Schizophrenia is a mental disorder characterized by loss of contact with reality (psychosis), hallucinations (usually, hearing voices), firmly held false beliefs (delusions), abnormal thinking, a restricted range of emotions (flattened affect), diminished motivation, and disturbed work and social functioning.

Schizophrenia is probably caused by hereditary and environmental factors.

People may have a variety of symptoms, ranging from bizarre behavior and rambling, disorganized speech to loss of emotions and little or no speech to inability to concentrate and remember.

Doctors diagnose schizophrenia based on symptoms after they do tests to rule out other possible causes.

How well people do depends largely on whether they take the prescribed drugs as directed.

Treatment involves antipsychotic drugs, rehabilitation and community support activities, and psychotherapy.

Schizophrenia is a major health problem throughout the world. The disorder typically strikes young people at the very time they are establishing their independence and can result in lifelong disability and stigma. In terms of personal and economic costs, schizophrenia has been described as among the worst disorders afflicting humankind.

Schizophrenia is the 9th leading cause of disability worldwide. It affects about 1% of the population. Schizophrenia affects men and women equally. In the United States, schizophrenia accounts for about 1 of every 5 Social Security disability days and 2.5% of all health care expenditures. Schizophrenia is more common than Alzheimer's disease and multiple sclerosis.

Determining when schizophrenia begins (onset) is often difficult because unfamiliarity with symptoms may delay medical care for several years. The average age at onset is 18 for men and 25 for women. Onset during childhood or early adolescence is uncommon (see Mental Health Disorders in Children: Childhood Schizophrenia). Onset is also uncommon late in life.

Deterioration in social functioning can lead to substance abuse, poverty, and homelessness. People with untreated schizophrenia may lose contact with their families and friends and often find themselves living on the streets of large cities.


Did You Know...


Schizophrenia is more common than Alzheimer's disease and multiple sclerosis.

Various disorders, including thyroid disorders, brain tumors, seizure disorders, and other mental health disorders, can cause symptoms similar to those of schizophrenia.



Causes

What precisely causes schizophrenia is not known, but current research suggests a combination of hereditary and environmental factors. Fundamentally, however, it is a biologic problem (involving changes in the brain), not one caused by poor parenting or a mentally unhealthy environment. People who have a parent or sibling with schizophrenia have about a 10% risk of developing the disorder, compared with a 1% risk among the general population. An identical twin whose co-twin has schizophrenia has about a 50% risk of developing schizophrenia. These statistics suggest that heredity is involved.

Other causes may include problems that occurred before, during, or after birth, such as influenza in the mother during the 2nd trimester of pregnancy, oxygen deprivation at birth, a low birth weight, and incompatibility of the mother's and infant's blood type.

Symptoms

The onset of schizophrenia may be sudden, over a period of days or weeks, or slow and insidious, over a period of years. Although the severity and types of symptoms vary among different people with schizophrenia, the symptoms are usually sufficiently severe as to interfere with the ability to work, interact with people, and care for oneself. In some people with schizophrenia, mental function declines, leading to an impaired ability to pay attention, think in the abstract, and solve problems. The severity of mental impairment largely determines overall disability in people with schizophrenia.

Symptoms may be triggered or worsened by environmental stresses, such as stressful life events. Drug use, including use of marijuana, may trigger or worsen symptoms as well.

Categories: Overall, the symptoms of schizophrenia fall into four major categories:

Positive symptoms

Negative symptoms

Disorganization

Cognitive impairment

People may have symptoms from one, two, or all categories.

Positive symptoms involve an excess or a distortion of normal functions. They include the following:

Delusions are false beliefs that usually involve a misinterpretation of perceptions or experiences. For example, people with schizophrenia may have persecutory delusions, believing that they are being tormented, followed, tricked, or spied on. They may have delusions of reference, believing that passages from books, newspapers, or song lyrics are directed specifically at them. They may have delusions of thought withdrawal or thought insertion, believing that others can read their mind, that their thoughts are being transmitted to others, or that thoughts and impulses are being imposed on them by outside forces.

Hallucinations of sound, sight, smell, taste, or touch may occur, although hallucinations of sound (auditory hallucinations) are by far the most common. People may hear voices in their head commenting on their behavior, conversing with one another, or making critical and abusive comments.

Negative symptoms involve a decrease in or loss of normal functions. They include the following:

Blunted affect refers to a flattening of emotions. The face may appear immobile. People make little or no eye contact and lack emotional expressiveness. Events that would normally make them laugh or cry produce no response.

Poverty of speech refers to a decreased amount of speech. Answers to questions may be terse, perhaps one or two words, creating the impression of an inner emptiness.

Anhedonia refers to a diminished capacity to experience pleasure. People may take little interest in previous activities and spend more time in purposeless ones.

Asociality refers to a lack of interest in relationships with other people. These negative symptoms are often associated with a general loss of motivation, sense of purpose, and goals.

Disorganization involves thought disorders and bizarre behavior:

Thought disorder refers to disorganized thinking, which becomes apparent when speech is rambling or shifts from one topic to another. Speech may be mildly disorganized or completely incoherent and incomprehensible.

Bizarre behavior may take the form of childlike silliness, agitation, or inappropriate appearance, hygiene, or conduct. Catatonia is an extreme form of bizarre behavior in which people maintain a rigid posture and resist efforts to be moved or, in contrast, display purposeless and unstimulated motor activity.

Cognitive impairment refers to difficulty concentrating, remembering, organizing, planning, and problem solving. Some people are unable to concentrate sufficiently to read, follow the story line of a movie or television show, or follow directions. Others are unable to ignore distractions or remain focused on a task. Consequently, work that involves attention to detail, involvement in complicated procedures, and decision making may be impossible.










Disorders That Resemble Schizophrenia


General medical and neurologic conditions such as thyroid disorders, brain tumors, seizure disorders, kidney failure, toxic reactions to drugs, and vitamin deficiencies can sometimes cause symptoms similar to those of schizophrenia. In addition, a number of mental disorders share features of schizophrenia.

Brief psychotic disorder: Symptoms of this disorder resemble those of schizophrenia but last only for 1 day to 1 month. This time-limited disorder often occurs in people with a preexisting personality disorder or in people who have experienced a severe stress, such as loss of a loved one.

Schizophreniform disorder: The schizophrenia-like symptoms characteristic of this disorder last for 1 to 6 months. This disorder may resolve or may progress to manic-depressive illness or schizophrenia.

Schizoaffective disorder: This disorder is characterized by the presence of mood symptoms, such as depression or mania, plus more typical symptoms of schizophrenia.

Schizotypal personality disorder: This personality disorder (see Personality Disorders: Schizotypal personality disorder) may share symptoms of schizophrenia, but they are generally not severe enough to meet the criteria for psychosis. People with this disorder tend to be shy and to isolate themselves and may be mildly suspicious and have other disturbances in thinking. Genetic studies indicate that schizotypal personality disorder may be a mild form of schizophrenia.



Subtypes of Schizophrenia: Some researchers believe schizophrenia is a single disorder, but others believe it is a syndrome (a collection of symptoms) based on numerous underlying disorders. Subtypes of schizophrenia have been proposed in an effort to classify people into more distinct groups. However, the subtype in a particular person may change over time. Subtypes include the following:

Paranoid: People are preoccupied with delusions or auditory hallucinations. Disorganized speech and inappropriate emotions are less prominent.

Disorganized: Speech and behavior are disorganized, and people do not express emotions or have inappropriate emotions.

Catatonic: Symptoms are mainly physical. They include immobility, excessive motor activity, and assumption of bizarre postures.

Undifferentiated: People have a mixture of symptoms from the other subtypes: delusions and hallucinations, thought disorder and bizarre behavior, and negative symptoms.

Residual: People have had a clear history of prominent schizophrenia symptoms that are followed by a long period of mild negative symptoms.

Diagnosis

No definitive test exists to diagnose schizophrenia. A doctor makes the diagnosis based on a comprehensive assessment of a person's history and symptoms. Schizophrenia is diagnosed when symptoms persist for at least 6 months and cause significant deterioration in work, school, or social functioning. Information from family members, friends, or teachers is often important in establishing when the disorder began.

Laboratory tests are often done to rule out substance abuse or an underlying medical, neurologic, or hormonal disorder that can have features of psychosis. Examples of such disorders include brain tumors, temporal lobe epilepsy, thyroid disorders, autoimmune disorders, Huntington's disease, liver disorders, and side effects of drugs. Testing for drug abuse is sometimes done.

People with schizophrenia have brain abnormalities that may be seen on a computed tomography (CT) or magnetic resonance imaging (MRI) scan. However, the abnormalities are not specific enough to help in diagnosing schizophrenia.


Did You Know...


About 10% of people with schizophrenia commit suicide.



Prognosis

For people with schizophrenia, the prognosis depends largely on adherence to drug treatment. Without drug treatment, 70 to 80% of people have another episode within the first year after diagnosis. Drugs taken continuously can reduce this percentage to about 20 to 30% and can lessen the severity of symptoms significantly in most people. After discharge from a hospital, people who do not take prescribed drugs are very likely to be readmitted within the year. Taking drugs as directed dramatically reduces the likelihood of being readmitted.

Despite the proven benefit of drug therapy, half of people with schizophrenia do not take their prescribed drugs. Some do not recognize their illness and resist taking drugs. Others stop taking their drugs because of unpleasant side effects. Memory problems, disorganization, or simply a lack of money prevents others from taking their drugs.

Adherence is most likely to improve when specific barriers are addressed. If side effects of drugs are a major problem, a change to a different drug may help. A consistent, trusting relationship with a doctor or other therapist helps some people with schizophrenia to accept their illness more readily and recognize the need for adhering to prescribed treatment.

Over longer periods, the prognosis varies. In general, one third of people achieve significant and lasting improvement, one third achieve some improvement with intermittent relapses and residual disabilities, and one third experience severe and permanent incapacity. Factors associated with a better prognosis include the following:

Sudden onset of the disorder

Older age at onset

A good level of skills and accomplishments before becoming ill

Presence of positive rather than negative symptoms

Factors associated with a poor prognosis include the following:

Younger age at onset

Poor social and vocational functioning before becoming ill

A family history of schizophrenia

Presence of negative rather than positive symptoms

About 10% of people with schizophrenia commit suicide.










What Is Neuroleptic Malignant Syndrome?


Neuroleptic malignant syndrome is unresponsiveness caused by use of certain antipsychotic drugs. It develops in up to 3% of people who are treated with antipsychotic drugs, usually within the first few weeks of treatment. The syndrome is most common among men who, because they are agitated, are given rapidly increased doses of the drugs or high doses initially.

Symptoms include muscle rigidity, a dangerously high temperature, a fast heart rate, a fast breathing rate, high blood pressure, and coma. Damaged muscles release the protein myoglobin, which is excreted in the urine. Myoglobin turns the urine brown. This condition (myoglobinuria) can result in kidney damage or even kidney failure.

People with this syndrome are usually treated in an intensive care unit. The antipsychotic drug is stopped, fever is controlled (usually by wetting people and blowing air on them and by placing special cooling blankets on them). People are also given a muscle relaxant (such as bromocriptine

or dantrolene
). Giving sodium bicarbonate
intravenously helps prevent myoglobulinuria by making the urine alkaline.

Almost 30% of people with this syndrome die, but most of the rest recover completely. After recovery, up to 30% of people develop the syndrome again if they are given the same antipsychotic drug.



Treatment

Generally, treatment aims

To reduce the severity of psychotic symptoms

To prevent the recurrence of symptomatic episodes and the associated deterioration in functioning

To provide support and thus enable people to function at the highest level possible

Antipsychotic drugs, rehabilitation and community support activities, and psychotherapy are the major components of treatment.

Antipsychotic Drugs: Drugs can be effective in reducing or eliminating symptoms, such as delusions, hallucinations, and disorganized thinking. After the immediate symptoms have cleared, the continued use of antipsychotic drugs substantially reduces the probability of future episodes. However, antipsychotic drugs have significant side effects, which can include drowsiness, muscle stiffness, tremors, weight gain, and motor restlessness. Antipsychotic drugs may also cause tardive dyskinesia, an involuntary movement disorder most often characterized by puckering of the lips and tongue or writhing of the arms or legs. Tardive dyskinesia may not go away even after the drug is stopped. For tardive dyskinesia that persists, there is no effective treatment. A rare but potentially fatal side effect of antipsychotic drugs is neuroleptic malignant syndrome. It is characterized by muscle rigidity, fever, high blood pressure, and changes in mental function (such as confusion and lethargy).

Some newer antipsychotic drugs, termed second-generation antipsychotic drugs, have fewer side effects. However, these drugs seem to cause significant weight gain. They also increase the risk of the metabolic syndrome (see Obesity and the Metabolic Syndrome: Metabolic Syndrome). In this syndrome, fat accumulates in the abdomen, blood levels of triglycerides (a fat) are elevated, levels of high density cholesterol (HDL, the “good” cholesterol) are low, and blood pressure is high. Also, insulin is less effective (called insulin resistance), increasing the risk of diabetes. These drugs may relieve positive symptoms (such as hallucinations), negative symptoms (such as lack of emotion), and cognitive impairment (such as reduced mental functioning and attention span) to a greater extent than the older antipsychotic drugs, although some doctors question these differences.

Clozapine
, the first of the second-generation antipsychotic drugs, is effective in up to half of
people who do not respond to other antipsychotic drugs. However, clozapine
can have
serious side effects, such as seizures or potentially fatal suppression of bone marrow activity (which includes making blood cells). Thus, it is usually used only for people who have not responded to other antipsychotic drugs. People who take clozapine
must have their white
blood cell count measured weekly, at least for the first 6 months, so that clozapine
can be
stopped at the first indication that the number of white blood cells is decreasing.

Rehabilitation and Community Support Activities: Community support activities, such as on-the-job coaching, are directed at teaching the skills needed to survive in the community. These skills enable people with schizophrenia to work, shop, care for themselves, manage a household, and get along with others. Hospitalization may be needed during severe relapses, and involuntary hospitalization may be needed if people pose a danger to themselves or others. However, the general goal is to have people live in the community. To achieve this goal, some people need to live in a supervised apartment or group home where someone can ensure that drugs are taken as prescribed.

A few people with schizophrenia are unable to live independently, either because they have severe, persistent symptoms or because they lack the skills necessary to live in the community. They usually require full-time care in a safe and supportive setting.

Psychotherapy: Generally, psychotherapy aims to establish a collaborative relationship between people, their family members, and doctor. That way people may learn to understand and manage their disorder, to take antipsychotic drugs as prescribed, and to manage stresses that can aggravate the disorder. A good doctor-patient relationship is often a major determinant of whether treatment is successful. Psychotherapy reduces the severity of symptoms in some people and helps prevent relapse in others.

What is an EEG?

An EEG (electroencephalogram) is a test that records the electrical activity of your child's brain. (The nerve cells in your child's brain work by carrying tiny electrical charges.)
When is it used?

An EEG can help your child's healthcare provider diagnose medical problems such as:
epilepsy
sleep apnea or other sleep problems
encephalitis (infection in the brain)
brain tumors

An EEG can help healthcare providers decide on the best medicine to treat epilepsy. This test is sometimes used during surgery to check the effect of anesthesia. It may be used to test for brain death in cases of severe injury or illness.
How do I prepare for an EEG?

Your child's head doesn't need to be shaved for an EEG. Some EEG labs ask that your child's hair be clean and free of hair products such as hairspray or mousse. On the day of the EEG, your child should not have any drinks that containe caffeine (such as sodas, sports drinks, or tea).

Ask your child's provider if there are any special instructions your child needs to follow. Also ask if there are any substances or medicines that your child should avoid before the test.

Sometimes a sedative is given just before the test to help your child relax during the EEG.
What happens during the test?

An EEG normally takes 45 to 60 minutes. During the test your child will relax in a bed. Small metal plates (electrodes) are pasted or taped to your child's head. The electrodes send information to a machine that records brain waves on paper. Young children do not like the feel of the electrodes, but it doesn't hurt except when the electrodes are removed.

EEGs may be done while your child is:
sleeping (Your child may be given a medicine to help your child sleep).
resting with eyes closed (for babies, this may be done by placing a hand over the baby's eyes and playing peek-a-boo)
resting with eyes open
breathing rapidly (and just after)
looking at a flashing light.

The EEG records how the brain responds to these changes. Your child may have a video EEG instead. This gives more time to study the brain waves. A video EEG may take 6 to 8 hours, or be done for 24 hours.
What happens after the test?

Your child can usually go home as soon as the test is done.
What are the benefits and risks of this test?

This test helps your child's healthcare provider diagnose certain medical conditions. There are no risks.
When should I call my child's healthcare provider?

Call your child's provider right away if your child has any change or worsening of symptoms after the test.

What is a migraine headache?

A migraine headache is a specific kind of headache that can last for hours to days. It can cause intense pain as well as other symptoms. For example, you may feel sick to your stomach or have changes in your vision just before or during the headache.
How does it occur?

The exact cause of migraines is not clear. Most experts think migraine attacks start with abnormal activity in the brain. They may be related to a problem with the blood flow in your brain, or they may happen with changes in brain chemicals. Migraine headaches often are triggered by specific things. Common migraine triggers include:
stress
tiredness
changes in the weather
certain foods, such as wine, cheese, or chocolate
MSG or food preservatives, such as nitrates
red wine
some medicines
bright lights.

Migraines tend to run in families. They affect women 3 times more often than men. They often happen right before or during a woman's menstrual period. Or they may happen when a woman is taking birth control pills or hormone replacement pills.
What are the symptoms?

Before a migraine starts, there is often a warning period when you don't feel well. Some people have vision changes before their head starts hurting. They lose part of their vision or see bright spots or zigzag patterns. These warning symptoms are called migraine aura. The vision changes of the aura usually go away as the headache begins.

Migraine symptoms may include:
throbbing or pounding headache
pain that gets worse with physical activity
extreme sensitivity to light, smells, and sounds
nausea
vomiting

The pain is usually more severe on one side of the head, but it can affect the whole head.

Sometimes a migraine can cause symptoms such as numbness or even weakness. However, these can also be symptoms of a stroke. If you have these other symptoms along with problems with your vision, do not assume a migraine is the cause. Call your healthcare provider right away.
How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. There are no lab tests or X-rays for diagnosing migraine headaches.

A careful history of your headaches is very helpful. Your healthcare provider may ask you to keep a headache diary in which you record the following:
date and time of each attack
how long the headache lasted
type of pain (for example, dull, sharp, throbbing, or a feeling of pressure)
location of pain
any symptoms before the headache began
foods and drinks you had before the headache began (This should include checking the ingredients in the product ingredient list of packaged foods you have eaten. Saving the labels of the foods or drinks might be a good way to record this information.)
use of cigarettes, caffeine, alcohol, or carbonated drinks before the headache began
time you went to bed and time you got up before the headache began
if you are a woman, the dates of your menstrual periods and use of birth control pills or other female hormones.

Depending on your headache symptoms and physical exam, your provider may recommend tests to check for other, more serious causes of your symptoms. For example, you may have a brain scan or magnetic resonance imaging (MRI).
How is it treated?

You may be able to stop mild migraine headaches by taking nonprescription pain-relief medicine when you start to have symptoms. Aspirin, acetaminophen, caffeine, ibuprofen, and naproxen have all been shown to be effective. You may find that any one of these medicines alone will treat your headache. Even just a caffeinated drink may help. However, some studies have shown combinations to be more effective and to work faster. Excedrin Migraine is an example of such a combination. It includes acetaminophen, aspirin, and caffeine. Other combination drugs, such as Midrin, are available for mild to moderate headaches with a prescription from your healthcare provider.

Check with your healthcare provider before you give any medicine that contains aspirin or salicylates to a child or teen. This includes medicines like baby aspirin, some cold medicines, and Pepto-Bismol. Children and teens who take aspirin are at risk for a serious illness called Reye's syndrome. Aspirin, ibuprofen, and naproxen are nonsteroidal anti-inflammatory medicines (NSAIDs). NSAIDs may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take NSAIDs for more than 10 days for any reason.

Other medicines your healthcare provider may prescribe to help keep headaches from getting severe once they start are:
A group of drugs called triptans, which are available as tablets (including some that may be taken without water), a shot, and a nasal spray. Examples of triptans are naratriptan, rizatriptan, sumatriptan, and zolmitriptan.
Ergot medicines such as dihydroergotamine (DHE) or ergotamine. These medicines are available in various forms, including pills you swallow or put under your tongue, nasal spray, rectal suppositories and shots.

It's best to take these medicines as soon as possible after a headache begins. This means you need to recognize the warning symptoms.

If you have frequent migraines (3 or more a month), you may need to take other medicine every day to prevent severe and frequent headaches. Examples of drugs your provider may prescribe for this purpose are:
antiseizure medicines (divalproex sodium/valproate, gabapentin, or topiramate)
antidepressants (tricyclics, such as amitriptyline, nortriptyline, or doxepin)
some beta blockers (such as atenolol, metoprolol, nadolol, nebivolol, propranolol, or timolol)
some calcium channel blockers (such as verapamil).

Women who have migraines triggered by their menstrual cycle may take preventive medicines for a few days around their period. Medicines that may be recommended are NSAIDs, triptans, and ergots. If these medicines do not work, hormone (estrogen) therapy may be helpful. Hormone therapy may also be helpful for women who have migraines during or after menopause. However, there is an increased risk of stroke for women with migraines who use birth control products (contraceptives) that contain estrogen.

You may need to take preventive medicine for several weeks before you know if it is helpful for you.

If you are planning to get pregnant, be sure to talk to your healthcare provider about whether the medicines you have been prescribed are safe during pregnancy. If they are not known to be safe, you will need a different treatment plan while you are trying to get pregnant and during pregnancy and breast-feeding.
How long will the effects last?

The headache may last from a few hours to a few days. You may tend to get migraines for the rest of your life. However, many people find that they have migraines less often as they get older.
How can I take care of myself?

When you have a migraine:
As soon as possible after the symptoms start, take the medicine recommended or prescribed by your healthcare provider.
If you can, rest in a quiet room until the symptoms are gone. The pain may go away with sleep.
Put a cool, moist washcloth on the painful side of your head. You might also try a heating pad set on the lowest setting.
Don't drive a car while you have the headache.

You can make your migraines easier to take care of. Learn to become aware of your early warning signs of headache. You will need to pay close attention to your body to be aware of these signs. When the warning signs appear, try going to a quieter place and doing relaxation exercises. This early care can make a big difference in how easily you can get over the migraine.

If your symptoms don't get better when you take medicine, make another appointment with your healthcare provider. It may take several visits to find the best way to control your headaches. Also, if you are having headaches more often, make a follow-up appointment with your provider to see if something has changed or you need more testing or preventive medicine.

Call your healthcare provider right away if:
Changes in your vision do not go away.
You have symptoms that are not usually part of your migraines, such as:
trouble talking or slurred speech
arm or leg weakness
You have other symptoms such as:
fever
stiff neck
repeated vomiting for several hours
numbness or tingling in your face, arms, or legs
You are pregnant and your headache is particularly bad or it seems different from your usual migraines, particularly in the last half of pregnancy. This is especially important if you have problems with your vision such as flashing lights, difficulty focusing or blurriness, any nausea or vomiting, or weakness in any part of your body. These may be signs of a pregnancy problem that needs immediate attention.
How can I help prevent migraine headaches?

Prevention is an important part of treatment. To help prevent migraine headaches:
You may need to take medicine prescribed by your healthcare provider.
You may need to avoid certain foods or activities suggested by your headache diary as possible triggers of headaches. Common food triggers are:
citrus fruit
chocolate
cheese and other preserved or aged foods containing tyramine, including leftovers held for more than 1 or 2 days at refrigerator temperature
sodium nitrate (found, for example, in food coloring, preservatives, processed meats and fish, hot dogs, and luncheon meats)
monosodium glutamate "MSG" (found, for example, in Chinese food, pepperoni, and many processed foods)
red wine and beer
the artificial sweetener aspartame
Ask your provider about avoiding medicines that may trigger headaches.
If you are taking birth control pills or other female hormones, ask your provider if you should stop taking them.
If you smoke, stop. If someone else in your household smokes, ask them to smoke outside. Cigarette smoke can make your symptoms worse.
Eat healthy meals at about the same time each day. Don't skip meals, especially breakfast.
Get regular rest and exercise.
Try to reduce stress. Relaxation exercises and biofeedback may help you manage stress.
Limit alcohol to no more than 1 drink a day for women and two drinks a day for men.

For more information, call or write:

American Council for Headache Education (ACHE)
Phone: 800-255-ACHE (255-2243)
Web site: http://www.achenet.org

National Headache Foundation
Phone: 800-843-2256
Web site: http://www.headaches.org
(includes more information about diet)

Feelings (emotions) are inner experiences of mood. They can be pleasant or unpleasant, mild or strong. They can be kept to yourself or shared with others. Often they come along with physical sensations like a rapid heartbeat or sweaty palms. Emotions can push human beings toward action.

Most human feelings fall into one of these groups: happy, sad, angry, scared, or confused. Within each group are many other feelings described by words that express shades of meaning or the level of intensity of the emotion.
Happy: joyful, delighted, pleased
Sad: hopeless, upset, sorry
Angry: hateful, irritated, annoyed
Scared: terrified, fearful, anxious
Confused: stunned, hesitant, torn

Other important human emotions that may not fall into these main groups are sexual feelings, guilt, shame, loyalty, and forgiveness.

How much feeling is “normal?”

All human beings have feelings. No particular amount is normal, but some people have intense feelings and must struggle to control them, while others have to work hard even to know what their feelings are.

Sometimes you may not be aware of what is causing strong feelings. You may think you are overreacting to something. It may help to discuss these strong feelings in some detail with someone who cares about you. What looks like an overreaction may actually make emotional, rather than logical, sense.

You can help friends or family understand their feelings by helping them put their emotions into words. With someone who is crying and grieving a loss, for example, it can be much more helpful to say, “You are feeling sad because you miss her so much”, than to say, “Don’t cry.”

How do people deal with feelings?

People may have trouble identifying how they feel. Many feelings can be mixed together. Having too many feelings they can’t separate, such as sadness mixed with anger, can cause “feeling overload”. Strong feelings push human beings toward action. If you are angry at being cut off by another driver in heavy traffic, for example, you can act (run into the other car), or think (say to yourself, “He certainly is in a hurry,” or, “I am not going to let my anger get out of control today”). Thoughts can be used to control how we express feelings.

If you are very logical, you may not be aware of your own feelings. You may use thoughts and ideas to hide your feelings, sometimes without even realizing that you are doing so. You may be afraid that if you allow any feeling into your life you will lose control.

In order to deal with feelings, people need to learn:
how to identify what their feelings are
how to accept feelings as normal and healthy
how to talk about their feelings
how to act appropriately on their feelings

Why are feelings important?

Feelings help make you who you are. No one can take your feelings away from you, and when you understand them, you can use your feelings to guide your actions. Get to know your feelings to help you understand yourself and others better.

Science of hair waving

Introduction
Since ancient cultures curly hair represented femininity and beauty. Women with straight hair purchased expensive wigs or spent hours for hair ondulation with water and heat, which was temporary.
Ÿ Permanent hair waving is a two-step chemical treatment modifying hair protein to achieve and retain a curly shape.
Ÿ The chemical treatment involves a thioglycolate reduction reaction that plasticizes hair while being wound on a rod. The following oxidation step with hydrogen peroxide reforms the hair in a new curly shape.
Ÿ Curl retention depends on hair thickness, rod diameter, and hair quality.
Ÿ Undesirable hair damage can occur with the wrong choice of perm and neutralizer, too much heat, incorrect processing time, or improper perm solution amount.

Chemophysical principles of hair waving

Because of hair’s great elasticity and strong resilient forces, it quickly resumes its original straight shape. Therefore it has to be softened and subsequently rehardened chemically to maintain a conformation change. Especially with permanent waving, it is important to select a reversible reaction to allow repeated treatments without hair destruction. The sulfur bridges of the amino acid cystine, linking the proteins, are best suited.
The conditions for permanent waving to be well tolerated are:

Low temperature (20-50®C), convection or contact heat;
ŸShort process time (5-30 minutes); and
Mildness to the skin.

A permanent wave occurs with two solutions:
Solution 1: the perming lotion, which contains a reducing agent, a “thiol” compound, designed to split off about 20-40% of hair cystine bonds.
Solution 2 : a fixing lotion, which contains an oxidizing agent, usually hydrogen peroxide, designed to rebuild cystine bridges between proteins at new sites in the curled hair shape. It must be emphasized that permanent waving is a two-step procedure where the chemical reaction and physical effects run in parallel reduction of disulfide-bonds, softening of hair, lateral swelling and length contraction, stress development and protein flow, then re-oxidation of cystin bonds and deswelling, fixation of a new curly shape.