Schizophrenia needs proper medical treatment

DEAR DR. GOTT: My sister and I are caring for both our mother and a sister who has schizophrenia. Unfortunately, this sister is in the last stages of our being able to care for her at home. She refuses to take her medicines and has become totally unmanageable. Our mother refuses to consider making a commitment one way or another about her and instead reads your column. She uses it as the final word on my sister’s illness. It is all we can do to hang on because of the verbally abusive behavior and her sudden physical violence. Please, Dr. Gott, don’t write any more columns about cures for mental illness.

DEAR READER: Upon reading your letter, I felt to compelled to answer it quickly despite your protest. I have never offered a cure in regards to any type of mental illness. In fact, most forms of mental disease are not curable, but many are treatable if the patient is compliant. I have written several times in the past about common forms of these disorders, such as anxiety, depression, manic behavior and others. I will use this opportunity to discuss schizophrenia, but I cannot offer in-depth information, as I am not a psychiatrist and have not had direct experience with this serious disorder.

First, I must say that I am sorry to hear that your mother uses my column as a final say, but I will not stop writing about a medical topic just because she misuses the information I provide. My column is not to be used as a final say, to provide a medical diagnosis, or as a substitute for appropriate medical care or physician advice. It is merely informative and meant to provide patients with a means to approach a doctor about symptoms they are experiencing. It also may give further aid to those patients who have a hard time making their doctors listen. The information is to be used to get proper treatment by a physician who can see, examine, and listen to any concerns. A medical diagnosis cannot be made through a letter, over the computer or by phone, but I can offer an opinion so readers can further explore issues with their physicians. That said, I will now offer some general advice to my readers and, I hope, your mother, in regards to schizophrenia. With luck, she will use this information to get you and your sisters the help you all need.

Schizophrenia is a severe brain disorder. It is chronic and often disabling. According to the National Institute of Mental Health (NIMH), about 1 percent of Americans suffer from this condition.

There are three categories of symptoms: positive, negative and cognitive. Positive symptoms are psychotic behaviors not seen in healthy people. These include hallucinations, delusions and thought and/or movement disorders. People with positive symptoms often appear to lose touch with reality.

Negative symptoms cause disruption of normal emotions and behaviors. These may be mistaken for signs of depression and include a lack of enjoyment in everyday life, an inability to begin and sustain planned activities, “flat affect” (having little or no facial movement or speaking in a monotonous or dull voice) and speaking very little, even if forced to interact with others.

Cognitive symptoms may also be difficult to recognize as a sign of schizophrenia, as they are typically discovered only when other testing is performed. These signs can include trouble focusing or paying attention, an inability to use information immediately after learning it, and a decreased ability to understand information provided and then using it to make a decision.

Men and women are equally affected, as are all ethnic groups. The first symptoms are typically hallucinations and/or delusions that generally begin between the ages of 16 and 30. Men may experience symptoms slightly earlier than women. Children are rarely affected; however, awareness of childhood-onset schizophrenia is increasing.

Because the causes of schizophrenia are not fully understood, treatment is aimed at eliminating symptoms. These can include antipsychotic medications, illness-management skills (teaching patients how to make informed decisions about their care), social and vocational rehabilitation, self-help group therapy, family education (to teach the family about the condition and learn how to handle situations that may arise) and cognitive behavioral therapy. It is important that the family and patient learn about the disorder and how to handle it. When caretakers cannot control a patient, such as when he or she is violent or dangerous to himself or herself or others, hospitalization is an appropriate option.

Unfortunately, I have run out of space to continue this topic. Therefore, I recommend that you and anyone else interested read more about the disorder on the National Institute of Mental Health’s Web site at www.nimh.nih.gov.