For over a century, neuroscience and psychiatry have been trying to understand diseases of the brain, among them the mental disorder called schizophrenia. It has been difficult to define this erratic disease, and even more difficult to medically treat and control it. What is known about schizophrenia is that it is not a “split personality” disorder as is commonly and erroneously believed. People living with schizophrenia, do not become other people or switch in and out of character, as portrayed in the story of Dr. Jekyll or Mr. Hyde.

 Around 1851, a French scientist was the first to try and give a name to the disease, referring to it as a “folie circulaire,” or cyclical madness, a name based on how the symptoms of this disease came and went in cycles, going through periods of severe attack, and then periods of rest. It wasn’t until 1911 when the actual term “schizophrenia” was used in identifying the disease.

 Schizophrenia is a chronic, severe, and debilitating brain disease which effects people all over the world, and in America alone, more than 2 million people each year who live with the symptoms of the disease.. Schizophrenia doesn’t discriminate among the sexes, effecting both men and women with about the same amount of frequency, however, it tends to appear earlier in men, usually in their late teens or early twenties, while with women, it usually doesn’t appear until their twenties or early thirties. It has also been observed that the first episodes of schizophrenia are more likely to occur among college-aged students who are away from home for the first time and subject to new stresses. With the prevalence of heavier alcohol and drug consumption among college-aged students, along with sleep patterns becoming radically altered by chemicals, stresses, studying, and working, an episode can be easily triggered during this time of life. People with schizophrenia often have symptoms which are terrifyingly real to them, such as hearing internal voices not heard by others, or believing that other people are reading their minds, controlling their thoughts, or are out to get them. These symptoms may leave them frightened and withdrawn, with their speech and behavior becoming so disorganized that they may be difficult to understand. In some extremely rare cases, children as young as five years of age have been diagnosed with the disease, however, it usually does not appear prior to adolescence.

Since the symptoms can be severe and long-lasting, a chronic pattern of schizophrenia often causes a high degree of disability. There are medications and other treatments that can help lesson the severity of these attacks, however, drug therapy must be used with regularity and consistency, working best when taken as prescribed. As odd as it may sound, even if the medicine is working as it should, one of the biggest challenges for caregivers of people who have schizophrenia is making sure they are actually taking their medication when and as they should. Many times they will prematurely discontinue treatment because of unpleasant side effects or for other reasons, which can then lead to an extremely severe attack. Even when treatment is effective, the lost opportunities, the stigma associated with the disease, the residual symptoms, and the side effects of medication may still haunt the person, making it extremely difficult for them to easily assimilate again within mainstream society.

The nature of schizophrenia is one of unpredictability, with the first signs of the disease appearing as radical and disturbing changes in behavior along with confusion on the part of the loved one who is afflicted. As with most diseases of the brain, like Alzheimer’s or bi-polar disease, it is especially difficult for family members to witness these changes, because they hold on to the memory of how their loved one behaved prior to the onset of the disease. During the “acute” phase of the disease, there may be a sudden start of psychotic symptoms or “psychosis” like hallucinations, delusions, and social isolation. Unusual speech, thought patterns and behavior may precede, coincide or follow these psychotic symptoms. Some people may only have one, major, psychotic episode in their life, while others may have many occurrences throughout their lifetime, yet lead relatively normal lives during the periods between these episodes. But people who have “chronic” schizophrenia, which is continuous or recurring, do not necessarily recover their full capability of normal functioning, and so require long-term treatment and medications to control the severity and frequency of the episodes.

 Making a quick and proper diagnosis of schizophrenia can be difficult, because similar symptoms can be caused by an underlying physical illness or by other brain diseases like manic-depressive (bi-polar disease) disorder or major depressive disorder. This is why a physical exam along with laboratory tests must be done in order to rule out other possible causes before concluding that it’s schizophrenia. Drug tests may also be performed on the urine and blood, since some commonly abused drugs can cause symptoms that resemble schizophrenia. Sometimes the symptoms just can’t be defined as being caused by one, certain brain disease, so a diagnosis of “schizoaffective disorder” may be given instead. To date, there is still no exact known cause of schizophrenia, but it has long been thought that perhaps genetics has something to do with a loved one’s predisposition for having the disease. Studies have shown that people who have a close relative with the disease are more likely to develop the disease than someone without a diagnosed relative. Presently, all the tools of biomedical research are being utilized in order to understand what causes schizophrenia.  Research is being done to locate multiple genes which may contribute to the disease, as well as mapping the history of an individual’s brain development, including any prenatal difficulties, intrauterine viral infections, and/or postnatal complications. Currently,  there is no way of accurately predicting whether someone will or will not develop the disease.

 Advances in neuroimaging technology have enabled scientists to study brain structure and function in living individuals. Many of these studies on people with schizophrenia have shown abnormalities in the structure of the brain, like the enlargement of fluid-filled cavities (ventricles) within the interior of the brain, and/or the decrease in size of certain brain regions, as well as a decrease in metabolic activity in certain parts of the brain. However, it’s important to keep in mind that these abnormalities are very subtle and are not characteristic of all people with schizophrenia, nor do they occur only in individuals with this disease. There have also been microscopic studies of brain tissue after death, which also show small changes in the distribution or number of brain cells in people with schizophrenia. Many, but not all of these changes in the brain tend to be present in a person before they become ill, which leads to the belief that schizophrenia may be a disorder in the actual development of the brain.

It is difficult to know exactly how to treat this disease, mainly because it seems to be caused by several conditions, however, antipsychotic medications which have been around since the 1950’s seem to help by reducing the amount and severity of psychotic symptoms. It’s important to remember that these medications are not considered a “cure” for schizophrenia, and even while a person is on their medication, there is no guarantee that the symptoms or episodes will not return. The 1990’s saw the creation of a number of new antipsychotic drugs (known as “atypical antipsychotics”). These drugs are very effective in treating certain symptoms of schizophrenia, especially hallucinations and delusions, but they may not be as helpful with other symptoms, such as reduced motivation and emotional expressiveness. Sometimes when people with schizophrenia become depressed, other symptoms can appear to worsen, so by adding an antidepressant medication to what is already being taken, further improvement can be seen.

 With new approaches for studying schizophrenia, from molecular genetics to new methods of imaging the brain’s structure and functions and innovative drug treatments currently being evaluated in clinical trials, there is a renewed hope that better and safer medications will be discovered soon.  Medicine now offers better options to control the many symptoms and causes of schizophrenia than ever before, and with them the possibility that in the future a cure for the disease will be developed.

 

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