scizophrenia, schizophenia
Schizophrenia is a chronic, severe, and disabling
brain disease.
Approximately 1 percent of the population develops schizophrenia during
their lifetime – more than 2 million Americans suffer from the illness in
a given year. Although schizophrenia affects men and women with equal
frequency, the disorder often appears earlier in men, usually in the late
teens or early twenties, than in women, who are generally affected in the
twenties to early thirties. People with schizophrenia often suffer
terrifying symptoms such as hearing internal voices not heard by others,
or believing that other people are reading their minds, controlling their
thoughts, or plotting to harm them. These symptoms may leave them fearful
and withdrawn. Their speech and behavior can be so disorganized that they
may be incomprehensible or frightening to others. Available treatments can
relieve many symptoms, but most people with schizophrenia continue to
suffer some symptoms throughout their lives; it has been estimated that no
more than one in five individuals recovers completely.
This is a time of hope for people with schizophrenia and their
families. Research is
gradually leading to new and safer medications and unraveling the complex
causes of the disease. Scientists are using many approaches from the study
of molecular genetics to the study of populations to learn about
schizophrenia. Methods of imaging the brain’s structure and function hold
the promise of new insights into the disorder.
Schizophrenia As An Illness
Schizophrenia is found all over the world. The severity of the symptoms
and long-lasting, chronic pattern of schizophrenia often cause a high
degree of disability. Medications and other treatments for schizophrenia,
when used regularly and as prescribed, can help reduce and control the
distressing symptoms of the illness. However, some people are not greatly
helped by available treatments or may prematurely discontinue treatment
because of unpleasant side effects or other reasons. Even when treatment
is effective, persisting consequences of the illness – lost opportunities,
stigma, residual symptoms, and medication side effects – may be very
troubling.
The first signs of schizophrenia often appear as confusing, or even
shocking, changes in behavior. Coping with the symptoms of schizophrenia
can be especially difficult for family members who remember how involved
or vivacious a person was before they became ill. The sudden onset of
severe psychotic symptoms is referred to as an “acute” phase of
schizophrenia. “Psychosis,” a common condition in schizophrenia, is a
state of mental impairment marked by hallucinations, which are
disturbances of sensory perception, and/or delusions, which are false yet
strongly held personal beliefs that result from an inability to separate
real from unreal experiences. Less obvious symptoms, such as social
isolation or withdrawal, or unusual speech, thinking, or behavior, may
precede, be seen along with, or follow the psychotic symptoms.
Some people have only one such psychotic episode; others have many
episodes during a lifetime, but lead relatively normal lives during the
interim periods. However, the individual with “chronic” schizophrenia, or
a continuous or recurring pattern of illness, often does not fully recover
normal functioning and typically requires long-term treatment, generally
including medication, to control the symptoms.
Making A Diagnosis
It is important to rule out other illnesses, as sometimes people suffer
severe mental symptoms or even psychosis due to undetected underlying
medical conditions. For this reason, a medical history should be taken and
a physical examination and laboratory tests should be done to rule out
other possible causes of the symptoms before concluding that a person has
schizophrenia. In addition, since commonly abused drugs may cause symptoms
resembling schizophrenia, blood or urine samples from the person can be
tested at hospitals or physicians’ offices for the presence of these
drugs.
At times, it is difficult to tell one mental disorder from another. For
instance, some people with symptoms of schizophrenia exhibit prolonged
extremes of elated or depressed mood, and it is important to determine
whether such a patient has schizophrenia or actually has a
manic-depressive (or bipolar) disorder or major depressive disorder.
Persons whose symptoms cannot be clearly categorized are sometimes
diagnosed as having a “schizoaffective disorder.”
Can Children Have Schizophrenia?
Children over the age of five can develop schizophrenia, but it is very
rare before adolescence. Although some people who later develop
schizophrenia may have seemed different from other children at an early
age, the psychotic symptoms of schizophrenia – hallucinations and
delusions – are extremely uncommon before adolescence.
The World of People With Schizophrenia
- Distorted Perceptions of Reality
People with schizophrenia may have perceptions of reality that are
strikingly different from the reality seen and shared by others around
them. Living in a world distorted by hallucinations and delusions,
individuals with schizophrenia may feel frightened, anxious, and confused.
In part because of the unusual realities they experience, people with
schizophrenia may behave very differently at various times. Sometimes they
may seem distant, detached, or preoccupied and may even sit as rigidly as
a stone, not moving for hours or uttering a sound. Other times they may
move about constantly – always occupied, appearing wide-awake, vigilant,
and alert.
- Hallucinations and Illusions
Hallucinations and illusions are disturbances of perception that are
common in people suffering from schizophrenia. Hallucinations are
perceptions that occur without connection to an appropriate source.
Although hallucinations can occur in any sensory form – auditory (sound),
visual (sight), tactile (touch), gustatory (taste), and olfactory (smell)
– hearing voices that other people do not hear is the most common type of
hallucination in schizophrenia. Voices may describe the patient’s
activities, carry on a conversation, warn of impending dangers, or even
issue orders to the individual. Illusions, on the other hand, occur when a
sensory stimulus is present but is incorrectly interpreted by the
individual.
Delusions are false personal beliefs that are not subject to reason or
contradictory evidence and are not explained by a person’s usual cultural
concepts. Delusions may take on different themes. For example, patients
suffering from paranoid-type symptoms – roughly one-third of people with
schizophrenia – often have delusions of persecution, or false and
irrational beliefs that they are being cheated, harassed, poisoned, or
conspired against. These patients may believe that they, or a member of
the family or someone close to them, are the focus of this persecution. In
addition, delusions of grandeur, in which a person may believe he or she
is a famous or important figure, may occur in schizophrenia. Sometimes the
delusions experienced by people with schizophrenia are quite bizarre; for
instance, believing that a neighbor is controlling their behavior with
magnetic waves; that people on television are directing special messages
to them; or that their thoughts are being broadcast aloud to others.
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Substance Abuse
Substance abuse is a common concern of the family and friends of
people with schizophrenia. Since some people who abuse drugs may
show symptoms similar to those of schizophrenia, people with
schizophrenia may be mistaken for people "high on drugs.” While most
researchers do not believe that substance abuse causes
schizophrenia, people who have schizophrenia often abuse alcohol
and/or drugs, and may have particularly bad reactions to certain
drugs. Substance abuse can reduce the effectiveness of treatment for
schizophrenia. Stimulants (such as amphetamines or cocaine) may
cause major problems for patients with schizophrenia, as may PCP or
marijuana. In fact, some people experience a worsening of their
schizophrenic symptoms when they are taking such drugs. Substance
abuse also reduces the likelihood that patients will follow the
treatment plans recommended by their doctors.
- Schizophrenia and Nicotine
The most common form of substance use disorder in people with
schizophrenia is nicotine dependence due to smoking. While the
prevalence of smoking in the U.S. population is about 25 to 30
percent, the prevalence among people with schizophrenia is
approximately three times as high. Research has shown that the
relationship between smoking and schizophrenia is complex. Although
people with schizophrenia may smoke to self medicate their symptoms,
smoking has been found to interfere with the response to
antipsychotic drugs. Several studies have found that schizophrenia
patients who smoke need higher doses of antipsychotic medication.
Quitting smoking may be especially difficult for people with
schizophrenia, because the symptoms of nicotine withdrawal may cause
a temporary worsening of schizophrenia symptoms. However, smoking
cessation strategies that include nicotine replacement methods may
be effective. Doctors should carefully monitor medication dosage and
response when patients with schizophrenia either start or stop
smoking. |
Schizophrenia often affects a person’s ability to “think straight.”
Thoughts may come and go rapidly; the person may not be able to
concentrate on one thought for very long and may be easily distracted,
unable to focus attention.
People with schizophrenia may not be able to sort out what is relevant
and what is not relevant to a situation. The person may be unable to
connect thoughts into logical sequences, with thoughts becoming
disorganized and fragmented. This lack of logical continuity of thought,
termed “thought disorder,” can make conversation very difficult and may
contribute to social isolation. If people cannot make sense of what an
individual is saying, they are likely to become uncomfortable and tend to
leave that person alone.
People with schizophrenia often show “blunted” or “flat” affect. This
refers to a severe reduction in emotional expressiveness. A person with
schizophrenia may not show the signs of normal emotion, perhaps may speak
in a monotonous voice, have diminished facial expressions, and appear
extremely apathetic. The person may withdraw socially, avoiding contact
with others; and when forced to interact, he or she may have nothing to
say, reflecting “impoverished thought.” Motivation can be greatly
decreased, as can interest in or enjoyment of life. In some severe cases,
a person can spend entire days doing nothing at all, even neglecting basic
hygiene. These problems with emotional expression and motivation, which
may be extremely troubling to family members and friends, are symptoms of
schizophrenia – not character flaws or personal weaknesses.
At times, normal individuals may feel, think, or act in ways that
resemble schizophrenia. Normal people may sometimes be unable to “think
straight.” They may become extremely anxious, for example, when speaking
in front of groups and may feel confused, be unable to pull their thoughts
together, and forget what they had intended to say. This is not
schizophrenia. At the same time, people with schizophrenia do not always
act abnormally. Indeed, some people with the illness can appear completely
normal and be perfectly responsible, even while they experience
hallucinations or delusions. An individual’s behavior may change over
time, becoming bizarre if medication is stopped and returning closer to
normal when receiving appropriate treatment.
Schizophrenia Is Not
"Split Personality"
There is a common notion that schizophrenia is the same as "split
personality” – a Dr. Jekyll-Mr. Hyde switch in character.
This is not correct. |
Are People With Schizophrenia Likely To Be Violent?
News and entertainment media tend to link mental illness and criminal
violence; however, studies indicate that except for those persons with a
record of criminal violence before becoming ill, and those with
substance abuse or alcohol problems, people with schizophrenia are not
especially prone to violence. Most individuals with schizophrenia are not
violent; more typically, they are withdrawn and prefer to be left alone.
Most violent crimes are not committed by persons with schizophrenia, and
most persons with schizophrenia do not commit violent crimes. Substance
abuse significantly raises the rate of violence in people with
schizophrenia but also in people who do not have any mental illness.
People with paranoid and psychotic symptoms, which can become worse if
medications are discontinued, may also be at higher risk for violent
behavior. When violence does occur, it is most frequently targeted at
family members and friends, and more often takes place at home.
What About Suicide?
Suicide is a serious danger in people who have schizophrenia. If an
individual tries to commit suicide or threatens to do so, professional
help should be sought immediately. People with schizophrenia have a higher
rate of suicide than the general population. Approximately 10 percent of
people with schizophrenia (especially younger adult males) commit suicide.
Unfortunately, the prediction of suicide in people with schizophrenia can
be especially difficult.
There is no known single cause of schizophrenia. Many diseases, such as
heart disease, result from an interplay of genetic, behavioral, and other
factors; and this may be the case for schizophrenia as well. Scientists do
not yet understand all of the factors necessary to produce schizophrenia,
but all the tools of modern biomedical research are being used to search
for genes, critical moments in brain development, and other factors that
may lead to the illness.
Is Schizophrenia Inherited?
It has long been known that schizophrenia runs in families. People who
have a close relative with schizophrenia are more likely to develop the
disorder than are people who have no relatives with the illness. For
example, a monozygotic (identical) twin of a person with schizophrenia has
the highest risk – 40 to 50 percent – of developing the illness. A child
whose parent has schizophrenia has about a 10 percent chance. By
comparison, the risk of schizophrenia in the general population is about 1
percent.
Scientists are studying genetic factors in schizophrenia. It appears
likely that multiple genes are involved in creating a predisposition to
develop the disorder. In addition, factors such as prenatal difficulties
like intrauterine starvation or viral infections, perinatal complications,
and various nonspecific stressors, seem to influence the development of
schizophrenia. However, it is not yet understood how the genetic
predisposition is transmitted, and it cannot yet be accurately predicted
whether a given person will or will not develop the disorder.
Several regions of the human genome are being investigated to identify
genes that may confer susceptibility for schizophrenia. The strongest
evidence to date leads to chromosomes 13 and 6 but remains unconfirmed.
Identification of specific genes involved in the development of
schizophrenia will provide important clues into what goes wrong in the
brain to produce and sustain the illness and will guide the development of
new and better treatments. To learn more about the genetic basis for
schizophrenia, the NIMH has established a Schizophrenia Genetics
Initiative (see Web site at http://www-grb.nimh.nih.gov/gi.html)
that is gathering data from a large number of families of people with the
illness.
Is Schizophrenia Associated With A Chemical Defect In The Brain?
Basic knowledge about brain chemistry and its link to schizophrenia is
expanding rapidly. Neurotransmitters, substances that allow communication
between nerve cells, have long been thought to be involved in the
development of schizophrenia. It is likely, although not yet certain, that
the disorder is associated with some imbalance of the complex,
interrelated chemical systems of the brain, perhaps involving the
neurotransmitters dopamine and glutamate. This area of research is
promising.
Is Schizophrenia Caused By A Physical Abnormality In The Brain?
There have been dramatic advances in neuroimaging technology that
permit scientists to study brain structure and function in living
individuals. Many studies of people with schizophrenia have found
abnormalities in brain structure (for example, enlargement of the
fluid-filled cavities, called the ventricles, in the interior of the
brain, and decreased size of certain brain regions) or function (for
example, decreased metabolic activity in certain brain regions). It should
be emphasized that these abnormalities are quite subtle and are not
characteristic of all people with schizophrenia, nor do they occur
only in individuals with this illness. Microscopic studies of brain
tissue after death have also shown small changes in distribution or number
of brain cells in people with schizophrenia. It appears that many (but
probably not all) of these changes are present before an individual
becomes ill, and schizophrenia may be, in part, a disorder in development
of the brain.
Developmental neurobiologists funded by the National Institute of
Mental Health (NIMH) have found that schizophrenia may be a developmental
disorder resulting when neurons form inappropriate connections during
fetal development. These errors may lie dormant until puberty, when
changes in the brain that occur normally during this critical stage of
maturation interact adversely with the faulty connections. This research
has spurred efforts to identify prenatal factors that may have some
bearing on the apparent developmental abnormality.
In other studies, investigators using brain-imaging techniques have
found evidence of early biochemical changes that may precede the onset of
disease symptoms, prompting examination of the neural circuits that are
most likely to be involved in producing those symptoms. Meanwhile,
scientists working at the molecular level are exploring the genetic basis
for abnormalities in brain development and in the neurotransmitter systems
regulating brain function.
Since schizophrenia may not be a single condition and its causes are
not yet known, current treatment methods are based on both clinical
research and experience. These approaches are chosen on the basis of their
ability to reduce the symptoms of schizophrenia and to lessen the chances
that symptoms will return.
What About Medications?
Antipsychotic medications have been available since the mid-1950s. They
have greatly improved the outlook for individual patients. These
medications reduce the psychotic symptoms of schizophrenia and usually
allow the patient to function more effectively and appropriately.
Antipsychotic drugs are the best treatment now available, but they do not
“cure” schizophrenia or ensure that there will be no further psychotic
episodes. The choice and dosage of medication can be made only by a
qualified physician who is well trained in the medical treatment of mental
disorders. The dosage of medication is individualized for each patient,
since people may vary a great deal in the amount of drug needed to reduce
symptoms without producing troublesome side effects.
The large majority of people with schizophrenia show substantial
improvement when treated with antipsychotic drugs. Some patients, however,
are not helped very much by the medications and a few do not seem to need
them. It is difficult to predict which patients will fall into these two
groups and to distinguish them from the large majority of patients who
do benefit from treatment with antipsychotic drugs.
A number of new antipsychotic drugs (the so-called “atypical
antipsychotics”) have been introduced since 1990. The first of these,
clozapine (Clozaril®), has been shown to be more effective than other
antipsychotics, although the possibility of severe side effects – in
particular, a condition called agranulocytosis (loss of the white blood
cells that fight infection) – requires that patients be monitored with
blood tests every one or two weeks. Even newer antipsychotic drugs, such
as risperidone (Risperdal®) and olanzapine (Zyprexa®), are safer than the
older drugs or clozapine, and they also may be better tolerated. They may
or may not treat the illness as well as clozapine, however. Several
additional antipsychotics are currently under development.
Antipsychotic drugs are often very effective in treating certain
symptoms of schizophrenia, particularly hallucinations and delusions;
unfortunately, the drugs may not be as helpful with other symptoms, such
as reduced motivation and emotional expressiveness. Indeed, the older
antipsychotics (which also went by the name of “neuroleptics”), medicines
like haloperidol (Haldol®) or chlorpromazine (Thorazine®), may even
produce side effects that resemble the more difficult to treat symptoms.
Often, lowering the dose or switching to a different medicine may reduce
these side effects; the newer medicines, including olanzapine (Zyprexa®),
quetiapine (Seroquel®), and risperidone (Risperdal®), appear less likely
to have this problem. Sometimes when people with schizophrenia become
depressed, other symptoms can appear to worsen. The symptoms may improve
with the addition of an antidepressant medication.
Patients and families sometimes become worried about the antipsychotic
medications used to treat schizophrenia. In addition to concern about side
effects, they may worry that such drugs could lead to addiction. However,
antipsychotic medications do not produce a “high” (euphoria) or addictive
behavior in people who take them.
Another misconception about antipsychotic drugs is that they act as a
kind of mind control, or a “chemical straitjacket.” Antipsychotic drugs
used at the appropriate dosage do not “knock out” people or take away
their free will. While these medications can be sedating, and while this
effect can be useful when treatment is initiated particularly if an
individual is quite agitated, the utility of the drugs is not due to
sedation but to their ability to diminish the hallucinations, agitation,
confusion, and delusions of a psychotic episode. Thus, antipsychotic
medications should eventually help an individual with schizophrenia to
deal with the world more rationally.
How Long Should People With Schizophrenia Take Antipsychotic
Drugs?
Antipsychotic medications reduce the risk of future psychotic episodes
in patients who have recovered from an acute episode. Even with continued
drug treatment, some people who have recovered will suffer relapses. Far
higher relapse rates are seen when medication is discontinued. In most
cases, it would not be accurate to say that continued drug treatment
“prevents” relapses; rather, it reduces their intensity and frequency. The
treatment of severe psychotic symptoms generally requires higher dosages
than those used for maintenance treatment. If symptoms reappear on a lower
dosage, a temporary increase in dosage may prevent a full-blown relapse.
Because relapse of illness is more likely when antipsychotic
medications are discontinued or taken irregularly, it is very important
that people with schizophrenia work with their doctors and family members
to adhere to their treatment plan. Adherence to treatment refers to
the degree to which patients follow the treatment plans recommended by
their doctors. Good adherence involves taking prescribed medication at the
correct dose and proper times each day, attending clinic appointments,
and/or carefully following other treatment procedures. Treatment adherence
is often difficult for people with schizophrenia, but it can be made
easier with the help of several strategies and can lead to improved
quality of life.
There are a variety of reasons why people with schizophrenia may not
adhere to treatment. Patients may not believe they are ill and may deny
the need for medication, or they may have such disorganized thinking that
they cannot remember to take their daily doses. Family members or friends
may not understand schizophrenia and may inappropriately advise the person
with schizophrenia to stop treatment when he or she is feeling better.
Physicians, who play an important role in helping their patients adhere to
treatment, may neglect to ask patients how often they are taking their
medications, or may be unwilling to accommodate a patient’s request to
change dosages or try a new treatment. Some patients report that side
effects of the medications seem worse than the illness itself. Further,
substance abuse can interfere with the effectiveness of treatment, leading
patients to discontinue medications. When a complicated treatment plan is
added to any of these factors, good adherence may become even more
challenging.
Fortunately, there are many strategies that patients, doctors, and
families can use to improve adherence and prevent worsening of the
illness. Some antipsychotic medications, including haloperidol (Haldol®),
fluphenazine (Prolixin®), perphenazine (Trilafon®) and others, are
available in long-acting injectable forms that eliminate the need to take
pills every day. A major goal of current research on treatments for
schizophrenia is to develop a wider variety of long-acting antipsychotics,
especially the newer agents with milder side effects, which can be
delivered through injection. Medication calendars or pill boxes labeled
with the days of the week can help patients and caregivers know when
medications have or have not been taken. Using electronic timers that beep
when medications should be taken, or pairing medication taking with
routine daily events like meals, can help patients remember and adhere to
their dosing schedule. Engaging family members in observing oral
medication taking by patients can help ensure adherence. In addition,
through a variety of other methods of adherence monitoring, doctors can
identify when pill taking is a problem for their patients and can work
with them to make adherence easier. It is important to help motivate
patients to continue taking their medications properly.
In addition to any of these adherence strategies, patient and family
education about schizophrenia, its symptoms, and the medications being
prescribed to treat the disease is an important part of the treatment
process and helps support the rationale for good adherence.
What About Side Effects?
Antipsychotic drugs, like virtually all medications, have unwanted
effects along with their beneficial effects. During the early phases of
drug treatment, patients may be troubled by side effects such as
drowsiness, restlessness, muscle spasms, tremor, dry mouth, or blurring of
vision. Most of these can be corrected by lowering the dosage or can be
controlled by other medications. Different patients have different
treatment responses and side effects to various antipsychotic drugs. A
patient may do better with one drug than another.
The long-term side effects of antipsychotic drugs may pose a
considerably more serious problem. Tardive dyskinesia (TD) is a disorder
characterized by involuntary movements most often affecting the mouth,
lips, and tongue, and sometimes the trunk or other parts of the body such
as arms and legs. It occurs in about 15 to 20 percent of patients who have
been receiving the older, “typical” antipsychotic drugs for many years,
but TD can also develop in patients who have been treated with these drugs
for shorter periods of time. In most cases, the symptoms of TD are mild,
and the patient may be unaware of the movements.
Antipsychotic medications developed in recent years all appear to have
a much lower risk of producing TD than the older, traditional
antipsychotics. The risk is not zero, however, and they can produce side
effects of their own such as weight gain. In addition, if given at too
high of a dose, the newer medications may lead to problems such as social
withdrawal and symptoms resembling Parkinson’s disease, a disorder that
affects movement. Nevertheless, the newer antipsychotics are a significant
advance in treatment, and their optimal use in people with schizophrenia
is a subject of much current research.
What About Psychosocial Treatments?
Antipsychotic drugs have proven to be crucial in relieving the
psychotic symptoms of schizophrenia – hallucinations, delusions, and
incoherence – but are not consistent in relieving the behavioral symptoms
of the disorder. Even when patients with schizophrenia are relatively free
of psychotic symptoms, many still have extraordinary difficulty with
communication, motivation, self-care, and establishing and maintaining
relationships with others. Moreover, because patients with schizophrenia
frequently become ill during the critical career-forming years of life
(e.g., ages 18 to 35), they are less likely to complete the training
required for skilled work. As a result, many with schizophrenia not only
suffer thinking and emotional difficulties, but lack social and work
skills and experience as well.
It is with these psychological, social, and occupational problems that
psychosocial treatments may help most. While psychosocial approaches have
limited value for acutely psychotic patients (those who are out of touch
with reality or have prominent hallucinations or delusions), they may be
useful for patients with less severe symptoms or for patients whose
psychotic symptoms are under control. Numerous forms of psychosocial
therapy are available for people with schizophrenia, and most focus on
improving the patient’s social functioning – whether in the hospital or
community, at home, or on the job. Some of these approaches are described
here. Unfortunately, the availability of different forms of treatment
varies greatly from place to place.
Broadly defined, rehabilitation includes a wide array of non-medical
interventions for those with schizophrenia. Rehabilitation programs
emphasize social and vocational training to help patients and former
patients overcome difficulties in these areas. Programs may include
vocational counseling, job training, problem-solving and money management
skills, use of public transportation, and social skills training. These
approaches are important for the success of the community-centered
treatment of schizophrenia, because they provide discharged patients with
the skills necessary to lead productive lives outside the sheltered
confines of a mental hospital.
Individual psychotherapy involves regularly scheduled talks between the
patient and a mental health professional such as a psychiatrist,
psychologist, psychiatric social worker, or nurse. The sessions may focus
on current or past problems, experiences, thoughts, feelings, or
relationships. By sharing experiences with a trained empathic person –
talking about their world with someone outside it – individuals with
schizophrenia may gradually come to understand more about themselves and
their problems. They can also learn to sort out the real from the unreal
and distorted. Recent studies indicate that supportive, reality-oriented,
individual psychotherapy, and cognitive-behavioral approaches that teach
coping and problem-solving skills, can be beneficial for outpatients with
schizophrenia. However, psychotherapy is not a substitute for
antipsychotic medication, and it is most helpful once drug treatment first
has relieved a patient’s psychotic symptoms.
Very often, patients with schizophrenia are discharged from the
hospital into the care of their family; so it is important that family
members learn all they can about schizophrenia and understand the
difficulties and problems associated with the illness. It is also helpful
for family members to learn ways to minimize the patient’s chance of
relapse – for example, by using different treatment adherence strategies –
and to be aware of the various kinds of outpatient and family services
available in the period after hospitalization. Family “psychoeducation,”
which includes teaching various coping strategies and problem-solving
skills, may help families deal more effectively with their ill relative
and may contribute to an improved outcome for the patient.
Self-help groups for people and families dealing with schizophrenia are
becoming increasingly common. Although not led by a professional
therapist, these groups may be therapeutic because members provide
continuing mutual support as well as comfort in knowing that they are not
alone in the problems they face. Self-help groups may also serve other
important functions. Families working together can more effectively serve
as advocates for needed research and hospital and community treatment
programs. Patients acting as a group rather than individually may be
better able to dispel stigma and draw public attention to such abuses as
discrimination against the mentally ill.
Family and peer support and advocacy groups are very active and provide
useful information and assistance for patients and families of patients
with schizophrenia and other mental disorders. A list of some of these
organizations is included at the end of this document.
A patient's support system may come from several sources, including the
family, a professional residential or day program provider, shelter
operators, friends or roommates, professional case managers, churches and
synagogues, and others. Because many patients live with their families,
the following discussion frequently uses the term "family." However, this
should not be taken to imply that families ought to be the primary support
system.
There are numerous situations in which patients with schizophrenia may
need help from people in their family or community. Often, a person with
schizophrenia will resist treatment, believing that delusions or
hallucinations are real and that psychiatric help is not required. At
times, family or friends may need to take an active role in having them
seen and evaluated by a professional. The issue of civil rights enters
into any attempts to provide treatment. Laws protecting patients from
involuntary commitment have become very strict, and families and community
organizations may be frustrated in their efforts to see that a severely
mentally ill individual gets needed help. These laws vary from State to
State; but generally, when people are dangerous to themselves or others
due to a mental disorder, the police can assist in getting them an
emergency psychiatric evaluation and, if necessary, hospitalization. In
some places, staff from a local community mental health center can
evaluate an individual's illness at home if he or she will not voluntarily
go in for treatment.
Sometimes only the family or others close to the person with
schizophrenia will be aware of strange behavior or ideas that the person
has expressed. Since patients may not volunteer such information during an
examination, family members or friends should ask to speak with the person
evaluating the patient so that all relevant information can be taken into
account.
Ensuring that a person with schizophrenia continues to get treatment
after hospitalization is also important. A patient may discontinue
medications or stop going for follow-up treatment, often leading to a
return of psychotic symptoms. Encouraging the patient to continue
treatment and assisting him or her in the treatment process can positively
influence recovery. Without treatment, some people with schizophrenia
become so psychotic and disorganized that they cannot care for their basic
needs, such as food, clothing, and shelter. All too often, people with
severe mental illnesses such as schizophrenia end up on the streets or in
jails, where they rarely receive the kinds of treatment they need.
Those close to people with schizophrenia are often unsure of how to
respond when patients make statements that seem strange or are clearly
false. For the individual with schizophrenia, the bizarre beliefs or
hallucinations seem quite real – they are not just "imaginary fantasies."
Instead of “going along with” a person's delusions, family members or
friends can tell the person that they do not see things the same way or do
not agree with his or her conclusions, while acknowledging that things may
appear otherwise to the patient.
It may also be useful for those who know the person with schizophrenia
well to keep a record of what types of symptoms have appeared, what
medications (including dosage) have been taken, and what effects various
treatments have had. By knowing what symptoms have been present before,
family members may know better what to look for in the future. Families
may even be able to identify some "early warning signs" of potential
relapses, such as increased withdrawal or changes in sleep patterns, even
better and earlier than the patients themselves. Thus, return of psychosis
may be detected early and treatment may prevent a full-blown relapse.
Also, by knowing which medications have helped and which have caused
troublesome side effects in the past, the family can help those treating
the patient to find the best treatment more quickly.
In addition to involvement in seeking help, family, friends, and peer
groups can provide support and encourage the person with schizophrenia to
regain his or her abilities. It is important that goals be attainable,
since a patient who feels pressured and/or repeatedly criticized by others
will probably experience stress that may lead to a worsening of symptoms.
Like anyone else, people with schizophrenia need to know when they are
doing things right. A positive approach may be helpful and perhaps more
effective in the long run than criticism. This advice applies to everyone
who interacts with the person.
The outlook for people with schizophrenia has improved over the last 25
years. Although no totally effective therapy has yet been devised, it is
important to remember that many people with the illness improve enough to
lead independent, satisfying lives. As we learn more about the causes and
treatments of schizophrenia, we should be able to help more patients
achieve successful outcomes.
Studies that have followed people with schizophrenia for long periods,
from the first episode to old age, reveal that a wide range of outcomes is
possible. When large groups of patients are studied, certain factors tend
to be associated with a better outcome – for example, a pre-illness
history of normal social, school, and work adjustment. However, the
current state of knowledge, does not allow for a sufficiently accurate
prediction of long-term outcome.
Given the complexity of schizophrenia, the major questions about this
disorder – its cause or causes, prevention, and treatment – must be
addressed with research. The public should beware of those offering "the
cure" for (or "the cause" of) schizophrenia. Such claims can provoke
unrealistic expectations that, when unfulfilled, lead to further
disappointment. Although progress has been made toward better
understanding and treatment of schizophrenia, continued investigation is
urgently needed. As the lead Federal agency for research on mental
disorders, NIMH conducts and supports a broad spectrum of mental illness
research from molecular genetics to large-scale epidemiologic studies of
populations. It is thought that this wide-ranging research effort,
including basic studies on the brain, will continue to illuminate
processes and principles important for understanding the causes of
schizophrenia and for developing more effective treatments.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
A new service available to patients provides a convenient means of staying informed, and ensures that the information is both reliable and accurate. If you wish to find out more about HealthNewsflash's innovative service, take the tour.
Resources
Information, support, and advocacy organizations:
National Alliance for the Mentally Ill (NAMI)
Colonial Place
Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201
Phone:
1-800-950-NAMI (6264) or (703) 524-7600
Internet:
http://www.nami.org
National Mental Health Association (NMHA)
2001 N. Beauregard
Street, 12th Floor
Alexandria, VA 22311
Phone: 1-800-969-6942 or
(703) 684-7722
TTY-800-443-5959
Internet: http://www.nmha.org
National Mental Health Consumers' Self-Help Clearinghouse
1211 Chestnut Street, Suite 1000
Philadelphia, PA 19107
Phone: 1-800-553-4key (4539) or (215) 751-1810
Internet:
http://www.mhselfhelp.org/index2.html
National Alliance for Research on Schizophrenia and Depression
(NARSAD)
60 Cutter Mill Road, Suite 404
Great Neck, NY
11021
Phone: (516) 829-0091
Infoline 1-800-829-8289
Internet:
http://www.mhsource.com/narsad/
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