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Fact Sheet
SCHIZOPHRENIA
ADDITIONAL
INFORMATION ...
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"Schizophrenia is a cruel disease. The lives of
those affected are often chronicles of constricted experiences, muted emotions, missed
opportunities, unfulfilled expectations. It leads to a twilight existence, a
twentieth-century underground man... It is in fact the single biggest blemish on the face
of contemporary American medicine and social services; when the social history of our era
is written, the plight of persons with schizophrenia will be recorded as having been a
national scandal."
- E. Fuller Torrey, M.D., Surviving Schizophrenia
- Schizophrenia interferes with a persons ability to
think clearly, manage emotions, make decisions, and relate to others. Specific
abnormalities that can be noted in individuals with schizophrenia include:
- delusions and hallucinations;
- alterations of the senses;
- an inability to sort and interpret incoming sensations, and
an inability therefore to respond appropriately;
- an altered sense of self; and
- changes in emotions, movements and behavior.
- Schizophrenia is a neurological brain disorder that affects 2.2
million Americans today, or approximately one percent of the population. Schizophrenia can
affect anyone at any age, but most cases develop between ages 16 and 30.
Symptoms of Schizophrenia
In healthy people, the brain functions in such a way that
incoming stimuli are sorted and interpreted, followed by a logical response (e.g., saying
"thank you" after a gift is given, realizing the potential outcome of arriving
late to work, etc.). Conversely, the inability of patients with schizophrenia to sort and
interpret stimuli and select appropriate responses is one of the hallmarks of the disease.
See brain scan.
- The symptoms of schizophrenia are generally divided into
three categories, including positive, disorganized, and negative symptoms.
- Overt Symptoms, or "psychotic"
symptoms, include delusions, hallucinations and disorganized thinking because the patient
has lost touch with reality in certain important ways. Delusions cause the patient to
believe that people are reading their minds or plotting against them, that others are
secretly monitoring and threatening them, or that they can control other peoples
thoughts. Hallucinations cause people to hear or see things that are not there.
Approximately three-fourths of individuals with schizophrenia will hear voices (auditory
hallucinations) at some time during their illness. Disorganized thinking, speech, and
behavior affect most people with this illness. 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 persons attitude, but to a lack
of certain characteristics that should be there.
Diagnosing Schizophrenia
- To be diagnosed with schizophrenia, a patient must have
psychotic, "loss-of-reality" symptoms for at least six months and show
increasing difficulty in functioning normally. Before the six-month period is reached, the
person is diagnosed as having a schizophreniform disorder.
- Prior to a medical diagnosis, it is critically important
that a doctor rule out other problems that may mimic schizophrenia, such as psychotic
symptoms caused by the use of drugs or other medical illnesses; major depressive episode
or manic episode with psychotic features; delusional disorder (no hallucinations,
disorganized speech or thought or "flattened" emotions) and autistic disorder or
personality disorders (especially schizotypal, schizoid, or paranoid personality
disorders). Schizoaffective disorder is a diagnosis used to indicate that the person has
an illness with a mix of symptoms of both schizophrenia and bipolar disorder.
- Although the cause of schizophrenia has not yet been
identified, recent research suggests that schizophrenia is linked to abnormalities of
brain chemistry and brain structure. Genes play some role, but the magnitude of that role
remains to be ascertained. Abnormalities of neurotransmitters (e.g., dopamine, serotonin)
and viruses also are under investigation. The brain changes in some cases
are suspected to
date to childhood. Brain-imaging technology has demonstrated that schizophrenia is as much
an organic brain disorder as is multiple sclerosis, Parkinsons or Alzheimers
disease.
Treating Schizophrenia
- While there is no cure for schizophrenia, it is a highly
treatable disorder. In fact, according to the National Advisory Mental Health Council, the
treatment success rate for schizophrenia is comparable to the treatment success rate for
heart disease.
- It is important to diagnose and treat schizophrenia as early
as possible to help people avoid or reduce frequent relapses and re-hospitalizations.
Several promising, large-scale studies
suggest early intervention may forestall the worst long-term outcomes of this devastating
brain disorder.
- People who experience acute symptoms of schizophrenia may
require intensive treatment, sometimes including hospitalization.
Hospitalization is necessary to treat severe delusions or hallucinations, serious suicidal
inclinations, inability to care for oneself, or severe problems with drugs or alcohol.
- It is critical that people with schizophrenia stay in
treatment even after recovering from an acute episode. About 80 percent of those who stop
taking their medications after an acute episode will have a relapse within one year,
whereas only 30 percent of those who continue their medications will experience a relapse
in the same time period.
- Medication appears to improve the long-term prognosis for
many people with schizophrenia. Studies show that after 10 years of treatment, one-fourth
of those with schizophrenia have recovered completely, one-fourth have improved
considerably, and one-fourth have improved modestly. Fifteen percent have not improved,
and 10 percent are dead.
- Individuals with schizophrenia die at a younger age than do
healthy people. Males have a 5.1 greater than expected early mortality rate than the
general population, and females have a 5.6 greater risk of early death. Suicide is the
single largest contributor to this excess mortality rate, which is 10 to 13 percent higher
in schizophrenia than the general population.
Suicide is in fact the number
one cause of premature death among people with schizophrenia, with an estimated 10 percent
to 13 percent killing themselves. The extreme depression and psychoses that can result due
to lack of treatment are the usual culprits in these sad cases. These suicides rates can
be compared to the general population, which is somewhere around 0.01%. Other contributors
to excess mortality include:
- Accidents: Although individuals with
schizophrenia do not drive as much as other people, studies have shown that they have
double the rate of motor vehicle accidents per mile driven. A significant but unknown
number of individuals with schizophrenia also are killed as pedestrians by motor vehicles.
- Diseases: There is some evidence that
individuals with schizophrenia have more infections, heart disease, type II (adult onset)
diabetes, and female breast cancer, all of which might increase their mortality rate.
Individuals with schizophrenia who become sick are less able to explain their symptoms to
medical personnel, and medical personnel are more likely to disregard their complaints and
assume that they are simply part of the illness. There also is evidence that some persons
with schizophrenia have an elevated pain threshold so they may not complain of symptoms
until the disease has progressed too far to be treatable.
- Homelessness: Although it has not been well
studied to date, it appears that homelessness increases the mortality rate of individuals
with schizophrenia by making them even more susceptible to accidents and diseases.
- One of the most effective tools in treating schizophrenia is
by Programs for Assertive Community Treatment (PACT), an intensive team effort in local
communities to help people stay out of the hospital and live independently. Serving as a
hospital without walls, PACT professionals are available around the clock and meet their
clients where they live, providing at-home support at whatever level is needed, for
whatever problems need to be solved. Professionals can make sure that clients are taking
their medication and help them meet the challenges of daily life every day tasks
ranging from grocery shopping and keeping doctor appointments to managing money and
getting along with others.
While PACT programs are an excellent means for delivering outpatient services, research
demonstrates that they improve medication compliance for some, but not all, patients. For
example, a recent Baltimore study of 77 homeless individuals with severe mental illness
(86 percent with schizophrenia or major affective disorder) were assigned to PACT teams
and followed for one year. Medication compliance improved from 29 percent to between 50
percent and 57 percent during the remainder of the year. The study found that
approximately one-third of the subjects were noncompliant at any given time during the
research year.
Antipsychotic Medications
- Antipsychotic drugs are used in the treatment of
schizophrenia. These medications help relieve the delusions, hallucinations, and thinking
problems associated with this devastating disorder. Scientists believe the drugs work by
correcting imbalances in the chemicals that help brain cells communicate with one another.
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 or Standard Antipsychotics include:
chlorpromazine (Thorazine); fluphenazine (Prolixin); haloperidol (Haldol); thiothixene
(Navane); trifluoperazine (Stelazine); perphenazine (Trilafon) and thioridazine
(Mellaril).
Atypical Antipsychotics are newer drugs with
fewer side effects and include risperidone (Risperdal); clozapine (Clozaril) and
olanzapine (Zyprexa).
- Since these medications do not work immediately, experts
recommend that doctors give the antipsychotic time to take effect before switching to
another antipsychotic, adjusting the dose, or adding another medication.
- Antipsychotic drugs are usually taken daily in tablet or
liquid form. Fluphenazine (Prolixin) and haloperidol (Haldol), for example, also can be
given in long-acting injections (called "depot formulations") at one- to
four-week intervals. With depot formulations, medication is stored in the body and slowly
released. This can be especially helpful for patients who have a hard time taking pills on
a daily basis.
Possible Side Effects of Antipsychotic Medication
- As a group, antipsychotic drugs are safe, and serious side
effects are relatively rare. Some people may experience side effects that are inconvenient
or unpleasant, but not serious.
Most common side effects: dry mouth, constipation, blurred
vision, and drowsiness.
Less common side effects: decreased sexual desire,
menstrual changes, and stiff muscles on one side of the neck and jaw.
More serious side effects: restlessness, muscle stiffness,
slurred speech, tremors of the hands or feet. Agranulocytosis, a decrease in the
production of white blood cells, which occurs only when taking clozapine, requires
monitoring of the blood every two weeks.
- Tardive Dyskinesia is the most unpleasant and
serious side effect of antipsychotic drugs causing involuntary facial movements and
sometimes jerking or twisting movements of other parts of the body. This condition usually
develops in older patients, affecting 15 to 20 percent of those who have taken older
antipsychotic drugs for years. In most cases, the tardive dyskinesia slowly goes away when
the medication is stopped.
NOTE:
The Treatment Advocacy
Center is pleased to announce a joint web site with Public Citizen's Health Research
Group, which provides individuals with severe mental illnesses information on current
antipsychotic medications. The "eLetter on Drugs for Severe Psychiatric
Illnesses" is located at http://www.citizen.org/eletter.
Neither the Treatment Advocacy Center nor Public Citizen accepts money from the
pharmaceutical industry.
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