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What isn't Known about Schizophrenia (Part One)

© Ian Chovil

Schizophrenia is an illness which has a direct impact on a lot of people since it appears in one out of a hundred people. It has been recognized as an illness since the mid to late eighteen hundreds. It has been a very disabling disease since that time, and treatments that improved functioning in schizophrenia have only been available since 1954 with antipsychotics such as Chlorpromazine. Most of what is known about schizophrenia has been learned in the last ten years with the development of brain imaging technology like MRI and PET scans. The pattern so far has been one where pharmaceutical companies create new medications that alleviate the symptoms of schizophrenia and then researchers try to understand why they are effective. There is a lot that isn't understood about schizophrenia. In this two part series I will highlight what isn't known about this illness from my perspective, that of a patient trying to understand what he is afflicted with.

It would be great if everyone agreed to what the word schizophrenia referred to. Many psychiatrists and researchers believe that schizophrenia is probably a spectrum of related disorders with possibly different causes that all appear relatively similar. Beuler who coined the term schizophrenia in the 19th century himself referred to the "schizophrenias", because the illness is quite variable in individuals. Different people have different changes in brain structure, readily apparent on MRI scans, and associated with different symptom profiles. Other prominent researchers though, like Dr. Weinberger, are "lumpers" rather than "splitters" and believe that one illness is occurring in different severities and stages of development.

There is only partial agreement on a classification of symptoms in schizophrenia. Everyone agrees that schizophrenia can cause severe reality distortion and these symptoms are often called positive or psychotic symptoms. This group of symptoms was the only one associated with schizophrenia for many years. As they became treatable psychiatrists recognized a group of deficit symptoms, or negative symptoms, behavior that should be there and was absent. I think it was the pharmaceutical companies, who in many ways lead the research in schizophrenia, who further differentiated deficit symptoms into cognitive symptoms, which are abilities of memory, attention and abstraction. They think the degree of cognitive impairment is the best predictor of long term outcome. Some people work with disorganization symptoms, as a category of symptoms separate from deficit and positive symptoms.

Mood symptoms are still often confused with negative symptoms, which appear very similar. Theoretically the only difference is the actual mood, an individual experiencing depressed feelings in depression and no feelings in negative symptoms. It can be a tough call for a psychiatrist and sometimes the only test is whether an individual responds to antidepressants, because negative symptoms don't improve with antidepressants. Ten to twenty per cent of depression doesn't respond to antidepressants either.

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