Dr. MJ Bazos MD,
We expect that nearly 3 million Americans
will develop schizophrenia during the course of their lives, and about 100,000
schizophrenic patients are in public mental hospitals on any given day. The
treatments available for schizophrenia, while very important in relieving at
least some of the suffering for many of the people affected, are not yet
preventing the common pattern of repeated relapse with chronic disabilities in
social and occupational functioning. Schizophrenia remains poorly understood and
largely feared by the public.
essay addresses five main questions about schizophrenia: What is it? What causes
it? How is it treated? How can other people help? What is the outlook? Accurate
information may help to remove misconceptions and thereby reduce the fear,
shame, and hopelessness that are too often associated with the disorder.
What Is Schizophrenia?
Schizophrenia is a term used to
describe a complex, extremely puzzling condition—the most chronic and
disabling of the major mental illnesses. Schizophrenia may be one disorder, or
it may be many disorders, with different causes. Because of the disorder's
complexity, few generalizations hold true for all people who are diagnosed as
With the sudden onset
of severe psychotic symptoms, the individual is said to be experiencing acute
schizophrenia. "Psychotic" means out of touch with reality, or unable to
separate real from unreal experiences. Some people have only one such psychotic
episode; others have many episodes during a lifetime but lead relatively normal
lives during the interim periods. The individual with chronic (continuous or
recurring) schizophrenia often does not fully recover normal functioning and
typically requires long-term treatment, generally including medication, to
control the symptoms. Some chronic schizophrenic patients may never be able to
function without assistance of one sort or another.
Approximately 1% of the population
develop schizophrenia during their lives. This disorder affects men and women
with equal frequency, and the information in this booklet is equally applicable
to both. The first psychotic symptoms of schizophrenia are often seen in the
teens or twenties in men and in the twenties or early thirties in women. Less
obvious symptoms, such as social isolation or withdrawal or unusual speech,
thinking, or behavior may precede and/or follow the psychotic symptoms.
Sometimes people have psychotic
symptoms due to undetected medical disorders. For this reason, a medical history
should be taken and a physical examination and laboratory tests should be done
during hospitalization to rule out other causes of the symptoms before
concluding that a person has schizophrenia.
The World of People With
Realities: Just as "normal" individuals view the world from their own
perspectives, schizophrenic people, too, have their own perceptions of reality.
Their view of the world, however, is often strikingly different from the usual
reality seen and shared by those around them.
Living in a world that can appear
distorted, changeable, and lacking the reliable landmarks we all use to anchor
ourselves to reality, a person with schizophrenia may feel anxious and confused.
This person may seem distant, detached, or preoccupied, and may even sit as
rigidly as a stone, not moving for hours and not uttering a sound. Or he or she
may move about constantly, always occupied, wide awake, vigilant, and alert. A
schizophrenic person may exhibit very different kinds of behavior at different
world of a schizophrenic individual may be filled with hallucinations; a person
actually may sense things that in reality do not exist, such as hearing voices
telling the person to do certain things, seeing people or objects tat are not
really there, or feeling invisible fingers touching his or her body. These
hallucinations may be quite frightening. Hearing voices that other people don't
hear is the most common type of hallucination in schizophrenia. Such voices may
describe the patient's activities, carry on a conversation, warn of impending
dangers, or tell the person what to do.
Delusions: Delusions are false
personal beliefs that are not subject to reason or contradictory evidence and
are not part of the person's culture. They are common symptoms of schizophrenia
and can involve themes of persecution or grandeur, for example. Sometimes
delusions in schizophrenia are quite bizarre—for instance, believing that
a neighbor is controlling the schizophrenic individual's behavior with magnetic
waves, or that people on television are directing special messages specifically
at him or her, or are broadcasting the individual's thoughts aloud to other
people. Delusions of persecution, which are common in paranoid schizophrenia,
are false and irrational beliefs that a person is being cheated, harassed,
poisoned, or conspired against. The patient may believe that he or she, or a
member of the family or other group, is the focus of this imagined persecution.
Disordered Thinking: Often the
schizophrenic person's thinking is affected by the disorder. The person may
endure many hours of not being able to "think straight." Thoughts may come and
go so rapidly that it is not possible to "catch them." The person may not be
able to concentrate on one thought for very long and may be easily distracted,
unable to focus attention.
The person 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, as thoughts may become disorganized and fragmented. Jumping
from topic to topic in a way that is totally confusing to others may result.
This lack of logical continuity of
thought, termed "thought disorder," can make conversation very difficult and
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.
Expression: People with schizophrenia sometimes exhibit what is called
"inappropriate affect." This means showing emotion that is inconsistent with the
person's speech or thoughts. For example, a schizophrenic person may say that he
or she is being persecuted by demons and then laugh. This should not be confused
with the behavior of normal individuals when, for instance, they giggle
nervously after a minor accident. Often people with schizophrenia show "blunted"
or "flat" affect. This refers to a severe reduction in emotional expressiveness.
A schizophrenic person may not show the signs of normal emotion, perhaps using a
monotonous tone of voice and diminished facial expression.
Some people with symptoms of schizophrenia
also exhibit prolonged extremes of elation or depression, and it is important to
determine whether such a patient is schizophrenic, or actually has a bipolar
(manic-depressive) disorder or major depressive disorder. Persons who cannot be
clearly categorized are sometimes diagnosed as having a schizoaffective
Abnormal: At times, normal individuals may feel, think, or act in ways that
resemble schizophrenia. Often normal people are unable to think straight. They
can be made extremely anxious, for example, speaking in front of groups so that
they could feel confused, be unable to pull their thoughts together, and forget
what they had intended to say. Just as normal people may occasionally do strange
things, many schizophrenic people often think, feel, and act in a normal
fashion. Unless in the midst of an extremely disorganized state, a schizophrenic
person will have some sense of common reality, for instance, knowing that most
people eat three times each day and sleep at night. Being out of touch with
reality (which is one way to describe the psychotic symptoms of schizophrenia)
does not mean that an individual is living totally in another world. Rather,
there are certain aspects of this individual's world that are not shared by
others and that seem to have no real basis. Hearing a voice of warning that no
one else can hear is not an experience shared by most people and is clearly a
distortion of reality, but it is only a distortion of one part of reality. A
schizophrenic person may, therefore, appear quite normal much of the time.
Schizophrenia Is Not "Split
There is a common notion
that schizophrenia is the same as "split personality"—a Dr. Jekyll-Mr.Hyde
switch in character. This is not an accurate description of schizophrenia. In
fact, split or multiple personality is an entirely different disorder that is
really quite rare.
a New Disease?
Although the term
"schizophrenia" was not used until the early 20th century, the disorder has
existed for a great many years and has been found in all types of societies.
In Western society, "madness" or
"insanity" was not generally regarded as a health problem until the early 19th
century. At that time, a movement to offer more humane treatment to the mentally
ill made it possible for them to receive more scientific, medical treatment. The
mentally ill were unchained, released from prisons, and given more appropriate
care. Several categories of mental disease were subsequently identified. By the
early 20th century, schizophrenia had been distinguished from manic-depressive
illness, and subcategories had been described. In 1911, Dr. Eugen Bleuler, a
Swiss psychiatrist, first used the term, "the group of schizophrenias." Despite
disagreement among scientists as to precisely what conditions should or should
not be included in this group, the term as been commonly used since then.
Can Children Be Schizophrenic?
Children over the age of 5 can develop
schizophrenia, but it is very rare before adolescence. Moreover, research is
needed to clarify the relationship of schizophrenia occurring in childhood to
that occurring in adolescence and adulthood. Although some people who later
develop schizophrenia may have seemed different from other children at an early
age, the psychotic symptoms of schizophrenia (for example, hallucinations,
delusions, and incoherence) are rarely seen in children.
Are People With Schizophrenia
Likely to Be Violent?
and entertainment media tend to link mental illness and criminal violence,
studies tell us that if we set aside those persons with a record of criminal
violence before hospitalization, mentally ill persons as a whole are probably no
more prone to criminal violence than the general public. Studies are underway to
refine our understanding of the different forms of mental illness to learn
whether some groups are more prone to violence than others.
Certainly most schizophrenic
individuals are not violent; more typically, they prefer to withdraw and be left
alone. Some acutely disturbed patients may become physically violent, but such
outbursts have become relatively infrequent following the introduction of more
effective treatment programs, including the use of antipsychotic medications.
There is general agreement that most violent crimes are not committed by
schizophrenic persons, and that most schizophrenic persons do not commit violent
What About Suicide?
Suicide is a potential danger in those
who have schizophrenia. If an individual tries to commit suicide or expresses
plans to do so, he or she should receive immediate professional help. People
with schizophrenia appear to have a higher rate of suicide than the general
population. Unfortunately, the prediction of suicide in schizophrenic patients
may be especially difficult.
There is no
known single cause of schizophrenia. As discussed later, it appears that genetic
factors produce a vulnerability to schizophrenia, with environmental factors
contributing to different degrees in different individuals. Just as each
individual's personality is the result of an interplay of cultural,
psychological, biological, and genetic factors, a disorganization of the
personality, as in schizophrenia, may result from an interplay of many factors.
Scientists do not agree on a particular formula that is necessary to produce the
disorder. No specific gene has yet been found; no biochemical defect has been
proven responsible; and no specific stressful event seems sufficient, by itself,
to produce schizophrenia.
It has long
been known that schizophrenia runs in families. The close relatives of
schizophrenic patients are more likely to develop schizophrenia than those who
are not related to someone with schizophrenia. The children of a schizophrenic
parent, for example, each have about a 10% chance of developing schizophrenia.
By comparison, the risk of schizophrenia in the general population is about 1%.
Over the past 25 years, two types of
increasingly sophisticated studies have demonstrated the importance of a genetic
factor in the development of schizophrenia. One group of studies examined the
occurrence of schizophrenia in identical and fraternal twins; the other group
compared adoptive and biological families.
Recent studies of twins have confirmed
the basic findings of earlier, scientifically less rigorous studies. Identical
twins (who are genetically alike) generally have a higher rate of "concordance"
for schizophrenia than fraternal twins (who are no more genetically alike than
ordinary siblings). "Concordance" occurs when both members of a twin pair
develop schizophrenia. Although studies of twins provide convincing evidence of
an inherited factor in schizophrenia, the fact that concordance for
schizophrenia among identical twins is only 40% to 60% suggests that some type
of environmental factor or factors also must be involved.
A second major group of studies looked
at adopted children to examine the effects of heredity and environment. In
Denmark, an exhaustive investigation of the mental health of adopted-away
children of schizophrenic parents was conducted. These children were compared
with adopted children whose biological parents had no history of mental illness.
A comparison was also made of the rates of mental disorder among the biological
relatives of two groups of adoptees—one known to be schizophrenic and the
other without a history of mental illness. Findings of adoption studies have
indicated that being biologically related to a schizophrenic person increased
the risk for schizophrenia, even when the related individuals have had little or
no personal contact.
indicate that schizophrenia has some hereditary basis, but the exact extent of
this genetic influence needs further exploration. Most scientists agree that
what may be inherited is a vulnerability or predisposition to the
disorder—an inherited potential that, given a certain set of factors, can
lead to schizophrenia. This predisposition may be due to an enzyme defect or
some other biochemical abnormality, a subtle neurological deficit, or some other
factor or combination of factors.
do not yet understand how the genetic predisposition is transmitted and cannot
predict accurately whether a given person will or will not develop the disorder.
In some people, a genetic factor may be crucial for the development of the
disorder; in others, it may be relatively unimportant.
Are the Parents at Fault?
Most schizophrenia researchers now
agree that parents do not cause schizophrenia. In past decades, there was a
tendency for some mental health workers to blame parents for their children's
disorder. Today, this attitude is generally seen as both inaccurate and
counterproductive. Mental health workers now commonly try to enlist family
members' aid in the therapeutic program and also show a heightened sensitivity
to the very real feelings of burden and isolation many families experience in
their attempts to care for a schizophrenic family member.
Is Schizophrenia Caused by a
neurochemical cause has yet been firmly established for schizophrenia, 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 that the disorder is associated with some imbalance
of the complex, interrelated chemical systems of the brain. Although we have no
definite answers, this area of schizophrenia research is very active and
Is Schizophrenia Caused
by a Physical Abnormality in the Brain?
Interest in this research question has
been stimulated by the development of CAT scans (Computerized Axial
Tomography)—a kind of x-ray technique for visualizing the structures of
living brains. Some studies using this technique suggest that schizophrenic
patients are more likely to have abnormal brain structures (for example,
enlargement of the cavities in the interior of the brain) than are normal
persons of the same age. It should be emphasized that some of the abnormalities
reported are quite subtle. These abnormalities have been found neither to be
characteristic of all schizophrenic patients nor to occur ONLY in individuals
A more recent
development is the PET (Positron Emission Tomography) scan. In contrast to the
CAT scan, which produces images of brain structures, the PET scan is a way of
measuring the metabolic activity of specific areas of the brain, including areas
deep within the brain. Only very preliminary research has been done with the PET
scan in schizophrenia, but this new technique, used in conjunction with other
types of scans, promises to provide important information about the structure
and function of the living brain.
special imaging studies that may increase our understanding of schizophrenia
include MRI, RCBF, and computerized EEG measures. MRI stands for magnetic
resonance imaging, a technique involving precise measurements of brain
structures based on the effects of a magnetic field on different substances in
the brain. This technique has sometimes been referred to as nuclear magnetic
resonance (NMR) imaging. In RCBF, or regional cerebral blood flow, a radioactive
gas is inhaled, and the rate of disappearance of this substance from different
areas of the brain gives information about the relative activity of brain
regions during various mental activities. The computerized EEG
(electroencephalogram) is a kind of brain wave test that maps electrical
responses of the brain as it reacts to different stimuli. All of these imaging
techniques are being used for research. They are not new forms of treatment.
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 schizophrenic symptoms and lessen the
chances that symptoms will return. A number of treatments and treatment
combinations have been found to be helpful, and more are being developed.
What About Antipsychotic Drugs?
Antipsychotic medications (also called
neuroleptics) 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 patients may vary a great deal in the amount of drug needed to reduce
symptoms without producing troublesome side effects.
Antipsychotic drugs are very effective
in treating certain schizophrenic symptoms (for example, hallucinations and
delusions). A large majority of schizophrenic patients show substantial
improvement. Some patients, however, are not helped very much by such
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.
Sometimes patients and families become
worried about the antipsychotic medications used to treat schizophrenia. In
addition to concern about side effects (discussed elsewhere in this pamphlet),
there may be worries that such drugs may lead to addiction. Antipsychotic
medications, however, do not produce a "high" (euphoria) or a strong physical
dependence, as some other drugs do.
Another misconception about
antipsychotic drugs is that they act as a kind of mind control. Antipsychotic
drugs do not control a person's thoughts; instead, they often help the patient
to tell the difference between psychotic symptoms and the real world. These
medications may diminish hallucinations, agitation, confusion, distortions, and
delusions, allowing the schizophrenic individual to make decisions more
rationally. Schizophrenia itself may seem to take control of the patient's mind
and personality, and antipsychotic drugs can help to free the patient from his
or her symptoms and allow the patient to think more clearly and make better
informed decisions. While some patients taking these medications may experience
sedation or diminished expressiveness, antipsychotic medications used in
appropriate dosage for the treatment of schizophrenia are not chemical
restraints. Frequently, with careful monitoring, the dosage of the medication
can be reduced to provide relief from undesirable effects. There is now a trend
in psychiatry that favors finding and using the lowest dosage that allows the
schizophrenic person to function without a return of psychosis.
How Long Should Schizophrenic
Patients Take Antipsychotic Drugs?
Antipsychotic drugs also reduce the
risk of future psychotic episodes in recovered patients. With continued drug
treatment, about 40% of recovered patients will suffer relapses within 2 years
of discharge from a hospital. Still, this figure compares favorably with the 80%
relapse rate when medication is discontinued. In most cases, it would not be
accurate to say that continued drug treatment prevents relapses; rather, it
reduces their frequency. The treatment of severe psychotic symptoms generally
requires higher dosages than those used for maintenance treatment. If symptoms
reappear with a lower dosage, a temporary increase in dosage may prevent a
Some patients may
deny that they need medication and may discontinue antipsychotic drugs on their
own or based on someone else's advice. This typically increases the risk of
relapse (although symptoms may not reappear right away). It can be very
difficult to convince certain schizophrenic people that they continue to need
medication, particularly since some may feel better at first. For patients who
are unreliable in taking antipsychotic drugs, a long acting injectable form may
be appropriate. Schizophrenic patients should not discontinue antipsychotic
drugs without medical advice and monitoring.
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.
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. It generally occurs in about 15%
to 20% of patients who have been receiving antipsychotic drugs for many years,
but TD can occur 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.
risk-benefit issue in any kind of treatment for schizophrenia is an extremely
important consideration. In this context, the risk of TD—as frightening as
it is—must be carefully weighed against the risk of repeated breakdowns
that can terribly disrupt patients' efforts to reestablish themselves at school,
at work, at home, and in the community. For patients who develop TD, the use of
medications must be reevaluated. Recent research suggests, however, that TD,
once considered irreversible, often improves even when patients continue to
receive antipsychotic medications.
What About Psychosocial Treatments?
Antipsychotic drugs have proven to be
crucial in relieving psychotic schizophrenic symptoms such as hallucinations,
delusions, and incoherence, but not consistently relieve all the symptoms of the
disorder. Even when schizophrenic patients are relatively free of psychotic
symptoms, many still have extraordinary difficulty establishing and maintaining
relationships with others. Moreover, because schizophrenic patients frequently
become ill during the critical trade-learning or career-forming years of life
(ages 18 to 35), they are less likely to complete the training required for
skilled work. As a result, many schizophrenic patients not only suffer thinking
and emotional difficulties, but they lack social and work skills as well.
It is with these psychological,
social, and occupational problems that psychosocial treatments help most. In
general, psychosocial approaches have limited value for acutely psychotic
patients (those who are out of touch with reality or have prominent
hallucinations or delusions), but may be useful for those with less severe
symptoms or those whose psychotic symptoms are under control. Numerous forms of
psychosocial therapy are available for patients with schizophrenia, and most
focus on improving the patient's functioning as a social being—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.
defined, rehabilitation includes a wide array of nonmedical 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. These talks may focus on current or past
problems, experiences, thoughts, feelings, or relationships. By sharing their
experiences with a trained, empathic person and by talking about their world
with someone outside it, schizophrenic individuals 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 tend to indicate that
supportive, reality-oriented therapy is generally of more benefit to
schizophrenic outpatients than more probing psychoanalytic or insight-oriented
psychotherapy. In one large-scale study, patients given psychotherapy oriented
toward reality adaptation and practical interpersonal skills generally did as
well or better than patients given more frequent and intensive insight-oriented
Family Therapy: As
usually practiced, family therapy involves the patient, the parents or spouse,
and a therapist. Brothers and sisters, children, and other relatives may also be
included. The purposes vary. Meeting in a family group can enable various family
members and the therapist to understand each others' viewpoints. It also can
help with treatment planning (such as discharge from the hospital) and enlisting
the aid of family members in the therapeutic program. Family therapy can also
provide a way for the therapist to offer the family needed support and
understanding in a time of crisis.
often, patients are discharged from the hospital to their families' care, so it
is important that family members have a clear understanding of schizophrenia and
are aware of the difficulties and problems associated with the illness. It is
also helpful for family members to understand the ways of minimizing the chance
of future breakdowns and to be aware of the different kinds of outpatient and
family services that are available in the period after hospitalization.
Group Therapy: Group therapy
sessions usually involve a small number of patients (for example, 6–12)
and one or two trained therapists. Here, the focus is on learning from the
experiences of others, testing out one person's perceptions against those of
others, and correcting distortions and maladaptive interpersonal behavior by
means of feedback from other members of the group. This form of therapy may be
most helpful after symptoms have subsided somewhat and patients have emerged
from the acute psychotic phase of the illness, since psychotic patients are
often too disturbed or disorganized to participate. Later, when patients are
beginning to recover, participation in group therapy will often be helpful in
preparing them to cope with community life.
Self-Help Groups: Another kind of
group that is becoming increasingly common is the self-help group. Although not
led by a professional therapist, the groups are therapeutic because
members—usually ex-patients or the family members of people with
schizophrenia— provide continuing mutual support as well as comfort in
knowing that they are not alone in the problems they face. These groups also
serve other important functions. Families working together can more effectively
serve as advocates for needed research and hospital and community treatment
programs. Ex-patients as a group may be better able to dispel stigma and draw
public attention to such abuses as discrimination against the formerly mentally
Family and peer support and
advocacy groups are now very active and provide useful information and
assistance for patients and families of patients with schizophrenia and other
Prolonged hospitalization is now very
much less common than it was 20 or 30 years ago, when approximately 300,000
schizophrenic patients were residents of State and county mental institutions.
Despite this trend, a minority of patients still seem to require long-term
inpatient care. For most patients, prolonged hospital stays are not recommended
because they increase dependence on institutional care and result in a loss of
social contacts with family, acquaintances, and the community. Short-term
residential care in well-staffed facilities can give patients needed relief from
stressful situations, provide a protective atmosphere for the troubled patient,
allow restarting or adjustment of medication, and reduce pressure on the family.
Many schizophrenic persons can benefit
from partial hospitalization (day care or night care), from outpatient treatment
(going to a clinic or office regularly for individual, group, or occupational
therapy), or from living in a halfway house (designed to aid patients in
bridging the gap between 24-hour hospitalization and independent living in the
What About Other Forms
Therapy (Ect) And Insulin Coma: These two forms of treatment are rarely used
today in the treatment of schizophrenia. In particular situations, however,
electroconvulsive therapy may be useful. It can be of help, for example, if a
severe depression occurs in the course of a schizophrenic episode. Insulin coma
treatment is virtually never used now because of the availability of other
effective treatment methods that have fewer potentially serious complications.
Psychosurgery: Lobotomy, a
brain operation formerly used in some patients with severe chronic
schizophrenia, now is performed only under extremely rare circumstances. This is
because of the serious, irreversible personality changes that the surgery may
produce and the fact that far better results are generally attained from less
drastic and hazardous procedures.
Large Doses Of Vitamins: Good
physical hygiene, including a nourishing diet and proper exercise, is important
to good health. Well-controlled studies have shown that the addition of large
doses of vitamins to standard therapy regimens does not significantly improve
the treatment of schizophrenia. Also, although vitamins have been thought to be
relatively harmless, reports of side effects raise the possibility that these
substances may have detrimental consequences when used in very high doses.
Reliance on high-dose vitamins as a treatment for schizophrenia is not
scientifically justified and does have risks.
reports that some schizophrenic patients appeared to improve following
hemodialysis, a blood-cleansing treatment used in certain kidney disorders,
attracted a great deal of attention. However, several more recent controlled
scientific studies have reported that the procedure has no beneficial effect on
the symptoms of schizophrenia. The weight of scientific evidence now indicates
that hemodialysis is not useful in the treatment of schizophrenia.
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 the majority of 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.
numerous situations in which patients with schizophrenia can be helped by people
in their support systems. First of all, for patients who do not recognize that
they are ill, family or friends may need to take an active role in having them
seen and evaluated by a professional. Often, a schizophrenic person will resist
treatment, believing that delusions or hallucinations are real and that
psychiatric help is not needed. Since laws regarding involuntary commitment have
become very strict, families and community organizations may be frustrated in
their attempts to see that a severely mentally ill individual gets needed help.
These laws vary from State to State, but generally people who are dangerous to
themselves or others due to a mental disorder can be taken by the police for
emergency psychiatric evaluation and, if necessary, hospitalization. In some
cases, a member of a local community mental health center can evaluate an
individual's illness at home if he or she will not voluntarily go in for
Sometimes only the family
or others close to the patient will be aware of strange behavior or ideas that
the patient has expressed. Since schizophrenic 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.
Seeing that a
schizophrenic patient continues to get treatment after hospitalization is also
important. Patients may discontinue medications or stop going for follow-up
treatment—often leading to a return of psychotic symptoms. Encouraging and
assisting the patient to continue treatment can be very important to recovery.
Without treatment, some schizophrenic patients 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 wind up on the streets or in jails, where they rarely receive the
kinds of treatment they need.
close to people with schizophrenia are often unsure of how to respond when
patients make statements that seem strange or are clearly false. The
schizophrenic patient's bizarre beliefs or hallucinations seem quite
real—they are not just "imaginary fantasies." Instead of going along with
a patient's delusions, family members or friends can tell the patient that they
do not see things the same way or do not agree with his or her conclusions,
while acknowledging that things may seem that way to the patient.
It may also be useful for those who know
the patient 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) better and earlier than the
patients themselves. Return of the psychosis may thus 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
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 this as a 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, and this advice applies
to all those who interact with the patient.
A common question raised by family and
friends concerns "street drugs." Since some people who take street drugs may
show symptoms similar to those typical of schizophrenia, people with
schizophrenia may be accused of being "high on drugs." To help understand the
cause of the patient's behavior, blood or urine samples can be tested for street
drugs at many hospitals or physician's offices. While most researchers do not
believe that schizophrenic patients develop their symptoms because of drug use,
people who have schizophrenia often have particularly bad reactions to certain
street drugs. Stimulants (such as amphetamines or cocaine) may cause major
problems for schizophrenic patients, as may drugs like PCP or marijuana. In
fact, some patients experience a worsening of their schizophrenic symptoms when
they are taking such drugs. Schizophrenic patients may also abuse alcohol or
other drugs for delusional reasons or in an attempt to lessen their symptoms.
This can cause additional problems requiring multiple treatment approaches. Such
patients may be helped by a combination of therapies such as medication,
rehabilitation, psychotherapy, or Alcoholics Anonymous or other substance abuse
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
schizophrenic patients improve enough to lead independent, satisfying lives. As
we learn more about the causes and treatment of schizophrenia, we should be able
to help more schizophrenic patients achieve successful outcomes.
Studies that have followed
schizophrenic patients for long periods, from the first breakdown to old age,
reveal that a wide range of outcomes is possible. A review of almost 2,000
patients' life histories suggests that 25% achieve full recovery, 50% recover at
least partially, and 25% require long term care. 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. Our current state of knowledge, however, does not allow for a
sufficiently accurate prediction of long-term outcome.
The development of a variety of
treatment methods and facilities is of crucial importance because schizophrenic
patients vary greatly in their needs for treatment. In particular, better
alternatives are needed to fill the gap between the relatively nonintensive
treatment offered in outpatient clinics and the highly regulated treatment
(including 24-hour supervision) provided in hospitals. With a wide variety of
facilities available, mental health professionals will be better able to tailor
treatment to the different needs of individual patients. Some patients require
constant care and attention, while others need a place to learn how to function
more independently without constant supervision.
Given the complexity of schizophrenia,
the major questions about this disorder—its cause or causes, prevention,
and treatment—are unlikely to be resolved in the near future. 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 a better understanding of schizophrenia, there is an urgent need for a
more rigorous and broad-based program of basic and clinical research. Research
on schizophrenia has benefited greatly from recent basic scientific discoveries,
and we hope that a better understanding of neurobiological and psychosocial
factors in schizophrenia will be achieved in the next decade.