Schizophrenia

Schizophrenia is a severe, chronic, and often disabling brain disease. While the term Schizophrenia literally means, "split mind," it should not be confused with a "split," or multiple, personality. It is more accurately described as a psychosis -- a type of illness that causes severe mental disturbances that disrupt normal thought, speech, and behavior. The first signs of schizophrenia usually appear as shocking or radical changes in behavior. Others may have severe psychotic symptoms listed above. But many people also show "negative" symptoms, such as decreased emotional arousal, mental activity, and inability to socialize. Schizophrenics often report a sense of strangeness and confusion about the source of their sensations. They feel great loneliness, anxiety, and an overwhelming sense of being disconnected from others.

A schizophrenic person may think and communicate incoherently, jumping from one idea mixing a "word salad" of new words or jumbled phrases. It is common for schizophrenics to be suspicious and resentful. They may sense that their thoughts are stolen, broadcast aloud, Or replaced by new information from strangers seeking to control their behavior. They may describe voices that speak directly to them or criticize their behavior

Schizophrenia often appears earlier in men -when they are in their late teens to early adulthood - and in women in their 20s and early 30s, but the disease affects men and women with equal frequency. According to the National Institute of Mental Health, approximately 2.2 million American adults or about 1. 1 % of the population age 18 and older in a given year have schizophrenia. Some people experience only a single episode and remain symptom-free afterward. More commonly, however, the course of illness fluctuates over several decades, with each recurrence leading to increasing impairment.

Experts don't know what causes schizophrenia, but they agree that it most likely results from a complex interplay of genetic, behavioral, and other factors, similar to other diseases. It is widely believed that neurotransmitters, brain chemicals that allow communication between brain cells, play a role in causing schizophrenia, but the exact mechanism is not known. Most medicines used to treat the disease target the neurotransmitter dopamine and its receptors. Genetics also seems to play a role, as schizophrenia runs in families, but there is no single "schizophrenia gene." It appears that multiple genes are involved in creating a predisposition to the disease. Research has also shown that a number of factors, such as prenatal difficulties or other stressful situations, influence the development of schizophrenia. Imaging studies of the brain (such as MRI) have revealed actual physical changes in the brain structure of people suffering from psychotic disorders. Still, doctors cannot accurately predict whether a given person will develop schizophrenia.

The goals of schizophrenia treatment include helping patients toward normal interactions with others, enabling patients to live in the community, and controlling the illness through the smallest effective dosage of medication. A combination of medication and psychotherapy is usually required.

The modern era of medical treatment for schizophrenia began in 1952 with the use of the tranquilizer Thorazine (chlorpromazine). This (and modern relatives like Haldol, Prolixin, and Trilafon) for the first time controlled psychotic symptoms, reduced hospitalization from years to days, and lowered the rate of relapse by more than 50%. However, not everyone responds these drugs, and they do not cure schizophrenia. Long-term control of the disease is less successful than short-term alleviation of symptoms. Also, prolonged use of most schizophrenia medications new drugs may bring serious harmful side effects, especially a problem known as tardive dyskinesia (TD), which causes involuntary facial movements, such as grimacing and sucking motions. TD occurs in about 15%-20% of patients who have been treated with these older antipsychotic medicines for many years, but also develops in those who have been on the drugs for shorter periods of time. Patients may be unaware of the movements.

Newer antipsychotic medicines (the so-called atypical antipsychotics) all appear to have a much lower risk of causing TD. Clozaril (clozapine), approved in the U.S. in 1990, has been helping many people unresponsive to other antipsychotic medications without causing TD; it does, however, cause a serious and life-threatening decline in the white blood cells that fight infection in the body in 1 % of patients, so weekly blood tests are required.

Newer drugs, such as Risperdal (risperidone), Seroquel (quetiapine), and Zyprexa (olanzapine), relieve the symptoms of schizophrenia but appear to be safer than the older drugs and Clozaril. For most patients, lifelong use of these drugs is necessary to prevent relapse or worsening of their symptoms.

Adherence to these medication regimens is often difficult for schizophrenics. They may deny that they are ill, or their disease itself may hinder their ability to take regular medication. Fortunately there are many ways for patients, doctors, and families to improve adherence. Some antipsychotic medications are available in long-acting injectable forms so that the patient can receive a dose of medication just once a month. Other useful tools include pillboxes or electronic timers that beep when medication should be taken. Families can also help by motivating the patient to take their medicines properly. Often, additional drugs, such as antianxiety medications or antidepressants, may be used to treat side effects of the antipsychotic