My brother has schizophrenia and I have heard that he may benefit from testosterone. Is this true?

Schizophrenia is a serious mental health disorder which affects close to 1% of the population. The only decent treatment available are anti-psychotic medications but these have a number of unpleasant side effects. Thus, many people have been turning to alternative treatments. One such treatment is testosterone derivatives. There are anecdotal reports that people treated with DHEA (testosterone derivative) plus anti-psychotics may have a positive response. Unfortunately the trials were small and not everyone obtained the same benefit. One should also remember that testosterone has many side effects which are very unpleasant. As of now, testosterone is not an accepted treatment for schizophrenia and there are no large scale studies to show that it works.

I tend to worry a lot. Is this a sign that I have paranoia?

Paranoia is more than too much concern or worry; it tends to involve a more intense sense of doubt and mistrust. This is different from worry - which is more a feeling of anxiety, hesitation, nervousness and uneasiness without automatically thinking and/or believing that other people are trying to harm you. Most people who worry can tell fact from fiction and have a good sense of situation. On the other hand, paranoid psychosis is a phony, rigid belief that doesn't dislodge even when one is confronted with evidence that disproves the belief.

Is paranoia only associated with schizophrenia?

NO.  Paranoia is a symptom that can occur in several other mental disorders including bipolar I disorder. More than 50% of individuals with bipolar I disorder have psychotic symptoms -- delusions or hallucinations -- when they develop mania.

Paranoia though is most common in schizophrenia. One may see it in people who abuse illicit drugs like cocaine, LSD or methamphetamine.

There are also some people who have mild degrees of paranoia and tend to function well in life. These people have a paranoid personality but are not delusional.

There are many examples of paranoia in people who have suffered brain trauma. Paranoia is also common in hospital patients but in such cases the paranoia is only mild and rarely reaches the severe intensity seen in schizophrenia. People who have borderline personality do tend to have a certain paranoia and tend not to trust people. These people live on the fringe of neurosis and psychosis.

Can you please tell me if paranoia is the same thing as not trusting someone?

Well, paranoia is much more than that. Paranoia is an overstated and unsubstantiated sense of suspicious or mistrust of someone. During paranoia, you may develop false beliefs that someone or something is planning to harm you or has evil intentions toward you. If you cannot distinguish fact from fiction there you have an impairment in relative awareness. If you are absolutely persuaded that others are against you and you cannot figure out alternative explanations for how you feel, then your paranoia is delusional in nature and intensity.  In psychosis this is the major problem- people cannot tell what is real and what is fiction. 

Does everyone with schizophrenia need treatment?

If schizophrenia is untreated, it can result in severe behavioral, emotional and physical health problems. Complications that are common with schizophrenia include suicide, self-destructive behaviors, depression, poverty, homelessness, difficulty in interpersonal relationships and family conflicts. Moreover, even if you are treated, the medications have many side effects. In general, schizophrenic individuals are often victims of crime because of their inability to differentiate safe from dangerous (and there are many evil people who take advantage of these unfortunate individuals). It is important for family members to read about schizophrenia so that they have a better understanding of the disorder and help provide care to the affected individual. 

Are there any risk factors that may precipitate schizophrenia?

While the cause of schizophrenia is not understood, some risk factors have been identified. These include a family history of schizophrenia, stressful life circumstances during childhood, older parental age at birth, use of illicit drugs during adolescence and perhaps exposure of the mother to certain virus or toxins during pregnancy. Again, these are only speculations and no one really knows why or how the disorder occurs.

What is the cause of schizophrenia?

The cause of schizophrenia is a mystery and despite intense research over the past 40 years, no physical cause has ever been identified. The diagnosis of the condition is based on history and clinical presentation. There are no laboratory studies or x-rays available that can help make the diagnosis. Once the diagnosis is made, treatment is lifelong. Individuals who do not undergo treatment develop disabling thoughts, hear voices and are not able to function in life. 

I am 22 and have been told I have schizophrenia. What is the major problem with this disorder?

Schizophrenia is a group of chronic brain disorders whereby individuals simply cannot differentiate fact from fiction. The disturbance in reality is also associated with hallucinations, delusions and disturbed thought processes. The disease tends to present itself in the 20s and is progressive. With time, most individuals are unable to take care of themselves and require institutionalization. Schizophrenia is a dreaded disorder where the balance between normal thoughts and emotions is completely fragmented. Some individuals also develop negative symptoms that may appear months or years before the hallucinations and delusions. These symptoms include social isolation, loss of motivation, no interest in everyday life, lack of emotion, neglect of personal hygiene, difficulty with memory and no attention span. Most of these individuals have trouble at work and home and often run into difficulties with the law. 

Is there any book I can buy to learn more about schizophrenia?

There are hundreds of books about schizophrenia in retail stores. However, for the consumer there is adequate information about schizophrenia on cyberspace and there is absolutely no need to buy any books. Sites like Mayo clinic and Medscape have more than ample information on this subject. These sites are maintained by physicians and are devoid of any advertisements and the information is unbiased. Moreover, you can even ask questions and get answers free from a physician – which is extremely rare today.  The majority of books about schizophrenia are written for professionals and thus, the layperson may not be able to understand all the information. However, there are a few books about schizophrenia written by non-health professionals which are easy to understand but these do not provide in depth knowledge about the medications used to treat this mental health disorder.

How many subtypes of schizophrenia are known?

The aim of all the tests is to differentiate between the several subtypes of schizophrenia, but not everyone fits in a specific category. The five common types of schizophrenia include 1) paranoid, 2) catatonic 3) disorganized 4) undifferentiated and 5) residual.

The majority of patients have the undifferentiated subtype whose dominant symptoms may be from any one of the other subtypes. The paranoid schizophrenia subtype is characterized by delusions and hallucinations, and has the best chance of improvement.

Does one have to have specific mental symptoms to be diagnosed as schizophrenic?

Yes, the diagnosis of schizophrenia is based on certain criteria established by the Diagnostic and statistical Manual of mental Disorders (DSM). The schizophrenia diagnostic test requires that an individual have at least two of the common symptoms of the disorder like delusions, hallucination, disorganized speech, abnormal behaviors or presence of negative symptoms for one month. Moreover, the schizophrenia test must indicate that the individual is significantly impaired and unable to work, attend school of perform daily living tasks. The symptoms must be present for at least 6 months.

Is there a blood test for schizophrenia?

When doctors suspect a mental health disorder with paranoia, the first schizophrenia diagnostic test is to conduct a proper physical exam and a number of psychological tests. The schizophrenia diagnosis test usually involves answering standardized questionnaires. Schizophrenia symptoms test also involves performing laboratory tests to help rule out any other medical condition and to screen for alcohol, prescription and illicit drugs. Some doctors will often order a CT scan or an MRI to make sure that there is no sinister pathology lurking in the brain. You will also undergo comprehensive psychological evaluation where a professional will observe your appearance, mannerism, speech, behavior and asking about different thoughts, delusions, hallucinations and potential for harm.

How is the diagnosis of schizophrenia usually made?

There are no definitive diagnostics tests for schizophrenia. If you have a family member or a friend whom you suspect of having symptoms of schizophrenia, the first step is to see your doctor.  Ultimately, you may be referred to a psychiatrist, as most general practitioners do not understand the intricacies about treating this peculiar mental disorder. The schizophrenia diagnostic test means that you write down all your symptoms and when they started. You also need to include all the recent stress or life changes that have taken place. The schizophrenia symptoms test also requires that you provide a list of all the medications, vitamins and supplements that you are taking.

Before you go to the doctor for your schizophrenia symptom test, write down questions that you want answered. Some basic questions that you should ask include 1) what is the likely cause for the symptoms, 2) what are other possibilities, 3) what type of test are required, 4) Is the condition chronic, 5) how is it treated and 6) where can I find material to read about the disorder.

The doctor says my brother has undifferentiated schizophrenia. What does this mean?

The undifferentiated subtype is diagnosed when individuals have symptoms of schizophrenia that are not clear or specific enough to permit classification of the mental disorder into one of the other subtypes. The symptoms may fluctuate at different points in time, resulting in confusion and uncertainty as to the correct subtype of schizophrenia. Other individuals may people exhibit symptoms that are remarkably stable over time but still not fit one of the typical subtype pictures. In either instance, diagnosis of the undifferentiated subtype may best describe the mixed clinical syndrome.

What is disorganized schizophrenia?

Another subtype is disorganized schizophrenia, which is also lifelong and has the worst prognosis. It is also known as hebephrenic schizophrenia. Disorganized schizophrenia is characterized by incoherent thoughts, bizarre behavior and illogical thinking. Individuals with disorganized schizophrenia are unable to carry out the simple daily living activities like dressing, eating or showering. Most of the individuals are difficult to understand. They do tend to get angry and lash out very easily because of frustration. The majority become institutionalized over time.

Which subtype of schizophrenia has the best prognosis?

Paranoid schizophrenia is one of several types of schizophrenia. Like all other types of schizophrenia, paranoid schizophrenia is also life long. The disorder has many features of paranoia. The typical clinical features of paranoid schizophrenia are having false beliefs (delusion) and hearing things that others cannot hear (auditory hallucinations).

Unlike other types of schizophrenia, the prognosis for paranoid type is better. Even though these individuals have disordered thoughts and abnormal thinking, they are better able to function in life than other subtypes of schizophrenia. Overall, individuals with paranoid schizophrenia generally tend to have more of the positive rather than the negative symptoms. These positive symptoms include presence of unusual persecutory thoughts and delusions. Unlike the other subtypes of schizophrenia, paranoid schizophrenics do not develop too many memory or concentration problems. However, it should be remembered that paranoid schizophrenia is still a serious long-term illness that has an increased risk of suicide.

Why is treatment of schizophrenia very difficult?

Because many medications used to treat schizophrenia affect the neurotransmitter, dopamine, some researchers believe that an alteration in this chemical may be a cause of schizophrenia. Because the cause(s) of schizophrenia is not known, the drug treatments have not been very effective or very specific. Most of the drug treatments for schizophrenia act as generalized brain depressants and affect many organ systems. Thus, side effects are very common. When schizophrenia is not treated, it can lead to numerous emotional, behavior and physical health problems, as well as a very poor quality of life. Many individuals end up with severe financial and legal problems because of their behavior.

Can you tell me what the major problem with schizophrenia is? My brother has it and we do understand what is happening?

One of the most misunderstood disorders in society is schizophrenia. While true estimates are lacking, it is believed that schizophrenia is present in 1/100 individuals. Schizophrenia often presents with a variety of mental symptoms including hallucinations, delusions and disordered thinking. Individuals who develop schizophrenia continue to get worse and over time are not able to take care of themselves. Despite what is widely believed, schizophrenia has nothing to do with multiple personalities. It is simply a disorder where one is not able to tell what is real and what is not. Individuals with schizophrenia generally do not harm others but only themselves. The paranoia can be so severe that most end up committing suicide. 

Despite intensive research, the disorder remains a puzzle and there is no ideal treatment. Schizophrenia has no cure and the only medications available only control the symptoms. No one really knows the cause of schizophrenia and this chronic disorder requires lifelong treatment.

Are there any risk factors for developing schizophrenia?

Even though the cause of schizophrenia is unknown, the risk factors for developing the disorder are well known. It is believed that schizophrenia is most likely to occur in individuals with a strong family history of mental disorders. Other risks include maternal exposure to any type of viral infection or toxin during pregnancy, presence of stress, older parents at birth and use of psychoactive drugs during adolescence. However, the majority of people who develop schizophrenia have none of the above risk factors. The disorder is a real mystery.

Does anyone know the cause of schizophrenia?

Over the years, many causes of schizophrenia have been speculated from abnormal genes, childhood stress, difficult parenting, head trauma, brain infections and chromosomal defects. However, in all cases the association to schizophrenia has been refuted upon close evaluation.

Despite numerous studies on the brain, the cause of schizophrenia remains a puzzle. In some individuals, an abnormal amount of the two neurotransmitters, dopamine and glutamate, have been postulated as chief causes of schizophrenia. Many radiological studies on the brains of patients with schizophrenia show some structure and functional difference. However, these changes are not consistent and not seen in all individuals with schizophrenia. Moreover, researchers are not able to understand the significance of imaging changes in the brain of schizophrenics.

When does schizophrenia actually present in life?

Irrespective of what causes schizophrenia, the symptoms in all individuals are similar. The disorder usually starts in early adolescence in males and a little later in females. The majority of schizophrenia symptoms and signs appear in early adolescence and peak in the mid 20s. It is very rare to be diagnosed with schizophrenia after the age of 40. It is very rare for schizophrenia to develop in childhood or in elderly individuals.

It is usually apparent much earlier on that these individuals have an altered perception of reality. Some of the early signs of schizophrenia include hearing things that no one else can hear, seeing things that do not exist and feeling things that no one can feel. In most individuals with schizophrenia, symptoms and signs between real and imaginary become blurred and appear very frightening. In response to these early signs of schizophrenia, most of the individuals withdraw from the outside world and become loners or sometimes act out because of perceived threats from the unknown.

Are delusions common in all types of schizophrenia?

Yes, Delusions are common symptoms of all subtypes of schizophrenia. In most cases, the individual develops false beliefs that someone is out to harm or poison them. Delusions often result in spontaneous aggression or violence because the individual starts to act in self-defence to protect him/her against harm. Others may develop delusions of grandeur- some many believe that they can fly or will not be harmed by traffic when standing in the middle of the road. Delusions often lead these individuals to become paranoid and solitary. They become afraid and live a miserable life.

What type of hallucinations occur in people with schizophrenia?

The auditory hallucinations are the most common. Usually these individual hear voices that no one can hear. The voices are soft, intermittent and often persecutory. The voices can be very disturbing and prevent the individual from concentration on other thoughts. The voices are usually unpleasant, critical and may even be harassing. The voice or voices may speak to the individual or to one another. Sometimes the voices may command the individual to do harmful things against others or to themselves. Individuals with schizophrenia are consumed with these voices that appear real and authoritarian. Antipsychotic medications can help diminish these hallucinations.

What does it mean when the doctor says someone has positive symptoms of schizophrenia?

The positive symptoms of schizophrenia usually reflect an excess of altered normal behaviors. These  signs of schizophrenia include 1) delusions which are not based on reality but are usually false perceptions- seeing things that are not physically present 2) auditory hallucinations involve hearing things that no one else can hear, and in most cases the voices are persecutory or religious 3) thought disorder which creates difficulty in speaking or organizing thoughts in a lucid form and 4) disorganized behavior which may present as unpredictable childish behavior, anger or irritability.

How is the diagnosis of schizophrenia usually made?

The diagnosis of schizophrenia is made from the history and clinical presentation. There are no radiological or blood tests to make the diagnosis. It is important to make an early diagnosis of schizophrenia so that the symptoms can be treated while they are mild. Once the symptoms of schizophrenia are established, treatment is difficult and relapse is very common. Most patients with schizophrenia are unaware of their mental health disorder and do not readily seek help. The majority of individuals are encouraged by family members and friends to seek help, but sometimes problems with the law lead to a proper mental health evaluation and diagnosis. Most individuals with paranoid schizophrenia, who seek treatment, can lead a decent quality of life.

How can one tell if someone in the family has schizophrenia?

The first signs and symptoms of schizophrenia are usually recognized by family members or associates at work. It is important to seek help as soon as these odd symptoms are recognized. Even though there is no cure for schizophrenia, there are medications that can help ease the symptoms. When treatment is continued, many individual with schizophrenia can become independent and lead productive lives. Individuals who are reluctant to seek help for fear of embarrassment should understand that the paranoid symptoms can be controlled. In many cases, the individual with schizophrenia will become a danger to himself or others and in such cases, and emergency hospitalization is required. Different states have different laws on involuntary confinement for mental health treatment. Sudden worsening of schizophrenia symptoms can be controlled with use of antipsychotic drugs and sedative medications.

Can Schizophrenia progress without treatment?

Definitely, YES.

As the disorder progresses many individuals develop anxiety, spontaneous anger and appear to be aloof. Because of delusions, some individuals with schizophrenia do become violent in order to protect themselves from unknown threats. Both at work and at home, verbal confrontations are common often leading to disharmony and poor relationships. Many individuals with schizophrenia develop suicidal thoughts.  Over time, the individuals become loners and tend to have difficulties at work and in interpersonal relationships. Unfortunately, all types of schizophrenia progress and without treatment, most individuals end up in health institutions or in legal difficulties.

What does the doctor mean when he says someone has negative symptoms of schizophrenia?

The negative symptoms are early signs of schizophrenia and may present months or years before the positive symptoms. These early signs of schizophrenia may present with loss of interest, no emotion, a flat affect, neglect of personal hygiene, loneliness, and absence of motivation. Some of the other early warning signs may be eccentric behavior, lack of emotion or empathy and reclusiveness. Most individuals who do not seek treatment tend to have poor performance at school and work.

In some individuals with schizophrenia, early signs may reveal poor cognition. These symptoms are the most disabling and interfere with everyday tasks. Other early signs of schizophrenia include inability to comprehend information, difficulty paying attention and having regular memory problems. Finally, schizophrenia may also affect mood or cause mood swings. In most cases, these individuals immediately appear odd and lead a solitary life.

What are the currently available atypical antipsychotics? And which is the best drug?

The currently available newer anti psychotic medications are preferred over the older medications as a treatment for schizophrenia, chiefly because they have less serious side effects. The newer atypical antipsychotics include  

• Aripiprazole (Abilify)
• Clozapine (Clozaril)
• Olanzapine (Zyprexa)
• Paliperidone (Invega)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Ziprasidone (Geodon)

Side effects of these newer atypical antipsychotic medications include mild to moderate weight gain, high blood sugar and cholesterol.

Unfortunately, all the newer anti psychotics are expensive and often do not  work in all individuals. Sometimes they may work initially and then stop working. Because many psychiatrists work as paid consultants for the drug industry, it is hard to tell which of these drugs really works well. No doctor is going to bite the hand that feeds them a lot of money. Therefore, in some cases, bad drugs are marketed and their side effects are hidden. Such is life in the world of psychiatry.

Is there anything in the near future for treatment of schizophrenia?

Because no one knows what causes schizophrenia, the disorder has been difficult to treat. The majority of medications used today are not curative buy only partially relieve symptoms of disordered thought. Some researchers believe strongly that causes of schizophrenia are intricately linked to the environment and bad genes.

Researchers have started to utilize the latest radiological brain imaging techniques to determine what causes schizophrenia. These brain scans can also be used to follow up patients and their response to medications. Unfortunately brain scans are also expensive and often do not relate to a cause and effect. Until the cause of schizophrenia is found, one cannot take preventive steps. However, individuals with a strong family history should take preventive steps by avoiding illicit drug use, reducing stress, eating right and getting adequate sleep. Because schizophrenia causes extremely disturbed thoughts, it is important to be compliant with anti psychoactive medications to help minimize the symptoms or prevent them from getting worse.

My brother has paranoid schizophrenia and we are having a hard time coping. Anything you can suggest to make life better?

Getting the proper treatment for paranoid schizophrenia is vital to help overcome the bizarre thoughts and hallucinations. Even if one is reluctant, one should try to work up confidence and courage to see a doctor. These first steps can help one lead a decent quality of life. Family members should not be judgmental and encourage the individual to seek professional help. If any member of your family with schizophrenia poses a danger to himself or others, one may need to call emergency services and ask for help. In some cases, emergency hospitalization is required to treat the acute symptoms. 

Paranoid schizophrenics do develop suicidal thoughts and anyone with recurrent thoughts or intent of suicide, should immediacy talk to someone. The best advice is to go to a local hospital emergency room or call 911 and ask for help. Families with members affected with mental illness like schizophrenia are also given a hotline number to call in case of an emergency. There are many support groups that you can join and for more information, speak to your doctor. Hope that helps