Schizophrenia
WHAT IS SCHIZOPHRENIA?
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 These symptoms may leave them fearful and withdrawn.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.
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.
Disordered Thinking
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.
WHAT CAUSES
SCHIZOPHRENIA?
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 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.
HOW IS IT TREATED?
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.
HOW CAN OTHER PEOPLE HELP?
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.
WHAT IS THE OUTLOOK?
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.
Source: National Institute of Mental Health
NIH Publication No. 02-3517
Printed 1999, Reprinted 2002
Page last modified or reviewed on February 9, 2009
|
 |
|
|
advertisement
Find a
Treatment Center
Click here
Additional Information
Schizophrenia
FAQs
Schizophrenia
Handbook
Schizophrenia
Guide for
Patients/Families
Schizophrenia
and Alcohol
Schizophrenia
FPN_9_8
Schizophrenia
FPN_9_8
Schizophrenia
FPN_7_15
Schizophrenia
FPN_6_14
Suicide
Assessment
FPN_7_3
Depression
FPN_7_14
Depression
FPN_5_20
Worry
and Anxiety
Bipolar
Disorder
FPN_9_1
Bipolar
Disorder
FPN_7_5
Medications
for Mental Illness
Chronic
Illness
FPN_6_5
Books on
Schizophrenia
|
