“F*** you! Leave me alone!” Her wild hair, awkward posture, and anger at something or someone I could not see, made me suspect she was in the middle of a psychotic episode, possibly as part of the illness schizophrenia. I saw this middle aged woman sitting at a bus stop alone, as I was walking my dogs. This is not the first time I have seen a person in the middle of what seems like a psychotic episode, yelling at things or people I cannot see. Sometimes the person will be talking quietly to him or herself, other times they may be staring into space laughing. Psychosis can have a variety of causes, including intoxication on street drugs, physical illnesses such as neurological disorders or kidney disease, overmedication on certain prescription drugs, sleep deprivation, or a mental illness. Doctors have developed treatments for several organic causes of psychosis, but individuals who are diagnosed with schizophrenia still find themselves with few treatment options that are effective at total symptom elimination.

Schizophrenia is a mental illness that is characterized by the presence of positive, negative, and cognitive symptoms. Positive symptoms are named as such because they include things that have been added to the individual’s experience of the world, hallucinations, delusions, disorder thinking (racing and/or disorganized thoughts), and movement disorders (agitated movements). Negative symptoms are named as such because they are things that have been taken from the individual as a part of the illness, social withdrawal, flat affect, difficulty initiating and maintaining tasks, difficulty speaking, and reduced feelings of pleasure in everyday life. Cognitive symptoms affect an individual’s ability to process information, including; reduced ability to use information to make appropriate decisions (executive functioning), trouble concentrating and/or paying attention, and problems with working memory (ability to manipulate information just received).

Current treatments for schizophrenia most often combine medication with some form of psychosocial treatment. This combination has been shown to be effective at reducing positive symptoms, alleviating the effects of negative and cognitive symptoms, and reducing hospitalizations. The class of drugs most often prescribed to individuals with schizophrenia are antipsychotics. However, the majority of individuals with chronic schizophrenia discontinue medication. These drugs work by effecting the neurotransmitter dopamine, which is believed to cause many positive symptoms of schizophrenia. Antipsychotics work by blocking the effects of dopamine at the D2 receptor site, and atypical antipsychotics (newer drugs developed to treat schizophrenia) also work on the neurotransmitter serotonin. Antipsychotic medications carry the risk of tardive dyskinesia, a movement disorder characterized by involuntary, repetitive movements (such as grimacing or eye blinking).  First generation antipsychotics (older medications) have a higher risk of side effects than newer atypical antipsychotics. However, all medications have some risk of side effects, and most individuals discontinue medication prematurely.

What if a cause of schizophrenia could be found? If the root of the disease could be revealed, we may be able to develop targeted treatments that can cure and/or prevent schizophrenia. Research has been delving into causes of schizophrenia and in future posts I will examine the latest knowledge and theories on the cause.

***If you are currently taking antipsychotic medication, DO NOT abruptly stop taking your medication. This can result in withdrawal symptoms and a return of psychotic symptoms. Speak with your physician.

Cloud LJ, Zutshi D, Factor SA. Tardive dyskinesia: therapeutic options for an increasingly common disorder. Neurotherapeutics. 2014;11(1):166-176.

Jeffrey A. Lieberman, M.D., T. Scott Stroup, M.D., M.P.H., Joseph P. McEvoy, M.D., Marvin S. Swartz, M.D., Robert A. Rosenheck, M.D., Diana O. Perkins, M.D., M.P.H., Richard S.E. Keefe, Ph.D., Sonia M. Davis, Dr.P.H., Clarence E. Davis, Ph.D., Barry D. Lebowitz, Ph.D., Joanne Severe, M.S., and John K. Hsiao, M.D., for the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators^*   (2005). Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia. New England Journal of Medicine, 53:1209-1223. September 22, 2005DOI: 10.1056/NEJMoa051688

Tardive Dyskinesia. Retrieved from https://medlineplus.gov/ency/article/000685.htm

(2013). Treating and Managing Tardive Symptoms Retrieved July 18, 2017, from https://www.aan.com/Guidelines/Home/GetGuidelineContent/614

Discontinuing Psychiatric Medications: What You Need to Know

https://psychcentral.com/lib/discontinuing-psychiatric-medications-what-you-need-to-know/