Schizophrenia is a chronic, severe and disabling brain disease. Approximately one percent of the population develops schizophrenia during their lifetime- more than two 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 These symptoms may leave them fearful and withdrawn.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 (Seligman, Walker, & Rosenhan, 2001).
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 (Levine, 2001). 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 (Levine, 2001). 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 (Seligman, Walker, & Rosenhan, 2001). The sudden onset of severe psychotic symptoms is referred to as an “acute” phase of schizophrenia.
Psychosis,” a common condition is 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 (Levine, 2001). 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 (Levine, 2001). 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 (Seligman, Walker, & Rosenhan, 2001). Sometimes they may seem distant, detached, or preoccupied and may even sit as rigidly as 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 are disturbances of perception that are common in people suffering from schizophrenia.
Hallucinations are perceptions that occur without connection to an appropriate source. 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 (Levine, 2001). Sometimes the delusions experienced by people with schizophrenia are quite bizarre, for instance, that their thoughts are being broadcast aloud to others. 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. They also may not be able to sort out what is relevant and what is not relevant to a situation. They often show “blunted” or “flat” affect, which refers to a severe reduction in emotional experience. A person may not show the signs of normal emotion, and may withdraw socially, avoiding contact with others (Seligman, Walker, & Rosenhan, 2001). People with schizophrenia do not always act abnormally.
Some people with the illness can appear completely normal and be perfectly responsible, even while they experience hallucinations or delusions. There is no known single cause of schizophrenia. Many diseases result from an interplay of genetic, behavioral, and other factors, and this may be the cause of schizophrenia as well. 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. Neurotransmitters, substances that allow communication between nerve cells, have long been thought to be involved in the development of the disorder.
It is likely that the disorder is associated with some imbalance of the complex, interrelated chemical systems of the brain, perhaps involving the neurotransmitters dopamine and glutamate (Levine, 2001). 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. Antipsychotic medications are one treatment many use.
They have been available since the mid- 1950’s. 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. Only a qualified physician who is well trained can make the choice and dosage of medication in the medical treatment of mental disorders (Levine, 2001).
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. A number of new antipsychotic drugs have been introduced since 1990. The first, clozapine, has been shown to be more effective than other antispyschotics.
Newer antipsychotic drugs, such as risperidone and olanzapine, are safer drugs. These drugs are often very effective in treating certain symptoms of schizophrenia, particularly hallucinations and delusions, but the drugs may not be as helpful with other symptoms, such as reduced motivation and emotional expressiveness. The older antipsychotics like haloperidol or chloropromazine may even produce side effects that resemble the more difficult to treat symptoms. Sometimes when people with schizophrenia become depressed, other symptoms can appear to worsen.
The symptoms may improve with the addition of an antidepressant medication (Levine, 2001). Another treatment that is often used is the psychosocial treatments. This 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. 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 (Levine, 2001). 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, feeling, or relationships. By sharing experiences with a trained empathetic 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 (Levine, 2001).
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 and to be aware of the various kinds of outpatient and family services available in the period after hospitalization (Seligman, Walker, & Rosenhan, 2001).
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.
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 twilight existence, a twentieth-century underground man It is in fact the single biggest blemish on the face of the 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 (Levine, 2001).
