Hey, I had a couple questions about schizophrenia. I know one person's experiences aren't necessarily universal, but there are different types, right? And how do they impact day to day life? (Also this is an out there question, but I'm fascinated by neurochemistry, do you know how antipsychotics work, or are they one of those psych meds that no one is really sure about? I know psych meds aren't always the answer, but they interest me)
Different Types of Schizophrenia:
There used to be different types of schizophrenia outlined in the DSM (paranoid, disorganized, catatonic, undifferentiated, and residual). Some people who were diagnosed more than 10 years ago might still have one of these types attached to their diagnosis, but the DSM-V kind of just lumped everything in together. Some mental health professionals still use the types to plan treatment, though.
Paranoid schizophrenia was the "classic" most common type of schizophrenia. It involved delusions, hallucinations, disorganized speech, trouble concentrating, behavioral impairment, and flat affect (inability to display emotions).
Disorganized schizophrenia mostly had "negative" and "cognitive" symptoms, without hallucinations or delusions. This type of schizophrenia included: flat affect, speech disturbances, disorganized thinking, involuntary or unexpected emotions or facial reactions, and trouble with daily activities.
Catatonic schizophrenia was rare, and catatonia itself can be a symptom of a lot of different mental health problems, so it wasn't a great descriptor. It included: immobility, mimicking behavior, inability to speak, and stupor.
Undifferentiated schizophrenia basically means the person had a combination of the symptoms of other types of schizophrenia.
Residual schizophrenia was basically a period of partial remission.
How schizophrenia impacts day-to-day life depends a lot on the individual. For example, while I do consider myself to have a psychiatric disability that limits me in certain ways, when I take the right meds (risperidone FTW), I am very functional. I live with my wife, work (at a very specific job), and go to (online, asynchronous) school.
But I also know people with my same diagnosis who, even medicated appropriately, live in assisted living or other supported housing arrangements and who are unable to work. It's definitely a spectrum.
Prior to getting the right medications I had trouble holding a job, thought someone had poisoned my walls, and that other people could hear my thoughts. I had many conversations with my wife where neither of us could understand the concepts the other was trying to get across. I still have trouble when people ask me verbal questions that require long answers- I simply forget what they asked a few sentences in and forget what I'm trying to say in response. I struggle with focus and motivation (you would not believe how many times I tried to make a Schizophrenia Awareness Day post). These are all schizophrenia things.
There are 3 types of antipsychotics. First generation, second generation, and next generation.
There are a lot of disrupted brain processes in schizophrenia. One of the main ones, and the one likely responsible for a lot of the "positive" symptoms (delusions, hallucinations, paranoia, etc...) is the presence of dopamine.
You and I rely on dopamine to make things interesting and assign meaning and importance to our world. In people with schizophrenia, certain parts of the brain have too much dopamine. Because of this, the brain assigns meaning where there is none. This causes delusions and paranoia, because normal things get "tagged" as important when they're innocuous, and the brain tries to explain that importance by making something up- and does it... badly. Cigarette stains on a wall become "someone poisoned my walls". A car going around a block twice becomes "the CIA is watching me". Etc... There are lots of theories as to why hallucinations occur, one of which is a misinterpretation of "noise" signals in the brain, which also has to do with dopamine.
First and second generation antipsychotics work by blocking the D2 dopamine receptors in these regions. Because of this, the excess dopamine can't cause as much misinterpretation, and the psychosis diminishes.
HOWEVER. We don't have a drug that can perfectly block D2 dopamine receptors only in the areas of the brain that are affected. And dopamine does a lot more than just make things interesting. So you get things like movement disorders and hormonal disorders and weight gain too since the drugs block dopamine everywhere in the body.
First generation (drugs like haloperidol, chlorpromazine, and loxapine) typically have more movement-related side effects, like tardive diskinesia. Second generation (drugs like risperidone, olanzapine, quetiapine, and aripiprazole) typically have more metabolic side effects like weight gain and diabetes.
Then there's next generation antipsychotics. Well, antipsychotic, singular, because there's only one of them on the market right now. This is xenomaline/trospium. As far as we know, it stimulates different kinds of receptor, called M1 and M4 muscarinic acetylcholine receptors, which indirectly impact dopamine production. Because it is not blocking dopamine receptors, it has a lot fewer side effects than first and second generation therapies.
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