Mental Health Matters: New standard set for treating schizophrenia
November 25, 2015
Serious mental disorders can cause a lifetime of suffering and incapacitation. Of all these disorders, one stands out as the most chronic, the most disabling, and the most terrifying: schizophrenia.
Most schizophrenic persons tend to be hidden from public view except during psychotic episodes when their bizarre behavior brings them public attention.
Many become homeless and can be found wandering the streets, tethered to a shopping cart with their worldly possessions, muttering or screaming at hallucinatory voices or delusional enemies.
Others commit minor nuisance violations, i.e. sleeping in doorways, urinating in public, and land in the criminal justice system.
Still others commit acts of violence, though schizophrenic persons are far more likely to be the victims of violence than to perpetrate it.
Schizophrenia is a heart-breaking mental disorder for the person experiencing it, and the family that loves them.
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Betty Principle captures the essence of this heartbreak in writing about her son: "I'm the mother of a son who has battled Schizophrenia for 40 years. No other serious illness has to beg for good care and treatment. It has been a very long struggle, and only those who are dealing with an ill loved one will understand the long held headache and pain. We as caregivers are exhausted and need a cure to be found."
Schizophrenia is not a rare disorder. One in a hundred develop it. More than 2 million Americans are affected each year.
This devastating illness impairs the ability to interact with others, to think clearly, and to moderate emotions. Typical symptoms include hallucinations, delusions, emotional numbing, extreme apathy, lack of initiative, and social withdrawal.
The disorder usually develops in late adolescence or early adulthood and frequently lasts a lifetime. Chronic suffering is typical. Some 10% of schizophrenic people commit suicide. Life expectancy is cut 20 years short on average.
Most research suggests that only 20% or so completely recover, though in one more hopeful study a third of this group recovered within three years of the initial episode.
For schizophrenic persons, life is hard; there are rare job opportunities, lost relationships, social isolation, residual symptoms, living with the stigma of this illness, and the sometimes crippling effects of long term medication maintenance.
The disorder affects both men and women equally and occurs at similar rates around the world. Fifty years ago, research focused on pathological psychological development.
Presently, with advances in brain science and genetics, the biological and genetic underpinnings of the disorder are coming into focus.
For those few who can afford it, frequently assisted by family money, social support, and/or assisted living, long term anti-psychotic drug maintenance has been the mainstay of treatment and a significant buffer against homelessness or incarceration.
A landmark study, just published in the American Journal of Psychiatry, confirms what wise clinicians have long suspected, that medications are overused and that social and psychological treatments have been underused and underfunded.
The study, undertaken with 404 people, most in their late teens and 20s, who exhibited a first-episode psychosis, divided the group — 1/2 received traditional medication treatment, and 1/2 received medication, family education, and one-on-one talk therapy, the latter directed at teaching social relationship skills, reducing concurrent substance abuse, and learning symptom management methods.
The study concludes that those who were in the combined treatment group had more symptom relief, functioned better and used less medication. Early illness identification and treatment improved outcome.
The study sets a new standard for the treatment of first-episode psychosis and could eventually lower the lifetime financial cost of this disorder.
For now, just like best practices for cancer, heart disease, and other medical illness, this research should set in motion training in both early identification of schizophrenia and combined treatments.
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. He can be reached for comment at firstname.lastname@example.org.