Schizophrenia explained

How is it diagnosed?
Diagnosis is difficult because the course of the illness is lengthy and some of the classic indications of schizophrenia may appear so slowly that only a family member would notice the change. The psychiatrist faced with making a diagnosis will base it on 'scoring' a whole range of symptoms: hearing voices, thoughts not being one's own, outside forces acting on body actions, delusional perception.

How it starts
Slowly: schizophrenia often starts gradually in the middle and late teens. It is hard to tell whether a gradual change in behaviour is a sign of mental illness or normal teenage rebellion. If the trend continues and other symptoms start to appear, get advice at once.

Suddenly: some cases of schizophrenic illness start suddenly, sometimes after a shock or other stress such as childbirth, infection or exams. A person starts to hear voices, has delusions and a gamut of positive symptoms. Yet there is often a complete and rapid recovery with treatment.

In later life: Some people get schizophrenia in their sixties or seventies. It is then more common in women, particularly those with poor hearing and living on their own. The illness usually responds well to medical treatment.

What are the causes?
Heredity is known to play a part. The great advances made during the past 20 years in genetics and understanding how heredity works make this an exciting area in the search for the causes of schizophrenia.

Abnormalities in the chemistry of the brain are also important. Individual brain cells communicate with one another by chemical messengers called neurotransmitters. Scientists have suggested that people with schizophrenia may produce too much of one of these transmitters, dopamine, and that this may explain the positive symptoms of the condition. Although dopamine transmission may be involved in some of the symptoms of schizophrenia, a dopamine abnormality is not a sufficient explanation for the disease. For many years, it has been suspected that there might be structural changes in the brains of patients with schizophrenia.

There is no convincing evidence that other psychological factors, such as distorted relationships within a family, are capable of bringing about schizophrenic illness, but it does appear that families can play an important part in preventing relapse by avoiding too much criticism, hostility or overprotection of the patient.