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What Is It?
Schizophrenia is a chronic (long-lasting) brain disorder that is easily misunderstood.
Although symptoms may vary widely, people with schizophrenia frequently have a hard time
recognizing reality, thinking logically and behaving naturally in social situations.
Schizophrenia is surprisingly common, affecting 1 in every 100 people worldwide.
Experts believe schizophrenia results from a combination of genetic and environmental
causes. The chance of having schizophrenia is 10% if an immediate family member (a parent
or sibling) has the illness. The risk is as high as 65% for those who have an identical twin
with schizophrenia.
Scientists have identified several genes that increase the risk of getting this illness. In fact,
so many problem genes have been investigated that schizophrenia can be seen as several
illnesses rather than one. These genes probably affect the way the brain develops and how
nerve cells communicate with one another. In a vulnerable person, a stress (such as a toxin,
an infection or a nutritional deficiency) may trigger the illness during critical periods of brain
Schizophrenia may start as early as childhood and last throughout life. People with this
illness periodically have difficulty with their thoughts and their perceptions. They may
withdraw from social contacts. Without treatment, symptoms get worse.
Schizophrenia is one of several psychotic disorders. Psychosis can be defined as the
inability to recognize reality. It may include such symptoms as delusions (false beliefs),
hallucinations (false perceptions), and disorganized speech or behavior. Psychosis is a
symptom of many mental disorders. In other words, having a psychotic symptom does
not necessarily mean a person has schizophrenia.
Symptoms in schizophrenia are described as either positive or negative. Positive
symptoms are psychotic symptoms such as delusions, hallucinations and disorganized
speech. Negative symptoms are the tendency toward restricted emotions, flat affect
(diminished emotional expressiveness), and the inability to start or continue productive
In addition to positive and negative symptoms, many people with schizophrenia also have
cognitive symptoms (problems with their intellectual functioning). They may have trouble
with working memory. That is, they have trouble keeping information in mind in order to
use it. For example, it may be hard to hold a phone number in memory. These problems can
be very subtle, but in many cases may account for why a person with schizophrenia has
such a hard time managing day-to-day life.
Schizophrenia can be marked by a steady deterioration of logical thinking, social skills and
behavior. These problems can interfere with personal relationships or functioning at work.
Self-care can also suffer.
As people with schizophrenia realize what it means to have the disease, they may become
depressed or demoralized. People with schizophrenia are therefore at greater than average
risk of committing suicide.

People with schizophrenia are also at more risk for developing substance abuse problems.
People who drink and use substances have a harder time adhering to treatment. People with
schizophrenia smoke cigarettes more than people in the general population. The smoking
leads to more health problems.
Anyone with serious and chronic mental illness is at greater risk for developing metabolic
syndrome. Metabolic syndrome is a group of risk factors that increase risk for cardiovascular
disease and diabetes. The risk factors include obesity, high blood pressure and abnormal
lipid levels in the bloodstream.
Schizophrenia has historically been divided into several subtypes, but the evidence suggests
that these divisions are probably not clinically useful.

The symptoms of schizophrenia are often defined as either positive or negative.
Positive symptoms

Delusions (distorted thoughts, false beliefs)

Hallucinations (disordered perceptions) that may involve any of the five senses,
including sight, hearing, touch, smell and taste

Disorganized speech

Unusual motor activity or disorganized behavior

Negative symptoms

Restricted emotional range (flat affect)

Limited, unresponsive speech with little expression

Trouble starting or continuing goal-directed activity

Negative symptoms may represent a reduced ability to express emotions. People with
schizophrenia may also have trouble experiencing pleasure, which may lead to apathy.
Cognitive or intellectual symptoms are harder to detect and include problems retaining and
using information for the purpose of organizing or planning.

The diagnosis of schizophrenia is often not easy to make. It is not possible to make the
diagnosis in one meeting. Even if the person has psychotic symptoms, that does not mean
he or she has schizophrenia. It may take months or even years to see if the pattern of illness
fits the description of schizophrenia.
Just as there are many causes of fever, there are many causes of psychosis. Part of an
evaluation is to check for some of these other causes, for example, a mood disorder, a
medical problem or a toxic substance.

Experts know that brain function is impaired in schizophrenia, but tests that examine the
brain directly cannot yet be used to make a diagnosis. Brain imaging, such as computed
tomography (CT), magnetic resonance imaging (MRI) or an electroencephalogram (EEG), is
not diagnostic for schizophrenia. Such exams, however, can help to rule out other possible
causes of symptoms, such as a tumor or a seizure disorder.

Expected Duration
Schizophrenia is a lifelong illness. Psychotic symptoms tend to wax and wane, while the
negative symptoms and cognitive problems are more persistent. In general, the impact of
the illness can be reduced by early and active treatment.

There is no way to prevent schizophrenia, but the earlier the illness is detected, the better
chance there is to prevent the worst effects of the illness.
Schizophrenia is never the parents fault. But in families where the illness is prevalent,
genetic counseling may be helpful before starting a family. Educated family members are
often in a better position to understand the illness and provide assistance.

Schizophrenia requires a combination of treatments, including medication, psychological
counseling and social support.
The major medications used to treat schizophrenia are called antipsychotics. They are
generally effective for treating the positive symptoms of schizophrenia. Every person reacts
a little differently to antipsychotic drugs, so a patient may need to try several before finding
the one that works best.
If a medication does help, it is important to continue it even after symptoms get better.
Without medication, there is a high likelihood that psychosis will return, and each returning
episode may be worse.
Antipsychotic medications are divided into older (first generation) and newer (second
generation) groups. In recent years, it has been shown that in general one group is not
more effective than the other, but side effects differ from one group to the other. Also there
are differences among the medications within each group. For any individual person with
schizophrenia it is impossible to predict which medicine will be best. Therefore, finding the
most favorable balance of benefits and side effects depends upon a thoughtful trial and
error process.
Patients who are having a first episode of psychosis are both more responsive to these
medicines and are more sensitive to adverse effects. Thus, experts suggest that low to
moderate doses be used at the start. They also suggest putting off trials of a couple of the
newer drugs, clozapine (Clozaril) and olanzapine (Zyprexa), until other medications have

been tried. Compared to other antipsychotic medications, clozapine and olanzapine are
more likely to cause weight gain. Also, about 1 in 100 people who take clozapine lose the
capacity to produce the white blood cells needed to fight infection (see below).
People who suffer a relapse can try any other medication in the first or second generation of
antipsychotics. Once a person has found a drug or combination of drugs that helps, it is a
good idea to continue maintenance treatment in order to reduce the risk of relapse.
Older first generation antipsychotics. The first antipsychotics developed are also
sometimes called typical (in contrast to atypical) antipsychotics. The group includes
chlorpromazine (Thorazine), haloperidol (Haldol) or perphenazine (Trilafon). First generation
agents have been shown to be as effective as most newer ones. Side effects can be
minimized if modest doses are used. These older drugs, since they are available in generic
form, also tend to be more cost effective. The disadvantage of these drugs is the risk of
muscle spasms or rigidity, restlessness and with long-term use the risk of developing
potentially irreversible involuntary muscle movements (called tardive dyskinesia).
Newer atypical antipsychotics. In addition to olanzapine and clozapine, newer
medications include risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon),
aripiprazole (Abilify), paliperidone (Invega), asenapine (Saphris), iloperidone (Fanapt) and
lurasidone (Latuda). The major risk with some of these agents is weight gain and changes in
metabolism. They tend to increase the risk for diabetes and high cholesterol.
Other side effects. All antipsychotic medications can cause sedation. One can also feel
slowed or unmotivated, or have trouble concentrating, changes in sleep, dry mouth,
constipation, or changes in blood pressure.
Clozapine. Clozapine (Clozaril) is a unique antipsychotic. It works so differently from other
antipsychotics that it is useful to try if no other medication has provided enough relief.
However, since clozapine can impair the bodys ability to make white blood cells, anyone
taking this drug must have regular blood tests to check those cell counts. Other side effects
include changes in heart rate and blood pressure, weight gain, sedation, excessive
salivation, and constipation. On the positive side, people tend not to develop the muscle
rigidity or the involuntary muscle movements seen with older antipsychotics. For some
people, clozapine may be the best overall treatment for schizophrenia symptoms, so they
may decide that the potential benefit of taking it is worth the risks.
Because other disorders can either mimic the symptoms of schizophrenia or may
accompany schizophrenia, other classes of medication may be tried, such as
antidepressants and mood stabilizers. Sometimes anti-anxiety medications help to control
anxiety or agitation.
Psychosocial Treatments
There is growing evidence that psychosocial treatments are essential to the treatment of
schizophrenia. These treatments are not given instead of medications; they are given in
addition to medications.
In other words, the combination of medication and psychosocial treatment is most helpful.
Several approaches are useful:

Psychotherapy. Cognitive behavior therapy (CBT) can reduce symptoms and distress in
schizophrenia. CBT in schizophrenia is conducted differently from CBT for depression. When
treating schizophrenia, the therapist puts a heavy emphasis on understanding the persons
experience, developing a relationship, and explaining psychotic symptoms in realistic terms
to defuse their distressing effect.
Assertive Community Treatment. A community-based team with a variety of caregivers
(for example, a psychiatrist, psychologist, nurse, social worker, and/or case manager) makes
frequent contact with patients, monitors treatment adherence, and assesses psychosocial
and health needs. The team may also provide emotional support to families. Some patients
do well living in housing where staff can monitor progress and provide practical assistance.
Supported Employment. Such programs rely upon rapid job placement rather than an
extensive training period before employment. Programs work hard to honor the persons
preferences regarding work. They integrate on-the-job support and mental health services
into the program. Most careful studies have found such an approach to be more effective
than traditional vocational services.
Family Education. Schizophrenia profoundly affects families. Education about the illness
and practical advice can reduce relapse rates of patients as well as reduce family distress
and help family members support the person suffering with the illness.
Substance Abuse Treatment. Substance abuse, which is a common problem in
schizophrenia, can make the illness worse. Such treatment is essential when substance
problems emerge.
General Health. Patients with schizophrenia have a higher incidence of smoking and
overweight. Thus, a comprehensive program may include a way to help patients with these
problems. Examples are smoke-ending advice, weight-loss programs or nutritional
The overall goal of psychosocial treatment is to provide ongoing emotional and practical
support, education about the illness, perspective on the symptoms of the illness, advice
about managing relationships and health, skills for improved functioning and orientation to
reality. There may be an emphasis on sustaining motivation and solving problems. All of
these efforts can help a patient stick with treatment. The longer and more trusting the
relationships (with a therapist or case manager), the more useful it will be for the person
affected by this illness.

When To Call a Professional

Seek treatment for anyone showing psychotic symptoms or having difficulty functioning
because of problems in thinking. Although the vast majority of people with this disorder
never harm themselves or others, there is some increased risk of suicide or violence in
schizophrenia, another reason to seek help. There is increasing evidence that earlier and
continuous treatment leads to a better outcome. Plus, a relationship with a team of care
providers increases access to new treatments as they become available.

The outlook for schizophrenia varies. By definition, schizophrenia is a long-lasting condition
that includes some periods of psychosis. Functioning may fall short of expectations, when
measured against the persons abilities prior to becoming ill. Poor functioning is, however,
not inevitable with early treatment and proper supports.
Life expectancy may be shortened if a person with schizophrenia drifts away from supportive
relationships, if personal hygiene or self-care decline, or if poor judgment leads to accidents.
However, with active treatment, the effects of the illness can be significantly reduced.
The prognosis is better if the first symptoms began after age 30 and if the onset was rapid.
Better functioning before the onset of illness is linked to better responses to treatment. The
absence of a family history of schizophrenia is also a good sign.

Bipolar Disorder (Manic Depressive Illness or Manic

What Is It?
Bipolar disorder, which used to be called manic depressive illness or manic depression, is a
mental disorder characterized by wide mood swings from high (manic) to low (depressed).

Periods of high or irritable mood are called manic episodes. The person becomes very active,
but in a scattered and unproductive way, sometimes with painful or embarrassing
consequences. Examples are spending more money than is wise or getting involved in
sexual adventures that are regretted later. A person in a manic state is full of energy or very
irritable, may sleep far less than normal, and may dream up grand plans that could never be
carried out. The person may develop thinking that is out of step with reality psychotic
symptoms such as false beliefs (delusions) or false perceptions (hallucinations). During
manic periods, a person may run into trouble with the law. If a person has milder symptoms

of mania and does not have psychotic symptoms, it is called hypomania or a hypomanic
The expert view of bipolar disorder will continue to evolve, but it is now commonly divided
into two subtypes (bipolar I and bipolar II) based on the dividing line between mania and
hypomania described above.

Bipolar I disorder is the classic form where a person has had at least one manic

In bipolar II disorder, the person has never had a manic episode, but has had at least
one hypomanic episode and at least one period of significant depression.

Most people who have manic episodes also experience periods of depression. In fact, there
is some evidence that the depression phase is much more common than periods of mania in
this illness. Bipolar depression can be much more distressing than mania and, because of
the risk of suicide, is potentially more dangerous.
A disorder that is classified separately, but is closely related to bipolar disorder, is
cyclothymia. People with this disorder fluctuate between hypomania and mild or moderate
depression without ever developing a full manic or depressive episode.
Some people with bipolar disorder switch frequently or rapidly between manic and
depressive symptoms, a pattern that is often called rapid cycling. If manic and depressive
symptoms overlap for a period, it is called a mixed episode. During such periods, it may be
difficult to tell which mood depression or mania is more prominent.
People who have had one manic episode most likely will have others if they do not seek
treatment. The illness tends to run in families. Unlike depression, in which women are more
frequently diagnosed, bipolar disorder happens nearly equally in men and women.
Since bipolar disorder can come in so many forms, it is difficult to determine its prevalence.
Depending on how they define the disorder, researchers estimate that bipolar disorder
occurs in up to 4% of the population. When a particularly broad definition is used, the
estimate can be even higher.
The most important risk of this illness is the risk of suicide. People who have bipolar disorder
are also more likely to abuse alcohol or other substances.

During the manic phase, symptoms can include:

High level of energy and activity

Irritable mood

Decreased need for sleep

Exaggerated, puffed-up self-esteem (grandiosity)

Rapid or pressured speech

Rapid thoughts

Tendency to be easily distracted

Increased recklessness

False beliefs (delusions) or false perceptions (hallucinations)

During elated moods, a person may have delusions of grandeur, while irritable moods are
often accompanied by paranoid or suspicious feelings.
During a depressive period, symptoms may include:

Distinctly low or irritable mood

Loss of interest or pleasure

Eating more or less than normal

Gaining or losing weight

Sleeping more or less than normal

Appearing slowed or agitated

Fatigue and loss of energy

Feeling worthless or guilty

Poor concentration


Thoughts of death, suicide attempts or plans

Since there are no medical tests to establish this diagnosis, a mental health professional
diagnoses bipolar disorder based on a persons history and symptoms. The diagnosis is
based not just on the current symptoms, but also take into account the problems and
symptoms that have occurred through a persons life.
People with bipolar disorder are more likely to seek help when they are depressed than when
manic or hypomanic. It is important to tell your doctor about any history of manic symptoms
(like those described above). If a doctor prescribes an antidepressant for a person with such
a history, the antidepressant could trigger a manic episode.
Because medications and other illnesses can cause symptoms of mania and depression, a
psychiatrist and primary care physician must sometimes work together with other mental
health professionals to evaluate the problem. For example, the course of the illness can be
affected by steroid treatment or a thyroid problem.

Expected Duration
If left untreated, a first episode of mania lasts an average of two to four months and a
depressive episode up to eight months or longer, but there can be many variations. If the

person does not get treatment, episodes tend to become more frequent and last longer as
time passes.

There is no way to prevent bipolar disorder, but treatment can prevent manic and
depressive episodes or at least reduce their intensity or frequency. Also, if you are able to
talk to your health care provider as early as you can about milder forms of the disorder, you
may be able to ward off more severe forms. Unfortunately, worries about stigma often stop
people from mentioning their concerns to their primary care doctor or other caregiver.

A combination of medication and talk therapy is most helpful. Often more than one
medication is needed to keep the symptoms in check.
Mood Stabilizers
The best-known and oldest mood stabilizer is lithium carbonate, which can reduce the
symptoms of mania and prevent them from returning. Although it is one of the oldest
medicines used in psychiatry, and although many other drugs have been introduced in the
meantime, much evidence shows that it is still the most effective of the available
Lithium also may reduce the risk of suicide.
If you take lithium, you have to have periodic blood tests to make sure the dose is high
enough, but not too high. Side effects include nausea, diarrhea, frequent urination, tremor
(shaking) and diminished mental sharpness. Lithium can cause some minor changes in tests
that show how well your thyroid, kidney and heart are functioning. These changes are
usually not serious, but your doctor will want to know what your blood tests show before you
start taking lithium. You will have to get an electrocardiogram (EKG), thyroid and kidney
function tests, and a blood test to count your white blood cells.
For many years, antiseizure medications (also called anticonvulsants) have also been used
to treat bipolar disorder. The most common in use are valproic acid (Depakote) and
lamotrigine (Lamictal). A doctor may also recommend treatment with other antiseizure
medications gabapentin (Neurontin), topiramate (Topamax), or oxcarbazepine (Trileptal).
Some people tolerate valproic acid better than lithium. Nausea, loss of appetite, diarrhea,
sedation and tremor (shaking) are common when starting valproic acid, but, if these side
effects occur, they tend to fade over time. The medication also can cause weight gain.
Uncommon but serious side effects are damage to the liver and problems with blood
platelets (platelets are necessary for the blood to clot).
Lamotrigine (Lamictal) may or may not be effective for treating a depression that is active,
but some studies show that it is more effective than lithium for preventing the depression of
bipolar disorder. (Lithium, however, is more effective than lamotrigine in preventing mania.)
The most troubling side effect of lamotrigine is a severe rash in rare cases, the rash can
become dangerous. To minimize the risk, usually the doctor will recommend a low dose to

start and increase dosages very slowly. Other common side effects include nausea and
Lithium and valproic acid should be avoided during the first three months of pregnancy,
because they are known to cause birth defects. In some cases, however, the return of manic
or depressive symptoms could present a more significant risk to the fetus than medicines
would. Therefore, it is important to discuss the various treatment options and risks with your
For valproic acid, lamotrigine, and other antiseizure medications, there is a small risk that
suicidal thoughts or behaviors will increase. The risk is quite low. However, anyone being
treated with psychotropic medications should report to their doctor immediately if new or
more intense symptoms occur symptoms of depression, changes in mood, thoughts of
suicide or any self-destructive behavior.
Antipsychotic Medications
In recent years, studies have shown that some of the newer antipsychotic medications can
be effective for controlling bipolar disorder symptoms. Side effects often have to be
balanced against the helpful effects of these drugs:

Olanzapine: sleepiness, dry mouth, dizziness and weight gain.

Risperidone: sleepiness, restlessness and nausea.

Quetiapine: dry mouth, sleepiness, weight gain and dizziness.

Ziprasidone: sleepiness, dizziness, restlessness, nausea and tremor.

Aripiprazole: nausea, stomach upset, sleepiness (or sleeplessness) or restlessness.

Asenapine: sleepiness, restlessness, tremor, stiffness, dizziness, mouth or tongue


Some of these new antipsychotic drugs can increase the risk of diabetes and cause problems
with blood lipids. Olanzapine is associated with the greatest risk. With risperidone,
quetiapine and asenapine, the risk is moderate. Ziprasidone and aripiprazole cause minimal
weight change and not as much risk of diabetes.
Antianxiety Medications
Antianxiety medications such as lorazepam (Ativan) and clonazepam (Klonopin) sometimes
are used to calm the anxiety and agitation associated with a manic episode.
The use of antidepressants in bipolar disorder is controversial. Many psychiatrists avoid
prescribing antidepressants because of evidence that they may trigger a manic episode or
induce a pattern of rapid cycling. Once a diagnosis of bipolar disorder is made, therefore,
many psychiatrists try to treat the illness using mood stabilizers.
Some studies, however, continue to show the value of antidepressant treatment to treat low
mood, usually when a mood stabilizer or antipsychotic medication is also being prescribed.
There are so many different forms of bipolar disorder that it is impossible to establish one
general rule. Using an antidepressant alone may be justified in some cases, especially if

other treatments have not given relief. This is another area where the pros and cons of
treatment should be reviewed carefully with your doctor.
Talk therapy (psychotherapy) is important in bipolar disorder as it provides education and
support and helps a person come to terms with the illness. Research has shown that for
mania, psychotherapy helps people recognize mood symptoms early and helps them follow
a course of treatment more closely. For depression, psychotherapy can help people develop
coping strategies. Family education helps family members communicate and solve
problems. When families are kept involved, patients adjust more easily, are more likely to
make good decisions about their treatment and have a better quality of life. They have
fewer episodes of illness, fewer days with symptoms and fewer admissions to the hospital.
Psychotherapy helps a person deal with painful consequences, practical difficulties, losses or
embarrassment stemming from manic behavior. A number of psychotherapy techniques may
be helpful depending on the nature of the persons problems. Cognitive behavioral therapy
helps a person recognize patterns of thinking that may keep him or her from managing the
illness well. Psychodynamic, insight-oriented or interpersonal psychotherapy can help to sort
out conflicts in important relationships or explore the history that has contributed to current

When To Call a Professional

A manic episode is a serious problem requiring immediate treatment. However, a person in a
manic episode may not be aware that he or she is sick. Some people with this illness may
have to be brought to a hospital, even when they dont want to go. Many patients are
grateful later when they learn that they avoided a loss or embarrassment and were pushed
to get the treatment they needed.
If you observe manic symptoms in a person who is unaware of his or her condition, arrange
a consultation with a health care provider. Treatment can prevent symptoms from
accelerating, and can improve a persons progress and functioning over time.
Given the elevated risk of suicide in bipolar disorder, any person with known bipolar disorder
who exhibits symptoms of worsening depression should promptly seek help.

The natural course of bipolar disorder varies. Without treatment, manic and depressive
episodes tend to occur more frequently as people get older, causing increasing problems in
relationships or at work. It often takes persistence to find the most helpful drug combination
that has the fewest side effects. Treatment can be very effective; many of the symptoms can
be diminished and in some cases eliminated. As a result, many people with bipolar disorder
are able to function completely normally and have highly successful lives.

Alcohol Use Disorder (Alcoholism)

What Is It?
In an alcohol use disorder (AUD, commonly called alcoholism), excessive alcohol use causes
symptoms affecting the body, thoughts and behavior. A hallmark of the disorder is that the
person continues to drink despite the problems that alcohol causes. There is no absolute
number of drinks per day or quantity of alcohol that defines an alcohol use disorder, but
above a certain level, the risks of drinking increase significantly.
Here are some defining characteristics of alcohol dependence:

Drinking more than intended. Loss of control over the amount of alcohol used.

Desire to stop drinking, but inability to do so.

Excessive time spent getting or using alcohol, or recovering from its effects.

Craving, or preoccupation with drinking.

Problems stemming from alcohol use; ignoring those problems; drinking despite
obvious hazards, including physical danger.
Retreating from important work, family or social activities and roles.

Tolerance The need to drink more and more alcohol to feel the same effects, or the
ability to drink more than other people without getting drunk.

Withdrawal symptoms After stopping or cutting back on drinking, symptoms are

anxiety, sweating, trembling, trouble sleeping, nausea or vomiting, and, in severe cases,
physical seizures and hallucinations. The person may drink to relieve or avoid such

A person with alcohol use disorder has come to rely on alcohol physically, psychologically
and/or emotionally. The brain adapts to the presence of alcohol and undergoes persistent
changes. When alcohol use suddenly stops, the body is not accustomed to being alcohol
free. The internal environment changes drastically, causing symptoms of withdrawal.
Excessive alcohol use can be associated with many psychological, interpersonal, social,
economic and medical problems. It can increase the risk of depression and suicide. It can
play a role in violent crimes, including homicide and domestic violence (abuse of a spouse or
child). It can lead to traffic accidents and even accidents involving intoxicated pedestrians
who decide to walk home after drinking. AUD also can lead to unsafe sexual behavior,
resulting in accidental pregnancy or sexually transmitted diseases.
Alcohol use disorder increases the risk of liver disease (hepatitis and cirrhosis), heart
disease, stomach ulcers, brain damage, stroke and other health problems. In pregnant
women who drink alcohol, there is also the danger that the child will develop fetal alcohol
syndrome, a cluster of health problems including unusually low birth weight, facial
abnormalities, heart defects and learning difficulties.
Alcohol use disorder is very common. In the United States, for people 18 and older, about
10% of men and almost 5% of women have severe problems with drinking. Millions more are

engaged in what experts consider risky drinking. Alcohol is a cause of about 88,000 deaths
per year in the United States it is the third leading preventable cause of death. About onethird of driving fatalities are related to alcohol use.
Alcohol problems come about from a combination of biological tendencies and
environmental influences.

Biology. People with a family history of alcohol use disorder are at greater risk for
developing the illness themselves. For example, if a parent has AUD, a child has a fourtimes greater risk of becoming a problem drinker. This is partly due to inheriting genes
that increase vulnerability, perhaps by governing a persons physical responses to
alcohol or the experience of intoxication. Sometimes alcohol is used to blot out feelings
arising from an underlying depression or anxiety disorder.

Environment. Alcohol may be a big part of a persons social group or may have
been a part of family life (sometimes quite destructively). A person may turn to alcohol
to get relief from stress (which frequently backfires, because the drinking causes
problems of its own). Family support and healthy friendships can reduce the risk.

Alcohol use disorder can involve any of the following symptoms or behaviors:

Long episodes of intoxication

Drinking alone

Work problems or financial problems caused by drinking

Losing interest in food

Carelessness about personal appearance


Driving drunk

Hurting oneself or someone else while intoxicated

Hiding liquor bottles and glasses to hide the evidence of drinking

Mood or personality changes

Because large amounts of alcohol can be toxic to the body (for example, the cardiovascular,
gastrointestinal or nervous systems), problem drinking also may cause physical symptoms:

Morning nausea or shaking

Signs of malnutrition due to a poor diet

Abdominal pain or diarrhea

A flushed red color to the face and palms

Numbness, weakness or tingling in the arms or legs

Unusually frequent accidental injuries, especially falls

Even though alcohol related disorders are very common, relatively few individuals recognize
the problem and get help. Therefore, screening is very important, whether primary care
physicians or friends and family do it.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has recommended that
primary care physicians ask simple, but specific questions to get a quick idea whether or not
the person is at increased risk for developing alcohol-related problems.
How many times in the past year have you had:

(Men) 5 or more drinks in a day?

(Women) 4 or more drinks in a day?

The limits are different for women and men because of known differences in how alcohol is
absorbed, distributed and eliminated from the body. Thus, the risk goes up for men who
drink more than 4 standard drinks in a day (or more than 14 in a week); for women, there is
a lower limit of 3 drinks in a day (and 7 drinks in a week).
Almost always, people feel nervous or defensive about their drinking, which is one reason
this very common problem so often goes undetected or unaddressed. Therefore, primary
care physicians often make a point of use time during a visit to provide education about
drinking and its dangers.
As a screening test, the single question about drinking patterns is as good as slightly more
detailed ones, such as the CAGE questions. But these may be easier for concerned family
members and friends to ask, since they may hesitate to ask direct questions about quantity.
The word CAGE is a device for remembering the questions (see the highlighted words):

Do you worry that you might need to CUT down on drinking?

Do you feel ANNOYED because other people have criticized your drinking?

Do you feel GUILTY about drinking?

Do you need a morning EYE OPENER drink to steady your nerves or to fight a

Another screening questionnaire used by physicians is the 10-question AUDIT (Alcohol Use
Disorders Identification Test) developed by the World Health Organization.
As much shame as symptoms may trigger, drinking problems are an understandable human
predicament. The best strategy is to be frank in response to a doctors questions.

Doctors often also ask whether a person has alcohol-related problems at work, at
home or with the law, such as getting into fights or driving while intoxicated.
Doctors also ask about physical symptoms of alcoholism.

A physical examination can reveal signs of poor nutrition and alcohol-related liver or
nerve damage.

Blood tests can check for anemia, vitamin deficiencies and abnormal levels of liver

The NIAAA has a very helpful set of resources for the general public and for clinicians. They
are all easily available online at

Expected Duration
For most people who have an alcohol use disorder, the first alcohol-related life problems
usually appear in the mid-20s to early 40s. Left untreated, AUD often persists and gets
worse over time. Up to 30% of people with alcohol use disorder do manage to abstain from
alcohol or control their drinking without formal treatment. On the other hand, the illness can
be fatal there are approximately 88,000 alcohol-related deaths per year in the United

There is no absolute way to prevent alcoholism. Screening is important, because early
detection and treatment can prevent dangerous complications.

Treatment used to be limited to self-help groups such as Alcoholics Anonymous (established
in 1935). Now there are a variety of evidence-based treatments, including psychotherapy
and medication, to treat alcohol use disorders.
The first task is recognizing the problem. The well-known phenomenon of denial, which is a
common part of the illness, often turns the illness into a chronic one. Unfortunately, the
longer the illness persists, the harder it is to treat.
A doctor or substance abuse expert may be able to help a person look at the consequences
of drinking. A nonjudgmental approach to the discussion is essential. If an individual is
beginning to think about alcohol as a problem worth trying to solve, educational groups may
provide support for weighing the pros and cons of drinking.
It is never easy for family members and friends to talk about a drinking problem. A
professional may have to help loved ones kindly, but realistically talk to the drinker about
the painful impact that drinking has on them.
Once an individual commits to stop drinking, the physician will watch out for and treat
withdrawal symptoms. Depending on the amount and duration of drinking and any
symptoms, detoxification (often simply called detox) from alcohol can be done as an
outpatient, or as an inpatient in a hospital or drug treatment facility. During the withdrawal

process, the doctor may prescribe a class of antianxiety drugs called benzodiazepines for a
short period in order to reduce withdrawal symptoms.
After weaning from alcohol, medication in some cases can help reduce cravings. Two
medications that fit in this category are naltrexone and acamprosate. As an alternative,
sometimes the drug disulfiram may be prescribed. Disulfiram does not reduce craving, but it
creates an incentive not to drink, because drinking alcohol while taking it causes nausea and
vomiting. An antiseizure drug called topiramate may diminish the reinforcing effects of
alcohol. Alcohol treatment is an off-label use of topiramate, which means the FDA has not
formally approved it for this use. Also not approved by the FDA, there is limited evidence
that baclofen, a drug used to treat muscle spasticity, could help people quit alcohol use.
After detoxification, many people with alcohol disorders need some form of long-term
support or counseling to remain sober. Recovery programs focus on teaching a person with
alcoholism about the disease, its risks, and ways to cope with lifes usual stresses without
turning to alcohol. Psychotherapy may help a person understand the influences that trigger
drinking. Many patients benefit from self-help groups such as Alcoholics Anonymous (AA),
Rational Recovery or SMART (Self Management and Recovery Training).
Other mental health disorders can increase the risk of drinking. Depression and anxiety
frequently occur along with an alcohol use disorder. It is very important to get treatment for
such disorders if they are contributing to the problem.
A doctor may order additional tests to find out whether alcohol-related damage to the liver,
stomach or other organs has occurred. A healthy diet with vitamin supplements, especially B
vitamins, is helpful.

When To Call a Professional

Call your doctor whenever you or someone you love has an alcohol-related problem.
Remember, alcoholism is not a sign of weakness or poor character. It is an illness that can be
treated. The sooner treatment begins, the easier alcoholism is to treat.

About 30% of people with alcohol use disorder are able to abstain from alcohol permanently
without the help of formal treatment or a self-help program. For the rest, the course of the
illness is very varied. Two of three people seeking treatment do reduce their intake and
improve their overall health. Some people will go through periods where they remain sober,
but then relapse. Others have a hard time sustaining any period of sobriety.
It is clear, however, that the more sober days you have, the greater the chance that you will
remain sober. Another motivating fact remaining sober can increase life expectancy by 15
or more years.

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Nursing Interventions for Schizophrenia


Set realistic goals with clients.


Set the desired outcomes for clients with schizophrenia.


Set the desired criteria for the families that have family members with schizophrenia.

Nursing Interventions for Schizophrenia

1. Clients who withdrew and isolation

Use a self-therapeutic.

Perform a planned interaction, brief, frequent, and not demanding.

Plan simple activities one-on-one.

Maintain consistency and honesty in interactions.

Gradually encourage clients to interact with their peers in a non-threatening situation

Provide social skills training.

Perform a variety of actions to improve self-esteem.

2. Clients show regressive behavior or unfair

Do approach, it is strange behavior (do not reinforce this behavior).

Treat the client as an adult, even though the client regresses.

Monitor the client's diet, and give support and assistance when necessary.

Assist the client in terms of hygiene and dress up, only when the client can not do it alone.

Be careful with the touch because it can be considered a threat

Create a regular schedule of activities of daily living.

Give a simple choice of two things for clients who experienceambivalence.

3. Clients with no clear pattern of communication

Keep your own communication to keep it clear and unambiguous.

Maintain consistency of your verbal and nonverbal communication.

Clarification of any meaning ambiguous or not clearly related to client communication

4. Clients who are suspicious and rude

Form professional relationships; too friendly to bet the threat.

Be careful with the touch because it can be considered a threat.

Give as much control and autonomy to the client within the therapeutic limits.

Create a sense of trust through brief interactions that communicate caring and respect.

Describe any treatment, medication and laboratory tests before the start.

Do not focus or strengthen the suspicion or delusional ideas.

Identify and provide a response to the underlying emotional needs of suspicion or delusional

Intervene when the client shows signs of increasing anxiety and potentially express an
unconscious behavior.

Be careful to not behave in a way that could be misinterpreted kilen.

5. Clients with hallucinations or delusions

Do not focus on hallucinations or delusions. Perform an interrupt to initiate interaction with the
client's hallucinatory one-on-one based on reality.

Tell them that you do not agree with the perception of the client, but the validation that you believe
that the hallucinations are real to the client.

Do not argue with the client about the hallucinations or delusions.

Respond to the feelings that are communicated to the client when he was
having hallucinations or delusions.

Switch and the client focus on a structured activity or task-based reality.

Move the client to a more quiet, less stimulating.

Wait until the client does not have hallucinations or delusions before starting the counseling
session about it.

Explain that hallucinations or delusions are symptoms of psychiatric disorders.

Say that the anxiety or increased stimulus from the environment, to stimulate the onset
of hallucinations.

Help clients to control hallucinations by focusing on reality and take medication as prescribed.

If hallucinations persist, Bantu clients ignore it and continue acting remedy properly despite
a hallucination.

Teach a variety of cognitive strategies and tell the client to use self talk ("voices that makes no
sense") and the cessation of the mind ("I will not think about it").