Schizophrenia

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Understanding Schizophrenia
Schizophrenia is a chronic mental illness that is easily misunderstood. While
schizophrenics can have a hard time recognizing reality and thinking logically, with
active treatment, the effects of the illness can be significantly reduced. Get the facts on
this surprisingly common condition ›

Is It Schizophrenia or Something Else?

It's confusing when your own reality seems out of sync with the rest of the world's view
of things. You might jump to the conclusion that the problem is schizophrenia. But other
conditions can also cause symptoms such as delusions and hallucinations. Getting a
correct diagnosis is the first—and very important—step toward finding effective help.

Life would be simpler if there were a lab test or brain scan that could definitely tell
whether you have schizophrenia. Unfortunately, it's not so easy. To make the diagnosis, a
health care professional first evaluates your symptoms, how long they've lasted, and how
they affect your daily life. Then the professional considers all possible causes before
deciding whether the symptoms are due to schizophrenia or something else.

For a diagnosis of schizophrenia, you must have two or more of the symptoms described
below. (Only one symptom is required if you have certain types of delusions or
hallucinations.) The symptoms are long-lasting or frequently recurring and lead to serious
problems in everyday life. But remember: All these symptoms can have other causes as
well. The only way to know for sure what's going on is to see a medical professional.

Delusions
Delusions are false beliefs based on a misinterpretation of reality. These beliefs aren't
shared by others in the same culture. People cling to their delusions even when all
evidence points in the other direction. Some people with schizophrenia believe that they
are being followed everywhere or plotted against by strangers. Others might believe that
aliens are controlling their bodies or that the radio is broadcasting their thoughts. Or they
might think that they are a famous figure from history or that a TV newscaster is talking
just to them.
Other possible causes: Severe depression, bipolar disorder, delirium (brain dysfunction
due to a medical illness), dementia, substance abuse or withdrawal, traumatic stress

Hallucinations
Hallucinations are things a person hears, sees, feels, tastes, or smells that no one else can
perceive. The most common type of hallucination in schizophrenia is "hearing voices."
These voices seem to be distinct from the person's own thoughts. They may keep up a
running commentary on the person's behavior. Or they may issue warnings or commands.
Other examples of hallucinations include seeing people who aren't there or feeling
another person's touch when no one else is around. The most immediately concerning
hallucinations are command hallucinations—voices demanding specific actions to be
taken—especially if these actions could be dangerous and if the person can't resist these
demands.

Other possible causes: Severe depression, bipolar disorder, delirium (brain dysfunction
due to a medical illness), dementia, substance abuse or withdrawal, epilepsy, narcolepsy,
sensory disorders (such as deafness or blindness), traumatic stress

Disorganized Thought or Speech

Many experts believe that disorganized thinking is the core symptom of schizophrenia.
This involves a lack of orderly flow and logical connection in a person's thought
processes. To the outside world, it often shows up as disorganized speech. When talking,
people may slip off track, veering from one train of thought to another, unrelated one. Or
they may garble their words so much that it's difficult for others to understand them.

Other possible causes: Severe depression, bipolar disorder, delirium (brain dysfunction
due to a medical illness), dementia, substance abuse or withdrawal, stroke, Tourette
syndrome, autism, speech and communication disorders

Disorganized Behavior or Odd Movements

People with schizophrenia may be extremely disorganized in their behavior. Some
behave bizarrely. Others act agitated at unpredictable times. In severe cases, people may
become catatonic, a state in which they seem totally unaware of the world around them.
They might repeat certain motions over and over without any obvious purpose, or they
might not move at all. Catatonic schizophrenia is rare today, but it occurred more often in
the era before modern treatments.

Other possible causes: Severe depression, bipolar disorder, delirium (brain dysfunction
due to a medical illness), autism, Parkinson's disease, dystonia, adverse drug reaction

Negative Symptoms
 Negative symptoms, or the inability to have feelings or express behaviors one ought to
have, aren't dramatic, yet they cause a lot of problems for those with schizophrenia. Some
people have "flat affect," which means that they speak in a monotone voice and show
little emotion on their face. Others talk as little as possible and can be curt to the point of
seeming rude. Still others lose all motivation and interest in daily life. As a result, they
may neglect personal hygiene or have trouble completing even the simplest tasks.

Other possible causes: Depression, delirium (brain dysfunction due to a medical illness),
dementia, autism, medication side effects, unstimulating environment, low morale

Medical Reviewer: Correll, Christoph MD

Last Annual Review Date: Tuesday, June 08, 2010
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PA 19067. All rights reserved. This information is not intended as a substitute for
professional medical care. Always follow your healthcare professional's instructions.

Early Treatment of Hearing, Vision Helps in Schizophrenia

FRIDAY, Dec. 11 (HealthDay News) -- Identifying sight and hearing problems in teens
who are in the early stages of schizophrenia may help doctors fully restore those senses
and lessen the impact of the devastating thought disorder, U.S. researchers say.

A new study found that problems in basic sensory processing abilities cause many of the
more complicated cognitive deficits in people with schizophrenia.

"In people with schizophrenia, we know that visual and auditory sensory systems that
functioned well in early childhood begin to break down during adolescence, years earlier
than the onset of the more complex cognitive symptoms of schizophrenia," Dr. Daniel C.
Javitt, of the New York University School of Medicine, said in a news release.

"We already know a lot about what people with this disorder can and cannot do," Javitt
said. "Our research focuses on understanding how the brain works and identifying
specific biomarkers for cognitive impairment that will distinguish schizophrenia from
Alzheimer's and other diseases."

He and his team determined that impaired function of the visual and auditory systems
makes it more difficult for people with schizophrenia to read, pay attention and
understand social cues. The researchers also identified biomarkers in the brain that could
help determine which patients would benefit from early intervention.

The study was scheduled to be presented Dec. 9 at the annual meeting of the American
College of Neuropsychopharmacology in Hollywood, Fla.

More information

Mental Health America has more about schizophrenia.

 SOURCE: American College of Neuropsychopharmacology, news release, Dec. 9, 2009

Long-Acting Injectable Medications: What You Need to Know

For people living with schizophrenia, taking maintenance medication to control

symptoms and prevent relapse is vital. But what type of medication is best for you or
your loved one? Long-acting injectable medications offer benefits that may be worth
considering.

If you haven't heard of these medications, it's because they're largely underused in the
United States. Doctors don't often prescribe them. Some reports estimate that as few as 5
to 19 percent of American schizophrenia patients are prescribed long-acting injectable
antipsychotic medication, compared to rates of up to 50 percent in other countries. Why?
Some doctors believe that their patients may not want to get injections. In addition, some
offices aren't equipped to administer them.

How Injectable Medications Work

Long-acting medications, also called depot injections, are specially prepared
antipsychotic drugs that are given by injection once or twice a month. They work by
slowly releasing medication into the body over time. There are a handful of antipsychotic
medications available in depot form. These include the older antipsychotics Haldol and
Prolixin and newer generation antipsychotics Risperdal, Zyprexa, and Invega. These
antipsychotics are also available in pill form. Oftentimes, people moving from an oral
medication to a depot injectable continue taking the same antipsychotic drug in the
injectable formulation. What changes is the form in which it's administered.

Help with Compliance

The greatest benefit of depot injections is that they help people comply with their
maintenance medication plan. Forgetting to take your medication—even for a day or two
—can greatly increase the risk for relapse and hospitalization. With depot-formulated
antipsychotics, you only need to remember to get your injection once or twice a month.

In addition, injectable medications make it easier for doctors to tell if their patients are
fully complying with their treatment plan. This helps doctors determine the effectiveness
of the drug for their patients, helping them make sound treatment decisions. For example,
if an antipsychotic doesn't work because it is taken inconsistently, it may be effective if
given at a different dose or taken in a reliable way. In contrast, if symptoms are
bothersome despite reliable medication intake at a sufficient dose and for a sufficient
period of time, the medication might need to be changed.

Understanding Risks
 The risks of depot injections are generally the same as the risks for antipsychotic drugs
taken in pill form, although in general, side effects may be less frequent with depot
injections. They may include weight gain, restlessness, stiffness, and dizziness. You
should discuss these with your doctor. Although pain can occur at the injection site, it's
usually mild and transient. People have commonly reported preferring depot injections
over pills after trying both.

If you or your loved one has had a tough time sticking with a treatment plan, or if you
prefer not to take a daily medication, talk with your doctor about depot injections. Using
this long-acting medication may better fit your lifestyle and ensure that you don't miss the
medication you need to help you achieve your life goals.

Medications for Schizophrenia

Content provided by the Faculty of the Harvard Medical School

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
quite effective at treating the positive symptoms of schizophrenia, but relatively less
successful for negative symptoms, with one notable exception (see clozapine, below).
Every person reacts a little differently to antipsychotic drugs, so a patient may need to try
several before finding the one that works best. It is also important to continue the
treatment even after symptoms get better, because there is a high likelihood that
psychosis will return without medication, and each returning episode may be worse.

Newer medications called "atypical" antipsychotics usually are tried first. They are as
effective as older medications at treating the psychotic symptoms of schizophrenia, and
they also may be a little better at treating cognitive symptoms. These medications include
risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone
(Geodon) and aripiprazole (Abilify). The most serious side effect of these newer drugs is
weight gain, which increases the risk for developing diabetes or high cholesterol.

Older antipsychotic medications, such as chlorpromazine (Thorazine) and haloperidol

(Haldol), are still quite effective and worth trying if atypical antipsychotics do not
provide enough relief. However, the older medications can cause sedation, muscle
spasms or rigidity, restlessness, dry mouth, constipation, weight gain or changes in blood
pressure. With long-term use, there is a risk of developing involuntary muscle
movements (called tardive dyskinesia).

Clozapine (Clozaril) is a unique antipsychotic that is effective not just for positive
symptoms, but also the negative symptoms of schizophrenia. However, it has a
potentially dangerous side effect. About 1 in 100 people who take this drug lose the
capacity to produce the white blood cells needed to fight infection. Anyone taking this
drug must have regular tests to check blood counts. Other side effects include changes in
heart rate and blood pressure, weight gain, sedation, excessive salivation and
constipation. On the positive side, people do not develop the muscle rigidity or the
involuntary muscle movements seen with older antipsychotics. Because clozapine may be
the best overall treatment for schizophrenia symptoms, some people may decide that the
potential benefit of taking it is worth the risks.

Because other disorders can either mimic the symptoms of schizophrenia or accompany
schizophrenia, other medications may be tried, such as antidepressants and mood
stabilizers. Sometimes anti-anxiety medications help to control anxiety or agitation.