Schizophrenia

What is Schizophrenia?

Fact: Schizophrenia is a real physical illness.

Schizophrenia

Many people do not have a clear understanding of schizophrenia. Many people hold different beliefs about it. But, we know that schizophrenia is a real physical illness. Schizophrenia has typical symptoms and signs that are recognizable in all patients with this illness.

Fiction: Schizophrenia means split personality.

Hollywood often misrepresents mental illness. One common thing you might hear is that schizophrenia means split personality. People with schizophrenia have just one personality. Their illness might cause them to hear voices or believe that someone is putting thoughts into their heads, but they still have their one and only personality.

Fact: Schizophrenia is a treatable illness.

Being diagnosed with any life long illness can be difficult to accept. But schizophrenia is a treatable illness. With medication and routine visits to your doctor, the symptoms of schizophrenia can be controlled. Once the symptoms improve, people can continue to have productive lives.

Fiction: People diagnosed with schizophrenia are crazy or mentally retarded.

People with schizophrenia are not crazy. Schizophrenia is an illness. The medical team doctors, nurses, psychologists, and social workers are treating an illness. They work with a person that has an illness. They are not treating a crazy person.

People with schizophrenia have a mental illness, but this does not mean they have mental retardation. When the symptoms of schizophrenia are at their worse, people do not think as clearly as they usually do. But after treatment and the reduction of symptoms, then their mental abilities return to their usual state.

Illness of the Brain

Brain

There are a lot of false beliefs about schizophrenia. But after all the years of research and millions of dollar spent on developing treatments, we know that schizophrenia is a real physical illness. The brain chemistry and brain activity seem to be different than usual when a person is suffering from schizophrenia. Just like heart disease is an illness of the heart, and asthma is an illness of the lungs, schizophrenia is an illness of the brain.

Like other illnesses, schizophrenia:

Has diagnosable symptoms and signs

Has a physical reason for why symptoms occur

Gets better with medication

Gets worse without treatment

Can be inherited

PET Scans of the Brain

Experts don’t know exactly what causes schizophrenia, but they do know that people diagnosed with schizophrenia’s brains are often physically different and used differently than other people’s.

Mental health professionals use a tool called PET scans that shows which parts of a person’s brain are active. Often the scan is typically done when the person engages in a task such as memorizing a list of words which makes their brain active. These particular pictures are the top view of a person’s brain.

The images show the average resting regional blood flow in a group of 8 people without schizophrenia (on the left) and 8 patients, carefully matched, who have schizophrenia (on the right). The color scale goes from green to red. The red areas are those with more blood flow. The schizophrenics have markedly lower blood flow in the frontal (1) and temporal regions (2). Occipital region (3) is not different between the two groups in this PET scan.

People with schizophrenia do not use their brains the same way that people without schizophrenia do. Scientists find that people diagnosed with schizophrenia have brains that are more active in some areas and less active in other areas than people without schizophrenia.

Scientists do not yet know how these differences come about, but they believe these changes are responsible for the negative and positive symptoms of schizophrenia. Recent studies seem to indicate that these changes may develop early in life, maybe even before birth, but don’t show up until you’re older.

Another thing that scientists have learned from treating the illness is that brain chemicals appear to be out of balance in people with schizophrenia. This link will help you better understand what this means. By explaining what the medications do to combat the symptoms.

The Brain Chemistry of Schizophrenia

Dopamine is a neurotransmitter that has long been thought as the main neurochemical imbalance in schizophrenia. Recently, serotonin may also play a significant role in the symptoms of schizophrenia.

Dopamine

The “dopamine hypothesis” has been the main theory about the basis of schizophrenia. Scientists believe that many of the symptoms of schizophrenia are essentially caused by an excess of dopamine activity in the brain. Scientists are not sure of the mechanism, but it can be the result of many different possibilities such as too much dopamine, too many dopamine receptors, or neurons that are extra-sensitive to dopamine. The animation below illustrates the increased dopaminergic activity between neurons in a person with schizophrenia.

Support that dopamine seems to play a major role in this illness:

Drugs that increase dopamine transmission, like amphetamines, can cause psychotic symptoms.

Medications that block dopamine transmission, like thorazine and haldol, established the first treatment and improvement of schizophrenia symptoms.

Serotonin

New neurochemical theories suggest that serotonin may also play a role in the symptoms of schizophrenia. Unlike previous antipsychotic medications, the newer medications (clozapine and risperidone) block dopamine and also serotonin transmissions. Clozapine has improved psychotic symptoms in people that have found no improvement on previous, dopamine blocking medication. Risperidone also appears to improve negative symptoms and may have less extra-pyramidal side effects than previous medications.

Schizophrenia Can Be Inherited

Schizophrenia appears to have a genetic component and seems to run in families. Scientists base their information on inheritance on studies of families and twins of people with schizophrenia. Although not an automatic outcome, relatives of people with schizophrenia are at greater risk for developing the illness.

In the general population:

About 1% of the people in this country may have schizophrenia.

In families with a person that has schizophrenia:

If a person had schizophrenia about 8% of their brothers and sisters developed schizophrenia.

If one parent had schizophrenia about 12% of their children developed schizophrenia.

If both parents had schizophrenia about 40% of their children developed schizophrenia.

In twins that grew up apart from one another:

If they had the same genetic make-up (monozygotic: from the same egg) 35 to 58% of the twins both developed schizophrenia.

If they had different genetic make-ups (dizygotic: from the two eggs) only 6 to 26% of the twins both developed schizophrenia.

There is no one schizophrenia gene:

Although there is an increased risk for relatives of a person with schizophrenia, it is obviously not an absolute certainty that one might develop this illness. There may be a number of different factors that influence the inheritance of schizophrenia.

The inheritance pattern does not appear to follow the usual one gene/one illness pattern.

There may be a number of genes involved with the development of schizophrenia.

The same genes may have different levels of effect in different people.

Schizophrenia may be the sum result of changes that occur in genes over a number of different generations of people.

Symptoms of Schizophrenia

Jeff’s Symptoms

After being discharged from the hospital, Jeff begins to attend group therapy for his illness not only to get more help, but also to learn more about what is effecting him. But first, to help him ease into the group, the group leader, Marcie asks him to tell the rest of the goup about his problems.

Marcie: Well why don’t you start off by telling us what was happening to you before you went to the hospital?

Jeff: (timid)Well, I was at school, studying for midterms and I’d hear somebody calling my name. I would look around for someone, but nobody was there. I started thinking some of the guys on my floor were playing jokes on me. (pause) Then the voices started saying some really nasty things about me. And they got so loud I couldn’t concentrate or study. Nobody else seemed to hear the voices but me.

Marcie: Have you heard any voices since you left the hospital?

Jeff: (embarrassed and fearful) Every once in a while, but they’re not as loud. They aren’t nearly as bad as they were before I went to the hospital. Before, it was so bad, that I couldn’t even sleep because the voices were always talking. I just couldn’t concentrate, study, or even go to class. I was really scared.

I was afraid there was a plot involving all the other students and the professors to prevent me from staying and getting good grades. It sounds crazy now, but at the time I really thought they were out to get me.

Jeff’s symptoms include:

Auditory Hallucinations

– hearing things that aren’t there, in Jeff’s case, voices.

Delusions

– believing that the students and professors were trying to prevent him from getting good grades.

Negative Symptoms of Schizophrenia

Negative symptoms are things that are missing, or absent, from a person’s regular behavior. Since these symptoms are not typically what people think of when they think of schizophrenia, they don’t recognize them. Interestingly, they are the most common symptoms. Remember, not everybody has exactly the same symptoms, but most people have a combination of both positive and negative ones. Please scroll through and familiarize yourself with this list of five negative symptoms.

Lack of Motivation

This symptom can make you feel as though you are being kept from doing what you want to do. This can also lead you to “forgetting” to do things. It is not that you are lazy.

Isolate

Not Wanting to be Around Others

Wanting to be alone may not be due to stubbornness. It could simply be a symptom of schizophrenia.

Poverty of Speech

If you have trouble speaking or answering questions even when you want to, you probably have this symptom. You may only be able to say one or two words at a time. Some people say that they can’t speak because the words just “disappear from their mind,” or won’t come to them.

Difficulty Concentrating

One of the negative symptoms of schizophrenia is being unable to concentrate on any one thing for very long. It may be hard for you to pay attention when someone is talking to you. Because it is hard to concentrate, it may be difficult to listen to others talk for more than a few minutes, read a book, or watch a long TV program.

Difficulty Showing or Feeling Emotion

If you have the symptom of difficulty with showing or feeling emotion, when people look at you they see that your face doesn’t have any expression at all. You don’t seem either sad or happy, you just have a blank expression on your face. That doesn’t mean you don’t care, your negative symptom prevents you from showing your true feelings.

Positive Symptoms of Schizophrenia

Positive symptoms are mental experiences that most people don’t have. Remember, not everybody has exactly the same symptoms, but most people have a combination of both positive and negative ones. Here are a few common positive symptoms.

Hallucinations

Hallucinations occur when a person senses things that aren’t really there. They often seem very real to the person experiencing them. Schizophrenic patients may experience auditory, visual, tactile, gustatory, or olfactory hallucinations. The most commonly experienced hallucination is hearing voices. The voices may be mumble or speak clearly and they may speak words, phrases, or sentences.

Delusions

Delusions are firmly held beliefs that are untrue as well as contrary to a person’s educational and cultural background. Whereas hallucinations are disturbances in perception; delusions are disturbances of thought. These delusions can be of a paranoid or bizarre nature. They include believing people are adding, taking, or listening to your thoughts or thinking you are being controlled.

Disorganized Speech

Known as formal thought disorder includes incoherence and derailment (loose associations). Other types of formal thought disorder have been identified and include responding to questions in an irrelevant way, reaching illogical conclusions, and coined (or newly made up) words only understood by the patient.

Disorganized Behavior

Many patients will display various types of disorganized behavior, including both motor and social behavior. Abnormal motor behavior can range from catatonic stupor to excitement. Patients may assume bizarre or uncomfortable postures, such as squatting, and maintain them for long periods. They may also involve themselves in a repetitive non-goal-directed movement such as rocking. Other symptoms are: echopraxia, automatic obedience, and negativism.

Medication

How the Medications Work

The most successful treatments for schizophrenia work by altering the communication between nerve cells, or neurons. In this graphic the nerve cells are represented by the yellow and lavender shapes. The nerves cells communicate with each other by sending chemical messengers from one cell to the other. These medications specifically work by blocking the chemical messenger, or neurotransmitter, dopamine represented here by blue dots. By changing the flow of dopamine, medications can reverse some of the symptoms of schizophrenia.

In this picture, you can see the cluster of the chemical messenger, dopamine. The problem with this cluster is that there are far too many dopamine neurotransmitters released.

Here, you can see that the cluster is beginning to disipate and the “balls” of dopamine are being released into the synapse. This is too many neurotransmitters to be absorbed by the neuron, and this is what causes the symptoms of schizophrenia.

Finally, you can see how the antipsychotic medications work. Their job is to block the excess dopamine from entering the neuron and causing the symptoms of schizophrenia. By blocking part of the dopamine from entering the pink neurotransmitter, fewer symptoms of schizophrenia occur, and the may patient begin to recover.

Medication Benefits

There are many positive effects of antipsychotic medications. Some of the benefits of antipsychotic medications are listed here.

Dampen or Remove Voices

Prior to taking your medication you may have had experiences where you heard sounds or voices that only you can hear. The medication can diminish these or assist you in coping with them.

Better Able to Concentrate

Before treatment you may have had difficulty concentrating. Medications can help you think more clearly. If the illness has interfered with your job or school, medication may help you return to your work or studies.

More Organized

You might feel that your life is disorganized or chaotic, or that day to day activities are overwhelming. By taking the medication, you may become more organized and capable and find it easier to keep up with daily demands.

Stable Mood

On your medication your mood may be more stable. In the past you might have become easily upset or irritated. With the medication, you may have better control over your mood and feel more calm over all.

More Social & Energetic

Prior to starting the medication you may have felt alone or unwilling to get together with other people. After starting the medication, you might find yourself becoming more involved with day to day activities, more energetic and more social.

Less Fearful

Schizophrenia can make you feel afraid of people or fearful that others want to hurt you. It can also make you have strange ideas that no one else can understand. The medications can reduce these feelings and make you more comfortable around other people.

Even though these benefits can greatly improve your quality of living, you must be aware that there are some side effects and risks of your medications. It is important to keep in touch with your doctor and let her/him know if you develop any of them.

Antipsychotic Medications: Low Potency

Antipsychotic-Medication

Low potency antipsychotic medications (also called neuroleptics or major tranquilizers) are used to alleviate agitation and psychosis, usually in schizophrenia. Antipsychotic medications work by blocking the neurotransmitter dopamine in the brain. By changing the flow of dopamine, medications can reverse some of the symptoms of schizophrenia.

Potency is a measure of how much of the drug is needed to effectively treat the symptoms of schizophrenia. If a drug is low potency, more of it is needed to relieve the symptoms of schizophrenia. Low potency antipsychotic medications include:

thioridazine (Mellaril®)

chlorprothixene (Taractan®)

chlorpromazine (Thorazine®)

mesoridazine (Serentil®)

promazine (Sparine®)

triflupromazine (Vesprin®)

Along with the many positive effects of your antipsychotic medication, you may also experience some side effects. Side effects are unintended or undesirable reactions to medications. Most of the side effects you experience can be lessened with additional medications, dosage changes, or changes in your daily habits. If you experience any side effects, contact your doctor or clinician right away and continue taking your medication.

It is also important to be aware of the risks of antipsychotic medication. The risks occur very rarely, but it is important to know what to look for, just in case. If you think you are experiencing one of the risks, contact your doctor or clinician or go to the emergency room right away!

Common side effects

Blurred vision

Blurred vision is another side effect of antipsychotic medication. If you think that you are experiencing blurred vision, don’t drive until you talk to your doctor or clinician about it.

Constipation

Antipsychotic medication can sometimes cause constipation. This side effect usually does not go away, but you can learn how to control it by increasing the amount of high fiber foods in your diet, such as breads, fruits, and vegetables, and bran. It also helps to exercise regularly and drink plenty of fluids. If constipation is still a problem, your doctor may recommend a laxative or fiber product, or may prescribe an additional medication to reduce the side effect.

Dizziness

If you feel dizzy when you sit or stand up quickly, there are some precautions that you can take to avoid injury. Get up very slowly from a laying or sitting position and make sure you have something to hold onto as you get up. Then, wait a moment or two before you start walking.

Drowsiness

When you first begin taking your medication, you may feel drowsy all of the time, even if you’ve had a good night’s sleep. You might move around more slowly, be less coordinated, and nod off more. This side effect should wear off after a few weeks. In the meantime, be sure not to drive a car or operate other heavy machinery while you are feeling drowsy.

Dry mouth

Some people taking antipsychotic medications experience dry mouth. Although dry mouth may not go away completely, it usually gets better with time. Dry mouth may be relieved by sucking on hard candy or crushed ice, drinking plenty of fluids, or eating frozen grapes.

Urinary retention

If you are unable to urinate but your bladder feels full, you may be experiencing urinary retention. Urinary retention is a serious side effect that primarily affects older people taking antipsychotic medications. If you think that you are experiencing urinary retention, contact your doctor immediately.

Weight gain

Some antipsychotic medications may cause you to gain weight. Your doctor or clinician can help you monitor your weight and suggest a healthy diet and exercise program for you if weight gain is a concern.

Occasional side effects

Sexual problems

Some antipsychotic medication may lead to decreased interest in sex or difficulty achieving orgasm, and in males, difficulty maintaining an erection. Another sexual-related problem that happens to both males and females is breast tenderness and enlargement due to antipsychotic medication.

Rare side effects

Akathisia

Antipsychotic medications may cause you to feel restless, nervous or anxious. You may find yourself pacing back and forth, tapping your foot all the time, or wringing your hands a lot. If you can’t sit still through a 30 minute TV program, you are probably experiencing akathisia. Also, you may find that you can’t control these actions and that they occur against your will.

Parkinsonism

Having these side effects does not mean that you have Parkinson’s disease. Rather, it is named as such because the side effect resembles the symptoms of Parkinson’s disease. Parkinsonism side effects include muscle rigidity or stiffness, slow, shuffling walk, tremors and mask-like appearance of the face. If this happens to you, call your doctor or clinician right away, but don’t stop taking your medication. Your doctor may change your dosage to control the side effect.

Skin problems

Some people taking antipsychotic medications may develop an allergic reaction in the form of a rash, hives or itchiness. Increased sensitivity to the sun is another skin problem that some people taking antipsychotic medications notice. If you develop increased sensitivity to the sun, your skin will burn more easily in the sun than it normally would. You should always use sunscreen when you go out, wear a hat with a wide brim, and avoid staying out in the sun for long periods of time.

Risks

Dystonia

Dystonia involves stiffening of the muscles, primarily of the neck, jaw and tongue. This risk usually occurs within the first few hours or days after beginning an antipsychotic medication, and it is usually only temporary. Dystonia is frightening and may be painful. If you experience dystonia, contact your doctor immediately or go to the emergency room. S/he can prescribe an additional medication that will reverse the dystonia in minutes.

Liver irritation

Liver-irritation

The symptoms of liver irritation include extreme tiredness, severe nausea, and yellowing of the whites of the eyes and skin.

Neuroleptic malignant syndrome (NMS)

Neuroleptic malignant syndrome (NMS) is a rare, serious, and sometimes fatal reaction to antipsychotic medications. Symptoms of this syndrome include a high fever, severe muscle stiffness, rapid heart rate, rapid breathing, excessive sweating and salivation, tremors, and seizures.

If you experience any of these symptoms, call your doctor or go the emergency room right away! You may be admitted to the hospital where your doctor will stop or reduce all antipsychotic medications you are taking. S/he may prescribe an additional medication to reverse the effects. You will be closely monitored by your doctor until all the symptoms of NMS have disappeared.

Tardive dyskinesia (TD)

If you have been taking an antipsychotic medication for a while, you may develop an uncontrollable movement of the muscles called tardive dyskinesia (TD). TD is a serious risk that happens to 10 to 15% of all people who have been taking antipsychotic medications for a number of years.

Repetitive motions of the tongue and mouth are commonly seen in people with TD. Involuntary finger and/or hand motions occur fairly often as well. Extreme cases of TD involve repetitive body motions. Because people with TD cannot control these body and facial movements, they may not even be aware that they are happening.

Unfortunately, TD worsens over many years and is not always reversible. If you and your doctor notice small but abnormal movements, you may be able to stop TD early.

Antipsychotic Medications: Medium Potency

Antipsychotics (also called neuroleptics or major tranquilizers) are used to alleviate agitation and psychosis, usually in schizophrenia. All (except the atypical antipsychotics) act by blocking the D2 dopamine receptors in the brain.

Medium Potency Antipsychotics mean that a moderate amount of the drug is needed to relieve a person of their symptoms. The frequency of medium potency drugs side effects are in the mid-range between high and low potency medication. These medications do not cause extra-pyramidal side effects as often as high-potency drugs and do not cause as much sedation and anticholinergic side effects as low-potency drugs. They do cause more sedation than high-potency drugs and more extra-pyramidal side effect than low-potency drugs.

Medium-potency drugs antipsychotics include prochlorperazine (Compazine), perphenazine (Trilafon), acetophenazine (Tindal), loxapine (Loxiane), molindone (Moban or Lindone) and droperidol (Inapsine).

Anti-Cholinergic side effects include dry mouth, blurred vision, constipation, and urinary retension.

Hypotension is a problem where you have a low blood pressure when you stand up. Typically people with hypotension feel dizzy when they get up suddenly

Extra-Pyramidal side effects include dystonia (or muscle stiffness), Parkinsonian effects, and akathesia (see below).

Akathesia

Akathesia is a feeling of intense restlessness that may show up as pacing or moving about. People report not being able to or feeling very uncomfortable when trying to sit still.

Neuroleptic Malignant Syndrome (or NMS)

A few people taking medications have developed a reaction to the medication called Neuroleptic Malignant Syndrome (or NMS). NMS is a rare, serious, reaction to some medications, which can sometimes be fatal when it is not treated quickly. Some of the symptoms of NMS are high fever, severe muscle stiffness, rapid heart rate and breathing, excessive sweating, excessive salivation, tremors, and seizures. If you feel that you may be suffering from this reaction, go to the emergency room and inform the physician of all the medications you are taking. A person who has developed NMS may be admitted to the hospital where the doctor will stop or reduce the current medications you are on. He or she may also treat this condition with a different medication.

Tardive Dyskinesia

Tardive dyskinesia is a disorder in which persons find themselves making repitive motions that they cannot control. These are often repetitive motions of the tongue and mouth, but sometimes tardive dyskinesia involves repetitive hand or finger motions and extreme cases involve repitive torso motions. Tardive dyskinesia rarely develops until after a person has been on antipsychotics for at least six months and is normally seen after several years of treatment (after four years of treatment, the incidence increased by 4 to 5 percent per year).

Antipsychotic Medications: High Potency

High potency antipsychotic medications (also called neuroleptics or major tranquilizers) are used to alleviate agitation and psychosis, usually in schizophrenia. Antipsychotic medications work by blocking the neurotransmitter dopamine in the brain. By changing the flow of dopamine, medications can reverse some of the symptoms of schizophrenia.

Potency is a measure of how much of the drug is needed to effectively treat the symptoms of schizophrenia. A high potency antipsychotic medication can be taken in a smaller amount to be effective. High potency antipsychotic medications include:

haloperidol (Haldol®)

thiothixene (Navane®)

pimozide (Orap®)

fluphenazine (Prolixin® or Permitil®)

trifluroperazine (Stelazine®)

Along with the many positive effects of your antipsychotic medication, you may also experience some side effects. Side effects are unintended or undesirable reactions to medications. Most of the side effects you experience can be lessened with additional medications, dosage changes, or changes in your daily habits. If you experience any side effects, contact your doctor or clinician right away and continue taking your medication.

It is also important to be aware of the risks of antipsychotic medication. The risks occur very rarely, but it is important to know what to look for, just in case. If you think you are experiencing one of the risks, contact your doctor or clinician or go to the emergency room right away!

Common side effects

Akathisia

Antipsychotic medications may cause you to feel restless, nervous or anxious. You may find yourself pacing back and forth, tapping your foot all the time, or wringing your hands a lot. If you can’t sit still through a 30 minute TV program, you are probably experiencing akathisia. Also, you may find that you can’t control these actions and that they occur against your will.

Muscle stiffness

If you experience this side effect, your neck, arms and legs might feel stiff and be hard to move. You may have trouble turning your head from side to side or may find yourself walking very slowly or shuffling your feet.

Parkinsonism

Having these side effects does not mean that you have Parkinson’s disease. Rather, it is named as such because the side effect resembles the symptoms of Parkinson’s disease. Parkinsonism side effects include muscle rigidity or stiffness, slow, shuffling walk, tremors and mask-like appearance of the face. If this happens to you, call your doctor or clinician right away, but don’t stop taking your medication. Your doctor may change your dosage to control the side effect.

Rare side effects

Constipation

Antipsychotic medication can sometimes cause constipation. This side effect usually does not go away, but you can learn how to control it by increasing the amount of high fiber foods in your diet, such as breads, fruits, and vegetables, and bran. It also helps to exercise regularly and drink plenty of fluids. If constipation is still a problem, your doctor may recommend a laxative or fiber product, or may prescribe an additional medication to reduce the side effect.

Dizziness

If you feel dizzy when you sit or stand up quickly, there are some precautions that you can take to avoid injury. Get up very slowly from a laying or sitting position and make sure you have something to hold onto as you get up. Then, wait a moment or two before you start walking.

Drowsiness

When you first begin taking your medication, you may feel drowsy all of the time, even if you’ve had a good night’s sleep. You might move around more slowly, be less coordinated, and nod off more. This side effect should wear off after a few weeks. In the meantime, be sure not to drive a car or operate other heavy machinery while you are feeling drowsy.

Dry mouth

Some people taking antipsychotic medications experience dry mouth. Although dry mouth may not go away completely, it usually gets better with time. Dry mouth may be relieved by sucking on hard candy or crushed ice, drinking plenty of fluids, or eating frozen grapes.

Sexual problems

Some antipsychotic medication may lead to decreased interest in sex or difficulty achieving orgasm, and in males, difficulty maintaining an erection. Another sexual-related problem that happens to both males and females is breast tenderness and enlargement due to antipsychotic medication.

Urinary retention

If you are unable to urinate but your bladder feels full, you may be experiencing urinary retention. Urinary retention is a serious side effect that primarily affects older people taking antipsychotic medications. If you think that you are experiencing urinary retention, contact your doctor immediately.

Weight gain

Some antipsychotic medications may cause you to gain weight. Your doctor or clinician can help you monitor your weight and suggest a healthy diet and exercise program for you if weight gain is a concern.

Risks

Dystonia

Dystonia involves stiffening of the muscles, primarily of the neck, jaw and tongue. This risk usually occurs within the first few hours or days after beginning an antipsychotic medication, and it is usually only temporary. Dystonia is frightening and may be painful. If you experience dystonia, contact your doctor immediately or go to the emergency room. S/he can prescribe an additional medication that will reverse the dystonia in minutes.

Neuroleptic Malignant Syndrome (NMS)

Neuroleptic malignant syndrome (NMS) is a rare, serious, and sometimes fatal reaction to antipsychotic medications. Symptoms of this syndrome include a high fever, severe muscle stiffness, rapid heart rate, rapid breathing, excessive sweating and salivation, tremors, and seizures.

If you experience any of these symptoms, call your doctor or go the emergency room right away! You may be admitted to the hospital where your doctor will stop or reduce all antipsychotic medications you are taking. S/he may prescribe an additional medication to reverse the effects. You will be closely monitored by your doctor until all the symptoms of NMS have disappeared.

Tardive Dyskinesia (TD)

If you have been taking an antipsychotic medication for a while, you may develop an uncontrollable movement of the muscles called tardive dyskinesia (TD). TD is a serious risk that happens to 10 to 15% of all people who have been taking antipsychotic medications for a number of years.

Repetitive motions of the tongue and mouth are commonly seen in people with TD. Involuntary finger and/or hand motions occur fairly often as well. Extreme cases of TD involve repetitive body motions. Because people with TD cannot control these body and facial movements, they may not even be aware that they are happening.

Unfortunately, TD worsens over many years and is not always reversible. If you and your doctor notice small but abnormal movements, you may be able to stop TD early.

Atypical Antipsychotic Medications: Risperidone

Risperidone (Risperdal®) is one new medication that has brought relief to some people with schizophrenia. In general, this medication has fewer side effects than standard antipsychotic medication. Risperidone also seems to help improve the negative symptoms of schizophrenia better than the other classes of antipsychotic medications.

Along with the many positive effects of risperidone, you may also experience some side effects. Side effects are unintended or undesirable reactions to medications. Most of the side effects you experience can be lessened with additional medications, dosage changes, or changes in your daily habits. If you experience any side effects, contact your doctor or clinician right away and continue taking your medication.

It is also important to be aware of the risks of antipsychotic medication. The risks occur very rarely, but it is important to know what to look for, just in case. If you think you are experiencing one of the risks, contact your doctor or clinician or go to the emergency room right away!

Occasional side effects

Blurred vision

Blurred vision is another side effect of antipsychotic medication. If you think that you are experiencing blurred vision, don’t drive until you talk to your doctor or clinician about it.

Drowsiness

When you first begin taking your medication, you may feel drowsy all of the time, even if you’ve had a good night’s sleep. You might move around more slowly, be less coordinated, and nod off more. This side effect should wear off after a few weeks. In the meantime, be sure not to drive a car or operate other heavy machinery while you are feeling drowsy.

Muscle stiffness

If you experience this side effect, your neck, arms and legs might feel stiff and be hard to move. You may have trouble turning your head from side to side or may find yourself walking very slowly or shuffling your feet.

Weight gain

Some antipsychotic medications may cause you to gain weight. Your doctor or clinician can help you monitor your weight and suggest a healthy diet and exercise program for you if weight gain is a concern.

Rare side effects

Sexual problems

Some antipsychotic medication may lead to decreased interest in sex or difficulty achieving orgasm, and in males, difficulty maintaining an erection. Another sexual-related problem that happens to both males and females is breast tenderness and enlargement due to antipsychotic medication.

Risks

Dystonia

Dystonia involves stiffening of the muscles, primarily of the neck, jaw and tongue. This risk usually occurs within the first few hours or days after beginning an antipsychotic medication, and it is usually only temporary. Dystonia is frightening and may be painful. If you experience dystonia, contact your doctor immediately or go to the emergency room. S/he can prescribe an additional medication that will reverse the dystonia in minutes.

Neuroleptic Malignant Syndrome (NMS)

Neuroleptic malignant syndrome (NMS) is a rare, serious, and sometimes fatal reaction to antipsychotic medications. Symptoms of this syndrome include a high fever, severe muscle stiffness, rapid heart rate, rapid breathing, excessive sweating and salivation, tremors, and seizures.

If you experience any of these symptoms, call your doctor or go the emergency room right away! You may be admitted to the hospital where your doctor will stop or reduce all antipsychotic medications you are taking. S/he may prescribe an additional medication to reverse the effects. You will be closely monitored by your doctor until all the symptoms of NMS have disappeared.

Seizures

A seizure is the result of abnormal electrical activity in the brain. A patient suffering from a seizure may experience involuntary body movements and/or a loss of consciousness. Less than 1% of people on antipsychotic medications experience seizures as a result of their medication. You will probably not be aware if you are having a seizure; someone will tell you when you regain consciousness. If you have had a seizure, have someone take you to the emergency room immediately.

Atypical Antipsychotic Medications: Clozapine

Clozapine, (Clozaril®) is a antipsychotic medication with unparalleled success in the treatment of schizophrenia. Clozapine can help people whose negative or positive symptoms have not improved with treatment, or who experienced severe side effects from taking antipsychotic medications in the past. In fact, clozapine has been found to improve symptoms in 50-60% of people in which standard antipsychotic medications were ineffective.

Along with the many positive effects of clozapine, you may also experience some side effects. Side effects are unintended or undesirable reactions to medications. Most of the side effects you experience can be lessened with additional medications, dosage changes, or changes in your daily habits. If you experience any side effects, contact your doctor or clinician right away and continue taking your medication.

It is also important to be aware of the risks of antipsychotic medication. The risks occur very rarely, but it is important to know what to look for, just in case. If you think you are experiencing one of the risks, contact your doctor or clinician or go to the emergency room right away!

Common side effects

Dizziness

If you feel dizzy when you sit or stand up quickly, there are some precautions that you can take to avoid injury. Get up very slowly from a laying or sitting position and make sure you have something to hold onto as you get up. Then, wait a moment or two before you start walking.

Drooling

Some people taking Clozapine may experience excessive drooling as a result of their antipsychotic medication. For many people, drooling is more prominent at night. Try using a plastic pillow or bed cover — or just a towel on your pillow — if drooling at night is a problem for you.

Weight gain

Some antipsychotic medications may cause you to gain weight. Your doctor or clinician can help you monitor your weight and suggest a healthy diet and exercise program for you if weight gain is a concern.

Occasional side effects

Constipation

Antipsychotic medication can sometimes cause constipation. This side effect usually does not go away, but you can learn how to control it by increasing the amount of high fiber foods in your diet, such as breads, fruits, and vegetables, and bran. It also helps to exercise regularly and drink plenty of fluids. If constipation is still a problem, your doctor may recommend a laxative or fiber product, or may prescribe an additional medication to reduce the side effect.

Increased heart rate

Some people taking clozapine experience increased heart rate. A person experiencing this side effect may feel that his/her heart is beating unusually fast.

Nausea

Most people who experience this side effect notice that it usually disappears in a few weeks. To reduce or eliminate nausea, eat several small meals per day instead of three big ones, or try snacking on dry toast or crackers.

Risks

Agranulocytosis

One or two percent of patients taking clozapine may develop a condition known as agranulocytosis, which is a decrease in the number of white blood cells. Agranulocytosis is a potentially deadly condition because it makes your body more susceptible to infection. For this reason, doctors only give patients enough clozapine for one week at a time. Each week, when you come in for your prescription, your doctor or clinician will take a blood sample to determine if it is safe for you to continue taking clozapine. You should also be alert for any symptoms of infection, such as fever, sore throat, or flu-like symptoms and report these to your doctor as soon as possible.

Seizures

A seizure is the result of abnormal electrical activity in the brain. A patient suffering from a seizure may experience involuntary body movements and/or a loss of consciousness. Less than 1% of people on antipsychotic medications experience seizures as a result of their medication. You will probably not be aware if you are having a seizure; someone will tell you when you regain consciousness. If you have had a seizure, have someone take you to the emergency room immediately.

Living with Schizophrenia

You Can Get Better

Untreated schizophrenia doesn’t have a good prognosis (future outcome). Before effective medications for schizophrenia were available, many people diagnosed with schizophrenia spent much of their lives in institutions. However, current medications make this much less likely. With medication, your symptoms should lessen over time, although they may not completely disappear.

The graph on the right gives a sense of how your progress could look. The top line represents when you are feeling your best. The “drops” are down times when your symptoms get worse and you are not able to function as usual. With treatment the time spent in illness and the severity of symptoms get less and less.

A review of almost 2,000 patients’ life histories* suggests:

At least three-fourths of people with schizophrenia get better with treatment.
A third of people with schizophrenia make full recoveries.

However, many of these persons were on older medications. With the newer medication available, the current prognosis is probably even better than what was reported in this study. For example. for people not helped by older medication, clozapine can now help 50-60% of these people. Clearly, however, your chances are much better in treatment than out of treatment.

Staying in Treatment

Scott: So how’s it going, Jeff?

Jeff: Well, I’m feeling pretty good these days…I mean, the voices aren’t bothering me too much, I can pretty well ignore them. I’m thinking that I’d be better off not taking the medication at all.

Scott: Jeff, let me give you some advice. I used to think like that. And I did try going off my medications. I thought, “hey, I’m feeling good, why do I need these pills? I’m all better!” When I stopped the medications, my symptoms came back and it took me a lot longer to get better again I restarted the pills. The medication is what is helping you feel good. If you go off your medication, you’ll probably get sick again, and end up in the hospital.

Staying in treatment and taking medications can be difficult, even with all the information on the illness and the importance of medicine. Sometimes medication side effects seem too much to tolerate. Sometimes the medications work so well that people feel they have recovered and are tempted to stop treatment (like Jeff). However, treating schizophrenia is an ongoing process, not a one-shot cure.

For some people staying in treatment means they “can’t be like everyone else.” But dropping out of treatment makes the illness worse. When the illness gets worse, people lose their ability to “live like everyone else.” The illness, not the medications, get in the way of things like working on a job or developing friendships.

One person with schizophrenia talked about treatment and medications this way:

“One, I realize that taking care of my mind is just like taking care of my body. I brush my teeth, bathe, eat well (and quit smoking!) for my body, so I should also take my meds and listen to my doctor for my mind. Two, it feels good for me to talk to someone who I know cares about me: my doctor.”

Staying in treatment does not mean handing responsibility of your life to the doctors. Staying in treatment means you are taking control of your own life.

Building a support network

Everyone can benefit from supportive relationships with others around them. Schizophrenia is a difficult illness to deal with and it is even harder if you try to do it alone. Many people find that talking with others about their problems helps. This “talking with others” can range from actual psychotherapy to talking with other persons with a similar diagnosis over the Internet. Talking with others can help you share coping strategies, vent frustrations, and gain encouragement for dealing with your diagnosis. Most of all, it helps you realize that you are not alone, that there are others around you that can help.

Here are some specific examples of how you can use a support network:

Sometimes your friends and family can help monitor your symptoms. When your symptoms begin to get worse, other people around you may realize it far earlier than you might. They can then help you intervene early to avoid a relapse.
Some people find support through religion or spirituality. Church-related organizations and groups may be able to provide you with types of support that you can’t get from other sources.
Talking with others who have been through some of the same things you are going through may give you new ideas about how to deal with your diagnosis.
There are several organizations that are dedicated to advocacy and/or services for persons with schizophrenia. For more details, check out our list of support groups.

Day to Day Living

Find a Living Situation Where You are Happy

One of the keys to staying healthy is having a stable home with low levels of stress. Try to find a place where you will be happy, that works for you. These options can range from living on your own, to living with your family, to living in a home with others who have schizophrenia. What you decide will depend on your personal preferences and needs.
Job Training

Dealing with employment issues

Getting a job may improve your life by maximizing your independence. You can develop your work skills through job education and training. Use the support resources available to you, such as the vocational rehabilitation people at your clinic. However, getting a job is only the first step. The next–and maybe more important–step is keeping your job. The following are a few tips to help you do this:

Know your limits and stress tolerances. That may mean working only a few hours a week at first.
Talk to your doctor about finding a medication program that keeps your head clear enough to work well.
Don’t keep frustrations or concerns about work to yourself; talk with others to help you find solutions and distinguish major problems from minor problems.
Remember that the Americans With Disabilities Act is designed to protect you against employment discrimination based on your diagnosis.

The Future

New medications for schizophrenia

Drug manufactures are developing new medications to treat schizophrenia. While older drug treatments for schizophrenia have focused on controlling the positive symptoms of schizophrenia (such as delusions, hallucinations, and paranoia), many of these newer drugs will also target the negative symptoms of schizophrenia (such as lack of energy and trouble showing emotion). Two such drugs, Clozaril and Risperidone, have already been approved for use in the United States.

Awareness and research

Public awareness of schizophrenia is increasing rapidly. This public interest has had enormous effect on research into the cause and treatment of schizophrenia. Schizophrenia treatment and research is now a health priority and is being investigated by the world’s top researchers.

Additional reading about schizophrenia or mental illness in general.

Working with healthcare professionals

Finding a Healthcare Professional

Before beginning to look for a mental health professional, check your insurance. Find out what services it covers and if your are limited to certain doctors. After you know that, you can:

Ask friends- People often find this to be the best method especially asking people who understand who you are and what you are looking for.
Seek the advice of your doctor or other health professional.
Contact local mental health centers, clinics, or hospitals.
Talk with your insurance company- This is especially important because many insurance company only cover certain types of professionals, certain individual professionals, and limited amounts of time.
If you or your spouse works for a large corporation or are a student, contact the health services department- Large corporation sometimes and colleges often have free counseling or counseling referrals.
Look in the yellow pages or in the blue pages – Sometimes there are also local referral centers. Try looking under “Guide to Health and Human Services.”

It is important to keep phone numbers, insurance coverage and other important information on hand as you begin to find a therapist. Use the Getting Help Worksheet to keep information organized.

Working With Your Doctor

Even after finding a doctor that they feel comfortable with, some people are intimidated by the thought of talking to their doctor. Office visits are short and some people feel they do not want to “bother” the doctor with their questions. However, a person’s recovery to health is a joint effort between patient and doctor. Doctors rely on information from patients to monitor and adjust treatment. Here are some suggestions to help you get the most out of working with your doctor.

Open and honest communication between you and your doctor is critical to getting better. You should be comfortable being honest with your doctor and be able to expect a genuine and open approach from your doctor.
Make a top five problem list of things that give you the most trouble. Developing your priorities in treatment helps the doctor focus your treatment and guides your recovery. You might make different lists for symptoms that give you the most problems or side effects you might have to medication. Keep track of your progress with the things you choose for your lists.
Write down any questions you have for your doctor. Sometimes people remember important questions after they have left the doctor’s office. Keep a running list of issues and questions that might occur to you in-between visits. Feel free to check your notes while you are talking to your doctor.
Let your doctor know about your symptoms. A doctor will not be able to modify your treatment unless he or she knows what you are experiencing. Sometimes symptoms can be much improved, but still annoy you. Discussing them with your doctor does not mean “treatment has failed,” but is an important way to deal with an illness. Decreasing the severity of some symptoms, but not totally getting rid them can still be a very positive goal.
Let your doctor know about any medication side effects. Not everyone experiences side effects, and many side effects may disappear once your body adjusts to the medication. But if any side effect is troubling you, your doctor may be able to give you another medication to counteract it. He or she may also have some practical advice on how to manage the side effect with diet or daily activity changes. If for any reason you feel that you cannot continue to take your medication, talk to your doctor immediately, but don’t stop taking them until he or she has directed you otherwise.

Your page!

We would like to use this space to include personal experiences that you think might help other people better understand and cope with schizophrenia. If you would like to submit a story, poem, or other work of art for possible display in this space, e-mail us.

Please include a first name (preferably not your real name) that you would like to use to identify yourself and try to keep the stories no longer than one typed page. Due to limitations of space on our computer, we may not be able to display all submissions. We also reserve the right to select what seems most appropriate for the site.