Schizophrenia

Schizophrenia is a complex medical disorder that affects speech, emotions, behaviour, and the way people think. In schizophrenia communications between nerve cells in the brain (through chemical messengers) appears to be disrupted in some way, resulting in symptoms of the disease. The prevalence of schizophrenia in the normal population is 1%. However this increases to 10% and 40% for individuals if one or both parents are affected with schizophrenia can be classified into two general types (i.e., positive and negative symptoms).

Positive symptoms include hallucinations, delusions, and disordered thinking. Hallucinations are disturbances of perception, which can affect the sense of touch, smell, sight, hearing and taste. Complaining of hearing voices is common in schizophrenia. These voices may carry on a conversation, warn of danger, or even issue orders. Delusions are irrational personal beliefs, held despite contradictory evidence. Delusions may occur in which a person believes he or she is an important or famous person. In patients with disordered thinking, thoughts are disorganized and fragmented, and they are unable to connect them into a logical sequence, making conversation difficult and leading to possible social isolation.

Negative symptoms include lack of initiative, apathy, social withdrawal, and emotional unresponsiveness. Typically people with schizophrenia have flat affect (i.e., lack of emotional expression), speak in monotones and have diminished facial expression.

Although schizophrenia cannot be cured, it is treatable. Proper treatment of schizophrenia includes medication, education, family counseling, hospitalization, regular follow-up, residential and rehabilitation programs, self-help groups, nutrition, rest, and exercise. Antipsychotics are used to control delusions, hallucinations and thinking problems associated with the illness. Mood stabilizers, anti-anxiety agents and antidepressants are also used to help control symptoms. Antipsychotis are classified as either conventional or atypical.

Conventional antipsychotics (e.g., haloperidol, trifluperazine, fluphenazine) have been used for several years to effectively control schizophrenia but they can cause troublesome side effects involving movement. They are used less frequently now that newer (atypical) antipsychotics have emerged. When compliance is a problem a depot injection is given at 2 to 4 week intervals. Depot injections are stored in the body and slowly released over time. Atypical antipsychotics (e.g., risperidone, olanzapine, quetiapine, clozapine) have become the treatment of choice for schizophrenia because they are less likely to cause the distressing movement side effects of conventional antipsychotics. Clozapine is reserved for treatment resistant patients, who do not respond to the other antipsychotics. It can however cause serious side effects affecting blood cells in about 1% of patients and therefore requires frequent monitoring.

For more information about schizophrenia and other psychiatric conditions visit www.mentalhealth.com and www.nimh.nih.gov/.