What is the presentation of schizophrenia?
The person usually has an unexeptional childhood. There may be a history of complications with the pregnancy and birth, delayed milestones, bed-wetting, and anxiety as a child.
Males and females are usually affected at equal rates, but males develop the disease at a younger age. It is thought that oestrogen conveys protection against early developent of schizophrenia. Males will typically develop schizophrenia in their late teens to early 20s. The incidence in females peaks in early 20s and then again in mid 30s. The earlier the disease starts developing, the poorer the prognosis. Females tend to develop schizophrenia later than males, and which usually means they attain a greater level of functioning before the illness, which confers a better outcome. Often there is comorbid drug abuse which complicates the diagnosis, and the use of alcohol to mask and cope with symptoms. It is then difficult to unravel the effects of the illness and that of the behavioural and/or psychogenic effects of the illicit drugs.
A so-called prodrome heralds the start of the illness. This might go unnoticed and only recognised in retrospect. This prodrome is seen as an important phase in the development of schizophrneia and a possibly early treatment opportunity. There may be an associated change in personality and a decline in social and academic peformance.
The mild attenuated symptoms of the prodrome eventually develop into overt symptoms is in late-teens to early adulthood. At this point if the individual is overwhelmed by his experiences there might be an acute decompensation and presentation to police or medical services. Or otherwise the individual might be able to cope and continue living with their symptoms with a more gradual decompensation.
There are various forms of schizophrenia. Paranoid schizophrenia is the commonest form. Family start noticing bizarre behaviours. eg talking and responding as if to someone when no one is around. Talking to the TV or radio. Appearing very suspicious or afraid and isolating themselves.
But the presentation can be varied. Rarely patients can present with catatonia. They may present with predominantly mood symptoms at first, and be diagnosed as anxious or depressed. The psychotic symptoms may only become more evident later.