Table of Contents
Acknowledgment xi
Foreword xiii
A Patient's Perspective xiii
A Sister's Perspective xvi
The Nurses' Perspective xxii
Note from the Author xxix
Introduction 1
Part 1 The Illness and Its Characteristics 7
Questions 1-24 provide information for people who've just been diagnosed with schizophrenia or related disorders:
1 What is schizophrenia? 8
2 What are the first signs of this illness? How do I know whether someone has schizophrenia? 14
3 Is being "schizophreniform" the same as having "schizophrenia"? 22
4 What does it mean to have a "schizotypal personality disorder"? 23
5 What is schizoaffective disorder? 24
6 How is schizophrenia different from manic depression or bipolar disease? 27
7 Is it possible to hear voices that are not there and not be ill? 29
8 Does being told one has a psychosis mean one has schizophrenia? 30
9 What is catatonia? 31
10 What is a delusion? 34
11 What is meant by positive and negative symptoms? 36
12 Do people with schizophrenia have language problems? 36
13 Do people with schizophrenia get depression? 38
14 Are memory problems symptoms of schizophrenia? 39
15 Do people with schizophrenia have a low IQ? 40
16 Are muscular problems associated with schizophrenia? 41
17 Do people with schizophrenia have a reduced life span or die from their illness? 42
18 Are there medical conditions that look like schizophrenia? 42
19 Do people with schizophrenia have fewer offspring? 43
20 Do people diagnosed with a first episode of schizophrenia recover? If so, how long will this take? 44
21 What is the course of chronic schizophrenia over time, and what can influence it? 46
22 What can patients and their families do to minimize symptoms and influence outcome? 48
23 What happens if someone opts for no treatment or gets the wrong treatment? 49
24 Are there some societies in which no individuals develop schizophrenia? 50
Part 2 Treatment: When, Where, by Whom, and With What? 53
Questions 25-41 review different options available to treat schizophrenia:
25 Who first sees an individual with schizophrenia, and what type of professional can treat the first symptoms? 54
26 Why won't some psychiatrists treat people with schizophrenia? 58
27 What if I do not have insurance or my policy does not cover psychiatric care? 59
28 Do I have to be treated in a hospital if I have schizophrenia? If so, for how long? 61
29 What treatments were used before pharmaceutical companies introduced neuroleptic medication? 63
30 What are the current choices for medication? 66
31 Are combinations of different medications more effective than one alone? 71
32 When to use clozapine and if it doesn't work, then what? 73
33 Are there any new possibilities for treatments on the horizon? 75
34 What are the medication side effects and how are they resolved? 76
35 How long does medication have to be taken? 79
36 Are long-acting injectables more helpful than oral medications? 80
37 Is electroconvulsive therapy (ECT) a treatment for schizophrenia? 81
38 What is transcranial magnetic stimulation (TMS), and what can it do? 82
39 What is cognitive behavioral therapy? 83
40 Can a specific diet help, or using vitamin and fish oil supplements? 85
41 Can individual, group, or family therapy help? 89
Part 3 Genetic Risk 91
Questions 42-57 discuss the genetic risks associated with schizophrenia:
42 Is schizophrenia inherited? 92
43 Should I adopt a baby whose birth parent had schizophrenia? 95
44 If someone related to me has schizophrenia, what are my chances of getting it? What are the chances of my children getting schizophrenia if my partner has a relative with it as well? 96
45 If I have an identical twin with schizophrenia, but I am well, what are my children's chances of having schizophrenia? 97
46 What chromosomal risk factors can increase one's risk for schizophrenia? 98
47 What are the methods used to find gene defects that are associated with schizophrenia? 99
48 What genes are currently implicated as risks for schizophrenia? 105
49 Are any risk genes specific to schizophrenia, or are they implicated in other diseases as well? 107
50 How is it assumed that genes cause schizophrenia? 107
51 What do DNA copy number variations (CNVs) have to do with schizophrenia? 110
52 What is an endophenotype for schizophrenia? 111
53 Are there lab tests to identify genetic risk for schizophrenia? 113
54 Should I order commercially available DNA tests for schizophrenia? 113
55 Can DNA testing enable physicians to determine which medications to administer? 115
56 How can genetic research provide new treatments? 116
57 What are the ethical concerns about genetic testing? Do those with genes for schizophrenia face discrimination? 117
Part 4 Nongenetic Risk Factors 121
Questions 58-64 discuss nongenetic-based risk factors that can contribute to schizophrenia:
58 Do birth complications cause schizophrenia? 122
59 Is schizophrenia more common in some cultural or racial groups than others? 123
60 Can bad family relationships cause schizophrenia? 124
61 Can immigration from another country increase risk for schizophrenia? 126
62 Does where you live affect your risk for illness (urban versus rural environments)? 127
63 Is schizophrenia infectious? 127
64 Do viruses cause schizophrenia? 128
Part 5 Substance Abuse and Schizophrenia 131
Questions 65-71 review the effects of substance abuse in schizophrenia:
65 Can the use of multiple street drugs in adolescence cause schizophrenia? 132
66 Can cannabis/marijuana specifically cause schizophrenia? 133
67 Can someone who has schizophrenia smoke cannabis/marijuana? Is it harmful, or can it also be beneficial? 134
68 Which drugs cause schizophrenia-like symptoms in people who do not have schizophrenia? 136
69 What does drug use do to people who have schizophrenia? 136
70 Can someone who has schizophrenia drink alcohol? 137
71 Why do people with schizophrenia smoke cigarettes excessively? 137
Part 6 The Biology Underlying Schizophrenia: Current Research Findings 139
Questions 72-79 provide information about the biologic findings on schizophrenia and testing being done to determine the disease's effects on the body:
72 Are there any tests that can be taken from blood, urine, or spinal fluid to definitively diagnose schizophrenia? 140
73 Is schizophrenia a "chemical imbalance"? 141
74 Are there any differences in the brains of people who have schizophrenia? 143
75 Should an MRI scan be performed? 146
76 Are functional MRI scans useful? 147
77 Should an EEG be done on patients with schizophrenia? 148
78 When do the brain changes occur, and is schizophrenia considered a progressive brain disorder? 149
79 Could the brain changes be due to an inflammatory process? 152
Part 7 Violence and Aggression in Schizophrenia 153
Questions 80-82 examine the connection between violent behavior and this mental illness:
80 Do people with schizophrenia frequently commit violent acts and crimes? 154
81 What should I do if my relative or friend is behaving violently or expressing violent thoughts? 157
82 How can violent behavior be predicted? 158
Part 8 Suicidal Behavior and Schizophrenia 161
Questions 83-84 discuss how to best recognize someone at high risk for suicidal behaviors and prevent this tragic outcome:
83 What are the signs of suicidal thoughts in schizophrenia? 162
84 What can be done to prevent suicide attempts? 164
Part 9 Issues for Women 165
Questions 85-90 review specific issues unique to female patients with schizophrenia:
85 Is schizophrenia different in women? 166
86 Should patients who are pregnant take medication for schizophrenia? 168
87 What is the risk of a postpartum relapse? 169
88 Should mothers with schizophrenia breast-feed infants? 170
89 Can estrogen for birth control help suppress symptoms? 171
90 Can schizophrenia be exacerbated during and after menopause? 171
Part 10 The Homeless and Schizophrenia 173
Questions 91-92 discuss the connection between homelessness and mental illness:
91 How prevalent is schizophrenia among the homeless? 174
92 What causes homelessness, and what is being done to prevent it? 176
Part 11 Legal and Ethical Issues 181
Questions 93-95 discuss legal and ethical questions posed by schizophrenia:
93 What does "involuntary" hospital commitment involve? 182
94 What is the legal insanity defense? 184
95 Why participate in research, and can patients with schizophrenia have the capacity to give informed consent for research and medical procedures? 190
Part 12 Living with Schizophrenia and Recovery 193
Questions 96-100 provide information on daily life with and recovery from schizophrenia:
96 Can people with schizophrenia recover? 194
97 What are the origins of the stigma attached to having schizophrenia? 195
98 Can a person with schizophrenia be professionally creative? 196
99 Should a person with schizophrenia drive a car? 197
100 What support groups, books, and websites can I go to for help? 199
Appendix: Resources 201
Glossary 211
Index 221