Schizophrenia: No easy understanding

Jan. 23--David's high school years were a disaster. He withdrew from his friends, often citing suspicions. At home he was sullen and irritable. His grades plummeted. His frustrated parents knew that adolescents frequently go through difficult periods, but David's problems continued, and he was eventually diagnosed with schizophrenia.

A severe mental disorder, schizophrenia is often difficult for doctors to diagnose. The symptoms are easily seen by family and friends as bizarre.

DELUSIONS: A schizophrenic person is usually delusional, holding beliefs that others see as clearly false. David told his parents that enemies in the neighborhood were causing vibrations in the microwave.

HALLUCINATIONS: Many of these delusions involve hearing voices that others don't hear or seeing imaginary persons or scenes. Voices are the most common, and these voices may warn the person of danger or order the person to do things.

DISORDERED THINKING: A schizophrenic may have trouble organizing thoughts, and this can be reflected through garbled language and speech. The person may be speaking and then stop abruptly in the middle of a thought. Or she may put together a string of meaningless words.

Other symptoms include agitated body movements ... or rigidity. The patient may show little facial expression and speak little, even in response to a question. When he does speak, it may be in a monotone and without normal hand or head movements.

In terms of daily life, most persons with schizophrenia are simply unable to function effectively -- to make rational decisions, plan and carry out daily activities or even take care of personal hygiene.

These are all pretty extreme symptoms, but doctors know that most can occur with other mental disorders as well: bipolar depression, borderline personality disorder, posttraumatic stress disorder, and certain types of depression. Over the short term, similar symptoms could also be a result of alcohol or drug abuse.

Although schizophrenia is a lifelong disorder, there are treatments that can help the patient live a relatively normal life, albeit usually with considerable support and assistance from family and the community.

Antipsychotic medications that have been available since the 1950s include Thorazine, Haldol, Etrafon, Trilafon and Prolixin. Known as "typical" antipsychotics, these come with rather serious side effects, including rigidity, persistent muscle spasms, tremors and restlessness.

Second-generation antipsychotic medications introduced in the 1990s include Risperdal, Zyprexa, Seroquel, Geodon, Abilify and Invega. Side effects of these drugs are generally less serious, although they can cause major changes in weight and metabolism.

Psychosocial treatments are aimed at helping the patient become more functional in terms of communication skills, relationships, self-care, job training and daily coping. Good psychosocial treatment can keep patients motivated to take their medications and better adjust to the challenges of living with their disease.

Schizophrenia is a very difficult disorder to understand, and the causes are not well understood. Genes clearly play a role. Environmental factors that have been explored include exposure to viruses and malnutrition before birth. Symptoms usually appear early in life, between age 16 and 30, and rarely before adolescence or after age 45.

In the past, a schizophrenic may have ended up in a mental hospital for many years. With treatment options now available, most are living in the community. In many cases, though, this is a mixed blessing. A good number of the homeless population are schizophrenics whose inner voices and delusions have led them further and further away from families and friends who are best able and most willing to help them. Some patients are in jail, usually for minor crimes. Although their talk may seem violent and threatening, schizophrenics are more likely to be victims than perpetrators of violent crimes.

Schizophrenia is an illness that requires a great deal of understanding -- on the part of patients, their families and the community. Unfortunately, this understanding is too often lacking.

Rupp is care coordinator for Long Term Care Authority of Enid Aging Services. Contact her at 237-2236.

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