Schizophrenia

Schizophrenia is a mental disorder that is characterized by severe disturbances of thought, perception, feeling, and behavior. Mental health professionals classify it as a psychotic disorder, defined as being out of touch with reality and unable to separate real from imaginary experiences.

Acute schizophrenia is marked by severe psychotic symptoms, which may include hallucinations, delusions, irrational acts, and bizarre behavior. Some people have only one such episode, while others have experienced many throughout their lives, sometimes interspersed with relatively normal periods. Still others suffer chronic recurrences without ongoing treatment.

About 200,000 new cases are diagnosed in the United States each year. The disease affects about 1 percent of the population from all economic, racial, and cultural groups, with men and women affected equally. Its cause is unknown, but researchers believe that a combination of inherited and environmental factors are involved.

Diagnostic Studies and Procedures

Since many patients with schizophrenia think, feel, and act quite normal much of the time, it is often hard to establish a diagnosis. In the active phase of the disease, at least two of the following symptoms must be present for most of the time for at least one month: delusions, hallucinations, disorganized speech or behavior, catatonic behavior, and a flat or abnormal facial expression.

A medical history is important in determining if the patient has become withdrawn and dysfunctional suddenly or over a period of time. Tests might include psychological and neurological studies, a blood workup, and CT scans or MRI to rule out a brain tumor.

Medical Treatments

Hospitalization is often needed for an initial episode or severe relapse. Long-term hospitalization is uncommon, but a few patients may require it.

The mainstays of treatment are antipsychotic medications, or neuroleptics. These drugs, which include chlorpromazine (Thorazine), haloperidol (Haldol), thiothixene (Navane), prochlorperazine (Compazine), loxapine (Loxitane), and clozapine (Clozaril), do not cure the condition, but they do enable most patients to think more clearly and rationally.

Antipsychotic drugs unfortunately have a number of adverse side effects, some of which can be eliminated by lowering the dosage. If this is not possible, some of the side effects can be controlled with other medications. Long-term use, however, can lead to tardive dyskinesia, a disorder in which involuntary movements occur, most often of the mouth, lips, and tongue.

Electroconvulsive therapy is rarely used to treat schizophrenia but may be helpful if a severe depression accompanies or triggers a psychotic episode. Lobotomy, a brain operation once used for severe chronic schizophrenia, is no longer advocated.

Alternative Therapies

Art Therapy. This modality encourages patients to express thoughts they cannot verbalize. The art also gives some insights into a patient's mental turmoil.

Behavior Modification. During hospital treatment this therapy is often used to encourage patients to adopt more socially acceptable behavior. A typical approach calls for praising and rewarding tolerable conduct while ignoring or punishing unacceptable behavior.

Music Therapy. Music not only has a soothing effect, but it also encourages movement, social interactions, and emotional expression.

Naturopathy and Nutrition Therapy. Although there is no scientific proof that diet helps control schizophrenia, some nutritionists recommend a high-fiber diet that also includes foods rich in niacin, such as poultry, seafood, seeds and nuts, potatoes, and fortified or whole-grain breads and cereals. They also advise against refined foods such as white flour, instant rice, sugar, and soft drinks.

Psychosocial Treatment. This is an essential adjunct to medical treatment, since antipsychotic drugs do not relieve all symptoms of schizophrenia. Even when schizophrenic patients are not suffering from psychotic symptoms, many still have trouble establishing and maintaining relationships. Therefore, psychosocial treatment usually includes one or more forms of psychotherapy, such as group and family therapy, as well as rehabilitation programs. The latter are often in group homes with other patients and emphasize social skills and lessons in daily living.

Self-Treatment

Self-treatment is not effective, although participation in self-help groups is often valuable both for patients and their families. Such groups provide continuing mutual support as well as comfort in letting individuals know that others have similar problems.

Because many patients with schizophrenia relapse when they stop taking medication, supervision is essential to make sure that they comply with their drug regimens. Following a routine that emphasizes regular meals, daily exercise, and adequate rest also helps.

Other Causes of Psychotic Symptoms

Organic brain disorders, mental retardation, severe depression, or paranoid disorders may produce some of the same symptoms as schizophrenia. Brain tumors, certain medications, and alcohol or drug abuse also can lead to psychotic behavior.