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Schizophrenia is defined as a common type of psychosis, characterized by abnormalities in perception, content of thought, and thought processes (hallucinations and delusions), and extensive withdrawal of one’s interest from other people and the outside world.  It is a chronic and severe mental disorder that affects 1% of the Canadian population  and more than 21 million people around the world.  This condition affects a person’s ability to think rationally, control emotions, make decisions and relate to others. Schizophrenia impairs a person’s ability to differentiate reality from what their mind is making up. Schizophrenia may result in some combination of hallucinations, delusions, extremely disordered thinking and behavior that impairs daily functioning.  Schizophrenia requires lifelong treatment. Even with treatment, the daily life of those affected are greatly impacted due to the side effects of drug therapy and the stigma around their condition. History Although the word “schizophrenia” is less than 100 years old, written documents can trace the mental illness as far back as the 2nd millennium BC. However the disease was first publicly identified as a discrete mental illness by German physician, Dr. Emile Kraepelin, in 1887.  Dr. Kraepelin was one of the first to classify the mental disorder into different categories. Originally he used the term “dementia praecox”, meaning early dementia, to distinguish it from other forms of dementia such as Alzheimer’s, which typically occurs late in life. Dementia praecox was used until Dr. Eugen Bleuler, coined the term, “schizophrenia” in 1911. The name schizophrenia comes from the Greek root words “schizo” meaning split, and “phrene” meaning mind. When put together schizophrenia means split mind. However, it should be recognized that people with schizophrenia do not have split personality disorder, but their mind is “split-off” from reality. Dr. Eugen Bleuler was also the first to describe the symptoms as “positive” or “negative.” Bleuler changed the name to schizophrenia as Kraepelin’s name was misleading because the illness was not a dementia. Bleuler’s studies found that the disease did not always lead to mental deterioration and could occur both late and early in life. Over the years, the definition of schizophrenia continues to evolve as we further learn about the disease and how the symptoms affect the body. Symptoms & Age of OnsetTypically, the age of onset for schizophrenia begins in early adulthood, between the ages of 15 and 25.  Typically, men will tend to get develop symptoms slightly earlier than women. Although relatively rare for young children and older adults to develop schizophrenia, there have been occurrences. Symptoms can be categorized into three main groups: positive, negative, and cognitive. Positive symptoms are any symptoms that are “added” to a person’s personality such as delusions, hallucinations, thought disorder, and movement disorder. Negative symptoms are capabilities “lost” from a person’s personality. These include emotional flatness, limited or monotone speech, general lack of interest in life, inability to plan or enjoy activities. Cognitive symptoms affect thinking processes in the brain. This includes difficulty focusing or paying attention, difficulty understanding information, and poor memory. The diagram on page 10 shows which areas of the brain that operate abnormally. The frontal lobe, which is responsible for problem solving, and the hippocampus, responsible for memory formation, are just two regions of the brain that can lead to cognitive symptoms. Although there are many ways to classify and identify, symptoms of schizophrenia vary dramatically from person to person in both pattern and severity. Not every person with schizophrenia will have all symptoms, and new symptoms of schizophrenia may appear, or disappear over time.DiagnosisThere is no single laboratory or brain imaging test for schizophrenia.  Healthcare professionals will first rule out multiple factors such as brain tumors, other medical conditions, and other psychiatric diagnoses. It can sometimes take upwards of a decade for an individual to be properly diagnosed with schizophrenia. To get an official diagnosis of schizophrenia, symptoms must have been present for six months and include at least one month of 2 active symptoms described in the section above. A psychiatrist will generally use the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is used to diagnose all mental illnesses and provide a set of common standards, to get a correct diagnoses. The DSM-5 characterizes delusions, hallucinations, disorganized speech and behavior, and other symptoms that cause social or occupational dysfunction as schizophrenia.  New to the current DSM-5 is the diagnostic criteria. In the past, subtypes were defined by the most predominant symptom at the time of evaluation. The DSM-5 no longer identify subtypes as they were not helpful because patients’ symptoms often changed from one subtype to another and presented overlapping subtype symptoms. Some of the subtypes are now specifiers to help provide further detail in diagnosis. CausesThe causes of schizophrenia are not fully determined. Researchers believe that schizophrenia may develop from genetics, brain chemistry, environmental factors or a combination of the three. Schizophrenia has an obvious genetic component. The risk for inheriting schizophrenia ranges from about 10% for those who have one first-degree family member (mother, father, sister, brother) with the disease and about 40 – 65% if the disease affects both parents or an identical twin.  The diagram on page 11 further shows the link between the percentage of genes shared and the risk of developing schizophrenia in graph form. However, heredity does not account for all cases of schizophrenia as 60% of people with schizophrenia have no close relatives with the illness. The other possible causes of include brain chemistry and structure. Scientists found an unusual imbalance of neurotransmitters, specifically dopamine. They also found that patients with schizophrenia had structural abnormalities in the brain through magnetic resonance imaging (MRI) scans. Environmental factors can also increase the risk of developing schizophrenia, especially for people who already have a genetic predisposition. The environmental factors possibly associated with schizophrenia include viral infections, prenatal and perinatal problems, father’s age, and childhood trauma. TreatmentUnfortunately there is no single, simple course of schizophrenia treatment that fits everyone, and there is currently no cure. Although schizophrenia affects the mind, it is categorized as a brain disease and not a psychological disorder, therefore drug treatment is the primary therapy. However, studies show that an integrated approach that includes psychotherapy may help to ease psychotic symptoms. An integrated approach can also include cognitive-behavioural therapy, community-based rehabilitation, and social skills training. As for drug therapy, the main medications used to treat schizophrenia are antipsychotics. Antipsychotics can be classified into two categories: Typical (first generation) and Atypical (second generation). Typical antipsychotics were the first generation to be discovered and developed in the 1950’s, whereas second generation antipsychotics (SGA) were developed more recently. The exact mechanism of action of antipsychotic drugs is unknown. However, according to the dopamine theory of schizophrenia, it is believed positive symptoms are the result of an over activity in the mesolimbic dopamine pathway.  Antipsychotics are thought to target the neurotransmitters in the brain, to reduce the hallucinations and delusions of psychosis. The neurotransmitter most targeted by antipsychotics is called dopamine. Although antipsychotic drugs are designed to do the same thing, they are known to affect people in different ways. Each experience of taking them will be unique to everyone. Many experience negative side effects, which can lead them to stop drug treatment altogether. CostThe cost of living with schizophrenia is very expensive. In Manitoba, the price of the common SGA Clozapine costs $0.66 per 25mg pill, and $2.64per 100mg pill. Keep in mind that is for the generic cheapest brand. The average dosage for schizophrenic people is between 300mg to 450mg a day in divided doses. If you calculate the pricing for just one month it costs anywhere between $238 and $715. To put this in perspective, for the minimum dosage it will cost approximately $2,856 a year for the rest of their lives. Since schizophrenia is diagnosed on average around the age of 20, and life expectancy of someone with schizophrenia is decreased by 20 years, the average person will spend around $114, 240 for 40 years. This is just the cost of medication, not including psychotherapy which costs approximately $125 to $175 per session. As for the economic burden of mental illness in Canada, it is an estimated $51 billion per year which includes cost of healthcare costs, lost productivity, and reductions in health-related quality of life. ConclusionUpon choosing the topic for our paper, we both knew very limited information about how people with schizophrenia function and live. We chose this disease because we both had people in our lives that suffered with schizophrenia. Faith has 2 people in her life who are diagnosed with schizophrenia, while Courtney’s childhood friend was diagnosed 4 years ago. It has been a struggle to research this paper and fully sympathize with the ordeals and struggles one with schizophrenia must go through. The internet had multiple good sources for reading up on facts and symptoms. The most helpful site we found was the University of Maryland Medical Center website. They had an in-depth and easy to read report about the causes, diagnosis and treatment of schizophrenia. The most interesting information we learned were the symptoms and how they were classified. We also found the different parts of the brain affected by schizophrenia to be interesting. However, it was confusing as to how the antipsychotics mechanism of action worked on the brain in direct link to schizophrenia. We understood that there is still more research to be done not only on diseases of the mind, but also the brain itself. Upon research we found an article written by a 22 year old female blogger who wrote about her experiences of living with schizophrenia. Her words struck a chord within us as she described what it’s like to tell people her diagnosis and face the stigma surrounding her disease. She wrote “when people do talk to me about my condition, they want to know what the voices sound like. They want to know I have more than one personality, or if each personality has a different hair color. (No, that’s not what schizophrenia is like) They want to know if I’ve seen A Beautiful Mind. Schizophrenia is a lifelong, disabling condition, but there are no relays for this disease. There are no walks to end schizophrenia, no T-shirts that say, ‘I love someone with schizophrenia.’ People look at me with fear, not empathy, when I tell them about my diagnosis.”  We both believe that although Canada has come so far in talking about mental health, there is still a long way to go for research for a cure and better understanding of schizophrenia, as well as further creating better treatments for those living with the disease.

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