Schizophrenia and Schizoaffective Disorders

A severe and debilitating psychotic disorder, schizophrenia is often a chronic condition that affects about 1% 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, and other psychosocial factors.
People with schizophrenia have an increased risk for co-occurring conditions, such as anxiety, obsessive-compulsive disorder, and tobacco use disorder. Sadly, 20% of individuals with schizophrenia will attempt suicide at least once, and 5%-6% will take their own life.

The symptoms of this condition are largely the same as in schizophrenia. What sets them apart is that in schizophreniform disorder, an episode of symptoms will last between 1 and 6 months, whereas in schizophrenia symptoms last at least 6 months and often much longer. It is estimated that approximately 33% 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 2 weeks afterward. As in schizophrenia, 5% 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 3% 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:

• Persecutory delusions—the belief that someone or a group of others intends to cause some kind of harm to the person. This is the most common type of delusion.
• Grandiose delusions—falsely believing they have extraordinary abilities (albeit unrecognized), notoriety, or financial success
• Erotomanic delusions—erroneous belief that someone, usually a person they don’t know (i.e. a famous actor) is in love with them
• Jealous delusions—believing that one’s spouse or significant other is being unfaithful, even though they are not. This delusion is more common in men than women.
• Somatic delusions—these involve imagined sensations and/or functions in the body

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 is 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.

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% 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:

• Head Injuries—Traumatic brain injuries increase the risk of psychosis in the months and years following the head injury.
• Neurological Disorders—Having Alzheimer’s disease or other type of dementia, stroke, brain tumor, epilepsy, and Parkinson’s disease may increase the risk for psychotic episodes.
• Infections—Some cases of chronic infections, such as Lyme disease, syphilis, and HIV/AIDS as well as strep, mycoplasma pneumonia, herpes simplex, toxoplasma gondii, and fungal infections have been associated with psychotic episodes.
• Hormonal Changes—The hormonal changes that occur during puberty put adolescents and young adults at greater risk of developing psychosis, as does the decline in estrogen for women approaching menopause.
• Sleep Deprivation—Chronic insomnia can lead to psychotic symptoms. Research has found that symptoms can appear after 24 hours without sleep and will worsen with continued sleeplessness.
• Autoimmune Diseases—Having an autoimmune disease can increase the risk for psychosis. Researchers have found many possible contributing factors, including:
  • Environmental allergens—pollen, dust mites, mold
  • Exposure to toxins
  • Food allergens—dairy, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soybeans are the top 8, according to the FDA
  • Lack of exercise or excessive exercise
  • Leaky gut
  • Obesity
  • Poor diet or nutrient deficiencies
  • Sleep disorders
  • Stress

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 conditions. 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:

• Strep
• Mycoplasma pneumonia
• Herpes simplex
• Toxoplasma gondii—a tiny single-celled parasite that is often carried in cats and shed in their feces
• Fungal infections

Many autoimmune illnesses are linked with psychiatric issues. For example, having an autoimmune disease is associated with a 45% 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:

• Leaky gut
• Environmental allergens—pollen, dust mites, mold
• Food allergens—dairy, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soybeans are the top 8, according to the FDA
• Toxins
• Obesity
• Head trauma
• Lack of exercise or excessive exercise
• Poor diet
• Nutrient deficiencies
• Stress
• Sleep disorders

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 schizophrenia, schizoaffective disorder, and other conditions, such as depression, bipolar disorder, anxiety, ADHD, autism, and addiction. 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.