Can schizophrenia be treated?

DEAR DOCTOR K:

There is a history of schizophrenia in my family. I’d like to learn more about it. Can it be treated?

DEAR READER:

Schizophrenia is a long-lasting psychotic disorder. People with the condition have a hard time recognizing reality, thinking logically and behaving naturally in social situations. Having a parent or sibling with schizophrenia increases your risk of developing it.

The symptoms of schizophrenia are often defined as “positive” (remarkable because of their presence) or “negative” (remarkable because of their absence). Positive symptoms include:

  • Delusions: distorted thoughts or false beliefs. A delusional person may speak of people who aren’t real. She may imagine she is in communication with people who are dead. He may believe he is capable of impossible feats — like leaping tall buildings in a single bound.
  • Hallucinations: hearing, seeing, touching, smelling or tasting things that aren’t there. The most common hallucinations involve hearing voices, music, noises like those made by machinery, or other sounds.
  • Disorganized speech.
  • Unusual movements or disorganized behavior.

Negative symptoms include:

  • An absence of much emotion — happy or sad. Just a flat, unexpressive appearance.
  • Limited speech: great difficulty in carrying on a conversation.
  • Trouble starting, continuing or completing any particular activity, including activities as simple as washing the dishes.

Many people with schizophrenia experience a steady decline of logical thinking, social skills and behavior. They can stop taking care of themselves — keeping clean, dressing properly, even combing or brushing their hair. These problems can interfere with work and personal relationships.

Positive symptoms tend to go through cycles where they get better and worse. Negative symptoms and cognitive problems are more constant.

People with schizophrenia are more likely to become depressed, to start drinking or abusing drugs, and to commit suicide.

The impact of the illness can be reduced by early and active treatment. The earlier it is diagnosed, the better chance there is to prevent its worst effects.

Treatment requires a combination of medication, psychological counseling and social support.

The major medications used to treat schizophrenia are called antipsychotics. They are generally effective for treating the positive symptoms of schizophrenia. If a medication does help, it is important to continue it even after symptoms get better. Without medication, there is a good chance that psychosis will return. Each recurring episode may be worse.

Psychosocial treatment is also essential. These treatments are given in addition to, not instead of, medications. The goal is to provide ongoing emotional and practical support, education about the illness, and perspective on the symptoms of the illness. Therapists may provide advice about managing relationships and health. And they may teach skills to improve functioning and orientation to reality.

There are many types of psychosocial treatments. One approach is cognitive behavioral therapy (CBT). Employment with on-the-job support and mental health services can also help.

We have more potent treatments for schizophrenia today than we did 50 years ago. Research is also bringing us closer to understanding what is going wrong in the brain. That’s what we need to know in order to cure this terrible illness.