Schizophrenia Spectrum Disorders

A severe and debilitating psychotic disorder, schizophrenia is often a chronic condition that affects a little less than one percent of the U.S. population. It is characterized by delusions, hallucinations, and disorganized speech, thinking, and behavior as well as negative symptoms, such as emotional flatness and lack of initiation. Symptoms typically emerge in males during late adolescence to early 20s and in females in the late 20s to early 30s, although there is some variability with age onset. 

There is thought to be a genetic component in schizophrenia. Research has found possible abnormalities in neurotransmitter activity in this disorder, although the exact mechanisms are still being studied. Additional risk factors include childhood adversity, oppression and discrimination, poverty, having an older birth father, and other psychosocial factors. 

People with schizophrenia have an increased risk for co-occurring conditions, such as anxiety disorders, obsessive-compulsive disorder (OCD), and tobacco use disorder. Sadly, 20 percent of individuals with schizophrenia will attempt suicide at least once, and five to six percent will take their own life. 

The symptoms of this condition are largely the same as schizophrenia. What sets them apart is that in schizophreniform disorder, an episode of symptoms will last between one and six months, whereas in schizophrenia symptoms last at least six months and often much longer. It appears that approximately 33 percent of people who are diagnosed with schizophreniform disorder won’t progress to a more severe condition. However, the other two-thirds will eventually be diagnosed with schizophrenia or schizoaffective disorder. 

In schizoaffective disorder, a person will have an episode of either mania or major depression at the same time they have positive and negative symptoms of schizophrenia (described above). Once the mood episode has passed, the psychotic symptoms persist for at least two weeks afterward. As in schizophrenia, five percent of people with this very challenging disorder will die by suicide. Although it typically develops in early adulthood, schizoaffective disorder can emerge any time from adolescence on—even later in life. 

People with schizotypal personality disorder display eccentric behaviors and have an uneasiness with interpersonal functioning as well as deficits in interacting with others. They are socially anxious and often have paranoid, strange, superstitious, or unusual beliefs. Stress may trigger psychotic episodes in those who have schizotypal personality disorder. It is estimated that slightly over three percent of the U.S. population have this condition, which does not change much during a person’s lifetime. However, a small percentage of people who have it will develop schizophrenia or a related psychotic disorder. 

As the name of this condition implies, people with it have delusions—false beliefs to which they hold tightly despite an absence of evidence that they are true or real. Delusions frequently fall into specific themes, such as these:

Although there is generally less impairment in this condition compared to other psychotic disorders, problems in social, relational, and occupational functioning as a result of their false, delusional beliefs are common. There is a genetic link between delusional disorder and both schizophrenia and schizotypal personality disorder. And some individuals with delusional disorder will eventually develop schizophrenia.

What separates brief psychotic disorder from other psychotic conditions is that there is a quick onset of symptoms which includes at least one of these: delusions, hallucinations, or incoherent/bizarre speech. The symptoms last anywhere from a single day to a full month. Even though this mental illness has a shorter course than the other psychotic disorders, the symptoms are very intense and distressing and can cause significant impairment in functioning as well as an increased risk for suicide. Often, patients will need to be hospitalized until they become stable, but once the episode has fully resolved, they return to their normal level of functioning. Brief psychotic disorder can emerge at almost any time during a person’s lifespan, and half of the people who have one episode will have another at some point. Although there is not a single cause for this condition, it has been known to occur during postpartum or very stressful periods in life. 

Not surprisingly, substance and alcohol abuse can lead to a psychotic episode. In some cases, it might come from excessive intake, such as a period of very heavy drinking or a cocaine binge. In other cases, psychosis can occur during withdrawal from drugs or alcohol. In one study, 74 percent of people with first episode psychosis had a substance use disorder at some point during their life. Cannabis, LSD, alcohol, amphetamines, cocaine, and other substances are associated with an increased risk of psychosis in people who have an underlying predisposition. 

It is also possible to become psychotic from prescribed pharmaceutical medications (that are not being abused), including some common antibiotics, muscle relaxants, pain relievers, Parkinsonian medications, and others. Some people, especially older individuals who are taking several medications for medical issues, can develop psychosis. Fortunately, in many cases the hallucinations or delusions go away when the offending medication is removed or changed, such as by adjusting the dose. 

There are many medical problems in which psychotic symptoms, especially hallucinations and delusions, can occur. Among them are: 

Many people with resistant psychiatric conditions, such as schizophrenia, have been exposed to infectious agents that damaged their brains. In 1994, the Schizophrenia Bulletin published an image comparing the areas of the United States with the highest rates of Lyme disease and schizophrenia. They were nearly identical. 

At Amen Clinics, we’ve treated hundreds of patients who came to us with resistant psychiatric symptoms and subsequently tested positive for Lyme disease. They were helped significantly when we treated their underlying Lyme infection. A 2014 study reported that the antibiotic minocycline, used to treat Lyme disease, was found to decrease symptoms of schizophrenia in a 12-month period. 

Other infections also have a connection to schizophrenia and other mental health disorders. In an important study from Denmark, patients who had infections, even those that did not require hospitalization, had a higher incidence of schizophrenia and depression. Infections that have been linked to schizophrenia include: 

Many autoimmune illnesses are linked with psychiatric issues. For example, having an autoimmune disease is associated with a 45 percent increased risk for schizophrenia. Researchers are still trying to pinpoint the exact causes of autoimmune disorders, but many factors can play a role in their development, including: 

Gluten sensitivity and celiac disease are related to a number of psychiatric disorders and symptoms, including schizophrenia. A growing body of evidence suggests that nutritional treatment may help prevent, treat, or improve the symptoms of schizophrenia spectrum disorders, and other conditions, such as depression, bipolar disorder, anxiety disorders, autism spectrum disorder, addiction, and attention deficit hyperactivity disorder (ADHD), also known as attention deficit disorder (ADD). Adopting a gluten-free diet has been associated with improvements in people with mental health conditions. Research found a decrease, or even full remission, of symptoms in a subset of patients with schizophrenia after following a gluten-free diet.