Schizophrenia 101: Schizophrenia and Psychosis

By Michael Bengston, M.D.

Throughout recorded history, the disease we now know as schizophrenia has been a source of bewilderment. Those suffering from the illness once were thought to be possessed by demons and were feared, tormented, exiled or locked up forever. In spite of advances in the understanding of its causes, course and treatment, schizophrenia continues to confound both health professionals and the public. It is easier for the average person to cope with the idea of cancer than it is to understand the odd behavior, hallucinations or strange ideas of the person with schizophrenia.

As with many mental disorders, the causes are poorly understood. Friends and family commonly are shocked, afraid or angry when they learn of the diagnosis. Expectations become more realistic as schizophrenia is better understood as a brain disease that requires ongoing treatment. Demystification of the illness, along with recent insights from basic neuroscience, gives new hope for finding more effective treatments for an illness that previously carried a grave prognosis.

Schizophrenia is characterized by a broad range of unusual behaviors that cause profound disruption in the lives of the patients suffering from the condition and in the lives of the people around them. Schizophrenia strikes without regard to gender, race, social class or culture.

One of the most important kinds of impairment caused by schizophrenia involves the person’s thought processes. The individual can lose much of the ability to rationally evaluate his surroundings and interactions with others. There can be hallucinations and delusions, which reflect distortions in the perception and interpretation of reality. The resulting behaviors may seem bizarre to the casual observer, even though they may be consistent with the schizophrenic’s abnormal perceptions and beliefs.

Nearly one-third of those diagnosed with schizophrenia will attempt suicide. About 10 percent of those with the diagnosis will commit suicide within 20 years of the beginning of the disorder. Patients with schizophrenia are not likely to share their suicidal intentions with others, making life-saving interventions more difficult. The risk of depression needs special mention due to the high rate of suicide in these patients. The most significant risk of suicide in schizophrenia is among males under 30 who have some symptoms of depression and a relatively recent hospital discharge. Other risks include imagined voices directing the patient toward self-harm (auditory command hallucinations) and intense false beliefs (delusions).

The relationship of schizophrenia to substance abuse is significant. Due to impairments in insight and judgment, people with schizophrenia may be less able to judge and control the temptations and resulting difficulties associated with drug or alcohol abuse.

In addition, it is not uncommon for people suffering from this disorder to try to “self-medicate” their otherwise debilitating symptoms with mind-altering drugs. The abuse of such substances, most commonly nicotine, alcohol, cocaine and marijuana, impedes treatment and recovery.

Schizophrenia 101: Schizophrenia and Substance Abuse

Substance abuse is a common concern of the family and friends of people with schizophrenia. Since some people who abuse drugs may show symptoms similar to those of schizophrenia, people with schizophrenia may be mistaken for people “high on drugs.”

While most researchers do not believe that substance abuse causes schizophrenia, people who have schizophrenia often abuse alcohol or drugs, and may have particularly bad reactions to certain drugs.

Substance abuse can reduce the effectiveness of treatment for schizophrenia. Stimulants (such as amphetamines or cocaine) may cause major problems for patients with schizophrenia, as may PCP or marijuana. In fact, some people experience a worsening of their schizophrenic symptoms when they are taking such drugs. Substance abuse also reduces the likelihood that patients will follow the treatment plans recommended by their doctors.

Schizophrenia and Nicotine

The most common form of substance use disorder in people with schizophrenia is nicotine dependence due to smoking. While the prevalence of smoking in the U.S. population is about 25 percent to 30 percent, the prevalence among people with schizophrenia is approximately three times as high.

Research has shown that the relationship between smoking and schizophrenia is complex. Although people with schizophrenia may smoke to self-medicate their symptoms, smoking has been found to interfere with the response to antipsychotic drugs. Several studies have found that schizophrenia patients who smoke need higher doses of antipsychotic medication.

Quitting smoking may be especially difficult for people with schizophrenia, because the symptoms of nicotine withdrawal may cause a temporary worsening of schizophrenia symptoms. However, smoking cessation strategies that include nicotine replacement methods may be effective. Doctors should carefully monitor medication dosage and response when patients with schizophrenia either start or stop smoking.

Source: National Institute of Mental Health

Telephone Counseling Helps Problem Drinkers

New research suggests that phone counseling with a professional may help those who have problems with alcohol and help them cut back on their drinking.

After just six telephone-based sessions, people who participated in the study were able to reduce their drinking in the short-term. Men’s total alcohol consumption was significantly reduced, as was their total number of at-risk drinking days.

The researchers studied 897 people who went to see their primary care physician or family doctor for a non-alcohol related issue.

The people in the study received up to six sessions of protocol-driven telephone counseling based on principles of motivational interviewing and stages of readiness to change. Each telephone call was followed by a letter from the therapist that summarized the conversation.

The comparison group only received a pamphlet on healthy lifestyles.

After three months, patients in the counseling group were drinking less, the study found.

Lead researcher Richard Brown, M.D., said that the study could empower time-strapped doctors to persuade reluctant alcoholism patients to seek treatment.

Read more

Why Alcohol and Depression Don’t Mix

Alcohol abuse and depression can be a deadly mix.

Often, a person with depression will also have alcoholism, and vice versa. In fact, 30 percent to 50 percent of people with alcoholism, at any given time, also are suffering from major depression. Family history of depression or alcoholism puts a person at greater risk for developing either illness.

You should know that while alcohol often causes a “good mood” at first, it is a depression-causing drug.

Alcoholism and depression

Alcoholism may cause a relapse in people with depression. The depressive symptoms from alcohol are greatest when a person first stops drinking. So people recovering from alcoholism who have a history of depression should be carefully monitored during the early stages of withdrawal; the symptoms of depression are greatly reduced after three to four weeks of stopping drinking.

Read more