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TREATING SCHIZOPHRENIA: THE OLD AND THE NEW
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Jul 31, 2008, 22:58

By Michael Craig Miller, M.D.
Tribune Media Services

My 19-year-old nephew was just diagnosed with schizophrenia. My sister says he doesn't want to take the medication. Does he need to start medication immediately? What else can he do?

Schizophrenia is a devastating psychiatric condition. It is a major cause of disability with huge human and financial costs. If his doctors have made the correct diagnosis, he probably does need to start medication. But medication is not the only treatment he needs.

Two important features of schizophrenia are psychosis and what psychiatrists call negative symptoms. Psychosis is the inability to recognize reality - for example, delusions (false beliefs) and hallucinations (false perceptions). The negative symptoms of schizophrenia include a restriction of emotional range, a tendency to be inexpressive, and the inability to be active and productive.

These problems almost always result in significant functional decline.

Early treatment is better, because affected patients respond better to treatment during their first psychotic episode. Also, the greatest decline in functioning is seen within the first few years of making a diagnosis. Symptoms get worse and are harder to treat with each subsequent episode.

Unfortunately, during a psychotic episode, patients may not be aware of the problem and may be frightened to go for help. If the situation becomes bad enough, they may be forced to go to a hospital. The use of force may frighten them away from getting further treatment. This leads to a cycle of running away from help, rather than toward it.

Antipsychotic drugs are the mainstay for reducing psychotic symptoms, and they are most effective during the first psychotic episode. The medications are not completely effective, however, and they do have troubling side effects, such as weight gain and sedation. People with schizophrenia also are more prone to depression, anxiety and substance abuse and their suicide risk is higher than average. Thus the medications turn out to be just one part of the proper treatment for this disease.

In recent years, centers in North America and Europe have learned that "multi-element" psychosocial approaches are quite helpful. A specialized mental health team provides one-stop shopping for the patient's mental health and social service needs, including medication management, psychotherapy, vocational assistance and family support. According to the model, teams of mental health professionals in the community reach out to families with this education and support.

Patients enrolled in these special programs have seen a reduction in symptoms and fewer hospitalizations than average. Their functioning and quality of life also seem to improve.

The initial goal is to eliminate psychotic symptoms. At the same time, psychosocial treatment is aimed at helping the person return to better functioning at home, work or school. By combining these two kinds of help, your nephew has a better chance of controlling the illness.

(Michael Craig Miller, M.D., is an Assistant Professor of Psychiatry at Harvard Medical School and an associate physician at Beth Israel Deaconess Medical Center in Boston. Dr. Miller is the editor-in-chief of the Harvard Mental Health Letter.)
(For additional consumer health information, please visit www.health.harvard.edu.)
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