My Views on Schizophrenia

My Views on Schizophrenia: Schizophrenia is a mental illness affecting nearly 1% of the US population. Schizophrenia manifests in delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior; negative symptoms lasting for one month or less if successfully treated. Two or more of these symptoms need to be present unless the delusions are bizarre or the hallucinations consist of two people conversing together or about the person's behaviors or thoughts. At this point, only one of the symptoms just mentioned needs to be present to warrant an investigation of Schizophrenia.

Other symptoms include social and or occupational dysfunction and a duration of 6 months in which at least 1 month of the symptoms previously described are persistent before treatment begins.

There are a few exclusions to the diagnosis of Schizophrenia, which include Schizoaffective Disorder and Mood Disorders along with Substance Abuse and General Medical Conditions, which need to be ruled out.

There are five main types of Schizophrenia depending on the person's main symptomatology. These are Paranoid Schizophrenia, Disorganized Schizophrenia, Catatonic Schizophrenia, Undifferentiated Schizophrenia and Residual Type of Schizophrenia.

Causes of Schizophrenia, might be due to an overabundance of the neurotransmitter Dopamine in the brain that causes the aforementioned symptoms of Schizophrenia, therefore, the medications that we use to treat it allow for the decrease in the levels of Dopamine in the brain and thus the person shows a decrease in the symptoms of hallucinations, delusions and other cognitive problems.

Regarding my views on Schizophrenia, we don't know exactly what causes this chemical imbalance of an overabundance of Dopamine in the brain; but some possible causes that are being looked at are the deficiency of Vitamin D during pregnancy, some studies point to fetal alcohol syndrome causing poisoning of the infant to the degree that only two drinks during pregnancy can cause the illness, environmental factors as well as genetic factors.

A person usually starts having symptoms of Schizophrenia at either late adolescence or early adulthood. There are some cases in childhood and in the elderly; but these are rare. A person with Schizophrenia diagnosed in early adulthood, usually has some premorbid symptoms. These premorbid symptoms can masquerade as a lot of other mental illnesses, such as, Conduct Disorder, Antisocial Personality Disorder, Bipolar Disorder, Depression... This is a challenge for Child Psychiatrists to know exactly what illness in the individual they are dealing with until full manifestation of the delusions, ideas of reference and other symptoms that are unique to Schizophrenia.

There are 'red flags" that give us some insight into what may be developing along with the accompanying symptoms. Usually the person develops Schizophrenia in early adulthood while they are either going to school or are working. There is usually a deterioration in their level of functioning, such that, they are unable to follow instructions, not able to eat or care for themselves in other ways properly, let alone them not being able to work. This list is not exhaustive by any means. Deterioration is seen usually over a period of 6 to12 months and it is generally first seen by the patients family members or boss. With this, they generally have the accompanying signs of feeling that others can read their minds or they are receiving messages from the TV, radio, or newspaper. They may feel that others are talking about them at work, when this isn't a reality; but they actual can hear others talking about them. People many times feel that the FBI is after them. This in and of itself can be very traumatizing to these individuals. Once medication is started and these delusional thoughts are gone, the person feels very disillusioned by what they just have experienced and may well need some trauma counseling to help them through this. Other symptoms other than the paranoia just described can be disorganized speech or behavior or flat or inappropriate affect. I don't see much of the disorganized behavior or speech or the other type of symptoms of Catatonia. This actual type of Schizophrenia has many different forms. One form of Schizophrenia is where a patient is displaying motor immobility. Another will show excessive motor activity. Another form of this type of Schizophrenia displays extreme negativism and resists all instructions or maintains a rigid posture against attempts to be moved. One form, displays peculiar displays of posturing. With the Undifferentiated Type of Schizophrenia, the patient meets criteria for Schizophrenia; but the patient doesn't meet criteria for the Paranoid, Disorganized, or Catatonic Types. The Residual Type of Schizophrenia is when there is continuing evidence of the disturbance in an attenuated form.

In my private practice as a Scottsdale Psychiatrist, I usually see patients that have more of the Paranoid Type of Schizophrenia. Sometimes, the patient has enough insight into his or her illness, such as them knowing there is something wrong with them, in that, they aren't doing well in college that they are willing to come in for help to get rid of the problem. Other times, I find that it is truly a challenge to convince them that they need to be on medication for Schizophrenia because for them this delusional thinking or hallucinations that they are experiencing are so real that they feel that I just think that they are "crazy" and need to be on medication. This is understandable if one understands that many theories of perception require there to be an "image" that mediates between the mind and the extended world. Maybe in the case of psychosis, the image exists yet there is no causal linkage to something in the extended world (reality) to ground this image. It is tough to explain to them that I understand that it is real to them; but the medication can help. Many times, the patient is having insomnia. This I tell them I can treat with the medications that are considered major tranquilizers. If they are willing to see that I am here to help them and they start on the medication, they then are able to see the "voices", or the paranoia diminish with time to the point that they want to stay on the medication because they see the benefits in not only their symptoms resolving along with the insomnia; but they are also able to see that they are much more functional and able to get back to school or work.

The importance of medications for Schizophrenia. Recent studies have revealed that the earlier a person with Schizophrenia is diagnosed and treated with the medication, the better the overall long-term prognosis. The reason for this is that the illness can damage brain cells also known as neurons. It can actually cause cell death. If we can start the medication early, we have less cell damage and death. Also, the sooner we can help people to get back to their previous much better level of functioning the sooner they are able to get back to school or work and get on with their lives. I don't want to minimize the seriousness of Schizophrenia. It can be one of the toughest to treat and have a downward course; but the sooner someone starts treatment the better chances they have of having a generally better prognosis. Convincing someone of the differences between hallucination vs reality can be a real challenge.

More serious cases of Schizophrenia in patients, can require court intervention to help get the patient treated especially if the patient is either a threat to him or herself or others. When this happens and the patient doesn't have enough insight into his or her illness to know that he or she needs medication, the court can intervene by way of an affidavit filled out by a friend or family member explaining why he or she thinks that a patient is a threat to his, herself or others and then try to get the patient into the hospital many times by calling 911. Once at the Behavioral Health Hospital ER, a psychiatrist will evaluate the patient to determine if the patient should be held on a 72 hour observation. If after 72 hours, the psychiatrist feels that the patient is still a threat to him or herself or others, he can go to court and get court-ordered treatment for the patient if the patient is unwilling to come into the hospital voluntarily. When this occurs, the patient is usually given an injectable major tranquilizer that lasts in depot form in the body for 2 to 4 weeks.

I used to work on a PACT (Program for Assertive Community Treatment) in the state system. This program treats on an outpatient basis the mostly severely mentally ill. I learned a lot of Schizophrenia information while working with many of the patients there have severe Schizophrenia, Schizoaffective or Bipolar Disorder. Quite a few of them needed to be on court-ordered treatment and some of them it was up to a year in duration. What is good about PACT is that it is a team effort to help people with severe mental illness stay out of the hospital and live independently. Available around the clock, case managers could go out to the consumers homes to make sure that they were taking their medications and taking them properly, and helping them meet daily challenges of grocery shopping and managing money. The PACT team of professionals include case managers, a nurse and a psychiatrist. The case managers are assigned only a very small group of consumers. I recall it being only seven to eight, so as, to be able to give them all the care that the consumers need.

My views on Schizophrenia is that it is one of the most potentially disabling of all the mental illnesses; but with today's medication breakthroughs and the genetic engineering that is occurring at present, there is a lot of hope for a future cure.

this article on My Views Schizophrenia is for informational purposes only and not for the diagnosing or treating of any mental health issue