Introduction
Schizophrenia is a severe, chronic mental disorder typically characterized by significant cognitive, emotional, and behavioral disturbances that severely impact the patient’s daily life and social functioning. The clinical features of the disease include hallucinations, delusions, emotional blunting, and cognitive dysfunction. These symptoms not only affect the patient's self-awareness and social interactions but can also lead to social isolation and loss of occupational function. Schizophrenia typically emerges in adolescence or early adulthood, with a high relapse rate and a chronic course, making it one of the most challenging mental disorders.
Although the exact cause of schizophrenia remains unclear, increasing research has revealed the significant roles of genetic factors, neurochemical imbalances, and environmental stressors in its development. There is a complex interplay between stress, sleep quality, and schizophrenia. Studies have shown that prolonged psychological stress can act as a triggering factor for schizophrenia (Green, Girshkin, Teroganova, Quide, 2014), especially in vulnerable individuals. Stress can alter the brain’s neurotransmitter systems (such as dopamine and cortisol) and reduce sleep quality (Zhang et al., 2024), thereby affecting psychological health (Zhang, Xiang, Li, Tang, & Hu, 2024). Furthermore, schizophrenia patients often experience sleep disturbances such as insomnia, early awakening, or sleep cycle disruption, which not only impair cognitive and emotional functions but may also exacerbate psychiatric symptoms (Hofstetter & Mayeda, 2008). Stress can further disrupt sleep by inducing anxiety and mood swings, creating a vicious cycle. Therefore, managing stress and improving sleep quality are crucial in the treatment of schizophrenia (Cohen & Wills, 1985).
With ongoing research into schizophrenia, treatment methods and rehabilitation strategies have gradually improved. Modern medical treatment is primarily based on antipsychotic drugs; however, the side effects, drug resistance, and issues of medication adherence remain significant barriers to treatment. As a result, in addition to pharmacotherapy, non-drug treatment approaches such as cognitive behavioral therapy, psychosocial interventions, and family support are increasingly being utilized. This review aims to summarize the latest advancements in the etiology, clinical symptoms, treatment methods, and rehabilitation process of schizophrenia, providing theoretical support for clinical treatment and offering insights into future research directions.
The Meaning, Symptoms, and Dangers of Schizophrenia
Schizophrenia typically manifests in adolescence or early adulthood, presenting with significant abnormalities in thought, emotion, and behavior. It is one of the most common forms of psychosis, affecting approximately 1% of the global population (American Psychiatric Association, 2013). The hallmark of schizophrenia is the severe disruption of cognitive, emotional, and social functioning. Patients often experience hallucinations, delusions, disorganized speech, and emotional blunting, leading to a severe distortion of reality. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnosis of schizophrenia requires the presence of at least two positive symptoms, such as hallucinations, delusions, or thought disorder, with symptoms lasting for more than six months (American Psychiatric Association, 2013).
What Causes Schizophrenia?
The exact cause of schizophrenia remains unclear, but research suggests that it results from the interaction of genetic, environmental, and neurobiological factors. Genetic factors play a significant role in the development of schizophrenia. A large body of family and twin studies indicates that schizophrenia has a hereditary component, with a significantly increased risk for relatives of affected individuals. Twin studies have shown that if one monozygotic twin is diagnosed with schizophrenia, the other twin has about a 50% chance of also being affected, whereas the likelihood in dizygotic twins is only about 10% (Gottesman, 1991). This suggests that genetic factors are one of the important causes of schizophrenia. However, genetic susceptibility alone cannot fully explain the onset of the disease, and environmental factors also play a crucial role.
In addition to genetic factors, environmental factors such as prenatal infections, birth trauma, malnutrition, and early psychosocial stress have been closely linked to the development of schizophrenia. For example, viral infections or other physiological stressors during pregnancy may lead to abnormal brain development in the fetus, increasing the risk of later developing schizophrenia (Moreno et al., 2011). Additionally, major life stresses, such as childhood abuse or prolonged social isolation, can trigger or exacerbate schizophrenia symptoms (van-Os et al., 2000). These environmental factors may influence brain development and neurochemical processes, potentially triggering the onset of schizophrenia in susceptible individuals.
Neurobiological factors, particularly abnormalities in neurotransmitter systems in the brain, are a key pathogenic mechanism in schizophrenia. The dopamine hypothesis is one of the classic theories of the pathological mechanisms of schizophrenia, suggesting that excessive dopamine activity is closely related to the positive symptoms (such as hallucinations and delusions) of the disorder (Meisenzahl, Schmitt, Scheuerecker, & Möller, 2007). Additionally, abnormalities in neurotransmitters such as glutamate and gamma-aminobutyric acid (GABA) are also associated with schizophrenia symptoms. Recent neuroimaging studies have revealed structural and functional abnormalities in the brains of individuals with schizophrenia, particularly in regions such as the prefrontal cortex and hippocampus, further supporting the important role of neurobiological factors in the pathogenesis of schizophrenia (Harrison, 1997).
Treatment Methods for Schizophrenia
The treatment of schizophrenia primarily involves a combination of pharmacotherapy, psychotherapy, social support, and rehabilitation training. Pharmacological treatment is the cornerstone of schizophrenia therapy, with antipsychotic medications effectively alleviating the positive symptoms, such as hallucinations and delusions. Traditional antipsychotics (such as chlorpromazine and haloperidol) can reduce symptoms but often come with significant side effects, such as movement disorders and sedation. In recent years, second-generation antipsychotics (such as risperidone and olanzapine) have been widely used in treatment. These medications are more effective in alleviating positive symptoms and have shown some benefits in improving negative symptoms and cognitive functions (Jibson & Tandon, 2003).
Psychotherapy is also an essential component of schizophrenia treatment. Cognitive-behavioral therapy (CBT) is considered one of the most effective psychological treatments. CBT helps patients identify and change negative thought patterns and behaviors, thereby alleviating symptoms like anxiety and depression and improving self-control and adaptability (Jauhar et al., 2014). Additionally, family therapy and supportive psychotherapy can assist both patients and their families in coping with the disease, offering emotional support and reducing the risk of relapse. By enhancing the patient's social support system, psychotherapy contributes to long-term recovery and the restoration of social functioning.
Social support and rehabilitation training also play crucial roles in treatment. Schizophrenia patients often face difficulties in social functioning, such as challenges with employment, social interactions, and independent living. Rehabilitation training aims to help patients reintegrate into society through skills training and community support, thereby improving their daily living skills and social interaction abilities (Tao et al., 2015). Multidisciplinary teams, including psychologists, social workers, nurses, and rehabilitation trainers, collaborate during the treatment process, helping patients improve their social functioning and overall quality of life.
Clinical Rehabilitation of Schizophrenia
The clinical rehabilitation of schizophrenia refers to the process of helping patients restore social function, improve quality of life, and enhance their ability to live independently through a series of treatments and interventions. The goal of rehabilitation is not only to alleviate symptoms but also to focus on the patient’s reintegration into social, occupational, and family life. After undergoing treatment for the acute phase of the illness, schizophrenia patients often face cognitive impairments, social withdrawal, reduced work capacity, and difficulties in communication with others. Therefore, rehabilitation treatment plays an extremely important role in the long-term management of the disease. Clinical rehabilitation typically involves a comprehensive approach, including pharmacological treatment, psychotherapy, social support, and functional training.
Firstly, pharmacological treatment is an important component of clinical rehabilitation. Antipsychotic medications effectively alleviate positive symptoms, reducing disturbances caused by hallucinations, delusions, and other symptoms, thus providing a foundation for patients to regain normal social functions. However, side effects of medications and issues with patient adherence remain one of the challenges in the rehabilitation process. Therefore, healthcare professionals must develop individualized treatment plans based on the patient's specific situation and regularly monitor the effects and side effects of the medications (Boison et al., 2012). In addition, patients' adherence to medication often directly influences the success of rehabilitation, as long-term medication treatment is closely related to the stabilization of symptoms.
Secondly, cognitive rehabilitation training is crucial for the clinical rehabilitation of schizophrenia patients. Research indicates that schizophrenia patients often experience cognitive impairments, including deficits in attention, memory, and executive functions. Cognitive training, through systematic psychological interventions, helps patients improve these cognitive deficits and enhances their daily living abilities (Zhao et al., 2013). Cognitive-behavioral therapy (CBT) is also widely used to treat emotional and thought disorders in schizophrenia patients, helping them identify and change negative thought patterns, thereby improving symptoms and increasing adaptability.
Conclusion
Schizophrenia is a complex mental disorder with significant biological, psychological, and sociological backgrounds. Although antipsychotic medications are currently effective in alleviating symptoms, issues such as poor medication adherence, side effects, and relapse remain challenges in treatment. To improve treatment outcomes, cognitive rehabilitation training, psychosocial interventions, and family support are increasingly being incorporated into schizophrenia treatment. With advances in genomics and neuroscience, researchers are exploring the genetic susceptibility to schizophrenia and its molecular mechanisms, hoping that through genetic screening and the identification of biomarkers, earlier diagnosis and personalized treatment will be possible. Meanwhile, advancements in neuroimaging technologies allow for a deeper understanding of the structural and functional changes in the brains of schizophrenia patients, providing new targets for treatment. In terms of pharmacological treatment, in addition to existing antipsychotic medications, the development of new drugs is ongoing, particularly those addressing drug tolerance and side effects, with the potential for more effective medications with fewer side effects in the future.
