What Is Schizophrenia

Joseph Battaglia, MD, Bronx Psychiatric Center, NY Dr. Anthony Salerno, PhD, Rockland Psychiatric Center, NY

Schizophrenia is a worldwide phenomenon. In the United States alone it is estimated that 2.5 million people suffer from schizophrenia, or one percent of the population. The brain disorder can progress slowly, until a person becomes hostile and aggressive, with hallucinations and delusions, often with references to conspiracies, and deterioration in function in major areas of life, like work, school, and family. Below, experts in schizophrenia treatment explore basic questions about this difficult condition.

What is schizophrenia?
JOSEPH BATTAGLIA, MD: Schizophrenia literally means "breakdown of the mind." It affects someone's attention capacity and how they deal with information in the environment. It affects someone's affective display, either blunting it or making it unpredictable, not connected to the environment. It affects their thinking in an autistic way, meaning they would be preoccupied with ideas that were very important to them but to no one else. At times it makes them avolitional, meaning they have very little motivation to do or move. It's a breakdown of these mental functions.

ANTHONY SALERNO, PH.D.: The mind plays tricks on the individual. They see things that aren't there, feel things that aren't there, or come to believe things that are not true, and it affects their behavior tremendously.

When you look at people with schizophrenic illness, they have structural abnormalities. It's a brain disorder. And in fact, males, in particular, tend to have stronger structural abnormalities in the brain than females do. There are also chemical imbalances that mark schizophrenics.

There are very strong misperceptions about schizophrenia. Why do you think it's so difficult for people to understand what the disease is?
ANTHONY SALERNO, PH.D.: With schizophrenia, it isn't like you can point to a lesion or point to a particular physical thing and say, "That's the problem." It really affects the personality. It's a transformation and a deterioration of the actual integration of that person and personality. I think humans tend to shy away from it. There are also a lot of myths about the disease. Some people assume there's some kind of moral deterioration in the individual, or laziness, or the patient is weird or demonic or inhabited by strange things.

It's only recently that we have been able to start understanding the brain, and the physical underpinnings of this disease.

When does it happen?
ANTHONY SALERNO, PH.D.: Late adolescence, early adulthood for males. For females, onset is usually in the mid-20s to the mid-40s.

When you think the illness starts is only when the person starts to behave noticeably differently, but first there is a prodromal phase. This phase can be two to three years and longer before someone has a nervous breakdown and gets treatment.

JOSEPH BATTAGLIA, MD: A defining feature of schizophrenia is that there is a deterioration in functioning for a minimum of about six months or so. But people often go for a long period of time without getting treatment while they're having symptoms even though they know something is going on. They're trying to understand it and sometimes they gravitate towards drugs or alcohol to try to self-medicate, but they're very ashamed, they're very frightened of what's taking place.

What do you do if you think a family member has it?
JOSEPH BATTAGLIA, MD: Schizophrenia doesn't go on 24 hours a day, it ebbs and flows with the voices and delusions. In this case, you don't "strike when the iron's hot" -- you have to approach it when the iron's cold. Wait until the emotions die down, which means the positive symptoms, until they're not active. That's how you approach someone to reduce the risk that they're going to show some aggression.

What is the treatment for schizophrenia?
JOSEPH BATTAGLIA, MD: There have been some recent developments, but prior to the last 10 years, the mainstay was medications that blocked dopamine. What they would do was reduce hallucinations and delusions. But they didn't improve someone's cognitive abilities or improve their emotional feelings. There was a realization that just reducing hallucinations and delusions didn't guarantee someone was going to get better.

Now there's evidence to show that cognitive therapies are very helpful, vocational, reintegration with work, family therapies -- that the three combined actually give someone the best chance of continuing to do well.

Can people with early schizophrenia manage the condition themselves?
ANTHONY SALERNO, PH.D.: Learning the symptom management skills and stress management skills are extremely important. It would be nice, if medication was the cure-all, but it's not. An individual needs to put considerable effort and energy into managing their symptoms, and there are techniques and skills to cope more effectively, and that's a very important part of what practitioners need to do.

JOSEPH BATTAGLIA, MD: Progress is really hard to make on the short-term basis. The issue about outcome is that within 25 or 30 years, 50% to 60% do not return to normal, but can be functioning with part-time jobs and an increased social network.