Schizophrenia, a brain disorder affecting approximately one percent of the population. Around one million people are currently being treated as outpatients for this psychotic disorder
Schizophrenia is a mental
illness characterized by prominent and persistent disturbances in the
way a person thinks, feels, sees and hears. The illnes can be either progressive
or episodic. While it is a serious illness, the prognosis varies from
individual to individual.
On the average, men experience their first
psychotic episode in their early- to mid- twenties and women in their
late twenties. However, it may strike in late adolescence when it seems
the pressures exerted during the transition into adulthood overtax the
system. Schizophrenia can emerge during middle age, particularly in
women. As a rule, when the disorder appears early the course tends to be
Schizophrenia may initially appear as a gradual
decline in behavior or a dramatic break with reality. When the latter is
the case, onset can be profoundly abrupt and alarming: a person can seem
perfectly normal one day, then, for all intents and purposes, lost the
next. In other cases, there is a sense that the person, even in
childhood, has never been quite normal.
Schizophrenia involves disordered thinking
(reflected in a disturbance in the logical and coherent structure and
form of speech), delusions (fixed beliefs that are unshakeable with
logic and reason and are not in keeping with one's socio cultural
background), and hallucinations (hearing sounds and seeing things that
don't exist for others). Usually a person with schizophrenia has trouble
distinguishing what is real from what is in his head.
Persecutory delusions are also typical of the illness. An individual with schizophrenia may truly believe that others are spying on him, tormenting him, following him, making fun of him or trying to trick him.
Referential delusions, the belief that everyday things within one's environment --advertisements, newscasts, passages from books, song lyrics, and the like-- are directly addressed to him, are common.
Schizophrenic thinking may also include delusions
of influence, the belief that outside forces are directly affecting
or controlling one's thoughts, actions, or sensations. This delusional
thinking goes beyond strongly held beliefs; rather, it involves complete
and utter convictions in the face of all contradictory evidence.
Feelings are also affected. A person suffering
from schizophrenia may be extremely moody or his feelings profoundly
flat. Sometimes his feelings are not appropriate to his situation. He
may laugh or be silly at somber or serious occasions, or appear to have
no reaction to clearly upsetting circumstances.
The behavior of an individual with
schizophrenia may also be grossly disturbed: his actions will appear
strange, bizarre, or disorganized. He may withdraw from all social
interactions. In severe cases, a person with schizophrenia is unable to
perform even the simplest of daily tasks. He may dress in an unsuitable
or disheveled fashion, and have trouble maintaining basic hygiene. He
may exhibit inappropriate sexual behaviors. Consequently, people
suffering from schizophrenia often live in a world circumscribed by
disordered perceptions, emotions, and behavior, most of which are beyond
Although there is little doubt that schizophrenia is a brain disorder, it is not clear just what causes the brain to malfunction. Studies indicate that genetic and environmental factors play a role. Other studies point to such biological components as gestational and birth complications (a viral condition present during pregnancy, for example), genetic mutation or a delay in a child's neurological development that combine to cause brain distortions which manifest usually during young adulthood. Recently, research into the brain's structure and chemical balance has yielded some promising results.
What Your Doctor Looks ForDisorganized speech and behavior; a flat emotional quality; expressions of profoundly paranoid or grandiose thinking; deteriorating social and vocational functioning; chaotic appearance. In order for a clinician to arrive at a diagnosis of schizophrenia, a combination of symptoms and signs must be present for a significant portion of time during at least a one-month period with some aspects of the disorder persisting for over six months.
TreatmentThe first and most effective form of treatment for schizophrenia is medication. Neuroleptics that affect dopamine neurotransmitter systems are effective in managing and reducing psychotic symptoms. This group of drugs traditionally includes haloperidol (Haldol), fluphenazine (Prolixin), chlorpromazine (Thorazine), and thioridazine (Mellaril). At the same time, these drugs can produce problematic side-effects including low blood pressure, drowsiness, dry mouth, blurred vision, lethargy, constipation, and weight gain. The high potency medications like Haldol and Prolixin may produce restlessness, muscle spasms, and tremors as well, but tend to cause fewer problems with blood pressure, blurred visions, dry mouth, and drowsiness. The most disturbing side-effect, tardive dyskinesia, an involuntary series of tics in the tongue, facial muscles, arms and legs, can occur after years of taking the drugs.
Newer neuroleptics, including risperidone (Risperdal),
olanzapine (Zyprexa) clozapine (Clozaril) and quetiapine work
particularly well on the more tenacious forms of schizophrenia. And
because they work more selectively among the brain's dopamine
neurotransmitter systems , they tend to have fewer side-effects. They
may not cause tardive dyskinesia at all. However, because clozapine (Clozaril)
can cause a dangerous drop in the blood's white cells, which can
interfere with the body's ability to to fight infection, it must be
monitored closely with weekly blood counts. In fact, the use of all such
anti-psychotic medication requires close monitoring.
Once the more troubling symptoms recede,
individuals may be tempted to discontinue the medications. Yet, if the
medications are stopped , it is highly likely that symptoms will return,
and the disorder will reemerge full force, sometimes immediately,
sometimes after a delay of a few months.
For this and other reasons, drug treatment is
almost always one aspect of a more elaborate plan for treating
schizophrenia. The illness is severe and chronic, and invariably
interferes with normal functioning. Therefore, treatment usually
includes day or partial hospitalization, rehabilitative therapy,
training in social skills, and vocational training. In many cases,
assisted or supervised living situations make it possible for adults
with schizophrenia to lead relatively independent lives. In addition, to
psychiatric management, supportive therapy, family support and education
are regularly part of the treatment plan. A case manager is often needed
to help the person deal with the complex set of services he or she
During an acute psychotic episode -- during the
first psychotic break, when medications have been discontinued, or when
an attack forces its way through the preventive effects of the
medication, for example -- full hospitalization may be required. Also, a
physician may decide to hospitalize the patient so that he can work out
the right medication protocol. If the diagnosis follows an attempt at
suicide, the individual may also be hospitalized until it is established
that she no longer presents a danger to herself.
As with any chronic disease, relapses may occur, often following stressful events. Schizophrenia is a serious illness that requires long-term intensive treatment.
When To Seek TreatmentIf you begin to experience schizophrenic symptoms, you may not be able to judge that they are unusual; it may therefore be up to friends and family members to recognize the problem and seek help. If you begin to experience, or notice in someone close to you, any of the symptoms listed above, call your physician immediately.
PrognosisFair. The later the onset, the better the prognosis. Many patients experience a full or almost full recovery from schizophrenia, although this might take many years. However, for others, the cumulative effect of schizophrenia is severe and long lasting. Some people who have schizophrenia continue to decline in their ability to function at work and in relationships and few return quickly to the level of functioning they had before their first psychotic episode. Many individuals with schizophrenia abuse drugs or alcohol, and there is a high rate of suicide associated with the disorder.
Yet, this does not mean that the diagnosis of schizophrenia automatically assigns a person to a lifetime of institutions, or homelessness. Most people who suffer from schizophrenia can be treated and the condition can be managed with reasonable success. Many recover in time and others are helped substantially with medications, family support, and special living arrangements to lead fully satisfying lives.