Schizophrenia is a devastating brain disorder the most
chronic and disabling of the severe mental illnesses. The first signs of
schizophrenia, which typically emerge in young people in their teens or
twenties, are confusing and often shocking to families and friends.
Hallucinations, delusions, disordered thinking, unusual speech or behavior and
social withdrawal impair the ability to interact with others. Most people with
schizophrenia suffer chronically or episodically throughout their lives,
losing opportunities for careers and relationships. They often are
stigmatized by lack of public understanding about the disease. However,
several new antipsychotic medications developed within the last decade, which
have fewer side effects than the older medications, in combination with
psychosocial interventions have improved the outlook for many people with
schizophrenia.
Some Facts About Schizophrenia
- In the U.S., approximately 2.2 million adults, or about 1.1 percent of
the population age 18 and older in a given year, have schizophrenia.
- Rates of schizophrenia are very similar from country to country. about 1
percent of the population.
- Schizophrenia ranks among the top 10 causes of disability in developed
countries worldwide.
- The risk of suicide is serious in people with schizophrenia.
News and entertainment media tend to link mental illnesses including
schizophrenia to criminal violence. Most people with schizophrenia, however,
are not violent toward others but are withdrawn and prefer to be left alone.
Drug or alcohol abuse raises the risk of violence in people with
schizophrenia, particularly if the illness is untreated, but also in people
who have no mental illness.
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Research Findings
- Family studies indicate that genetic vulnerability is a risk factor for
schizophrenia. A person with a parent or sibling with schizophrenia has
approximately a 10 percent risk of developing the disorder compared to a 1
percent risk for a person with no family history of schizophrenia. At the
same time, among individuals with schizophrenia who have an identical twin,
and thus share the exact genetic makeup, there is only a 50 percent chance
that both twins will be affected with the disease. Scientists conclude that
nongenetic factors, such as environmental stress perhaps occurring during
fetal development or at birth, also may contribute to the risk of
schizophrenia.
- Research suggests that schizophrenia may be a developmental disorder
resulting from impaired migration of neurons in the brain during fetal
development.
- Advances in neuroimaging have shown that some people with schizophrenia
have abnormalities in brain structure consisting of enlarged ventricles, the
fluid-filled cavities deep within the brain.
- Schizophrenia can appear in children, though it is very rare.
Neuroimaging research of childhood-onset schizophrenia has shown evidence of
progressive abnormal brain development.
While providing clues about the brain regions involved in schizophrenia,
these findings are not yet sufficiently specific to schizophrenia to be useful
as a diagnostic test.
Treatments for Schizophrenia
The newer medications for schizophrenia the atypical antipsychotics
are very effective in the treatment of psychosis, including
hallucinations and delusions, and may also help treat the symptoms of reduced
motivation or blunted emotional expression. Intensive case management,
cognitive-behavioral approaches that teach coping and problem-solving skills,
family educational interventions, and vocational rehabilitation can provide
additional benefit. Evidence suggests that early and sustained treatment
involving antipsychotic medication improves the long-term course of
schizophrenia. Over time, many people with schizophrenia learn successful ways
of managing even severe symptoms.
Because schizophrenia sometimes impairs thinking and problem solving, some
people may not recognize they are ill and may refuse treatment. Others may
stop treatment because of medication side effects, because they feel their
medication is no longer working, or because of forgetfulness or disorganized
thinking. People with schizophrenia who stop taking prescribed medication are
at high risk for a relapse of illness. A good doctor-patient relationship may
help people with schizophrenia continue to take medications as prescribed.
Present and Future Research Directions
In addition to the development of new treatments,
current research is focusing on the relationships among genetic, behavioral,
developmental, social and other factors to identify the cause or causes of
schizophrenia. Utilizing increasingly precise imaging techniques, scientists
are studying the structure and function of the living brain. New molecular
tools and modern statistical analyses are enabling researchers to close in on
the particular genes that affect brain development or brain circuitry involved
in schizophrenia. Scientists are continuing to investigate possible prenatal
factors, including infections, which may affect brain development and
contribute to the development of schizophrenia.
