Schizophrenia

Because the illness may cause unusual, inappropriate and sometimes unpredictable and disorganized behavior, people who are not effectively treated are often shunned and the targets of social prejudice. The apparent erratic behavior is often caused by the delusions and hallucinations that are symptoms of schizophrenia. Along with medication, psychosocial rehabilitation and other community-based support can help those with schizophrenia go on to lead meaningful and satisfying lives. A lack of appropriate services devoted to individuals living with schizophrenia has left many improperly placed in jails and prisons without the help they need.

Schizophrenia is often mischaracterized as an untreatable disease associated with violent behavior and many untrue and unfortunate stereotypes have developed. Most individuals living with schizophrenia are not violent; risk of violence is associated primarily with factors such as psychotic symptoms or substance abuse. Even then, violent behavior is generally uncommon and the overall contribution of schizophrenia to violence in a community is small. When engaging in treatment, schizophrenia is a manageable disease. The varying nature of each case though means that recovery for every individual is different.

Like any other illness, schizophrenia can often have a profoundly negative effect on a person’s life, on their families and on their communities if not addressed. Suicide is a serious risk for those with schizophrenia, occurring at a much higher rate than the general population. However, the risk of suicide can be greatly reduced through the use of medication.

Getting an individual to take medication for his or her illness is difficult, especially when the person does not believe they are sick. Studies have shown that the majority of those living with schizophrenia do not believe themselves to be ill. This lack of awareness, or insight, is known as Anosognosia. To learn more about Anosognosia, read the NAMI Anosognosia Fact Sheet.

Led primarily by real people living with schizophrenia, there is a changing assumption on what is possible for those living with the illness. Long viewed as an incurable illness, new data suggests that as many as 50 percent of people diagnosed with schizophrenia have positive outcomes when they receive appropriate treatment. With new research and expanding knowledge for the causes of schizophrenia, the outlook for those living with schizophrenia continues to improve. To learn more about the latest in schizophrenia research, check the Latest Research page.

The rest of this section will explain the symptoms, discuss treatment options and explore the latest in schizophrenia research. You will also find information on where you can turn for medical care and the support needed to manage this persistent illness.

When a person cannot appreciate that they have a serious psychiatric illness, a tremendous challenge to family members and caregivers follows. About one-half of people living with schizophrenia, and a smaller percentage who live with bipolar disorder, have this clinical feature. Individuals with Alzheimer’s disease and dementia also often have this feature. The medical term for not seeing what ails you is anosognosia, or more commonly known as a lack of insight. Having a lack of awareness raises the risks of treatment and service nonadherence. From the person’s point of view, if they feel they are not ill why should they go to appointments, take medication or engage in therapy?

Why can’t a person see what is so apparent to those around them? The best thinking indicates this is a core feature of the neurobiology of the conditions. Frontal lobes organize information and help to interpret experiences. In conditions like schizophrenia and Alzheimer’s disease, frontal lobe difficulty is central to the neurological processes that underlie the disorders. Psychological denial is not the reason for the lack of insight in these illnesses.

Efforts to get people to see that they are ill are frequently fraught with frustration and may be met with denial or anger. Approaching the person in a supportive way will be beneficial for your relationship. Finding out what goals a person has (for instance getting a job, forming relationships, living independently) can be a good place to start engaging in next steps. Check to see if the service system has outreach workers who work on engaging people who lack insight. Working with the person’s goals does not mean you have to pretend he or she is well. For example, if the person applies for disability services, encourage the doctor to review the diagnosis; getting a person to agree to disagree can be a first step. You don’t need to argue about diagnosis to have a person participate in-or respect-basic household chores and rules.

There are situations where a person’s lack of insight can, at times, create dangerous situations. This combination of no insight and dangerous acts often requires intervention. In more than 40 states, there are laws for Assisted Outpatient Treatment (AOT), also known as outpatient commitment. AOT status requires a person to engage in treatment and gives the state authority to bring the person to a treatment center if they do not. All states that have these laws have protections and a process for assessing whether this intervention is appropriate. In most states, doctors are required to submit an affidavit of the person’s state and the reasons for the requested AOT status and a judge decides.

NAMI has active support groups all across the nation and local NAMI members may have information on outreach services for service engagement or doctors who are interested in this issue. You do not need to worry alone with this difficult situation.

Every year new research is produced concerning schizophrenia. Although schizophrenia is not fully understood, new research is identifying some potential interventions and possible causes of schizophrenia.

Prevention and Early Intervention Research

One new study found that taking a fish oil supplement prior to any symptoms of schizophrenia may actually help prevent psychosis from developing. Researchers tested the efficacy of taking long-chain Omega-3 fatty acids for the prevention of psychotic disorders. The results show that taking Omega-3 not only reduces the risk psychotic disorders developing further but may also provide a viable strategy of prevention in young children with a predisposition for psychotic states. Omega-3 fatty acids have lately become popular in mainstream society for potentially helping prevent heart disease and cancer. Often labeled as Omega-3 fish oil, it can be purchased in most supermarkets and pharmacies.

Omega-3 fatty acids and the possible prevention of psychosis

In a randomized controlled study of at risk young adults, a European study showed that Omega-3 fatty acids (found in fish oil) reduced the number of young adults who develop psychosis. The effect was powerful but the total number of subjects was only 81, so the promising study needs to be replicated with a larger

sample. Despite this sample limitation, this is a powerful piece of the prevention literature and more needs to be understood about dosing and effect. At this time, NAMI’s medical director advises individuals in the teen to young adult developmental stage who have early symptoms or prodrome of psychosis to take omega three fatty acids as there appear to be few risks in this strategy with potential benefit. The study can be found in the February 2010 edition of the Archives of General Psychiatry.

The RAISE Project

The Recovery After Initial Schizophrenia Episode (RAISE) Project is a research initiative started by the National Institute of Mental Health (NIMH) in 2009 to explore the benefits of early and aggressive treatment in reducing the symptoms of schizophrenia. Previous research has shown that stepping in during the early stages of psychosis proves to be most beneficial because symptoms are the most responsive to treatment. By addressing the illness early and designing a personalized program, individuals may have more success in accepting and maintaining treatment and consequently improved functional ability in life.

In August 2011 the RAISE Project began full-scale clinical trials. Two independent research groups are working in parallel to develop and test potential intervention approaches. The treatments are similar but the research approaches and settings are different, allowing RAISE researchers to rigorously test interventions under a variety of conditions. One group, led by John M. Kane, M.D., of the Feinstein Institute for Medical Research, is called the RAISE Early Treatment Program (ETP). The ETP will compare two different ways of providing care to people in early stages of schizophrenia. Treatment may include personalized medication treatment, individual resiliency training and supportive services such as family psychoeducation and education or employment assistance.

The second team, the RAISE Connection Program, headed by Susan Essock, Ph.D., of Columbia University, aims to engage participants in individually tailored treatment, illness management strategies, education and/or employment assistance, supportive services and follow-up care for up to two years.

Marijuana as Trigger in Some Individuals

There are two broad areas of causation for schizophrenia, genetic and environmental. One of these environmental factors that have been studied of late is the effect that smoking marijuana has on the increased risk of experiencing psychotic symptoms. Environmental causes act by triggering specific genes, causing them to “turn on or off.” According to a study published in March 2011 by Dr. Jim van Os, researchers found that not only did smoking marijuana increase the risk psychotic incidents but increased the risk of ongoing psychotic experiences. Further results pointed to the notion that smoking marijuana was a causal factor to the onset of schizophrenia rather than a form of self-medication.

Corroborating this evidence is a study released in February of 2011, which found that the smoking of marijuana led to earlier onset of schizophrenia and almost always preceded the manifestation of the illness. The opinion that marijuana is a cause of schizophrenia as opposed to a byproduct is qualified by another study, also released this past February, which found that certain genetic variations increased the effects that marijuana had on triggering psychosis. This body of literature is strengthening the evidence for the risks that marijuana poses for the development of schizophrenia.

Genetics

Genes and Risk

Unlike some other conditions, schizophrenia is not caused by just one genetic variation but rather is a complex interplay of many genetic and environmental influences. New research continues to find other genetic mutations as potential contributing causes, albeit to only small populations. For example, one genetic difference recently identified appears to increase the likelihood by 14 times. However, this genetic variation only appears in about one percent of patients. This study represents a trend in understanding in more detail some genetic vulnerabilities, but they do not yet account for more than a small percentage of overall genetic factors to understand risk. Each study in this genetic risk area represents progress but the field has a long way to go.

Schizophrenia Research Foundation

The Schizophrenia Research Forum website is a rich resource that fosters collaboration among researchers by providing an international online forum where ideas, research news and data can be presented and discussed. The website is independent of industry sponsorship and open to the public. Though geared toward researchers, they welcome other visitors-people with mental illnesses, families, the media and others who need accurate information on research into schizophrenia.

NAMI Family Support Found To Be Effective

Dr. Lisa Dixon and her colleagues at the University of Maryland evaluated NAMI’s own Family-to-Family program. She designed a randomized controlled study to evaluate the impact of family to family on those who took it and a randomly assigned group who had to wait. The individuals who took the course felt better educated, more empowered and showed better coping strategies. This is a groundbreaking study of the intervention. This study makes advocating for the popular program even easier, as it now has a scientifically validated evidence base.

A new antipsychotic medication named lurasidone was approved by the U.S. Food and Drug Administration (FDA) in February 2011 and is distributed under the brand name Latuda. Lurasidone has been shown to be effective on both positive and negative symptoms, as well as possibly be efficacious in treating cognitive and memory deficits.

New, more effective medications are always needed. Recent developments point to ones that will be effective on both positive and negative symptoms, as well as possibly being efficacious in treating cognitive and memory deficits.

Taking medication is not, and should not be the only way a serious mental illness such as schizophrenia is treated. Education and social support are also critical to recovery. However, support is not only crucial for the individual living with schizophrenia; the family and loved ones of this individual sometimes need support as well. A recent study published looked at the helpfulness of enrolling in NAMI’s Family-to-Family Program, an evidence-based practice. At the conclusion of the 12-week program, participants demonstrated greater feelings of empowerment and reduced displeasure and worry about the family member who live with mental illness. In a follow up six months later, these positive benefits were still maintained, pointing to the long term benefits of engaging in an education and support.