10-14-2006–About 1 percent of the population — some 3 million plus in the United States and hundreds of millions in the world — will be diagnosed with schizophrenia at some point in their lifetime.
That means that though the chronic, severe and disabling brain disorder is not as common as diabetes or hypertension, it is more widespread than many illnesses — including multiple sclerosis and ALS (amyotrophic lateral sclerosis or Lou Gehrig’s disease), said Dr. Dost Ongur, medical director of the Schizophrenia and Bipolar Disorder Program at McLean Hospital in Belmont, Mass. McLean, which is affiliated with Harvard Medical School, is ranked one of the nation’s top hospitals for mental health care and research.
And though it is most likely to be diagnosed in late adolescence or early adulthood — “at a time when someone is leaving for college or getting their first job” — it is a lifelong illness “so most of the people with schizophrenia are in their 30s, 40s and 50s,” he said.
People with schizophrenia may hear voices others don’t or they may believe others are reading their minds, controlling their thoughts or plotting to harm them.
Since these experiences are terrifying, they cause fearfulness, withdrawal or extreme agitation, according to experts at the National Institute of Mental Health in Bethesda, Md.
Those with schizophrenia also may not make sense to someone else when they talk or they may sit for hours without moving or talking much. They are not especially prone to violence, often preferring to be left alone.
For many, schizophrenia begins with something called a “prodromal” period when a person becomes more anxious or depressed, withdraws from friends, has sleep problems, becomes irritable and often makes odd comments, Ongur said.
This period can last anywhere from six months to two years before the onset of schizophrenia’s first psychotic symptoms such as hallucinations and delusions. Still, there are some for whom the symptoms will appear with an abrupt onset of hallucinations and delusions.
With hallucinations, a person will see, hear, smell or feel something that no one else is experiencing. Delusions are false personal beliefs that aren’t part of the person’s culture and won’t change even when other people present proof they aren’t logical.
“They might tell us things like aliens are coming to see them or people have been experimenting on them,” Ongur said.
These psychotic symptoms usually emerge in men in their late teens and early 20s and in women in their mid-20s to early 30s. They seldom occur after age 45 and only rarely before puberty, according to NIMH statistics.
Schizophrenia is believed to result from a combination of environmental and genetic factors.
For instance, scientists have long known that though schizophrenia occurs in 1 percent of the general population, 10 percent of people with a first-degree relative — parent, brother or sister — will be diagnosed with the disorder. People who have second-degree relatives with the disorder — aunts, uncles, grandparents or cousins — also develop schizophrenia more often than the general population.
Still, there is no definitive test that can be used to diagnose schizophrenia or predict the likelihood someone will develop the disorder, Ongur said.
Currently, schizophrenia is a clinical diagnosis made after a psychiatrist talks with a patient and his or her family, he said.
“There’s hope that the research will lead to developing either a brain-imaging or blood test” that will diagnose a patient who has schizophrenia, Ongur said. “But we’re really not there yet — that’s probably decades away.”
Once a patient is diagnosed with schizophrenia, “a very important part of their treatment” is medication, said Dr. Ted Drummond, associate medical director of the Seacoast Mental Health Center with offices in Portsmouth and Exeter.
Yet, both Drummond and Ongur said overwhelming evidence has shown that the best comprehensive treatment approach includes not only antipsychotic medications, but therapy and vocational rehabilitation so the patient either can be trained to do something productive with his or her time or function more effectively in the community.
“Most people with treatment are able to lead a satisfying and meaningful life,” Drummond said. “Many are able to work — some full time, some part time. Many are able to establish positive and meaningful lives with families, work, their churches and their communities.”
Across the board, it is helpful to have a support system, which might include family members, a job counselor and medical professionals, Drummond said.
In Portsmouth, the Consumer Alliance on Islington Street also offers those with schizophrenia a resource for socialization, group activities and educational support, Drummond said.
In addition to a psychiatrist, Drummond said, someone with schizophrenia may do well to work with a therapist, a case manager and vocational counselor.
“A case manager helps with the practical aspects of managing life,” Drummond said. “They pull it all together.” When needed, they are able to assist with everything from grocery shopping and applying for benefits like food stamps to transportation and household management.
“It really depends, if you’re getting really good care, many (with schizophrenia) will do very well,” Ongur said. “Many work and can live independently. Unfortunately, though, it’s a lifelong illness and many of our patients don’t have jobs and don’t have families. The disease really robs them of many of those opportunities.”
Certainly, those with schizophrenia don’t do as well when they abuse substances like drugs and/or alcohol, since that makes it more likely they will not follow their treatment plan, Ongur said.
“About half of the patients struggle with the idea that they have (a) mental illness and they try to avoid working with treaters,” he said. “Patients off treatments who get involved with substance abuse will get more acutely ill.”
In fact, research has shown that not getting treatment, thus allowing more “toxic events” in the brain, will damage brain tissue.
“If someone starts treatment early on and stays on the treatment, there is emerging evidence that it keeps the brain healthier and it makes things better for the patient,” Ongur said. “You’re actually preserving brain tissue if you’re on treatment.”
And, though most people with schizophrenia do not commit violent crimes — and most violent crimes are not committed by people with schizophrenia — The New York Times recently published a story about a prominent schizophrenia specialist, Dr. Wayne S. Fenton, who was beaten to death in his suburban Washington, D.C., office by a 19-year-old, severely psychotic patient he was meeting for a weekend session. Fenton, an associate director at the NIMH, was trying to persuade his patient to take his medications.
Ongur, for one, cautioned that news such as Fenton’s death does a serious disservice to most people with schizophrenia who are not prone to violence.
“Dr. Fenton was a great advocate for those with schizophrenia,” Ongur said. “The one thing he would have hated was people being afraid of schizophrenics. Most patients need help — it is not fear or distance that they need.”
SOURCE:- firstname.lastname@example.org – By Rachel M. Collins
Copyright 1999 – 2004 Seacoast Newspapers, a division of Ottaway Newspapers Inc., all rights reserved.
(This concludes our series on “Schizophrenia – One Man’s Story” )