SCHIZOPHRENIA TREATMENT IN SCOTTSDALE

Treatment for schizophrenia is one of the specialties offered at my practice in Scottsdale AZ. I have treated a lot of schizophrenia as a psychiatrist; especially while working for the state of Arizona on the ACT team. Schizophrenia is a serious medical illness effecting over 2 million American adults. Although schizophrenia is often feared and misunderstood, schizophrenia is a treatable medical condition. Schizophrenia often interferes with a person’s ability to distinguish reality from illusion, to manage emotions, make decisions, and relate to others. Scientists still don’t know the specific causes of schizophrenia. We know that psychosis is usually caused by too much dopamine in the system.

Research has shown that the brains of people with schizophrenia are different from the brains of people without the illness. Like many other medical illnesses, schizophrenia seems to be caused by a combination of problems. Including genetic vulnerability and environmental factors that occur during a person’s development. Recent research has identified certain genes that appear to increase risk for schizophrenia. Other studies have revealed that causes of schizophrenia are linked to Vitamin D, a lack or plethora of certain vitamins. Fetal alcohol poisoning, or the pregnant mother’s inability to produce sufficient amounts of GABA that might be a factor of schizophrenia as well.

Diagnosing Schizophrenia

No one symptom positively identifies schizophrenia. All of the symptoms of this illness can also be found in other mental illnesses. For example, psychotic symptoms may be caused by the use of illicit drugs, may be present in individuals with Alzheimer’s disease, or may be characteristics of a manic episode of bipolar disorder. However, when a doctor observes the symptoms of schizophrenia and carefully assesses the family history, and the course of the illness over six months, he or she can almost always make a correct diagnosis. Ideas-of-reference are symptoms unique to this illness whereby the individual believes that someone is communicating to them through repeated gestures or comments on television, radio or other behavior that are interpreted as signs or signals. These ideas of reference are major red flags unique to schizophrenia.

It is important to have a good medical work-up to be sure the diagnosis is correct. Drug abuse can mimic the symptoms of schizophrenia and may also trigger vulnerability in individuals at risk. Other medical concerns also need to be ruled out before a correct diagnosis can be made. Trauma to the head or tumors can also produce similar symptoms as well.

Early Symptoms

The first signs of schizophrenia typically emerge in the late teenage years or early twenties, often later for females. The early symptoms often appear in childhood, are varied and very difficult to diagnose until the disease has fully manifested. These symptoms are often dismissed as anti-social behavior, or ADHD. Schizophrenia is not caused by bad parenting or personal weakness. A few studies have shown that families that are prone to expressing emotion and dysfunctional might play a role in this illness, yet this is inconclusive.

Most people with schizophrenia are not dangerous or violent towards others, especially while they are receiving treatment. The World Health Organization has identified schizophrenia as one of the ten most debilitating diseases affecting humans. Schizophrenia is not to be confused with Multiple Personality Disorder, in which, a person takes on or manifests more than one distinct personality, in their speech and actions at different times. Multiple Personality Disorder is not a psychiatric condition. This occurs in a person that has undergone some very traumatic childhood experiences and coping with the abusive past by creating other personalities.

Symptoms of Schizophrenia Positive, Negative, and Cognitive:

Positive Symptoms include paranoia, delusions and hallucinations. The individual has lost touch with reality experiencing auditory or visual hallucinations. Positive refers to having overt symptoms. Delusions cause individuals to believe that people are reading their thoughts or plotting against them, that others are secretly monitoring and threatening them, or that they can control other people’s minds.
Negative Symptoms include emotional flatness or lack of expression, an inability to start and follow through with activities, speech that is brief and devoid of content, and a lack of pleasure or interest in life. Negative doesn’t refer to a person’s attitude but to a lack of certain characteristics that should be there. These symptoms mimic those of someone who is depressed. Patients with Schizophrenia who are displaying negative symptoms tend to be socially withdrawn and reclusive.
Cognitive Symptoms pertain to thinking processes. People may have difficulty with gathering thoughts and prioritizing tasks, certain kinds of memory functions. Most persons with this illness are not aware of it and have no insight into their condition. The sensory data presented to their minds is every bit as real to them as reality itself. Often their delusions have a bit of grounding in reality and are difficult to separate the truth from the delusion.
Other signs of cognitive symptoms include their inability to communicate in a normal way. Their speech is often tangential, they go off on tangents mid-sentence, or are very circumstantial taking a very long time to come to the logical end or importance of the sentence.

Schizophrenia also affects mood. While many individuals affected with schizophrenia become depressed, some also have apparent mood swings and even bipolar-like states. When mood instability is a major feature of the illness, it is called schizoaffective disorder, The elements of schizophrenia and mood disorders are prominently displayed by the same individual. It’s not clear whether schizoaffective disorder is a distinct condition or simply a sub-type of schizophrenia. Bipolar disorder with psychotic features has symptoms very similar to schizoaffective disorder as well.

Treatment for Schizophrenia

The difficult aspect of treating this disease is getting the individual to have insight into the disorder. This insight may or may not be present depending on the particular individual’s illness. Some people have some insight, others don’t and cannot be persuaded. Sometimes, through the medication, the diminution of the symptoms can help people gain more insight. Many times, court-ordered treatment is necessary. Patients can receive fast-acting injections to speed up the medication, sometimes giving them insight into their illnesses. There is no cure for schizophrenia, yet it is a treatable illness.

Maintaining Prescription Treatment

Newer treatments with fewer side effects are being developed every year to treat psychosis. Vraylar is one of these medications that works very well. People with schizophrenia who stop taking prescribed medication are at risk of relapse into an acute psychotic episode. This happens often and an intervention is necessary. It’s important to realize that the needs of the person with schizophrenia may change over time. Here are a few examples of supports and interventions:

Recovery Supports/Relapse Prevention: There is increasing recognition of the benefits of learning from “someone who has been there.” NAMI’s Peer to Peer program is designed to help individuals with mental illness learn from those who have become skilled at managing their illness. Peer support groups are also recognized as invaluable as individuals living with mental illness report better recovery outcomes as the shared experience is recognized as extremely beneficial. NAMI C.A.R.E. support groups are available in many communities and are expanding to better meet this need.
Family Support: Caregivers benefit greatly from NAMI’s Family-to-Family education program; taught by family members who have the knowledge and the skills needed to cope effectively with a loved one with a mental disorder.
Hospitalization: Individuals who experience acute symptoms of schizophrenia may require intensive treatment, including hospitalization. Hospitalization is necessary to treat severe delusions or hallucinations, suicidal thoughts, an inability to care for oneself. Hospitalization may be essential to protect people from hurting themselves or others.
Medication: The primary medications for schizophrenia are the anti-psychotics. These help relieve the positive symptoms of schizophrenia by helping to correct an imbalance in the chemicals that enable brain cells to communicate with each other. Some of these are major tranquilizers that dampen the response to dopamine. Patients may need to try several different anti-psychotic medications before they find the one, or the combination of medications, that works best for them. Vraylar seems to show good results with minimal side effects.
Conventional Anti-psychotics: were introduced in the 1950’s and all had similar ability to relieve the positive symptoms of schizophrenia. However, most of these older “conventional” anti-psychotics differed in the side effects they produced. Some of the risks that may be incurred from taking these medicines include dry mouth, blurred vision, drowsiness, constipation, liver disease, and movement disorders such as stiffness, a sense of restless motion.
“Atypical” Anti-psychotics were introduced in the 1990’s. When compared to the older “conventional” anti-psychotics, these medications appear to be equally effective for helping reduce the positive symptoms such as hallucinations and delusions, but may be better than the older medications at relieving the negative symptoms of the illness such as withdrawal, thinking problems, and lack of energy. All the anti-psychotics have serious side effects such as weight gain and the risk of diabetes.

Medication Side Effects

Different medications produce different side effects, and people differ in the amount and severity of side effects they experience. NAMI’s fact sheets on medications, developed by independent pharmacists, are a starting point to understand the risks and benefits of any individual medication. As with many issues in life, one has to consider the benefits with the side effects and determine which they care to live with based on the impact to their quality of life. Individuals thinking of starting or changing their medication should always gather good information, consider the risks and benefits, consult with their doctor and loved ones and work together to develop the most safe and effective treatment plan possible. Additional information on these topics about schizophrenia are available at NAMI.

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