Dr.: Do you hear voices?
Patient: Do I hear voices? I hear voices. People talk. Do I hear voices? No… People talk. I hear voices when people talk.
Throughout the examination, He made repetitive chewing and biting motions… He seemed unresponsive to much of what was going on around him..
If this interview had taken place, say, about the time Michelangelo started painting the Sistine Chapel, the outcome for the patient would have been poor indeed. The diagnosis almost certainly would have been witchcraft, and the patient would have looked forward to treatments such as burning, drowning, or perhaps a life in prison.
Fortunately for the 1% to 2% of the world’s population affected by schizophrenia, medical science has advanced light-years since Michelangelo’s day. Schizophrenia is now recognized as an organic brain disorder a biologically based disease that reveals itself as a dysfunction of the thinking process, with symptoms such as delusions and hallucinations, and withdrawal from the outside world.
Impact of the Disease
Schizophrenia is a socially and financially devastating disease that robs people of their most productive years of life. Men and women are at equal risk of developing the illness. Most men become ill between 16 and 25 years old, whereas women usually develop symptoms between ages 25 and 30. Frequently, family members are also unable to achieve their own social, economic and career goals because they must provide constant care and supervision for the schizophrenia patient.
A person exhibiting schizophrenia’s positive symptoms may hear voices, have delusion of grandeur and suffer from hallucinations or acute paranoia. Someone suffering from the less apparent but equally devastating negative symptoms might appear depressed, socially withdrawn, apathetic or emotionally unresponsive. Negative symptoms are strongly related to poor social functioning and inability to hold a job. Between 18% and 55% of people with schizophrenia attempt suicide. More than 10% of them succeed.
The estimated cost of schizophrenia o the United State is $33 billion annually, with one in 100 Americans and their family care givers affected by the disorder. At any given time, 25% of psychiatric hospital beds are occupied by schizophrenia patients. Hospitalization costs per patient are estimated to exceed $100,000 annually for chronic inpatient treatment. The cost of each acute readmission ranges up to $10,000. Research reveals roots in chemical imbalances.
The causes of schizophrenia are not well understood. Through years of research, several theories have emerged, including heredity, stress, and viral, social, and neurobiological causes. Recent advances in brain imaging have confirmed imbalances of two brain chemicals-dopamine and serotonin-in people with schizophrenia.
Antipsychotic drugs such as haloperidol, chlorpromazine, and fluphenazine, first introduced in the 1950s, are presumed to correct dopamine imbalances and have been considered the treatment standard for schizophrenia. Although they effectively control the positive symptoms of schizophrenia, they often cause debilitating extrapyramidal symptoms (EPS) such as uncontrollable and restlessness.
An estimated 40% of people with schizophrenia taking conventional medications require readmission in their first year following hospital discharge. A major cause of readmission, noted Richard Borison, M.D.. Ph.D., professor and chairman, Department of Psychiatry and health Behavior, Medical College of Georgia, is that patients stop taking their medication because of EPS despite the symptomatic relief the treatment may offer. New research and drugs may offer help for positive and negative symptoms, with fewer side effects.
The development of a new chemical class of drug, the benzisoxazole derivatives, is now offering fresh hope for improving the lives of Americans with schizophrenia. RISPERDAL, developed by researchers at Janssen Pharmaceutica, recently received clearance for marketing in the United States. Available in Canada and the United Kingdom as well, RISPERDAL is the antipsychotic drug introduced in almost 20 years for use as first-he option for treating patients with schizophrenia.
“Every time we have a new drug to treat schizophrenia, we have enormous new hope because each patient responds differently to each medication. The more choices, the better chance we have to reduce the ‘revolving door’ hospitalization cycle many patients now experience” said Jack Gorman, M.D., professor of clinic psychiatry, Columbia Unveracity Department of Psychiatry. “A break in this vicious cycle can mean less hospitalizations and a better chance of productive, quality living for schizophrenia sufferers and their families.”
While the exact mechanism of action is unknown, it is presumed that RISPERDAL’s clinical benefits derive from an unconventional way of working in the body by blocking nerve cell entrances for the chemicals dopamine and serotonin. Excessive activation of the cells by these brain chemicals appears to be associated with both positive and negative symptoms of schizophrenia. An excess of dopamine, responsible for emotions and motivations, has long been considered one of the causes of positive symptoms of schizophrenia.
Research has shown that over stimulation of serotonin, which acts as a messenger and stimulates muscle movement, may result in negative symptoms.
“In clinical trials, RISPERDAL, at its optimal dose of 6mg per day. allowed statistically significant improvement in both the positive and negative symptoms of schizophrenia,” said Dr.Borison.
“Negative symptoms have been considered difficult to treat in most patients,” he continued. “Because it improves both the positive and negative symptoms, and the incidence of extrapyramidal symptoms is comparable to placebo at recommended doses, RISPERDAL will be a new first-line option for treating patients with schizophrenia.”
Survey Finds Treatment Services Lacking
To translate research advances into patient care, access to new treatments and community services are even more urgently needed, according to the first survey of people diagnosed with the disease, their care givers, and psychiatrists. Conducted by Roper Starch for the National Alliance for the Mentally Ill (NAMI), Columbia University, and the American Psychiatric Association (APA), the survey profiled the emerging needs of people with schizophrenia through telephone interviews with 112 caregivers, 80 patients, and 101 psychiatrists across the nation.
“There’s a lot of excitement about new treatments for schizophrenia, especially medications that can made dramatic changes in individuals lives,” said Laurie Flynn, executive director of NAMI. “But as our survey shows, to maximize the potential of new medications and support patients’ return to productive living, we also need more and broader access to services.”
Survey findings revealed the most significant disruption to respondents was their inability to hold a job or maintain healthy relationships. When asked if they were employed, almost 70% of these polled said they were not, and almost half had not held a job for more than two years. The same percentage reported relapse of dis ease symptoms, and 97% of psychiatrists confirmed that their patients experienced relapse. Those polled attributed relapse episodes to discontinuing medication.
Many people with schizophrenia respond differently to various drugs. The mental health advocates, therefore, called for access to new treatment choices for all schizophrenia patients.
“The nation still lacks a uniform health care system for pro viding new treatments for people with schizophrenia,” said Harvey Bluestone, M.D., director of psychiatry. Bronx-Lebanon Hospital, and trustee of the American Psychiatric Association.
“Ironically, as medical science has begun to produce new medicines, we still lack an effective network to deliver them. We must have consistent ways of getting these medications out at the community level, and we need social support systems to facilitate the integration of people being treated for schizophrenia or other severe mental illnesses back into the mainstream of community life.”
Barriers to Treatment Identified
Survey respondents said the stigma associated with schizophrenia is the most critical barrier to people seeking help for the disease. Other significant barriers identified were a lack of organizations and trained personnel to provide support and help. Those polled believe the public has a negative perception of people with schizophrenia, characterizing them as “dangerous” and “strange.” and treating them as out casts.
The NAMI, APA, and Columbia coalition believes that providing community-based rehabilitation programs, including job training and housing, modeled after programs already shown to work, will improve the lives of people with schizophrenia. Successful outcomes, in turn. will challenge negative perceptions about the disease.
“Until recently, schizophrenia was one of the most devastating diagnoses a family could hear. People thought there was no hope not even for partial recovery.” said NAMI’S Laurie Flynn. “Now there’s no reason why hopelessness should be a barrier. With the growing variety of treatment choices and better community support services and trained professionals, we can achieve a significant improvement in quality of living for patients and caregivers alike. As an advocate and caregiver. I’m extremely optimistic about the future for people like my daughter who have schizophrenia.”
For more information about schizophrenia, treatments options, and support services, contact NAMI at 1-800-950 6264. NAMI is a 140,000 member grass-roots self-help support and advocacy organization for people with mental illnesses and their families. The organization has state affiliates and local contacts in 54 cities around the country.