Paranoid Schizophrenia -- The Psychiatric Disease
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Paranoid Schizophrenia
| Understanding Schizophrenia |
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Schizophrenia, one of the most debilitating and
baffling mental illnesses, defines a group of disorders that cause distorted
thought and perception. Thoughts can be scrambled or jump from subject to
subject. Perception can be distorted beyond reality, causing people to hear or
see things that are not there.
People with schizophrenia go through periods of getting better and worse - remission and relapse. They can go for long periods of time without any symptoms, but because schizophrenia is often a chronic illness it requires ongoing medical attention, like hypertension and diabetes.
Schizophrenia is neither "split" personality nor multiple personality disorder, a different and extremely rare problem. Though often stigmatized for the behaviors caused by the illness, people with schizophrenia did not bring the illness upon themselves by becoming involved with the "wrong" crowd or interests. And contrary to the beliefs that are reinforced by movies, television and books, people with the disorder are more likely to withdraw into isolation or become victims of crime than they are to hurt anyone else.
Much less common than other chronic diseases, schizophrenia occurs in around 150 of every 100,000 people, or about one to one and a half percent of the population, and usually appears during adolescence or young adulthood. However, it can be one of the most catastrophic illnesses because it can cause devastating impairments, emotional and financial losses, and the need for intensive medical and supportive care.
Paranoid schizophrenia sufferers endure constant feelings of being watched, followed and persecuted. Paranoid schizophrenia may be more common in men. Victims of paranoid schizophrenia develop grandiose delusions associated with protecting themselves from the perceived plot. Paranoid schizophrenia usually appears initially between the ages of 15 and 34. There is no cure for paranoid schizophrenia, however paranoid schizophrenia can be medically controlled. Severe attacks of paranoid schizophrenia may require hospitalization.
Causes of paranoid schizophrenia are still debatable. Heredity does play a part in paranoid schizophrenia, and although stress is NOT a factor in paranoid schizophrenia it certainly exacerbates the symptoms of paranoid schizophrenia
The signs and symptoms of paranoid schizophrenia are apparent to friends and family before the victim of paranoid schizophrenia notices the changes. Some signs of paranoid schizophrenia are confusion; indecision; nervousness; strange behavior; general withdrawal; indifference; anger; argumentative tendencies, changes in normal habits suicide and homicide.
If a friend or family member displays some or many of these paranoid schizophrenia symptoms, please contact HCPC for help with diagnosis and treatment of paranoid schizophrenia.
If paranoid schizophrenia sufferers fall prey to an acute attack they require full-time hospitalization. As the symptoms of paranoid schizophrenia begin to wane they can be transferred to a partial care program.
At HCPC we will help you to receive the most appropriate treatment for the paranoid schizophrenia patient.
The following hospital procedures are common for paranoid schizophrenia treatment:
group therapy allows paranoid schizophrenia patients to share coping strategies
individual therapy allows personal discussion to deal with paranoid schizophrenia
family meetings with medical staff prepare for the discharge of the paranoid schizophrenia patient.
If the paranoid schizophrenia patient is dangerous to himself and others, appropriate treatment for the severe paranoid schizophrenia case will be discussed at every level with a HCPC paranoid schizophrenia counselor. This paranoid schizophrenia treatment may involve one or all of these options for the paranoid schizophrenia patient:
Time-out isolation in your own room or a “safety” room separates the uncontrollable paranoid schizophrenia patient from others.
Leather band restraints are imposed on paranoid schizophrenia patients who pose a danger.
Electroconvulsive Therapy or ECT is the choice when the paranoid schizophrenia victim becomes severely depressed and is a very successful treatment.
HCPC personnel also explain how to control the symptoms of paranoid schizophrenia. How to take paranoid schizophrenia prescribed medication; the substance abuse agents to avoid; the instruction of stress-control techniques; how to join a paranoid schizophrenia support group and prime family members of paranoid schizophrenia sufferers.
Childhood schizophrenia symptoms seldom develop before age 12 but studying these childhood schizophrenia cases is important for studying the disorder. Childhood schizophrenia is 1/60th as common as the adult-onset type.
The damage neuro-developmentally seems greater in childhood schizophrenia than in the adult-onset type. Childhood schizophrenia patients are more anxious and disruptive than their adult counterparts. Psychosis in childhood schizophrenia develops at a more gradual level than the sudden psychotic onset in adolescents and adults with the disease.
Adult-onset schizophrenia is common in both sexes and childhood schizophrenia displays the same correlation.
The treatment of childhood schizophrenia parallels the adult onset-type and standard anti-psychotic drugs are equally effective. In a few childhood schizophrenia cases their symptoms completely disappear. Unfortunately the childhood schizophrenia patients may be even more susceptible than adults to the toxic side-effects and a third of the childhood schizophrenia patients have to terminate the treatment. Newer and safer anti-psychotic drugs for childhood schizophrenia patients may be just as effective.
Contact HCPC if you suspect the onset of childhood schizophrenia. Our competent childhood schizophrenia counseling and medical staff will isolate the symptoms of childhood schizophrenia and recommend the appropriate treatment for childhood schizophrenia.
A schizophrenia video called “What is schizophrenia?” Schizophrenia video is an educational video primer for patients, relatives and professionals. This schizophrenia video is designed to provide an overview of current scientific knowledge and practice regarding schizophrenia. Included in this schizophrenia video are implications for diagnosis, treatment, rehabilitation and long-term adjustments. This schizophrenia video is intended for use in graduate and undergraduate training programs in psychology, psychiatry, social work and nursing. Mental health professionals can use the schizophrenia video during in-patient and out-patient education for mentally ill persons and their families. The schizophrenia video is useful for introducing the many complexities of the illness. The schizophrenia video presents concepts in both visual and verbal terms in a minimum jargon. Included with the schizophrenia video is a Discussion Guide that facilitates the use of the schizophrenia video for educational and self-help groups.
Once you have viewed schizophrenia video and ascertained the direction you would like to pursue in this regard, call HCPC for final arrangements for your treatment program.
According to NIMH (National Institute of Medical Health) about one in a hundred people develop schizophrenia during their lifetime. Schizophrenia cause is not a result of poor parenting, on the contrary the schizophrenia causes in most victims are errors in brain development that arises from genetic and environmental factors.
Damage to the brain is not a schizophrenia cause, although schizophrenia cause can rather be attributed to faulty brain development.
Although it has been ascertained that schizophrenia appears in males in their teens and 20s in women in 20s and early 30s and that childhood schizophrenia is rare, the schizophrenia cause of this devastating affliction has not reached a solution although there has been extensive research for schizophrenia cause.
Some schizophrenia causes spring from hormonal changes of puberty and the biochemical changes of those at risk begin at this point.
It seems as if schizophrenia cause probably happens prior to birth. Schizophrenia cause increases with complications surrounding birth. Schizophrenia cause exacerbate during labor and delivery complications. Schizophrenia causes are also based on theories that the risk for schizophrenia increases when the developing fetus or newborn is deprived of oxygen.
Schizophrenia causes are also linked to a higher rate of the disease in cities than in non-urban areas. Schizophrenia causes resulting from virus such as flu epidemics need more research to substantiate the link. There is no single schizophrenia cause, although there is ongoing research into schizophrenia causes.
Early schizophrenia symptoms are benign enough to go unnoticed by family and friends. As the illness progresses the variety of schizophrenia symptoms increase as well as intensify. Schizophrenia symptoms are triggered by a number of disease processes coupled with genetic factors and environmental stresses.
The most common of the schizophrenia symptoms are hallucinations, delusions, disordered thinking and behavior, and an abnormal and lethargic expression of emotions. The most prominent schizophrenia symptom is hallucination. Hearing voices that others don’t is the most common type of hallucination of the schizophrenia symptoms. This hallucinatory schizophrenia symptom embraces voices that either describe the patient’s activities, carries on a conversation, warns of impending dangers or these voices orders the patient what to do.
Another common schizophrenia symptom is delusions of persecution or grandeur. This schizophrenia symptom involves incomplete lines of thought. The result of this schizophrenia symptom is fragmented thinking and jerky conversing.
An added schizophrenia symptom is a deadened emotional syndrome resulting in a voice monotone and mask-like facial expression. A linked schizophrenia symptom is inappropriate emotional response.
As the disease progresses the symptom of schizophrenia branches to embrace varied examples and they appear intense and bizarre. If you recognize or suspect any symptom of schizophrenia, and certainly when more than one symptom of schizophrenia is present, call the experts at HCPC to garner early treatment.
Delusional behavior, a belief that someone can hear their thoughts, control their feelings, actions and impulses, is one symptom of schizophrenia that requires attention.
Another symptom of schizophrenia is a distortion of the senses known as hallucinations:
The patient with the auditory hallucination symptom of schizophrenia hears sounds that are not there.
The visual hallucination symptom of schizophrenia causes one to see things that don’t exist.
The tactile hallucination symptom of schizophrenia is an intense sensation that has no cause like burning or itching.
Finally the olfactory hallucination symptom of schizophrenia causes the patient to smell non-existent odors.
Some experts recommend classifying the variety of symptoms into different groups - positive symptom of schizophrenia and negative symptom of schizophrenia. An example of a negative symptom of schizophrenia is low sociability. An example of a positive symptom of schizophrenia is manifested as a psychotic symptom (either hallucination or delusion) or cognitive impairment (thought disorder).
It is important to remember that a patient may have more than one symptom of schizophrenia, but rarely does a schizophrenic patient have all of them. Many or just one symptom of schizophrenia may occur during remission and then worsen during the active phase.
If a friend or family member displays many or just one symptom of schizophrenia, please contact HCPC for help with diagnosis and early treatment.
Like many other mental illnesses schizophrenia treatment involves many therapies tailored to the individual patient’s needs and symptoms. There are many forms of schizophrenia treatments (medications and therapies) used in isolation or more effectively in combination. While no absolute cure has been found the improvement in the last 20 years in schizophrenia treatment leads to schizophrenic patients leading fulfilling and independent lives.
Call your helpful counselors at HCPC sooner rather than later because early diagnosis is imperative so that multi schizophrenia treatments can be initiated immediately.
An early schizophrenia treatment in the 1940’s whose benefits are not definitive is electroconvulsive therapy (ECT) or shock treatment. This alternate and newer ECT technique for schizophrenia treatment does not affect the brain structure. This schizophrenia treatment is viewed as safer than drug therapy for severe depression.
Substance abuse increases non-compliance with anti-psychotic drug schizophrenia treatment in addition to other adverse effects.
Nicotine may be a form of self-medication schizophrenia treatment that helps reduce psychotic symptoms.
Once the patient has responded to one or multi schizophrenia treatments, the addition of individual, family or group psychotherapy sessions may be a helpful schizophrenia treatment enhancement.
Utilizing both drug therapy and some form of psychosocial treatment for schizophrenia treatment is supportive, positive and reality-oriented.
Schizophrenia treatment that is geared towards rehabilitation programs for job counseling and training, problem-solving or money-management, social skills and the use of public transportation is found to be the most essential and beneficial post crisis schizophrenia treatment.
Cognitive therapy to relearn problem solving techniques, retrain basic living skills for a basic quality of life and strategies to reduce the risk of relapse is a favorable schizophrenia treatment.
Relapse figures decrease significantly when positive family involvement is introduced as a part of the schizophrenia treatment. Caregivers with this part of the schizophrenia treatment can be taught to recognize impending symptoms and stressful situations as well as helping enforce drug regimens.
Community schizophrenia treatment programs can be highly beneficial and cost effective. Professional caregivers who provide treatment and support within the home is preferable to frequent hospitalization as a schizophrenia treatment choice.
Vocational rehabilitation is a schizophrenia treatment that helps the health of the patient through paid employment.
Although there is no current schizophrenia cure, the combination therapy and drug schizophrenia treatment effectively controls the disordered symptoms enabling the patient to live more functional lives.
Approximately 1% of the population develops schizophrenia during their lifetime. According to schizophrenia research, more than 2 million Americans suffer from schizophrenia in a given year. Schizophrenia research is gradually leading to new and safer medications. Current treatment methods are based on experience and schizophrenia research. Schizophrenia research is a time of hope for people with schizophrenia and their families. The scientists of schizophrenia research are using molecular genetics to study populations and learn about schizophrenia. Schizophrenia research is employing methods of imaging the brain’s structure and function. This schizophrenia research holds the promise of new insights into the disorder.
Schizophrenia research has been studying genetic factors in the disorder and multiple genes appear to be involved in creating a predisposition to develop schizophrenia.
Another area of schizophrenia research that has made dramatic advances is neuroimaging technology. This form of schizophrenia research permits scientists to study brain structure and function. Schizophrenia research has been spurred to identify prenatal factors that bear on this apparent abnormal development. Other related schizophrenia research is in the areas of brain-imaging techniques, the examination of neural circuits that is likely involved in early biochemical changes. Schizophrenia research involves scientists exploring genetic based abnormalities in brain development.
Information on schizophrenia is found world-wide. Information on schizophrenia shows severe symptoms are long-lasting and the chronic pattern of schizophrenia often causes a high degree of disability. Information on schizophrenia say some people have one such psychotic episode, while others suffering schizophrenia have many episodes. This information on schizophrenia also says that sufferers lead relatively normal lives during the interim periods. However in the information on schizophrenia “chronic” patients don’t fully recover normal functioning. Information on schizophrenia report these sufferers require long-term treatment, including medication, to control the schizophrenia symptoms. Information on schizophrenia report it as a chronic, severe and disabling brain disease. Men and women according to information on schizophrenia are affected with equal distribution. The information on schizophrenia accounts for early appearance in men (late teens or early twenties) than women (twenties to early thirties). People with the disease according to information on schizophrenia suffer terrifying symptoms such as hearing internal voices not heard by others, or believing that people can read their minds, control their thoughts or plot to harm them. Information on schizophrenia reveals that symptoms cause fear and withdrawal. Information on schizophrenia reports that most victims of schizophrenia suffer the symptoms all their lives and no more than one in five victims recover completely.
According to information on schizophrenia schizophrenics may be mistaken for people “high on drugs” because the symptoms of schizophrenia are mimicked.
Information on schizophrenia and its associated support and advocacy organizations are:
Another more severe schizophrenia symptom is called catatonic schizophrenia in which the patient is immobile and unresponsive. Catatonic schizophrenia is characterized by marked psychomotor disturbance. In catatonic schizophrenia, a catatonic stupor indicates a marked decrease in reactivity to the environment and in spontaneous activity. Catatonic schizophrenia sufferers display a resistance to all instructions or attempts to be moved. Symptoms of catatonic schizophrenia can also involve the maintenance of a rigid posture. In another form catatonic schizophrenia victims can be excited and display uncontrollable and apparently purposeless motor activity. Associated features of catatonic schizophrenia are stereo-typed behavior, mannerisms and waxy flexibility. Catatonic schizophrenia is dominated by physical symptoms.
"Any person with schizophrenia is incapable of making life decisions and requires the help of a legal guardian."
The diagnosis of schizophrenia does not mean that the person will always be dependent upon others to make decisions and care for them. In fact, most people with this illness handle their own affairs successfully. However, just as people with other medical conditions may have symptoms that cause periods when their ability to make decisions is impaired, people with schizophrenia may require the appointment of someone to handle their affairs for a specified length of time.
"Smoking "pot" can help sometimes more than regular medicine."
Wrong. The use of any illicit drug is dangerous and illegal, no matter who uses them. For people with schizophrenia, such use can impair judgment, worsen symptoms and cause interactions with medications. People with schizophrenia often have difficulty with healthy social interaction. Being with people who sell or use drugs can place an already vulnerable person in a potentially dangerous position.
For these reasons it is important to inform the treating psychiatrist of any substance use or abuse. He or she will recommend steps to take to avoid illicit drug use and deal with the reasons why the medication appears not to help.
"People with schizophrenia are violent."
Violence is not a symptom of schizophrenia and is not common in people with this disorder. In fact, people with schizophrenia are more likely to become victims of violence themselves. However, if violence or aggression occurs, it usually does when a person feels cornered or misunderstands the intentions of the other person. Usually hallucinations, delusions, preoccupations or jumbled thoughts have caused the fears and misunderstandings that lead to violence.
The outlook for people with schizophrenia has improved over the last two decades. While no absolute cure has been found, modern treatments have allowed many schizophrenic patients to lead independent, fulfilling lives. It is important, however, that people who might have the disorder be diagnosed quickly so that treatment can begin as soon as possible.
The first way family and friends can help is to take an active role in having the patient seek treatment. The schizophrenic person usually believes that delusions and hallucinations are real and that psychiatric treatment is not needed.
When treatment begins, recognize that many of the antipsychotic medications will likely cause the patient to require more sleep than usual. Also, understand and be prepared to recognize possible medication side effects as well as symptoms that would require contacting the doctor.
Speak clearly and simply. Because the illness can cause problems with thinking, it is helpful to limit conversation to the most simple statements and questions. Recognize delusions and hallucinations as symptoms. The perceptions are real to the patient; do not argue that the delusion is true or false. Pointing out that he or she does not have to listen to the voice or wait for the voice to speak again can be helpful.
Find a way to empathize. For example, the loud music played by the neighbors at night might be interpreted in a delusion as a tactic to control the patient's thoughts. Rather than insisting this is untrue, acknowledge how upsetting loud music can be while trying to sleep.
Provide structure. Help the person recovering from the illness to plan the days to include plenty of sleep, healthy food, fresh air, time for exercise, cleanliness and social interaction.
Family and friends should plan ahead and be prepared for possible crises. Medications, phone numbers, and other important information and materials should be kept readily available.
Dealing with a relative or friend with schizophrenia can be tremendously stressful.
Family and friends can find emotional support, understanding and hope from outreach, education and advocacy groups. Whether you are the victim, a family member or a friend, everyone who is affected by this mental illness should seek help.
| Welcome to the professional web site for
SEROQUEL, a resource for health care professionals who treat patients with
schizophrenia. SEROQUEL is a first-line treatment for schizophrenia.
The most common adverse events associated with the use of SEROQUEL are dizziness (10%), postural hypotension (7%), dry mouth (7%), and dyspepsia (6%). The majority of adverse events are mild or moderate. The incidence of somnolence in clinical trials was 18% versus 11% for placebo. As with all antipsychotic medications, prescribing should be consistent with the need to minimize the risk of tardive dyskinesia, seizures, and orthostatic hypotension. Only dyspepsia, weight gain, and abdominal pain were reported at a significantly higher incidence with increasing doses of SEROQUEL. Patients should be periodically reassessed to determine the need for maintenance treatment. *SEROQUEL® (quetiapine fumarate) Prescribing Information, Rev 01/01, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware.
References |
 
If you would like additional information regarding AstraZeneca's products, please contact the Information Center at AstraZeneca in the U.S. at 1-800-237-8898, Monday through Friday 8am - 7pm ET, excluding holidays. |
Robert Bayley, 35, from Northampton, has had schizophrenia for almost 20 years, and he tells BBC News Online how switching from to the newer atypical medicines - changed his life for the better.
"I was 16 and still at school, when I was admitted to a local mental hospital.
"I was diagnosed as a psychotic with schizoid tendencies, then eventually diagnosed with paranoid schizophrenia.
"From an early stage, doctors tried me on the old-school antipsychotics.
"I was on them for at least 10 years.
It's not a cure, but it gives you a certain strength
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Robert Bayley
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"The drugs caused involuntary movement and loss of control of the tongue and mouth which was very distressing, especially in social situations.
"I didn't feel confident to go out and make contact with people.
"I had very bad attacks a couple of times when my oesophagus started to constrict.
"I felt like a zombie, I had no clarity of thought.
"I had a terrible lethargy and all you want to do is be still and you can't do much that's productive in the day.
'More creative'
"I began taking Clozaril (clozapine) in 1993. It can affect your white blood cell count, so you have to have blood tests before you get each prescription, and you start taking it at quite a low dose.
"So it was probably several months before I started to feel the benefits.
"It's not a cure, but it gives you a certain strength and the residual capacity to deal with the illness, which the other drugs didn't do.
"There are side effects, but they're not nearly as distressing as those caused by the old school antipsychotics.
"It's helped me be creative. I write and paint and compose music, and those are things which I was very restricted in being able to do before
"Schizophrenics and manic depressives should have the right to the most effective treatment there is."
![[U.S. Food and Drug
Administration]](images/header.gif){kind=small}
| This article was published in FDA Consumer magazine several years ago. It is no longer being maintained and may contain information that is out of date. You may find more current information on this topic in more recent issues of FDA Consumer or elsewhere on the FDA Website, by checking the site index or home page, or by searching the site. |
New Schizophrenia Drug:
Balancing Hope with Safety
by Judy Folkenberg
Thirty-year-old "Claudia" was a problem-to her parents, to the state mental
institution where she had spent her last six years, and to her doctor. Prone
to hallucinating and holding imaginary conversations, her thoughts tumbled
around her mind in wild disarray. Disheveled, agitated and violent, on her
infrequent visits home Claudia (not her real name) often tried to hit her
parents.
The young woman suffered from schizophrenia, a devastating mental disorder
that strikes people most often in their late teens. Doctors had tried most
of the major antipsychotic drugs to give her life some normalcy, but nothing
worked.
As a last resort, a psychiatrist decided to treat Claudia with a new
antipsychotic drug under study at several institutions across the country.
The drug seemed to work on patients who failed to improve on other drugs.
After a few weeks the change became obvious. Her hallucinations decreased,
she stopped babbling, her violent outbreaks ceased, and she started combing
her hair and putting on make-up. In a few months, she left the mental
institution to live in a supervised apartment. Today, two years after she
started taking this drug, Claudia dresses meticulously, holds a volunteer
job at a local library, and has a boyfriend. No one, her doctor says, would
ever know she had once led a life of such total disarray in a mental
institution.
This is a story about a drug called Clozaril (clozapine), which, on one
hand, has the ability to release thousands of the sickest schizophrenic
patients like Claudia from mental institutions, but on the other hand is
associated with a potentially fatal adverse event.
Serious Side Effects
Clozaril has at least two serious side effects: 1 out of 20 patients suffers
from convulsive seizures, and 1 or 2 out of 100 suffer from agranulocytosis.
Agranulocytosis is a serious blood disorder in which the number of white
blood cells (the body's disease-fighting cells) are reduced, leaving the
patient vulnerable to infection--so that even a common cold could be fatal.
A simple blood test can detect this dangerous decrease in white blood cell
levels, and early detection of this disorder, along with the discontinuation
of Clozaril, can decrease the risk of death. In clinical trials in the
United States, 17 patients who developed agranulocytosis while taking
Clozaril recovered from the blood disease when they stopped taking the drug.
Although agranulocytosis is a side effect of other antipsychotic drugs, it
is far more common with Clozaril.
The rate of seizures can also be controlled. Lowering the dose of Clozaril
or adding an anticonvulsant drug usually controls the seizures.
Despite these serious side effects, Clozaril has proved to be free of
certain other side effects commonly found with typical antipsychotic drugs,
such as chlorpromazine or haloperidol. For example, there have been no
documented cases of tardive dyskinesia, a serious side effect that consists
of involuntary movements of the tongue and mouth such as chewing, sucking,
or smacking the lips. This condition affects about 1 out of 6 patients on
other antipsychotic drugs. Nor does Clozaril cause other side effects found
with other antipsychotic drugs, such as rigidity, mask-like facial
expression, or slowed movements. A significant number of schizophrenic
patients may stop taking their drugs because of these side effects.
Researchers estimate that perhaps 200,000 chronic schizophrenia patients
don't improve with traditional antipsychotic drugs. They hope that many may
improve with Clozaril.
"We have patients from state hospitals who are now working in the
competitive commercial area having obtained jobs on their own," said Dr.
Herbert Meltzer, a research psychiatrist at Case Western Reserve University
Medical School who has studied Clozaril for some 15 years. "Another patient
who is taking the drug is maintaining a straight A average as a physics
major after five years of hospitalization."
Bumpy Trip
Clozaril's journey to approval was not without mishap. The drug was first
synthesized in 1960 and was marketed in several European countries by the
late 1960s. But in the 1970s, as clinical trials were being started in this
country, post-market reports from Finland that a number of schizophrenic
patients on Clozaril had died from agranulocytosis reached American
researchers. As a result, research in this country came almost completely to
a halt.
Interest in the drug, however, was kept alive by occasional reports of
remarkable results achieved in some desperately ill patients being treated
in special situations. (For compassionate reasons, FDA gave permission to a
few research physicians to continue prescribing Clozaril to schizophrenic
patients who did not get well on other antipsychotic drugs.)
Other factors helped sustain interest in Clozaril. Families of schizophrenic
patients pressured clinicians to make the drug more readily available to
treatment-resistant patients, or those patients with tardive dyskinesia.
By the 1980s, researchers had crude estimates on the rate of agranulocytosis
among patients who took Clozaril--1 or 2 out of every 100 patients developed
this disorder--a higher rate than for other drugs used to treat
schizophrenia. Research by Sandoz also suggested that Clozaril was effective
in typical schizophrenic patients, but the company didn't have any valid
data supporting Clozaril's effectiveness in treatment-resistant patients.
Sandoz applied to FDA in 1983 for approval to market Clozaril for
treatment-resistant schizophrenia, but FDA turned down Sandoz's request: The
grim specter of agranulocytosis made the drug too dangerous in the agency's
eyes to market in the absence of strong proof of effectiveness in
treatment-resistant patients. Nonetheless, an FDA advisory committee (an
independent body of outside experts) encouraged Sandoz to prove Clozaril's
superior effectiveness in treating schizophrenic patients who had failed to
get better on other antipsychotic drugs.
FDA and Sandoz designed a major research study testing this hypothesis.
Sandoz established the multi-site study with 265 treatment-resistant
schizophrenic patients in 1985. The results were impressive. After six weeks
on Clozaril, 25 percent of the treatment-resistant schizophrenic patients
greatly improved, compared to only 5 percent of those assigned to
chlorpromazine (an approved antipsychotic drug). Further results from an
uncontrolled follow-up study show that after six months, up to 50-60 percent
of the schizophrenics taking Clozaril improved.
The schizophrenics who improved were the proverbial "hopeless" patients. The
average length of their illness was 16 years; average number of
hospitalizations, eight; and all had tried at least three other
antipsychotic drugs that had been no help at all. Many were so sick that
using a knife and fork, getting dressed, or taking a bath were skills long
lost.
One long-term study from Europe on Clozaril's effectiveness seems to support
this optimistic picture, though, because it was an open and uncontrolled
study, it cannot be considered conclusive. This Swedish study of 96
treatment-resistant schizophrenics showed that 43 percent improved
significantly while 38 percent improved moderately. More importantly, over
half of the patients were discharged from mental institutions and able to
live on their own.
Additional U.S. study data verified the rate of agranulocytosis to be one or
two patients out of l00. Due to the careful monitoring and early detection
of patients with this disorder, none of the affected patients died in these
studies. More experience will be needed with the drug before it can be known
with greater certainty that the risk of death can be substantially reduced
by early detection of agranulocytosis. The rate of seizures was also high.
One out of 20 patients may experience a grand-mal (epileptic) seizure.
(Lowering the dose of Clozaril or adding anticonvulsant drugs usually
controls seizures.)
Despite these side effects, FDA approved the drug in September of 1989. Why?
"The severity and hopelessness of unremitting chronic schizophrenia was an
important factor in the decision to approve Clozaril, despite the fact that
it is associated with some serious risks," said Paul Leber, M.D., FDA's
director of the division of neuropharmacological drug products.
"Remember, the lives of chronic schizophrenics are tormented and hopeless,"
adds Case Western's Meltzer.
A Risk Worth Taking
Leber admits that approval of Clozaril is a gamble but says it's a risk
worth taking. His opinion is shared by others.
"We think that the potential risk for death is worth the benefit Clozaril
brings for people who have almost no life of their own," said Laurie Flynn,
executive director of the National Alliance for the Mentally Ill, an
organization made up of patients and the relatives of the severely mentally
ill.
Consider the following: As many as 30 percent of schizophrenics attempt
suicide, and 1 out of 10 succeeds. In addition to suicide, other causes of
death are higher among schizophrenics. A Swedish study of more than 1,000
schizophrenic patients showed that fatal injuries were eight times higher,
deaths from infections four times higher, and deaths from other diseases two
times higher than those of the general population. The reasons for this
higher death rate are varied but include neglect, because untreated
schizophrenics are unable to take care of themselves and to explain their
symptoms to medical personnel.
Nonetheless, Leber says there is no objective way to weigh risk versus
benefit. There are no right answers, and the seriousness of the disease is
balanced by the seriousness of the side effects. And while clinical trials
may answer some "objective" questions, when Clozaril moves from the research
institution to the real clinical world, the situation becomes less
controlled.
Monitoring Patients
In some people, agranulocytosis can strike very suddenly. The white blood
count can drop dramatically, so that in days the white blood cells are
completely eradicated, leaving the body defenseless against infection. Once
agranulocytosis is detected and Clozaril is stopped, it may take two to
three weeks for the white cell count to return to normal. During the period
of recovery, patients are vulnerable to infection. It is preferable to
detect agranulocytosis before infections develop, since the risk of dying
from the complications of agranulocytosis appears to be greater if it is
detected after the onset of infection.
To help ensure the early detection of agranulocytosis and, therefore,
decrease the risk of fatal complications, Sandoz has established a
distribution system requiring that patients have a sample of blood drawn for
a white blood count before they are given the next week's supply of
Clozaril.
If the blood test shows a significant decrease in white blood cells, the
physician will be notified immediately and the patient must be taken off the
medication. No other drug in the United States is prescribed with such
stringent controls, according to FDA officials. Once agranulocytosis
develops, the patient cannot go back on Clozaril because preliminary
research shows that there's a good chance the reaction will recur.
Distribution of Clozaril started last February. For many schizophrenic
patients, Clozaril may be the drug that allows them to lead a life outside a
mental institution.
As NAMI's Flynn points out, "while Clozaril is not a cure for schizophrenia,
it's a remarkable advance."
Judy Folkenberg is a staff writer for FDA Consumer.
A Psychiatric Mystery
"Is there no way to cure this?
No new device to beat this from his brain?"
Henry the Eighth, Act III, Scene 2
William Shakespeare
Many people think of it as the disease that best defines madness.
Schizophrenia can inflict suffering for decades and in 10 percent of the
cases lead its victims to suicide. Long considered one of psychiatry's most
baffling mysteries, it continues to stump scientists.
Most psychiatrists feel that schizophrenia is a collection of brain diseases
that they haven't been able to sort out yet. Schizophrenia sufferers can
range in severity from the babbling patient who remains in an institution to
a responsible job holder on medication. Although much has been learned in
the past 40 years, doctors still don't know what causes schizophrenia, and
there is no cure.
Schizophrenia strikes about 1 out of every 100 persons--usually young people.
Patients with schizophrenia are unable to think coherently and often
misinterpret the meaning of events. Consequently, they are often incapable
of caring for themselves and living independently. Moreover, many live in
continual fear and distress, threatened by hallucinations and plagued by
paranoid delusions. It's "as if our brain began playing tricks on us, [as]
if unseen voices shouted at us, [as] if we lost the capacity to feel
emotions, and [as] if we lost the ability to reason logically," says E.
Fuller Torrey, M.D., a psychiatrist, in his book Surviving Schizophrenia.
Descriptions of a disorder thought to be schizophrenia have been found among
civilizations predating the Greeks. Physicians didn't begin to focus on
schizophrenia as a distinct disorder, however, until around the 1900s, when
psychiatrist Emil Kraepelin coined the term "dementia praecox" to
distinguish schizophrenia-like symptoms from the depressive illnesses. A
decade later, Swiss psychiatrist Eugen Bleuler coined the term
"schizophrenia."
Although scientists were finally able to describe the disease, they still
couldn't treat it. Dentists pulled some patients' teeth because
psychiatrists thought the teeth produced a toxin that caused psychiatric
symptoms. Other patients were injected with colloidal gold or deactivated
horse serum, or dropped down wells in vain efforts to remove supposed toxins.
It wasn't until the 1930s that minor successes were first achieved. At that
time, physicians began treating schizophrenic patients with
electroconvulsive shock therapy. Although some improved, the changes often
didn't last.
The first big breakthrough in schizophrenia treatment came from an unlikely
event--the French-Indochinese War in the early 1950s. Dr. Pierre Laborit, a
French navy surgeon, accidentally found that chlorpromazine, a drug he gave
wounded soldiers to control shock during surgery, also soothed them. He
persuaded psychiatric colleagues to try the drug on schizophrenic patients
and found it controlled the thought disorders and agitation experienced by
many of them.
Chlorpromazine became the first antipsychotic drug used to treat
schizophrenia. Laborit's discovery ushered in the use of drugs in treatment.
His discovery also prompted doctors to examine more carefully the notion
that schizophrenia has a physiologic basis and is not caused by poor toilet
training, domineering mothers, or, in the words of the late psychiatrist
R.D. Laing, "a sane response to an insane world."
There is ample evidence that the brains of persons who have schizophrenia
are as a group different from the brains of persons who don't have the
disease, comments Torrey.
For instance, some studies using brain imaging techniques in schizophrenics
show a loss of brain tissue, abnormalities in brain density, brain
asymmetry, and atrophy of the cerebellum (the part of the brain involved in
muscular and motor activity). Other studies have shown an excessive number
of receptors for dopa-mine (a brain chemical involved in controlling body
movements), abnormal electrical responses, abnormal EEGs
(electroencephalograms), and abnormal eye movements in schizophrenic
patients compared to healthy controls. By all brain measures--gross
pathology, neurochemistry, and microscopic pathology--it can be shown that
schizophrenia ranks with multiple sclerosis, Parkinson's disease, and
Alzheimer's disease as a major brain disease, Torrey says.
Less is known about causes of schizophrenia. The disease runs in families;
but how it is transmitted remains unclear. There have been reports that
obstetrical complications are associated with a higher risk of
schizophrenia, and that more babies born in late winter and early spring
eventually become schizophrenic. Why this happens, though, no one is sure.
Researchers have also been intrigued by theories linking nutritional and
immunological deficiencies to development of schizophrenia. It has been
reported that schizophrenic patients have immune system abnormalities, but
researchers don't agree on what these changes are. A viral cause for the
disease has also been suggested. Among babies born during the 1957 flu
epidemic in Finland, a greater number developed schizophrenia than would
normally be expected in the general population.
Schizophrenia is a devastating disease, but some individuals do get better.
About half become at least moderately independent. A summary of 25 studies
in which schizophrenic patients were followed for 10 years showed that 25
percent completely recovered (whether or not they were treated), 25 percent
improved and were able to live a moderately independent life, 25 percent
improved somewhat but required an extensive support network, 15 percent did
not improve and remained hospitalized, and 10 percent died--usually by
suicide.
--J.F.
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Alcohol and Drug Services ¿What is methamphetamine? Meth ("speed" or crystal) is a form of amphetamine and a powerful central nervous system stimulant. Amphetamine is used legally a treatment for hyperactivity in children and narcolepsy. Meth, however, is primarily a drug of abuse. Ice, the crystallized form of methamphetamine, is smoked and the resulting high sometimes lasts for up to 24 hours, which makes it attractive to stimulant abusers. However, tolerance rapidly develops and often results in compulsive use leading to addiction in a relatively short time. Health Problems Related to Use Use results in increased heart rate, increased blood pressure, and elevated temperature. Excessive doses can cause irritability, nervousness, insomnia, nausea, hot flashes, palpitations, mental confusion, severe anxiety, depression, and death. A more severe manifestation of chronic toxicity is a state of paranoia closely resembling paranoid schizophrenia. Psychotic symptoms include hallucinations, paranoid delusions, and delusions of parasites and bugs in the skin. Continued use may lead to permanent damage to the brain or death. Users who inject the drug and share needles risk exposure to the Human Immunodeficiency Virus (HIV), the virus that causes Acquired Immunodeficiency Syndrome (AIDS). Signs and Syptoms of Meth Use Symptoms include hyperactivity, wakefulness, and loss of appetite. Chronic use can result in days of bingeing with no sleep, followed by a crash in which the user sleeps for days. Withdrawal symptoms include: emotional depression, decreased energy, lack of interest, and inability to experience pleasure. Withdrawal is accompanied by intense craving for the drug. San Diego User Profile In 1994, there were 3,508 meth users admitted to public treatment programs, up 190% from 1990: about half the admissions were women; more than half (71%) were Caucasian; 5% were African-American; and 16% were Latino.The average age was 29. Almost half reported that their major means of using the drug is inhalation, or "snorting". Smoking, however, has increased; 28% reported smoking the drug. Twenty-two percent (22%) reported injecting meth. More than two-thirds (68%) reported they also use other drugs, the most common secondary drug being marijuana. San Diego Patterns of Use Meth has a long history in San Diego, once regarded as the "methamphetamine capital of the world". At one time, more meth labs were seized in San Diego County than in all other seizures combined. This is no longer true. Much of the meth now available here comes from Mexico, and Mexican nationals are major distributors of the drug. Meth is cheap, costing $10 for 1/10 of a gram.1
1Narcotics Task Force, Annual Report, 1995 |
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What is Schizophrenia?
| Schizophrenia is
a serious mental disorder, which affects a person’s thought processes,
reasoning, emotions and behaviour.
Who gets schizophrenia? Some facts about schizophrenia:
What causes it? Nobody really knows, but the following list includes those at greater risk of developing it.
How does it develop? Schizophrenia may come on gradually over a period of many months (chronically) or very suddenly (acutely) as a result of a clearly identifiable trigger e.g. death of a friend or close relative. The person may recover from a one-off attack and never experience it again or get recurrent attacks with periods of normality in between. Whether the condition is an acute attack or a chronic progression, the sufferer usually has no insight, i.e. they are unaware that anything is wrong, that their behaviour is different or that they are ill.
What are the symptoms? Symptoms vary enormously between one person and the next. They tend to be divided into what are called "positive" and "negative" symptoms. People may have just one type or a mixture to varying extents. Acute attacks tend to be mainly positive symptoms, whilst chronic schizophrenia shows mainly negative features. The symptoms affect thinking, perception, emotion and behaviour.
How is it diagnosed? Any friend or relative of somebody who is showing combinations of the above symptoms should contact a doctor, as the sufferer himself/herself will not know anything is wrong. If he/she is talking about suicide, take them seriously, talk it over, remove harmful objects from the area and seek medical help urgently. The doctor will examine the patient and carry out blood and urine tests, and possibly brain scans to check for other reasons for the strange behaviour e.g. alcoholism or a brain tumour. The doctor will identify for how long the strange behaviour has been going on and look for particular symptom groups as mentioned above. If the duration has been for less than a month, acute schizophrenic-like psychotic disorder may be diagnosed. Chronic schizophrenia itself is only considered if the duration of the problems is many months. Paranoid schizophrenia is the most common type, whereby the positive symptoms are very obvious. In middle aged and older people, the first case of paranoid schizophrenia is given the name "paraphrenia".
What can be done to help someone with schizophrenia? If the doctor (GP) suspects a diagnosis of schizophrenia, a specialist (psychiatrist) will admit the patient to hospital for assessment. (This may be with or without the person’s consent. If the doctor believes the person is at high risk of harming themselves or a danger to others, he/she may legally enforce admission to hospital). On confirmation of diagnosis treatment will begin. Antipsychotic drugs* are used to control the strange behaviour. Fast acting drugs such as chlorpromazine or trifluoperazine may be given three times daily for a number of weeks with dose adjustment until the behaviour is controlled. (* Some antipsychotic drugs may be prescribed for other purposes than schizophrenia e.g. persistent hiccups, vomiting or severe anxiety). The patient will need to be stabilised on a suitable medication before being discharged from hospital. "Suitable" is determined by control of symptoms balanced against quite common side effects. Different drugs have different side effects, but the most common side effects are dry mouth, blurred vision, dizziness and drowsiness, caused by an imbalance of neurotransmitters (naturally occurring chemicals in the nerves). Alcohol makes these effects worse, so is best avoided. A drug called procyclidine may be taken to correct this imbalance, such that the antipsychotic can still be taken in most cases. Some of the newer antipsychotics have a different side-effect profile. Many schizophrenics do not take/remember to take their medication. As a result their condition worsens and they find themselves back in medical care in hospital. No antipsychotic medications should be stopped abruptly without consulting a doctor. If a drug is unsuitable because side effects become intolerable the dose would have to be gradually reduced according to doctor’s instructions. For such patients an alternative to frequent dosing with tablets, capsules or liquids is a longer acting "depot" injection given into muscle from where it slowly releases the drug over a period of up to 4 weeks. Electroconvulsive therapy or ECT is only used for very severe cases of schizophrenia which have not responded to a variety of drug choices. Before being sent home, arrangements are made to ensure the environment in which the person will find himself or herself is calming and that stress factors have been removed. Support should be available from family, friends or mental health care workers e.g. the community psychiatric nurse or CPN for short. Frequent contact and supervision with the CPN is essential to evaluate the ongoing needs of the patient, and of the family. This may require the patient to visit a day centre where a number of health care specialists will help the patient adjust. The family will need to be supported too. They will be counselled in their understanding and acceptance of their relative’s condition, how they can help support him/her and what help they themselves can get from the health care services. Watching for signs of relapse is key to ensuring the patient receives prompt attention and avoids the need for readmission to hospital.
What if it’s left untreated? Without appropriate treatment and support the sufferer is likely to become more withdrawn and isolated. The likelihood of suicide will be greater.
What does the future look like? The course of the condition will depend upon so many factors; it may be difficult for a doctor to predict the future outcomes for a patient. The list below is not exhaustive.
Where can extra help be found? Suicidal and have no family to talk things through with or know someone who is talking about it and don’t know how to cope? Call the Samaritans on Schizophrenia Association of Great Britain PREPARED: October 2002. |
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