with an interval rest period whereupon the pattern recurs. P wave rate = 60-100 bpm P height < 2.5 mm in lead II P width < .11 in lead II PR interval = .12-.20 s QRS complex < .12 s Normal ST segment = no elevation or depression
Glucose test	Abnormal levels of glucose denote the possibility of diabetes which, if uncontrolled, can cause confusion and decrease mental acuity.	After a tourniquet is applied to the upper arm, the puncture site of skin is swabbed with alcohol pads and a needle punctures the skin. Blood is then drawn into a syringe and sent to the lab for analysis. The needle is removed and a pressure bandage is applied to the puncture site.	Fasting glucose = 60-110 2 hour post-prandial = up to 140 mg/dl
Vitamins	Certain vitamins can cause confusion. For example, Wernicke syndrome is from a deficiency of thymine (B1).	After a tourniquet is applied to the upper arm, the puncture site of skin is swabbed with alcohol pads and a needle punctures the skin. Blood is then drawn into a syringe and sent to the lab for analysis. The needle is removed and a pressure bandage is applied to the puncture site.	Thymine level = 26-28 ng/ml is the lower limit for whole blood

Common Medications and Treatments for Schizophrenia

Treatment of schizophrenia involves a combination of therapy and medication. Therapy enables individuals to develop skills for work and socialization.

Because schizophrenia is a lifelong condition, the need for treatment will be constant. While medications are not a cure, they help control symptoms of schizophrenia.

Treatment	How/Why it Works
Typical antipsychotics (first generation)	Inhibit the effects of dopamine (a brain chemical)
Atypical antipsychotics	Associated with less side effects than typical or conventional antipsychoticsRectify the imbalance of neurotransmitters in the brain (which control nerve pathway functions)