Schizophrenia is characterised by significant impairments in the way reality is perceived and changes in behaviour related to:
- persistent delusions: the person has fixed beliefs that something is true, despite evidence to the contrary;
- persistent hallucinations: the person may hear, smell, see, touch, or feel things that are not there;
- experiences of influence, control or passivity: the experience that one’s feelings, impulses, actions, or thoughts are not generated by oneself, are being placed in one’s mind or withdrawn from one’s mind by others, or that one’s thoughts are being broadcast to others;
- disorganized thinking, which is often observed as jumbled or irrelevant speech;
- highly disorganised behaviour e.g. the person does things that appear bizarre or purposeless, or the person has unpredictable or inappropriate emotional responses that interfere with their ability to organise their behaviour;
- “negative symptoms” such as very limited speech, restricted experience and expression of emotions, inability to experience interest or pleasure, and social withdrawal; and/or
- extreme agitation or slowing of movements, maintenance of unusual postures.
People with schizophrenia often also experience persistent difficulties with their cognitive or thinking skills, such as memory, attention, and problem-solving.
At least one third of people with schizophrenia experiences complete remission of symptoms (1). Some people with schizophrenia experience worsening and remission of symptoms periodically throughout their lives, others a gradual worsening of symptoms over time.
Magnitude and impact
Schizophrenia affects approximately 24 million people or 1 in 300 people (0.32%) worldwide. This rate is 1 in 222 people (0.45%) among adults (2). It is not as common as many other mental disorders. Onset is most often during late adolescence and the twenties, and onset tends to happen earlier among men than among women.
Schizophrenia is frequently associated with significant distress and impairment in personal, family, social, educational, occupational, and other important areas of life.
People with schizophrenia are 2 to 3 times more likely to die early than the general population (3). This is often due to physical illnesses, such as cardiovascular, metabolic, and infectious diseases.
People with schizophrenia often experience human rights violations both inside mental health institutions and in community settings. Stigma against people with this condition is intense and widespread, causing social exclusion, and impacting their relationships with others, including family and friends. This contributes to discrimination, which in turn can limit access to general health care, education, housing, and employment.
During humanitarian and public health emergencies, extreme stress and fear, breakdown of social supports, isolation and disruption of health-care services and supply of medication can occur. These changes can have an impact on the lives of people with schizophrenia, such as exacerbation of existing symptoms. During emergencies, people with schizophrenia are more vulnerable than others to various human rights violations, including neglect, abandonment, homelessness, abuse and exclusion.
Causes of schizophrenia
Research has not identified one single cause of schizophrenia. It is thought that an interaction between genes and a range of environmental factors may cause schizophrenia. Psychosocial factors may also affect the onset and course of schizophrenia. Heavy use of cannabis is associated with an elevated risk of the disorder.
Services
Currently, the vast majority of people with schizophrenia around the world are not receiving mental health care. Approximately 50% of people in mental hospitals have a schizophrenia diagnosis (4). Only 31.3% of people with psychosis receive specialist mental health care (5). Most resources for mental health services are inefficiently spent on care within mental hospitals.
There is clear evidence that mental hospitals are not effective in providing the care that people with mental health conditions need and, regularly, violate the basic human rights of persons with schizophrenia. Efforts to transfer care from mental health institutions to the community need to be expanded and accelerated. Such efforts start with the development of a range of quality community-based mental health services. Options for community-based mental health care include integration in primary health and general hospital care, community mental health centres, day centres, supported housing, and outreach services for home-based support. The engagement of the person with schizophrenia, family members and the wider community in providing support is important.
Management and support
A range of effective care options for people with schizophrenia exist, and these include medication, psychoeducation, family interventions, cognitive-behavioural therapy and psychosocial rehabilitation (e.g., life skills training). Facilitated assisted living, supported housing and supported employment are essential care options that should be available for people with schizophrenia. A recovery-oriented approach – giving people agency in treatment decisions – is essential for people with schizophrenia and for their families and/or caregivers as well.
WHO response
WHO’s Comprehensive Mental Health Action Plan 2013-2030 highlights the steps required to provide appropriate services for people with mental disorders including schizophrenia. A key recommendation of the Action Plan is to shift services from institutions to the community. The WHO Special Initiative for Mental Health aims to further progress towards objectives of the Comprehensive Mental Health Action Plan 2013-2030 by ensuring 100 million more people have access to quality and affordable care for mental health conditions.
WHO's Mental Health Gap Action Programme (mhGAP) uses evidence-based technical guidance, tools and training packages to expand service in countries, especially in resource-poor settings. It focuses on a prioritized set of conditions, including psychosis, directing capacity building towards non-specialized health-care providers in an integrated approach that promotes mental health at all levels of care. Currently mhGAP is being implemented in more than 100 WHO Member States.
The WHO QualityRights Project involves improving the quality of care and human rights conditions in mental health and social care facilities and to empower organizations to advocate for the health of people with mental health conditions and psychosocial disabilities.
The WHO guidance on community mental health services and person-centred and rights-based approaches provides information and support to all stakeholders who wish to develop or transform their mental health system and services to align with international human rights standards including the UN Convention on the Rights of Persons with Disabilities.
References
(1) Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J. Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry 2001;178:506-17.
(2) Institute of health Metrics and Evaluation (IHME). Global Health Data Exchange (GHDx). //ghdx.healthdata.org/gbd-results-tool?params=gbd-api-2019-permalink/27a7644e8ad28e739382d31e77589dd7 (Accessed 25 September 2021)
(3) Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. Annual Review of Clinical Psychology, 2014;10, 425-438.
(4) WHO. Mental health systems in selected low- and middle-income countries: a WHO-AIMS cross-national analysis. WHO: Geneva, 2009
(5) Jaeschke K et al. Global estimates of service coverage for severe mental disorders: findings from the WHO Mental Health Atlas 2017 Glob Ment Health 2021;8:e27.
Communication can be a window into your thoughts, making it an important clue in understanding possible mental health conditions.
Almost everyone experiences moments of confusion. You might have a word on the tip of your tongue and you just can’t get it out, or maybe you’ve forgotten where you’re going with a conversation.
Many things can impact thought clarity, but disorganized speech that prevents you from daily communication may be a sign of something more than forgetfulness.
Disorganized speech is also known as “formal thought disorder” since language is the primary way to detect changes in your thought patterns.
Disorganized speech is any interruption that makes communication difficult — and sometimes impossible — to understand.
Brief disorganized speech can be common and nonspecific, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).
But if it becomes severe enough to prevent effective communication, you may be experiencing formal thought disorder.
Types and examples of disorganized speech
There are many ways your speech might be considered disorganized, but symptoms often fall into categories:
- Symbolism: pairing of thoughts with the correct meaning
- Tempo: the fluidity of words and conversation
- Processing: quality of thought content
- Continuity: direction of thought and conversation
Examples of specific types of disorganized speech may include:
- Paralogism: unusual word choice
- Verbal paraphasia: incorrect word usage
- Literal paraphasia: disordered sounds or sound sequence in words
- Neologism: creation of new words
- Displacement: citing a similar idea but not the correct one
- Contamination: fusing ideas into one another
- Accelerated thinking: rapid flow and increased volume of speech
- Flight of ideas: losing track of where a thought is going
- Inhibited thinking: slow processing of ideas
- Alogia: restricted speech and/or inadequate relay of information
- Circumstantial thinking: inability to determine essential information from unessential
- Desultory thinking: random topic jumps during conversation
- Derailment: sudden drop in train of thought
- Omission: inability to recall a main thought point
- Overinclusive thinking: conversation limits are never identified
- Echolalia: repetition of words or phrases
- Palilalia: fast repetition of words or phrases with decreasing audibility
- Thought blocking: Sudden gaps in thought for no obvious reason
- Verbigeration: nonsensical repetition of words
- Incoherence: complete speech disorganization; “word salad”
There’s no “one size fits all” way to describe disorganized speech. At its core, it can be any language-focused symptom that impairs communication.
If you’re experiencing disorganized speech, you may notice speech patterns related to:
- repetition
- unexpected pauses
- incorrect words
- unusual pronunciation
- loss of thought placement
- lack of words
- excess of words
- slow or absent word processing
The exact cause of disorganized speech is still being investigated.
As a symptom closely associated with mental health conditions, disorganized speech may be partially due to differences in the central nervous system.
Language and words are skills you learn. They’re stored in your memories.
Many of the mental health conditions that feature symptoms of disorganized speech involve changes in regions of the brain related to memory, speech, and language.
Some 2017 research suggests changes in neural connectivity in these areas could affect communication.
If you’re unable to form the proper connections in the part of the brain that grants access to language memories, you may not be able to organize your thoughts into words.
Other factors may also influence disorganized speech. Times of extreme stress, anxiety, or fear could cause an interruption in your natural speech patterns.
Seeking professional treatment can be one of the best ways to learn to manage disorganized speech and see an improvement.
Treatment largely depends on addressing the underlying condition causing disorganized speech as a symptom.
Seeking treatment for a traumatic brain injury, for example, may be significantly different than treatment for bipolar disorder.
Your physician or therapist can help identify why you’re experiencing disorganized speech. If a mental health condition is contributing, successful treatment may involve:
- medications
- psychotherapy
- self-care or lifestyle changes
The medication you’re prescribed and the type of therapy recommended will depend on the condition your physician and therapist feel is at the heart of your symptoms.
Coping with disorganized speech
Aside from medications and therapy, there are many other strategies for coping with disorganized speech.
Self-care and simple lifestyle changes that can help you manage disorganized speech include:
- Social support: building a supportive network of understanding family and friends, joining support groups
- Building communication skills: participating in discussion groups around building social skills, developing alternative communication options with your therapist or counselor
- Medical self-care: staying on track with taking medications as directed, attending appointments regularly for the entire treatment protocol
- Lifestyle changes: developing stress-relief options and relaxation techniques, trying to eat a nutritious diet, focusing on sleep hygiene, exercising regularly, spending time outside
Disorganized speech can present in many different ways and may even prevent effective communication if it progresses. And while it can be a symptom of many mental health conditions, disorganized speech is not a diagnosis in itself.
Living with disorganized speech can be frustrating and may even cause social anxiety, stress, and isolation in some people.
However, disorganized speech can be managed with the proper treatment, which often involves addressing conditions causing this symptom.
Working with your doctor or physician to tailor a treatment plan to you is often the best first step. Depending on any underlying conditions, treatment plans for disorganized speech commonly involve a combination of:
- medication
- therapy
- self-care and lifestyle changes
It’s not always easy to reach out for help with mental health conditions. If you’re ready to seek support but don’t know where to start, check out Psych Central’s guide to mental health help.