|
What
is schizophrenia?
Schizophrenia is a devastating brain disorder that affects
approximately 2.2 million American adults, or 1.1 percent
of the population age 18 and older. Schizophrenia interferes
with a person's ability to think clearly, manage emotions,
make decisions, and relate to others. The first signs of schizophrenia
typically emerge in the teenage years or twenties. Most people
with schizophrenia suffer chronically or episodically throughout
their lives, and are often stigmatized by lack of public understanding
about the disease. Schizophrenia is not caused by bad parenting
or personal weakness. A person with schizophrenia does not
have a "split personality," and almost all people
with schizophrenia are not dangerous or violent towards others
when they are receiving treatment.
What
are the symptoms of schizophrenia?
No one symptom positively identifies schizophrenia. All of
the symptoms of this illness can also be found in other brain
disorders. For example psychotic symptoms may be caused by
the use of drugs, or may be characteristics of a manic episode
in bipolar disorder. However, when a doctor sees the symptoms
of schizophrenia and carefully asses the course of the illness
over six months, he or she can almost always make a correct
diagnosis.
The symptoms of schizophrenia are generally divided into three
categories, including positive, disorganized and negative
symptoms.
-
Positive Symptoms, or "psychotic" symptoms,
include delusions and hallucinations because the patient
has lost touch with reality in certain important ways. "Positive"
as used here does not mean "good." Rather, it
refers to having overt symptoms that should not be there.
Delusions cause the patient to believe that people are reading
their thoughts or plotting against them, that others are
secretly monitoring and threatening them, or that they can
control other people's minds. Hallucinations cause people
to hear or see things that are not there.
- Disorganized
Symptoms include confused thinking and speech, and
behavior that does not make sense. For example, people with
schizophrenia sometimes have trouble communicating in coherent
sentences or carrying on conversations with others; move
more slowly, repeat rhythmic gestures or make movements
such as walking in circles or pacing; and have difficulty
making sense of everyday sights, sounds and feelings.
-
Negative Symptoms include emotional flatness or
lack of expression, an inability to start and follow through
with activities, speech that is brief and lacks content,
and a lack of pleasure or interest in life. "Negative"
does not, therefore, refer to a person's attitude, but to
a lack of certain characteristics that should be there.
What
are the causes of schizophrenia?
Scientists still do not know the specific causes of schizophrenia,
but research has shown that the brains of people with schizophrenia
are different, as a group, from the brains of people without
the illness. Like many other medical illnesses such as cancer
or diabetes, schizophrenia seems to be caused by a combination
of problems including genetic vulnerability and environmental
factors that occur during a person's development.
How
is schizophrenia treated?
While there is no cure for schizophrenia, it is a highly treatable
and manageable illness. However, people may stop treatment
because of medication side effects, disorganized thinking,
or because they feel the medication is no longer working.
People with schizophrenia who stop taking prescribed medication
are at a high risk of relapse into an acute psychotic episode.
-
Medication: The primary medications for
schizophrenia are called antipsychotics. Antipsychotics
help relieve the positive symptoms of schizophrenia by helping
to correct an imbalance in the chemicals that enable brain
cells to communicate with each other. As with drug treatments
for other physical illnesses, many patients with severe
mental illnesses may need to try several different antipsychotic
medications before they find the one, or the combination
of medications, that works best for them.
- Conventional
Antipsychotics were introduced in the 1950's and all
had similar ability to relieve the positive symptoms
of schizophrenia. Most of these older "conventional"
antipsychotics differed in the side effects they produced.
These conventional antipsychotics include chlorpromazine
(Thorazine), fluphenazine (Prolixin), haloperidol (Haldol),
thiothixene (Navane), trifluoperazine (Stelazine), perphenazine
(Trilafon), and thioridazine (Mellaril).
- New
"Atypical" Antipsychotics. In the last decade
new "atypical" antipsychotics have been introduced.
Compared to the older "conventional" antipsychotics
these medications appear to be equally effective for
helping reduce the positive symptoms like hallucinations
and delusions - but may be better than the older medications
at relieving the negative symptoms of the illness, such
as withdrawal, thinking problems, and lack of energy.
The atypical antipsychotics include risperidone (Risperdal),
clozapine (Clozaril), olanzapine (Zyprexa), quetiapine
(Seroquel), and ziprasidone (Geodon).
- Current
treatment guidelines recommend using one of the atypical
antipsychotics other than clozapine as a first line
treatment option for newly diagnosed patients. However,
for people already taking a conventional antipsychotic
medication that is working well, a change to an atypical
may not be the best option.
- People
thinking of changing their medication should always
consult with their doctor and work together to develop
the most safe and effective treatment plan possible.
- Hospitalization:
People who experience acute symptoms of schizophrenia may
require intensive treatment including hospitalization. Hospitalization
is necessary to treat severe delusions or hallucinations,
serious suicidal thoughts, an inability to care for oneself,
or severe problems with drugs or alcohol.
- Psychosocial
Rehabilitation: Research shows that people with
schizophrenia who attend structured psychosocial rehabilitation
programs and continue with their medical treatment manage
their illness best. One of the most effective psychosocial
approaches for the most severely ill or those with both
mental illness and substance abuse, is the Program for Assertive
Community Treatment (PACT), an intensive team effort in
local communities to help people stay of the hospital and
live independently. Available 24-hours a day, seven-days
a week, PACT professionals meet their clients where they
live, providing at-home support at whatever level is needed.
Professionals work with clients to address problems effectively,
to make sure medications are being properly taken, and to
meet the routine daily challenges of life, such as grocery
shopping and managing money.
- PACT
programs are statewide in four states and growing
in another 20 states. PACT is significantly reducing hospital
admissions, and improving functioning and the quality of
life for people with schizophrenia.
What
are the side effects of the medications used to treat schizophrenia?
All medications have side effects. Different medications produce
different side effects, and people differ in the amount and
severity of side effects they experience. Side effects can
often be treated by changing the dose of the medication, switching
to a different medication, or treating the side effect directly
with an additional medication. Common inconvenient side effects
of all antipsychotic drugs used to treat schizophrenia include
dry mouth, constipation, blurred vision, and drowsiness. Some
people experience sexual dysfunction or decreased sexual desire,
menstrual changes, and significant weight gain. Other common
side effects relate to muscles and movement problems. These
side effects include: restlessness, stiffness, tremors, muscle
spasms, and one of the most unpleasant and serious side effects,
a condition called tardive dyskinesia.
-
Tardive dyskinesia is a movement disorder where there are
uncontrolled facial movements and sometimes jerking or twisting
movements of other body parts. This condition usually develops
after several years of taking antipsychotic medications
and more predominantly in older adults. Tardive dyskinesia
affects 15 to 20 percent of people taking conventional antipsychotic
medications. The risk of developing tardive dyskinesia is
lower for people taking the newer antipsychotics. Tardive
dyskinesia can be treated with additional medications or
by lowering the dosage of the antipsychotic if possible.
- Clozapine
was the first atypical antipsychotic in the United States
and seems to be one of the most effective medications, particularly
for people who have not responded well to other medications.
However, in some people it has a serious side effect of
lowering the number of white blood cells produced. People
taking clozapine must have their blood monitored every one
or two weeks to count the number of white blood cells in
the bloodstream. For this reason clozapine is usually the
last atypical antipsychotic prescribed, and is usually used
as a last line treatment for people that do not respond
well to other medications or have frequent relapses.
For
more in-depth information about mental illness, treatments
and supports, and medications;
please choose from the following topics:
By
Illness | What is Mental Illness?
| Treatments & Supports
| About Medications
|
