The recent tragedy in Tucson, and the potential contribution of the disorder “paranoid schizophrenia” to the action of the alleged perpetrator, is a reminder of how mental illness is not only a personal affliction, but one with public implications. Many high-profile disturbing crimes have a similar association, and so a discussion of this misunderstood, treatable and manageable illness is timely.
Schizophrenia is a chronic brain disorder which affects one percent of the population. Typically, symptoms usually begin in early adulthood and follow a waxing and waning lifelong course. It is a disease that is socially crippling to the individual and one that profoundly affects the family. Psychosis (a break with reality) is a hallmark of schizophrenia, but is not diagnostic of the disorder as this can be seen in other conditions (many of which need to be ruled out before a diagnosis of schizophrenia can be made). Schizophrenia is not, as a popular misconception holds, a “multiple personality disorder.”
The prime symptoms of the disease are delusions, hallucinations (particularly the hearing of voices) and disordered thinking. Paranoid schizophrenia, one of the most common types of the disease, is further characterized by anger, argumentativeness, violence and suicidal behavior. Memory and concentration loss tends to be less pronounced than in other forms of schizophrenia.
The cause of schizophrenia is likely a mix of an inherited genetic predisposition and environmental triggers. Factors which are associated with an increase risk of the disease include a family history of schizophrenia, poor nutrition while in the womb, older paternal age and adolescent drug abuse.
The evaluation of patients whose behavior and thoughts suggest the possibility of schizophrenia includes both a medical and psychological component. A detailed history (including interviews with family, friends, teachers, etc.), physical examination and blood tests are essential. Often a brain imaging test such as an MRI or CT is required. In the end, however, the diagnosis needs to be made by a psychiatrist with experience in evaluation and treatment.
Although paranoid schizophrenia is a chronic condition which requires lifelong therapy, effective options are available with the goals of achieving a safer, happier and healthier life. Treatment options include medications, psychotherapy, hospitalization and skills training. The best plan, which needs to be individualized, almost always includes a combination of these modalities.
If you are concerned about yourself or a loved one, encourage them to seek evaluation. To see a mental health expert at NUMC, please call 516-572-6822. For more information, log on to the excellent website of the Mayo Clinic at www.mayoclinic.com/health/paranoid-schizophrenia/DS00862.