Schizophrenia is a devastating brain disorderthe most chronic and disabling of the severe mental illnesses. The first signs of schizophrenia, which typically emerge in young people in their teens or twenties, are confusing and often shocking to families and friends. Hallucinations, delusions, disordered thinking, unusual speech or behavior and social withdrawal impair the ability to interact with others. Most people with schizophrenia suffer chronically or episodically throughout their lives, losing opportunities for careers and relationships. 1 They often are stigmatized by lack of public understanding about the disease. However, several new antipsychotic medications developed within the last decade, which have fewer side effects than the older medications, in combination with psychosocial interventions have improved the outlook for many people with schizophrenia. 2This painting was done for the Schizophrenia Bulletin, which features art created by people who have struggled with schizophrenia. The artist, Philip Kurz, has provided us with the following description of this artwork: I believed that everything within me and around me was through my blank mind and my arm onto the paper. I felt that keeping a blank mind was important to the success of the painting, and this was relatively easy to do since it approximated my normal state. This feeling all seems outlandish now.
News and entertainment media tend to link mental illnesses including schizophrenia to criminal violence. Most people with schizophrenia, however, are not violent toward others but are withdrawn and prefer to be left alone. Drug or alcohol abuse raises the risk of violence in people with schizophrenia, particularly if the illness is untreated, but also in people who have no mental illness.8,9
While providing clues about the brain regions involved in schizophrenia, these findings are not yet sufficiently specific to schizophrenia to be useful as a diagnostic test.
The newer medications for schizophreniathe atypical antipsychoticsare very effective in the treatment of psychosis, including hallucinations and delusions, and may also help treat the symptoms of reduced motivation or blunted emotional expression.16 Intensive case management, cognitive-behavioral approaches that teach coping and problem-solving skills, family educational interventions, and vocational rehabilitation can provide additional benefit.2 Evidence suggests that early and sustained treatment involving antipsychotic medication improves the long-term course of schizophrenia.17 Over time, many people with schizophrenia learn successful ways of managing even severe symptoms.
Because schizophrenia sometimes impairs thinking and problem solving, some people may not recognize they are ill and may refuse treatment. Others may stop treatment because of medication side effects, because they feel their medication is no longer working, or because of forgetfulness or disorganized thinking. People with schizophrenia who stop taking prescribed medication are at high risk for a relapse of illness.18 A good doctor-patient relationship may help people with schizophrenia continue to take medications as prescribed.19 Developing safer and more effective medications, as well as identifying strategies to enhance the acceptability of currently available treatments, are important NIMH priorities.
In addition to the development of new treatments, NIMH research is focusing on the relationships among genetic, behavioral, developmental, social and other factors to identify the cause or causes of schizophrenia. Utilizing increasingly precise imaging techniques, scientists are studying the structure and function of the living brain. New molecular tools and modern statistical analyses are enabling researchers to close in on the particular genes that affect brain development or brain circuitry involved in schizophrenia. Scientists are continuing to investigate possible prenatal factors, including infections, which may affect brain development and contribute to the development of schizophrenia.
NIMH is funding a large-scale clinical trial to compare the effectiveness of the newer, atypical antipsychotic medications for the treatment of schizophrenia. For more information about this studythe Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) projectand others, visit the Clinical Trials page of the NIMH Web site.
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NIH Publication No. 01-4599
3 Narrow WE. One-year prevalence of mental disorders, excluding substance use disorders, in the U.S.: NIMH ECA prospective data. Population estimates based on U.S. Census estimated residential population age 18 and over on July 1, 1998. Unpublished.
4 Regier DA, Narrow WE, Rae DS, et al. The de facto mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry, 1993; 50(2): 85-94.
6 Murray CJL, Lopez A.D, eds. Summary: The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, MA: Published by the Harvard School of Public Health on behalf of the World Health Organization and the World Bank, Harvard University Press, 1996. http://www.who.int/msa/mnh/ems/dalys/intro.htm
8 Swartz MS, Swanson JW, Hiday VA, et al. Taking the wrong drugs: the role of substance abuse and medication noncompliance in violence among severely mentally ill individuals. Social Psychiatry and Psychiatric Epidemiology, 1998; 33(Suppl 1): S75-S80.
9 Steadman HJ, Mulvey EP, Monahan J, et al. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry, 1998; 55(5): 393-401.
16 Dawkins K, Lieberman JA, Lebowitz BD, et al. Antipsychotics: past and future. National Institute of Mental Health Division of Services and Intervention Research Workshop, July 14, 1998. Schizophrenia Bulletin, 1999; 25(2): 395-405.