Schizophrenia

Schizophrenia is a neuropsychiatric illness which gets expressed by symptoms involving thoughts, mood, and behavior. It usually presents during the late teenage years and is now considered to be neurodevelopmental, which means that the symptoms are really the result of faulty development of the brain from birth.

Adolescence is a time of significant neurologic change in the brain, so it is not surprising that this is the time one sees symptoms develop. These symptoms commonly begin with odd behaviors including social isolation and impairment in school/work function. This progresses to problems with thinking such as disorganized thoughts or the development of delusions (fixed false beliefs). Commonly, the individual begins to experience auditory hallucinations (hearing people’s voices without them being present. Mood symptoms also develop including depression, lack of interest, lack of drive/motivation, and facial expression (affect) changes to become more constricted or blunted. Cognitive function (that is, memory, concentration, learning, planning) also is commonly impaired and these symptoms play the most important role in impairing overall function. When one’s ability to distinguish what is real from what is being abnormally produced by the brain (“reality testing”), is impaired, we call this state psychosis. The process of psychosis is toxic to the brain; it leads to further dysfunction. If left untreated, it leads to ongoing deterioration of the brain.

Treatments can be very effective, although not curative. There are many medicines, called antipsychotics, which can resolve the “positive” symptoms (that is, delusions, hallucinations, and grossly disorganized thinking). However, they are not so effective for the “negative” symptoms (the blunted affect, social isolation, low motivation, decreased enjoyment). The medicines commonly used include the brands Zyprexa, Risperdal, Geodon, Abilify, and Clozaril. They all can be effective but tend to have different side effect profiles. Clozaril has helped the negative symptoms for many people and is often effective when the others are not.

In addition to psychopharmacologic treatment, it is important for the individual to engage in psychotherapy to learn how best to cope with the illness. Both group and individual therapies can be very effective. Further, substance abuse is common in people with schizophrenia and this worsens symptoms and interferes with treatment, so it is imperative that this be addressed concomitantly.