Schizophrenia

Overview

A shattering of thought, mood, and deed

People with schizophrenia live in a world that is often intensely frightening and confusing to them. Voices may speak to them in words only they can hear, or imagined enemies may track their every move. Schizophrenia shatters thinking, emotions, behavior, and perception.

The illness takes many forms, from hallucinations to withdrawal, from rambling words to incoherent thoughts. Schizophrenia can be ongoing, or it can come in severe episodes punctuated by periods of relatively normal — but rarely returning to completely normal — functioning. When episodes happen, they massively disrupt lives.

No one knows exactly what causes schizophrenia, or how to cure it, and doctors estimate that no more than one in five people with the disorder recovers completely. But there is good news. Using antipsychotic medication and psychotherapy, doctors can control symptoms in about 70% of all cases.

Detailed Description

Schizophrenia is a mental illness marked by an extreme disturbance of thinking and personality. It is NOT multiple personality disorder. In schizophrenia, the form and content of thinking is disorganized — such as with hallucinations or delusions — and behavior deteriorates. Schizophrenia is an extremely serious condition, which researchers believe is caused by functional and structural problems in the brain.

Schizophrenia has five subtypes, all defined by the most obvious behavior:

• Paranoid: delusions of persecution
• Disorganized or hebephrenic: highly disorganized thought and behavior, often showing a "young" or primitive way of thinking
• Catatonic: physical symptoms such as immobility, excessive muscular motion, or assuming bizarre postures
• Undifferentiated: a mix of symptoms, or symptoms that are difficult to define
• Residual: continued symptoms that are not prominent or acute

Disorders that resemble schizophrenia include:

• Schizophreniform disorder: symptoms that last at least one month but less than six months. Between 15%-30% of people will recover and have no further episodes.
• Schizo-affective disorder: delusions and hallucinations that are accompanied by the mood changes of either mania or depression
• Simple schizophrenia: loss of motivation and ambition, and avoidance of personal relationships
• Latent schizophrenia: aloofness and occasional odd behavior

How Common Is Schizophrenia?

Schizophrenia affects approximately 2.4 million people in the United States (about 1% of the general population). Because the symptoms are often disabling, people with schizophrenia occupy one of every four hospital beds. It is about as common in men as in women, although in children it is more common in boys than in girls. Schizophrenia usually emerges between ages 18 and 25 for men and between 26 and 45 for women, but onset before age 18 for both sexes is not uncommon. For those who experience symptoms later in life, the episodes are almost always chronic.

What You Can Expect

The prognosis for schizophrenia depends greatly on the number of episodes that happen. If you have one episode and receive treatment, and then have no further episodes for more than a year, you can likely return to normal functioning.

If you have more schizophrenic episodes after treatment, however, the outlook is less positive: most likely, life-long antipsychotic drug therapy to control symptoms. If you do not seek treatment, there is a 70-80% chance you will relapse over the next 12 months. If you stick to a schedule of proper medication and counseling, however, you can lower the chances of relapse to about 30%.

Almost one in four people with schizophrenia is unable to hold a job or live independently, and about one in ten — especially younger adult males — commits suicide.

Conventional Treatment

Goals of Treatment

Although there is currently no cure for schizophrenia, treatments are available. The variety of symptoms and degrees of schizophrenia require that doctors individually tailor treatment goals to each person. But the following goals apply to most people with chronic schizophrenia:

• Consistent control of symptoms with the lowest possible doses of antipsychotic drugs
• Individual evaluation and a treatment plan that determines the most effective drug and dosage schedule, including consideration of occasional dosage versus continual long-term dosage
• Prevention of recurring psychotic episodes
• Improvement of ability to function in society as normally as possible
• Provide education to the person with schizophrenia and his or her family about the disorder, treatments, and signs of relapse

Treatment Overview

Because much about schizophrenia remains a mystery, all treatment issues are continually evolving. Currently, careful use of antipsychotic drugs manages schizophrenia most effectively. Adding psychotherapy to a drug therapy program improves social adjustment and reduces disabling symptoms.

After you have an acute psychotic episode, your doctor will initially treat you with carefully selected antipsychotic drugs, for six to 12 months. The varying nature and unpredictable qualities of schizophrenia mean that each drug's effectiveness depends on individuals — often what works for one person will have no effect on another. Your doctor can more easily determine which drugs will help if he or she knows your previous drug history.

After the first psychotic episode has receded and you have stabilized, your doctor will gradually withdraw antipsychotic drugs. If you relapse, you may require continual drug therapy, and may likely struggle with this disorder throughout your life.

Much of the success of treatment depends on how faithfully you take your medications. The good news is that the combination of psychotherapy and antipsychotic drug therapy can control symptoms in an estimated 70% of cases. Unfortunately, antipsychotic drugs can produce major side effects, such as sedation, muscle stiffness, tremors, weight gain, sexual dysfunction, and long-term movement disorder. And 10%-20% of people with schizophrenia do not respond to any drugs currently available.

Drug Therapy

A class of medications for schizophrenia — the atypical antipsychotics — can successfully manage schizophrenia in many cases. However, these drugs can cause a number of serious side effects. The older generation of antipsychotics appears less frequently but is still in use, largely in short-acting and injectable forms. Currently available drugs include:

Schizophrenia Medications
Abilify
Geodon
Seroquel
Zyprexa
Schizoaffective Disorder Medications
Lamictal
Prozac
Tegretol
Trileptal

Psychotherapy

Psychotherapy is an important part of treatment for schizophrenia, as well as any mental illness. While antipsychotic drugs relieve the psychotic symptoms of schizophrenia — such as hallucinations, delusions and incoherence — psychotherapy manages behavioral symptoms, such as communication, motivation, and establishing relationships with others. Psychotherapy can help you deal with your illness, take your drugs as prescribed, and manage stressful situations that can make your illness worse. In general, psychotherapy can help you function better in society.

Rehabilitation and Community Support Activities

You can learn skills to help you survive in the community, from working and shopping to caring for yourself and managing your household. Support programs such as supervised apartments or group homes are available to make sure you take your medications as prescribed.

Appropriate Healthcare Settings

At first, you'll need to stay in the hospital for testing and treatment of acute symptoms. If your doctor achieves a stable dose of medication, you can continue treatment at home.

Healthcare Professionals Who May Be Involved in Treatment

Many specialists can help treat schizophrenia, such as:

• Family physicians
• General internists
• Psychiatrists
• Neuropsychiatrists
• Neurologists
• Psychiatric social workers

Monitoring the Condition

A physician may advise psychiatric therapies for you, in a group and/or with your family, in addition to continued drug treatment. Vocational rehabilitation and day hospitals are also available. You'll need to visit the doctor frequently to monitor drug effectiveness and side effects.

Possible Complications

One of the most controversial areas is the follow-up treatment of people with schizophrenia after they are released from the hospital. The unstable, disorganized aspects of schizophrenic symptoms means that many people will take inconsistent doses of the drugs. People with schizophrenia often deny that anything is wrong or that they need to take medication, so compliance is often a problem. And when they do not stick to medication schedules, the vast majority of people with schizophrenia have a return of symptoms, further worsening their instability.

Other complications include:

• Risk of suicide (40%-70% attempt suicide, and 10%-15% commit suicide)
• High concordance with substance abuse, which complicates treatment
• Depression

Additionally, antipsychotic medications have numerous possible side effects to watch for, such as:

• Parkinson-like stiffness and impaired movement
• Other movement disorders (tardive dyskinesia)
• Seizures
• Endocrine effects
• Eye complications
• Neuroleptic malignant syndrome — a life-threatening episode that can include very high fever, rigid muscles, and altered blood pressure
• Weight gain
• Low blood pressure
• Blood cell changes
• Dry mouth
• Blurry vision
• Constipation
• Difficulty with urine flow

Quality of Life

Schizophrenic episodes can severely disrupt your life. Repeated episodes interfere with your ability to make a living or develop a career. Since treatment for episodes can be expensive, you may have additional costs. Even though medication may improve your illness, you may still experience the social and vocational effects of schizophrenia.

Considerations for Women

Pregnancy

Because of the risk of passing the disease on to your child, possible fetal complications with antipsychotic drugs, and the seriousness of schizophrenic symptoms, you should talk with your doctor before considering pregnancy.