Schizophrenia, marked by disturbances in thinking, emotional reactions and social behavior, usually results in chronic illness and personality change. Delusions, hallucinations and thought disorders are common in this condition. It affects about 1 percent of the population.

It’s all about the brain

The condition is thought to reflect changes in the structure of the brain, which could possibly result from disease or injury at the time of birth, and a genetic predisposition exacerbated by environmental stress. Several genes have recently been identified that appear to influence the risk of developing schizophrenia. Particularly involved in the pathogenesis of the disorder are brain systems using the chemicals dopamine, glutamate and GABA. Brain scans show that people with schizophrenia possess abnormalities in the brain, such as enlarged ventricles and a reduced size of certain regions. In addition, functional neuroimaging techniques, such as PET and fMRI scans have shown abnormal functioning in specific brain areas during intellectual tasks, performed by people with this disorder.

Symptoms

Usually, the disorder commences between ages 15 and 25. Some patients can fully recover after treatment, but most continue to have moderate to severe symptoms, specifically in response to stress. Roughly 15 percent of patients returns to normal life after a single episode, 60 percent will suffer from intermittent episodes throughout their lives and 25 percent will not recover their ability to lice as independent adults. Frequent, lifelong manifestations in most patients, even those that recover good from acute symptoms are deficits in cognition, particularly in memory and attention.

Treatment

• During the late 1940s, the drug chlorpromazine was developed after a long search for an effective antipsychotic drug. By the 1950s it had become one of the most used antipsychotic treatments, including schizophrenia.
• Since then, many alternative agents have been developed. If these are administered as long-acting injections, they reduce some symptoms and aid patients in their adjustment to return to their communities. However, chronic use of these drugs may cause abnormal muscle movements and tremors in some patients. Safer treatments are being vigorously sought after.
• Most drugs thus far are effective in treating hallucinations and thought disorders. Clozapine is a drug that acts somewhat different from other antipsychotic treatments and is used by the approximately 30 percent of patients that is not helped by conventional drugs. This drug, however, can induce a potentially fatal blood disorder, called agranulocytosis, in about 1 percent of the patients. In order to prevent this, patients must take blood tests weekly, which makes using the drug very expensive. Several new antipsychotics offer some of the benefits of clozapine, without risk of the blood disorder, but their long term side effects are not yet fully known.