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| Vol. 21, No. 1 |
| January 15, 1999 |
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A Disease that's Very Hard to Understand
by ROGER WIDMEYER Texas Medical Center News "You need to keep in mind that before 1956, half of the hospital beds in the country had patients in them who were mentally ill, the majority of them schizophrenic," says Dr. Stuart C. Yudofsky, chairman of the psychiatry department at Baylor College of Medicine and director of the psychiatry service at The Methodist Hospital. The powerful anti-psychotic drug thorazine was introduced in 1956, and hospitalized schizophrenics began being treated with medication and discharged into their communities. "We were, essentially, warehousing these patients at state hospitals," says Dr. Yudofsky. Compared to other chronic diseases, schizophrenia may not effect a large number of the population (it is believed to affect 1 percent of the world's population, so it is not as rare as many people believe), but it is one of the most debilitating diseases - and one of the most difficult to understand. From the Greek, the word means "splitting of the mind," and many people think of schizophrenics as people with separate and distinct personalities - a kind of schizophrenia that is, in fact, very rare. The "splitting" might more correctly describe the cyclic course of the disease, with patients seemingly getting better, then relapsing. Schizophrenia is, essentially, a disease which distorts thoughts and perception. Thoughts may well be so jumbled that the patient cannot make even a basic decision. Perception can be so altered that the patient sees and hears things that are not there. "Today, many people with schizophrenia are living quite normally," says Dr. Yudofsky. "It's a myth that all people with severe mental illness need to be hospitalized. Some do, of course, require custodial care. But many more do very well with medication, family support, occupational therapy and psychotherapy." The etiology - the cause or causes - of schizophrenia remain a mystery. "We were so wrong for so many years, thinking it was fundamentally caused by stress and life experiences," says Dr. Yudofsky. "Now of course, we see that the disease - a chronic disease of the brain - has biologic roots, though it may well be affected by life experiences." (Evidence of biochemical causes of the disease are not conclusive, although important research in new medications - conducted at both Baylor and The University of Texas-Houston Health Science Center - will no doubt increase knowledge of the disease's cause. Already known is that the disease is marked by increased sensitivity in specific regions of the brain to the chemical neurotransmitter dopamine, and that the disease seems to affect the frontal lobes, the mid-brain and the limbic system. ) There is a genetic risk factor for the disease; it seems to run in families. Because schizophrenia typically begins to exhibit its symptoms during the teen years or early 20s, there may also be a hormonal factor. ("Usually, the child is completely normal," says Dr. Yudofsky, "so there's very little reason to anticipate the disease.") Other risk factors that have been noted are viral infection, or living with extreme stress, poverty and violence. In the beginning stages of schizophrenia, the person may exhibit a personality change concurrent with social withdrawal, prolonged periods of nervous tension, sleeplessness and poor concentration. The first year or so of the disease may be the most difficult for the patient and family because the symptoms require a re-adjustment to life expectations. It is essential that treatment begin as soon as possible, and that the family take an active role in the patient's course of treatment. Though the disease can vary in intensity, some of the following symptoms are usually evident:
Very few people experience all of these symptoms at one time, and the intensity of these symptoms can decrease or increase depending if the patient is in remission or relapse. The new generation of anti-psychotic medications have been of tremendous benefit in treatment of the disease, and they have fewer movement-disorder side effects. But they are, unfortunately, expensive. "There has been enormous stigma associated with this illness," says Dr. Yudofsky. "We need to put an end to this. The more we understand the biology of the disease, the better we will be able to treat it and, hopefully, diminish the misunderstanding and stigma which still surrounds it."
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