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
- 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schizophrenia, however, are not violent toward others but are withdrawn and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.
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 non genetic 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. Developing
safer and more effective medications, as well as identifying strategies to
enhance the acceptability of currently available treatments, are important NIMH
(National Institute of Mental Health) priorities.
Present and Future Research Directions
Last Editorial Review: 1/18/2005
In addition to
the development of new treatments, NIMH (National Institute
of Mental Health)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.
Source: National Institutes of Health (www.nih.gov)