SCHIZOPHRENIA and OTHER PSYCHOTIC DISORDERS The term psychosis refers to a set of symptoms that impair the ability

of a person experiencing psychosis to distinguish reality from fiction. It is characterized by the following signs and symptoms: Delusionsbeliefs that are not consensually validated or demonstrably true; Hallucinationsperceptions that cannot be verified by others; and Communication and behavior that are partly or completely unintelligible. Psychosis is usually thought of in association with schizophrenia, but is also present to varying degrees in a number of other mental health disorders. It should be noted that discrete psychotic symptoms (e.g. seeing something that is not there, as can occur in delirium associated with fever, for example) can be experienced without necessarily being part of a psychotic disorder. If the symptoms are severe enough, or there are multiple symptoms co-occurring for a sufficient time, then a psychotic disorder, such as schizophrenia, may be diagnosed. Psychotic disorders such as schizophrenia are a group of serious illnesses that affect the mind. These illnesses alter a person's ability to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately. When symptoms are severe, people with psychotic disorders have difficulty staying in touch with reality and often are unable to meet the ordinary demands of daily life. However, even the most severe psychotic disorders usually are treatable. SCHIZOPHRENIA Schizophrenia is a mental disorder that generally appears in late adolescence or early adulthood - however, it can emerge at any time in life. It is one of many brain diseases that may include delusions, loss of personality (flat affect), confusion, agitation, social withdrawal, psychosis, and bizarre behavior.

Schizophrenia facts Schizophrenia is a chronic, severe, debilitating mental illness that affects about 1% of the population, more than 2 million people in the United States alone. With the sudden onset of severe psychotic symptoms, the individual is said to be experiencing acute schizophrenia. Psychotic means out of touch with reality or unable to separate real from unreal experiences. There is no known single cause of schizophrenia. As discussed later, it appears that genetic factors produce a vulnerability to schizophrenia, with environmental factors contributing to different degrees in different individuals. There are a number of various treatments for schizophrenia. Given the complexity of schizophrenia, the major questions about this disorder (its cause or causes, prevention, and treatment) are unlikely to be resolved in the near future. The public should beware of those offering "the cure" for (or "the cause" of) schizophrenia. Schizophrenia is one of the psychotic mental disorders and is characterized by symptoms of thought, behavior, and social problems. Symptoms of schizophrenia may include delusions, hallucinations, catatonia, negative symptoms, and disorganized speech or behavior. There are five types of schizophrenia based on the kind of symptoms the person has at the time of assessment: paranoid, disorganized, catatonic, undifferentiated, and residual. Children as young as 6 years of age can be found to have all the symptoms of schizophrenia as their adult counterparts and to continue to have those symptoms into adulthood. Although the term schizophrenia has only been in used since 1911, its symptoms have been described throughout written history. Schizophrenia is considered to be the result of a complex group of genetic, psychological, and environmental factors. Health-care practitioners diagnose schizophrenia by gathering comprehensive medical, family, mental-health, and social/cultural information. The practitioner will also either perform a physical examination or request that the individual's primary-care doctor perform one. The medical examination will usually include lab tests. In addition to providing treatment that is appropriate to the diagnosis, professionals attempt to determine the presence of mental illnesses that may co-occur. People with schizophrenia are at increased risk of having a number of other mentalhealth conditions, committing suicide, and otherwise dying earlier than people without this disorder.

Medications that have been found to be most effective in treating the positive symptoms of schizophrenia are first- and second-generation antipsychotics. Psychosocial interventions for schizophrenia include education of family members, assertive community treatment, substance-abuse treatment, social-skills training, supported employment, cognitive behavioral therapy, and weight management. Cognitive remediation, peer-to-peer treatment, and weight-management interventions remain the focus topics for research.

TYPES OF SCHIZOPHRENIA The kinds of symptoms that are utilized to make a diagnosis of schizophrenia differ between affected people and may change from one year to the next within the same person as the disease progresses. Different subtypes of schizophrenia are defined according to the most significant and predominant characteristics present in each person at each point in time. The result is that one person may be diagnosed with different subtypes over the course of his illness. Schizophrenia: Paranoid Subtype

The defining feature of the paranoid subtype (also known as paranoid schizophrenia) is the presence of auditory hallucinations or prominent delusional thoughts about persecution or conspiracy. However, people with this subtype may be more functional in their ability to work and engage in relationships than people with other subtypes of schizophrenia. The reasons are not entirely clear, but may partly reflect that people suffering from this subtype often do not exhibit symptoms until later in life and have achieved a higher level of functioning before the onset of their illness. People with the paranoid subtype may appear to lead fairly normal lives by successful management of their disorder. Paranoid schizophrenia is the most common subtype. People diagnosed with the paranoid subtype may not appear odd or unusual and may not readily discuss the symptoms of their illness. Typically, the hallucinations and delusions revolve around some characteristic theme, and this theme often remains fairly consistent over time. A persons temperaments and general behaviors often are related to the content of the disturbance of thought. For example, people who believe that they are being persecuted unjustly may be easily angered and become hostile. Often, paranoid schizophrenics will come to the attention of mental health professionals only when there has been some major stress in their life that has caused an increase in their symptoms. At that point, sufferers may recognize the need for outside help or act in a fashion to bring attention to themselves.

Since there may be no observable features, the evaluation requires sufferers to be somewhat open to discussing their thoughts. If there is a significant degree of suspiciousness or paranoia present, people may be very reluctant to discuss these issues with a stranger. There is a broad spectrum to the nature and severity of symptoms that may be present at any one time. When symptoms are in a phase of exacerbation or worsening, there may be some disorganization of the thought processes. At this time, people may have more trouble than usual remembering recent events, speaking coherently or generally behaving in an organized, rational manner. While these features are more characteristic of other subtypes, they can be present to differing degrees in people with the paranoid subtype, depending upon the current state of their illness. Supportive friends or family members often may be needed at such times to help the symptomatic person get professional help. Schizophrenia: Disorganized Subtype

As the name implies, this subtypes predominant feature is disorganization of the thought processes. As a rule, hallucinations and delusions are less pronounced, although there may be some evidence of these symptoms. These people may have significant impairments in their ability to maintain the activities of daily living. Even the more routine tasks, such as dressing, bathing or brushing teeth, can be significantly impaired or lost. Often, there is impairment in the emotional processes of the individual. For example, these people may appear emotionally unstable, or their emotions may not seem appropriate to the context of the situation. They may fail to show ordinary emotional responses in situations that evoke such responses in healthy people. Mental health professionals refer to this particular symptom as blunted or flat affect. Additionally, these people may have an inappropriately jocular or giddy appearance, as in the case of a patient who chuckles inappropriately through a funeral service or other solemn occasion. People diagnosed with this subtype also may have significant impairment in their ability to communicate effectively. At times, their speech can become virtually incomprehensible, due to disorganized thinking. In such cases, speech is characterized by problems with the utilization and ordering of words in conversational sentences, rather than with difficulties of enunciation or articulation. In the past, the term hebephrenic has been used to describe this subtype. Schizophrenia: Catatonic Subtype

The predominant clinical features seen in the catatonic subtype involve disturbances in movement. Affected people may exhibit a dramatic reduction in activity, to the point that voluntary movement stops, as in catatonic stupor. Alternatively, activity can dramatically increase, a state known as catatonic excitement.

Other disturbances of movement can be present with this subtype. Actions that appear relatively purposeless but are repetitively performed, also known as stereotypic behavior, may occur, often to the exclusion of involvement in any productive activity. Patients may exhibit an immobility or resistance to any attempt to change how they appear. They may maintain a pose in which someone places them, sometimes for extended periods of time. This symptom sometimes is referred to as waxy flexibility. Some patients show considerable physical strength in resistance to repositioning attempts, even though they appear to be uncomfortable to most people. Affected people may voluntarily assume unusual body positions, or manifest unusual facial contortions or limb movements. This set of symptoms sometimes is confused with another disorder called tardive dyskinesia, which mimics some of these same, odd behaviors. Other symptoms associated with the catatonic subtype include an almost parrot-like repeating of what another person is saying (echolalia) or mimicking the movements of another person (echopraxia). Echolalia and echopraxia also are seen in Tourettes Syndrome. Schizophrenia: Undifferentiated Subtype

The undifferentiated subtype is diagnosed when people have symptoms of schizophrenia that are not sufficiently formed or specific enough to permit classification of the illness into one of the other subtypes. The symptoms of any one person can fluctuate at different points in time, resulting in uncertainty as to the correct subtype classification. Other people will exhibit symptoms that are remarkably stable over time but still may not fit one of the typical subtype pictures. In either instance, diagnosis of the undifferentiated subtype may best describe the mixed clinical syndrome. Schizophrenia: Residual Subtype

This subtype is diagnosed when the patient no longer displays prominent symptoms. In such cases, the schizophrenic symptoms generally have lessened in severity. Hallucinations, delusions or idiosyncratic behaviors may still be present, but their manifestations are significantly diminished in comparison to the acute phase of the illness. Just as the symptoms of schizophrenia are diverse, so are its ramifications. Different kinds of impairment affect each patients life to varying degrees. Some people require custodial care in state institutions, while others are gainfully employed and can maintain an active family life. However, the majority of patients are at neither of these extremes. Most will have a waxing

and waning course marked with some hospitalizations and some assistance from outside support sources. People having a higher level of functioning before the start of their illness typically have a better outcome. In general, better outcomes are associated with brief episodes of symptoms worsening followed by a return to normal functioning. Women have a better prognosis for higher functioning than men, as do patients with no apparent structural abnormalities of the brain. In contrast, a poorer prognosis is indicated by a gradual or insidious onset, beginning in childhood or adolescence; structural brain abnormalities, as seen on imaging studies; and failure to return to prior levels of functioning after acute episodes. CAUSES OF SCHIZOPHRENIA There is no single cause for schizophrenia. Rather, it is the result of a complex group of genetic, psychological, and environmental factors. Genetically, schizophrenia and bipolar disorder have much in common, in that the two disorders share a number of the same risk genes.

Genetics: Schizophrenia typically runs in families, so its likely the disorder is inherited. If an identical twin has schizophrenia, the other twin is 50 percent more likely to have the disorder. That also points out the likelihood of other causes: If schizophrenia were purely genetic, both identical twins always would have the disorder. Brain chemistry and structure: Neurotransmitterschemicals in the brain, including dopamine and glutamate, that communicate between neuronsare believed to play a role. There also is evidence to suggest that the brains of individuals with schizophrenia are different from those of healthy individuals (for details, see Keshavan, Tandon, Boutros & Nasrallah, 2008). Environment: Some research points to child abuse, early traumatic events, severe stress, negative life events and living in an urban environment as contributing factors. Additional causes include physical and psychological complications during pregnancy, such as viral infection, malnutrition and the mothers stress.

Is Schizophrenia Hereditary? One frequently asked question about schizophrenia is if it is hereditary. As with most other mental disorders, schizophrenia is not directly passed from one generation to another genetically, but it is known to run in families. Thus, the risk of illness in an identical twin of a person with schizophrenia is 40%-50% and a child of a parent suffering from schizophrenia has a 10% chance of developing the illness.

After a person has been diagnosed with schizophrenia in a family, the chance for a sibling to also be diagnosed with schizophrenia is 7 to 9 percent. If a parent has schizophrenia, the chance for a child to have the disorder is 10 to 15 percent. Risks increase with multiple affected family members. SIGNS & SYMPTOMS The symptoms of schizophrenia fall into three broad categories: positive symptoms, negative symptoms, and cognitive symptoms. Positive symptoms Positive symptoms are psychotic behaviors not seen in healthy people. People with positive symptoms often "lose touch" with reality. These symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether the individual is receiving treatment. They include the following: Hallucinations are things a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel. "Voices" are the most common type of hallucination in schizophrenia. Many people with the disorder hear voices. The voices may talk to the person about his or her behavior, order the person to do things, or warn the person of danger. Sometimes the voices talk to each other. People with schizophrenia may hear voices for a long time before family and friends notice the problem.

Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects, and feeling things like invisible fingers touching their bodies when no one is near.

Delusions are false beliefs that are not part of the person's culture and do not change. The person believes delusions even after other people prove that the beliefs are not true or logical. People with schizophrenia can have delusions that seem bizarre, such as believing that neighbors can control their behavior with magnetic waves. They may also believe that people on television are directing special messages to them, or that radio stations are broadcasting their thoughts aloud to others. Sometimes they believe they are someone else, such as a famous historical figure. They may have paranoid delusions and believe that others are trying to harm them, such as by cheating, harassing, poisoning, spying on, or plotting against them or the people they care about. These beliefs are called "delusions of persecution." Thought disorders are unusual or dysfunctional ways of thinking. One form of thought disorder is called "disorganized thinking." This is when a person has trouble organizing his or her thoughts or connecting them logically. They may talk in a garbled way that is hard to understand. Another form is called "thought blocking." This is when a person stops speaking abruptly in the middle of a thought. When asked why he or she stopped talking, the person may say that it felt as if the thought had been taken out of his or her head. Finally, a person with a thought disorder might make up meaningless words, or "neologisms." Movement disorders may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other extreme, a person may become catatonic. Catatonia is a state in which a person does not move and does not respond to others. Catatonia is rare today, but it was more common when treatment for schizophrenia was not available.

Negative symptoms Negative symptoms are associated with disruptions to normal emotions and behaviors. These symptoms are harder to recognize as part of the disorder and can be mistaken for depression or other conditions. These symptoms include the following: "Flat affect" (a person's face does not move or he or she talks in a dull or monotonous voice) Lack of pleasure in everyday life Lack of ability to begin and sustain planned activities Speaking little, even when forced to interact.

People with negative symptoms need help with everyday tasks. They often neglect basic personal hygiene. This may make them seem lazy or unwilling to help themselves, but the problems are symptoms caused by the schizophrenia.

Cognitive symptoms Cognitive symptoms are subtle. Like negative symptoms, cognitive symptoms may be difficult to recognize as part of the disorder. Often, they are detected only when other tests are performed. Cognitive symptoms include the following: Poor "executive functioning" (the ability to understand information and use it to make decisions) Trouble focusing or paying attention Problems with "working memory" (the ability to use information immediately after learning it).

Cognitive symptoms often make it hard to lead a normal life and earn a living. They can cause great emotional distress. How Is Schizophrenia Diagnosed? As is true with virtually any mental-health diagnosis, there is no one test that definitively indicates that someone has schizophrenia. Therefore, health-care practitioners diagnose this disorder by gathering comprehensive medical, family, and mental-health information. Patients tend to benefit when the professional takes into account their client's entire life and background. This includes but is not limited to the person's gender, sexual orientation, cultural, religious and ethnic background, and socioeconomic status. The practitioner will also either perform a physical examination or request that the individual's primary-care doctor perform one. The medical examination will usually include lab tests to evaluate the person's general health and to explore whether or not the individual has a medical condition that might produce psychological symptoms. What Is the Prognosis for Schizophrenia? Individuals with schizophrenia have more than twice the rate of death than those without the disorder. Almost half of people with schizophrenia will suffer from a substance-use disorder (for example, alcohol, marijuana, or other substance) during their lifetime. Research shows that people with schizophrenia or schizoaffective disorder have a better quality of life if their family members tend to be more supportive and less critical of them. TREATMENT FOR SCHIZOPHRENIA Because the causes of schizophrenia are still unknown, treatments focus on eliminating the symptoms of the disease. Treatments include antipsychotic medications and various psychosocial treatments.

Antipsychotic medications Antipsychotic medications have been available since the mid-1950's. The older types are called conventional or "typical" antipsychotics. Some of the more commonly used typical medications include: Chlorpromazine (Thorazine) Haloperidol (Haldol) Perphenazine (Etrafon, Trilafon) Fluphenazine (Prolixin).

In the 1990's, new antipsychotic medications were developed. These new medications are called second generation, or "atypical" antipsychotics. One of these medications, clozapine (Clozaril) is an effective medication that treats psychotic symptoms, hallucinations, and breaks with reality. But clozapine can sometimes cause a serious problem called agranulocytosis, which is a loss of the white blood cells that help a person fight infection. People who take clozapine must get their white blood cell counts checked every week or two. This problem and the cost of blood tests make treatment with clozapine difficult for many people. But clozapine is potentially helpful for people who do not respond to other antipsychotic medications. Other atypical antipsychotics were also developed. None cause agranulocytosis. Examples include: Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) Aripiprazole (Abilify) Paliperidone (Invega).

What are the side effects? Some people have side effects when they start taking these medications. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include: Drowsiness Dizziness when changing positions

Blurred vision Rapid heartbeat Sensitivity to the sun Skin rashes Menstrual problems for women.

Atypical antipsychotic medications can cause major weight gain and changes in a person's metabolism. This may increase a person's risk of getting diabetes and high cholesterol. A person's weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking an atypical antipsychotic medication. Typical antipsychotic medications can cause side effects related to physical movement, such as: Rigidity Persistent muscle spasms Tremors Restlessness.

Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements a person can't control. The movements commonly happen around the mouth. TD can range from mild to severe, and in some people the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking the medication. TD happens to fewer people who take the atypical antipsychotics, but some people may still get TD. People who think that they might have TD should check with their doctor before stopping their medication. How are antipsychotics taken and how do people respond to them? Antipsychotics are usually in pill or liquid form. Some anti-psychotics are shots that are given once or twice a month. Symptoms of schizophrenia, such as feeling agitated and having hallucinations, usually go away within days. Symptoms like delusions usually go away within a few weeks. After about six weeks, many people will see a lot of improvement. However, people respond in different ways to antipsychotic medications, and no one can tell beforehand how a person will respond. Sometimes a person needs to try several medications before finding the right one. Doctors and patients can work together to find the best medication or medication combination, as well as the right dose.

Some people may have a relapse-their symptoms come back or get worse. Usually, relapses happen when people stop taking their medication, or when they only take it sometimes. Some people stop taking the medication because they feel better or they may feel they don't need it anymore. But no one should stop taking an antipsychotic medication without talking to his or her doctor. When a doctor says it is okay to stop taking a medication, it should be gradually tapered off, never stopped suddenly. How do antipsychotics interact with other medications? Antipsychotics can produce unpleasant or dangerous side effects when taken with certain medications. For this reason, all doctors treating a patient need to be aware of all the medications that person is taking. Doctors need to know about prescription and over-thecounter medicine, vitamins, minerals, and herbal supplements. People also need to discuss any alcohol or other drug use with their doctor. To find out more about how antipsychotics work, the National Institute of Mental Health (NIMH) funded a study called CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness). This study compared the effectiveness and side effects of five antipsychotics used to treat people with schizophrenia. In general, the study found that the older typical antipsychotic perphenazine (Trilafon) worked as well as the newer, atypical medications. But because people respond differently to different medications, it is important that treatments be designed carefully for each person. More information about CATIE is on the NIMH website. Psychosocial treatments Psychosocial treatments can help people with schizophrenia who are already stabilized on antipsychotic medication. Psychosocial treatments help these patients deal with the everyday challenges of the illness, such as difficulty with communication, self-care, work, and forming and keeping relationships. Learning and using coping mechanisms to address these problems allow people with schizophrenia to socialize and attend school and work. Patients who receive regular psychosocial treatment also are more likely to keep taking their medication, and they are less likely to have relapses or be hospitalized. A therapist can help patients better understand and adjust to living with schizophrenia. The therapist can provide education about the disorder, common symptoms or problems patients may experience, and the importance of staying on medications. For more information on psychosocial treatments, see the psychotherapies section on the NIMH website. Illness management skills. People with schizophrenia can take an active role in managing their own illness. Once patients learn basic facts about schizophrenia and its treatment, they can make informed decisions about their care. If they know how to

watch for the early warning signs of relapse and make a plan to respond, patients can learn to prevent relapses. Patients can also use coping skills to deal with persistent symptoms. Integrated treatment for co-occurring substance abuse. Substance abuse is the most common co-occurring disorder in people with schizophrenia. But ordinary substance abuse treatment programs usually do not address this population's special needs. When schizophrenia treatment programs and drug treatment programs are used together, patients get better results. Rehabilitation. Rehabilitation emphasizes social and vocational training to help people with schizophrenia function better in their communities. Because schizophrenia usually develops in people during the critical career-forming years of life (ages 18 to 35), and because the disease makes normal thinking and functioning difficult, most patients do not receive training in the skills needed for a job.

Rehabilitation programs can include job counseling and training, money management counseling, help in learning to use public transportation, and opportunities to practice communication skills. Rehabilitation programs work well when they include both job training and specific therapy designed to improve cognitive or thinking skills. Programs like this help patients hold jobs, remember important details, and improve their functioning. Family education. People with schizophrenia are often discharged from the hospital into the care of their families. So it is important that family members know as much as possible about the disease. With the help of a therapist, family members can learn coping strategies and problem-solving skills. In this way the family can help make sure their loved one sticks with treatment and stays on his or her medication. Families should learn where to find outpatient and family services. Cognitive behavioral therapy. Cognitive behavioral therapy (CBT) is a type of psychotherapy that focuses on thinking and behavior. CBT helps patients with symptoms that do not go away even when they take medication. The therapist teaches people with schizophrenia how to test the reality of their thoughts and perceptions, how to "not listen" to their voices, and how to manage their symptoms overall. CBT can help reduce the severity of symptoms and reduce the risk of relapse. Self-help groups. Self-help groups for people with schizophrenia and their families are becoming more common. Professional therapists usually are not involved, but group members support and comfort each other. People in self-help groups know that others are facing the same problems, which can help everyone feel less isolated. The networking that takes place in self-help groups can also prompt families to work together to advocate for research and more hospital and community treatment

programs. Also, groups may be able to draw public attention to the discrimination many people with mental illnesses face. Classification Systems and Their Relation to Schizophrenia Process vs. Reactive Distinction Process Insidious onset, biologically based, negative symptoms, poor prognosis Reactive Acute onset (extreme stress), notable behavioral activity, best prognosis Good vs. Poor Premorbid Functioning in Schizophrenia Focus on persons level of function prior to developing schizophrenia No longer widely used Type I vs. Type II Distinction and Schizophrenia Type I Positive symptoms, good response to medication, optimistic prognosis, and absence of intellectual impairment Type II Negative symptoms, poor response to medication, pessimistic prognosis, and intellectual impairments Are people with schizophrenia violent? People with schizophrenia are not usually violent. In fact, most violent crimes are not committed by people with schizophrenia. However, some symptoms are associated with violence, such as delusions of persecution. Substance abuse may also increase the chance a person will become violent. If a person with schizophrenia becomes violent, the violence is usually directed at family members and tends to take place at home. The risk of violence among people with schizophrenia is small. But people with the illness attempt suicide much more often than others. About 10 percent (especially young adult males) die by suicide. It is hard to predict which people with schizophrenia are prone to suicide. If you know someone who talks about or attempts suicide, help him or her find professional help right away. Suicide Risk People with the condition have a 50 times higher risk of attempting suicide than the general population; the risk of suicide is very serious in people with schizophrenia. Suicide is the number one cause of premature death among people with schizophrenia, with an estimated 10 percent to 13 percent killing themselves and approximately 40% attempting suicide at least once (and as much as 60% of males attempting suicide). The extreme depression and psychoses that can result due to lack of treatment are the usual causes. These suicides rates can be compared to the general population, which is somewhere around 0.01%. What about substance abuse?

Some people who abuse drugs show symptoms similar to those of schizophrenia. Therefore, people with schizophrenia may be mistaken for people who are affected by drugs. Most researchers do not believe that substance abuse causes schizophrenia. However, people who have schizophrenia are much more likely to have a substance or alcohol abuse problem than the general population. Substance abuse can make treatment for schizophrenia less effective. Some drugs, like marijuana and stimulants such as amphetamines or cocaine, may make symptoms worse. In fact, research has found increasing evidence of a link between marijuana and schizophrenia symptoms. In addition, people who abuse drugs are less likely to follow their treatment plan. Schizophrenia and smoking Addiction to nicotine is the most common form of substance abuse in people with schizophrenia. They are addicted to nicotine at three times the rate of the general population (75 to 90 percent vs. 25 to 30 percent). The relationship between smoking and schizophrenia is complex. People with schizophrenia seem to be driven to smoke, and researchers are exploring whether there is a biological basis for this need. In addition to its known health hazards, several studies have found that smoking may make antipsychotic drugs less effective. Quitting smoking may be very difficult for people with schizophrenia because nicotine withdrawal may cause their psychotic symptoms to get worse for a while. Quitting strategies that include nicotine replacement methods may be easier for patients to handle. Doctors who treat people with schizophrenia should watch their patients' response to antipsychotic medication carefully if the patient decides to start or stop smoking. THE COURSE OF SCHIZOPHRENIA Early intervention and early use of new medications lead to better medical outcomes for the individual The earlier someone with schizophrenia is diagnosed and stabilized on treatment, the better the long-term prognosis for their illness Teen suicide is a growing problem -- and teens with schizophrenia have approximately a 50% risk of attempted suicide In rare instances, children as young as five can develop schizophrenia.

Anti-psychotic medications are the generally recommended treatment for schizophrenia. If medication for schizophrenia is discontinued, the relapse rate is about 80 percent within 2

years. With continued drug treatment, only about 40 percent of recovered patients will suffer relapses. Wide variation occurs in the course of schizophrenia. Some people have psychotic episodes of illness lasting weeks or months with full remission of their symptoms between each episode; others have a fluctuating course in which symptoms are continuous but rise and fall in intensity; others have relatively little variation in the symptoms of their illness over time. At one end of the spectrum, the person has a single psychotic episode of schizophrenia followed by complete recovery; at the other end of the spectrum is a course in which the illness never abates and debilitating effects increase. Recent research increasingly shows that the disease process of schizophrenia gradually and significantly damages the brain of the person, and that earlier treatments (medications and other therapies) seem to result in less damage over time. After 10 years, of the people diagnosed with schizophrenia: 25% Completely Recover 25% Much Improved, relatively independent 25% Improved, but require extensive support network 15% Hospitalized, unimproved 10% Dead (Mostly Suicide)

After 30 years, of the people diagnosed with schizophrenia: 25% Completely Recover 35% Much Improved, relatively independent 15% Improved, but require extensive support network 10% Hospitalized, unimproved 15% Dead (Mostly Suicide)

What Percentage of Individuals with severe mental illnesses are untreated, and why? Recent American studies report that approximately half of all individuals with severe mental illnesses have received no treatment for their illnesses in the previous 12 months. These findings are consistent with other studies of medication compliance for individuals with schizophrenia and manic-depressive illness (bipolar disorder). The majority (55 percent) of those not receiving treatment have no awareness of their illness (anosognosia) and thus do not seek treatment. Stigma and dissatisfaction with services are relatively unimportant reasons why individuals with severe mental illnesses do not seek treatment.

The 45 percent who acknowledged that they needed treatment (and thus had awareness of their illness) but still were not receiving treatment cited many reasons for this. These included (respondent could check several reasons): 32% "wanted to solve problem on own" 27% "thought the problem would get better by itself" 20% "too expensive" 18% "unsure about where to go for help" 17% "help probably would not do any good" 16% "health insurance would not cover treatment"

Illuminating 13 Myths of Schizophrenia Its safe to say that no mental disorder is more shrouded in mystery, misunderstanding and fear than schizophrenia. The modern-day equivalent of leprosy is how renowned research psychiatrist E. Fuller Torrey, M.D., refers to schizophrenia in his excellent book, Surviving Schizophrenia: A Manual for Families, Patients, and Providers. While 85 percent of Americans recognize that schizophrenia is a disorder, only 24 percent are actually familiar with it. And according to a 2008 survey by the National Alliance on Mental Illness (NAMI), 64 percent cant recognize its symptoms or think the symptoms include a split or multiple personalities. (They dont.) Aside from ignorance, images of the aggressive, sadistic schizophrenic are plentiful in the media. Such stereotypes only further the stigma and quash any shred of sympathy for individuals with this illness, writes Dr. Torrey. Stigma has a slew of negative consequences. Its been associated with reduced housing and employment opportunities, diminished quality of life, low self-esteem and more symptoms and stress (see Penn, Chamberlin & Mueser, 2003). So its bad enough that people with schizophrenia are afflicted with a terrible disease. But they also have to deal with the confusion, fear and disgust of others. Whether your loved one has schizophrenia or youd like to learn more, gaining a better understanding of it helps demystify the disease and is a huge help to those who suffer from it. Below are some pervasive myths followed by actual facts regarding schizophrenia. 1. Individuals with schizophrenia all have the same symptoms. For starters, there are different types of schizophrenia. Even individuals diagnosed with the same subtype of schizophrenia often look very different. Schizophrenia is a huge, huge range of people and problems, said Robert E. Drake, M.D., Ph.D, professor of psychiatry and of community and family medicine at Dartmouth Medical School.

Part of the reason that schizophrenia is so mysterious is because were unable to put ourselves in the shoes of someone with the disorder. Its simply hard to imagine what having schizophrenia would be like. Everyone experiences sadness, anxiety and anger, but schizophrenia seems so out of our realm of feeling and understanding. It may help to adjust our perspective. Dr. Torrey writes: Those of us who have not had this disease should ask ourselves, for example, how we would feel if our brain began playing tricks on us, if unseen voices shouted at us, if we lost the capacity to feel emotions, and if we lost the ability to reason logically. 2. People with schizophrenia are dangerous, unpredictable and out of control . When their illness is treated with medication and psychosocial interventions, individuals with schizophrenia are no more violent than the general population, said Dawn I. Velligan, Ph.D, professor and co-director of the Division of Schizophrenia and Related Disorders at the Department of Psychiatry, UT Health Science Center at San Antonio. Also, People with schizophrenia more often tend to be victims rather than perpetrators of violence although untreated mental illness and substance abuse often increase the risk of aggressive behavior, saidIrene S. Levine, Ph.D, psychologist and co-author of Schizophrenia for Dummies. 3. Schizophrenia is a character flaw. Lazy, lacking in motivation, lethargic, easily confusedthe list of qualities individuals with schizophrenia appear to have goes on and on. However, the idea that schizophrenia is a character defect is no more realistic than suggesting that someone could prevent his epileptic seizures if he really wanted to or that someone could decide not to have cancer if he ate the right foods. What often appears as character defects are symptoms of schizophrenia, write Levine and co-author Jerome Levine, M.D., in Schizophrenia for Dummies. 4. Cognitive decline is a major symptom of schizophrenia. Seemingly unmotivated individuals most likely experience cognitive difficulties with problem solving, attention, memory and processing. They may forget to take their medication. They may ramble and not make sense. They may have a tough time organizing their thoughts. Again, these are symptoms of schizophrenia, which have nothing to do with character or personality. 5. There are psychotic and non-psychotic people. The public and clinicians alike view psychosis as categorical youre either psychotic or youre not instead of symptoms residing on a continuum, said Demian Rose, M.D., Ph.D, medical director of the University of California, San Francisco PART Program and director of the UCSF Early Psychosis Clinic. For instance, most people will agree that individuals arent simply

depressed or happy. There are gradients of depression, from mild one-day melancholy to deep, crippling clinical depression. Similarly, schizophrenia symptoms are not fundamentally different brain processes, but lie on a continuum with normal cognitive processes, Dr. Rose said. Auditory hallucinations may seem extraordinarily different but how often have you had a song stuck in your head that you can hear pretty clearly? 6. Schizophrenia develops quickly. Its quite rare to have a big drop in functioning, Dr. Rose said. Schizophrenia tends to develop slowly. Initial signs often show during adolescence. These signs typically include school, social and work decline, difficulties managing relationships and problems with organizing information, he said. Again, symptoms lie on a continuum. In schizophrenias beginning stages, an individual may not hear voices. Instead, he may hear whispers, which he cant make out. This prodromal period before the onset of schizophrenia is the perfect time to intervene and seek treatment. 7. Schizophrenia is purely genetic. Studies have shown that in pairs of identical twins (who share an identical genome) the prevalence of developing the illness is 48 percent, said Sandra De Silva, Ph.D, psychosocial treatment co-director and outreach director at the Staglin Music Festival Center for the Assessment and Prevention of Prodromal States (CAPPS) at UCLA, departments of psychology and psychiatry. Because other factors are involved, its possible to reduce the risk of developing the illness, she added. There are various prodromal programs that focus on helping at-risk adolescents and adults. Along with genetics, research has shown that stress and family environment can play a big role in increasing a persons susceptibility to psychosis. While we cant change genetic vulnerability, we can reduce the amount of stress in someones life, build coping skills to improve the way we respond to stress, and create a protective low-key, calm family environment without a lot of conflict and tension in hopes of reducing the risk of illness progression, De Sliva said. 8. Schizophrenia is untreatable. While schizophrenia is not curable, it is an eminently treatable and manageable chronic illness, just like diabetes or heart disease, Levine said. The key is to get the right treatment for your needs. 9. Sufferers need to be hospitalized.

Most individuals with schizophrenia do well living in the community with outpatient treatment, Velligan said. Again, the key is the right treatment and adhering to that treatment, especially taking medication as prescribed. 10. People with schizophrenia cant lead productive lives. Many individuals can lead happy and productive lives, Velligan said. In a 10-year study of 130 individuals with schizophrenia and substance abuse which co-occurs in nearly 50 percent of patients from the New Hampshire Dual Diagnosis Study, many gained control over both disorders, reducing their episodes of hospitalization and homelessness, living on their own and achieving a better quality of life (Drake, McHugo, Xie, Fox, Packard & Helmstetter, 2006). Specifically, 62.7 percent were controlling symptoms of schizophrenia; 62.5 percent were actively attaining remissions from substance abuse; 56.8 percent were in independent living situations; 41.4 percent were competitively employed; 48.9 percent had regular social contacts with nonsubstance abusers; and 58.3 percent expressed overall life satisfaction. 11. Medications make sufferers zombies. When we think of antipsychotic medication for schizophrenia, we automatically think of adjectives like lethargic, listless, uninterested and vacant. Many believe medication causes these sorts of symptoms. However, most often these symptoms are either from schizophrenia itself or because of overmedication. Zombie-like reactions are relatively minor, compared with the number of patients who have never been given an adequate trial of available medications, according to Dr. Torrey in Surviving Schizophrenia. 12. Antipsychotic medications are worse than the illness itself . Medication is the mainstay of schizophrenia treatment. Antipsychotic medications effectively reduce hallucinations, delusions, confusing thoughts and bizarre behaviors. These agents can have severe side effects and can be fatal, but this is rare. Antipsychotic drugs, as a group, are one of the safest groups of drugs in common use and are the greatest advance in the treatment of schizophrenia that has occurred to date, Dr. Torrey writes. 13. Individuals with schizophrenia can never regain normal functioning . Unlike dementia, which worsens over time or doesnt improve, schizophrenia seems to be a problem thats reversible, Dr. Rose said. Theres no line that once its crossed signifies that theres no hope for a person with schizophrenia, he added. Schizophrenia and Genetics: Research Update

Fortunately, weve come a long way since the theory that less-than-affectionate mothers cause schizophrenia. Today, its widely accepted that a complex interplay of genes and environment contributes to schizophrenia, which affects about one percent of the population and is characterized by cognitive dysfunction, delusions and hallucinations. Researchers have made significant strides in teasing apart schizophrenias convoluted genetic vulnerabilities, but there are still a slew of questions. Even with sophisticated technology, researchers are still left scratching their heads about the specifics: what genes are involved, how they incur risk, whether certain mutations link to the different subtypes and so on. Below is a discussion of how genetic research has evolved and what we know today. Early Research: Family, Twin & Adoption Studies To determine whether genetics plays any role in schizophrenia, decades ago, researchers began by looking at the prevalence of the disorder in families along with fraternal and identical twins. As many already know, these studies showed that schizophrenia runs in families and has a high heritability rate among identical twins, upward of 80 percent. What does heritability mean exactly? According to Anna Need, Ph.D, schizophrenia researcher and assistant professor in the Center for Human Genome Variation at Duke University, it tells us that in those particular studies, roughly 80 percent of the variance can be explained by genetics. Adoption studies are another avenue for answers. This research revealed that kids whose biological parents are schizophrenic (whether the onset was before or after the adoption) were at an elevated risk for psychosis. But kids adopted into families where one of the adoptive parents has schizophrenia were not at an increased risk for developing schizophrenia. Linkage Studies Linkage studies explore regions of chromosomes within large families affected by schizophrenia and compare these families to those untouched by the disorder. According to Need, although some loci have more evidence than others, no chromosomal region has been consistently implicated through linkage studies. Researchers have either reported different results or others have refuted their findings. Part of the problem may be that linkage studies typically combine families because families affected by schizophrenia usually dont have many members. This may confound results, Need said, because it may be that there are strong *genetic+ contributors but theyre different in different families, *so+ when you try to combine different studies, they dont replicate.

Two fairly recent genome scan meta-analyses did find some significance on several chromosomes. One meta-analysis, which looked at 20 different genome-wide datasets, identified a region on chromosome 2q. The second meta-analysis of 32 studies confirmed a region on chromosome 2q and also on chromosome 5q. These researchers conducted another analysis on 22 studies with samples of European descent and found potential linkage on chromosome 8q. Still, these chromosome regions are very large and have hundreds of genes. What we know for sure is there isnt one or a few causes. Thats all we can say for linkage studies, Need said. Candidate Gene Studies In candidate gene studies, researchers select individual genes that make sense biologically, or because they are in linkage regions, or both, Need said. Then they look for differences in the frequency of different variants in people with schizophrenia and without. However, these types of studies can be confounded by population differences between cases and controls, small sample size and positive publication bias. Few if any of the hundreds of genes implicated in candidate gene studies are likely to have real effects. The Schizophrenia Gene Resource is a database of all the genes implicated in schizophrenia. Currently, the number of genes implicated by candidate gene studies is 281. Genome-Wide Association Studies (GWAS) In genome-wide association studies (GWAS), researchers examine specific gene variants that may be associated with schizophrenia. They compare large groups of people with schizophrenia to healthy controls. In other words, This is the genetic equivalent of trying to find the person responsible for a crime by fingerprinting everyone in town, writes one UK neuroscientist on his blog Neuroskeptic. In 2009, three of the biggest GWAS studies were published in Nature. One study from the International Schizophrenia Consortium compared 3,322 Europeans with schizophrenia with 3,587 people without the condition. They found the strongest association on chromosome 22 on the gene that codes for the protein myosin. They also found an association on chromosome 6p at the major histocompatibility complex(MHC). A second study used the Molecular Genetics of Schizophrenia sample, consisting of 2,681 people of European descent with schizophrenia and 2,653 without, along with 1,286 African American people with schizophrenia and 973 without. They also found an association between chromosome 6p and schizophrenia.

In the last study, researchers part of the SGENE-plus consortium analyzed a sample of 2,663 people with schizophrenia and 13,498 healthy controls. Like the others, they implicated the MHC region on chromosome 6p. When they increased their sample by adding subjects from the latter studies, they also found two other gene variants on the MHC region and two variants on other chromosomes not found in the other studies. These studies caused quite the stir, but for different reasons depending on who you asked. UKs The Independent, for instance, declared that researchers had unlocked the secrets of schizophrenia. Press releases referred to the studies as landmark and breakthroughs. Many science writers, however, were unimpressed, slamming such overly enthusiastic interpretations. As Nicholas Wade of The New York Times wrote: Schizophrenia too seems to be not a single disease, but the end point of 10,000 different disruptions to the delicate architecture of the human brain. Yes, that discovery is a landmark. The kind that says you have 10,000 miles yet to go. The march of science is not direct but two steps forward, one step back. This was the step back. But it was a completely necessary one (This is another critique from the Neuroskeptic blog.) Need acknowledged that the increased risk *conveyed by any one of these associated variants+ is minuscule. One of the papers also reported that the combined effects of thousands of gene variants with very tiny effects could account for up to 30 percent of the risk for schizophrenia. Still, while these findings dont bring us closer to predicting schizophrenia, they do pinpoint molecular pathways that may be involved, she said. Take the implication of the major histocompatibility complex (MHC). Researchers have been studying MHCs role in schizophrenia since the 1970s. While the MHC region has a variety of functions, most are involved in immune function, such as recognizing foreign substances in the body. This region has been linked to about 100 different diseases, including type 1 diabetes and multiple sclerosis. Many researchers have theorized that exposure to infections may contribute to schizophrenia. A 2006 study of Danish people with schizophrenia and their parents found that nine autoimmune diseases were more common in the schizophrenia sample than in controls. Twelve were more common in parents with affected kids than in controls. Also, a history of any autoimmune disease was associated with a 45 percent increased risk for schizophrenia. However, Kri Stefnsson, CEO of deCode Genetics in Iceland who also led one of the Nature studies, told the Associated Press: Its guilt by association; its not really a link.

Rare Gene Variants Rare variations in genes may explain why researchers have struggled to find specific genes that cause schizophrenia. GWAS only examine common variants, but the same technology can allow the detection of large rare variations, called copy number variations (CNVs). These are regions of the chromosome that are either deleted or duplicated. (For instance, if a normal sequence is W, X, Y, Z, a deletion might look like: W, Y, Z; a duplication might look like: W, W, X, Y, Z.) There were two noteworthy studies published in Nature in 2008 that found the same deletions in schizophrenia patients. One study found three deletions on chromosomes 1 and 15: 1q21.1, 15q11.2 and 15q13.3. The International Schizophrenia Consortium also found deletions on chromosomes 15q13.3 and 1q21.1. Also, according to the authors, As expected, deletions were found within the region critical for velo-cardio-facial syndrome, which includes psychotic symptoms in 30% of patients. These deletions are so rare that they only occurred in less than 1 percent of the schizophrenia sample. But, according to the researchers calculations, these deletions increased schizophrenia risk 12- and 15-fold. Several regions, and even one single gene (NRXN1) have now been associated with schizophrenia through CNV studies, Need said. Curiously, every variant associated with schizophrenia also has been linked to other seemingly very different brain conditions including mental retardation, autism and even epilepsy, she added. The next natural step for researchers, Need said, is to begin sequencing the entire genome to locate smaller rare variations. She and her colleagues at Duke have already sequenced 60 to 70 genomes, and 150 exomes (just the coding parts of the genome). Interestingly, just a year ago, it wouldve taken six weeks to sequence one genome and a hefty amount of $40,000. (The first ever genome cost $3 billion and took more than a decade.) Now it takes about two weeks and costs around $5,000 (an amount thats steadily decreasing).

OTHER PSYCHOTIC DISORDERS

Psychotic disorder facts

Psychotic disorders include schizophrenia and a number of lesser-known disorders.

The number of people who develop a psychotic disorder tends to vary depending on the country, age, and gender of the sufferer, as well as on the specific kind of disorder. There are genetic, biological, environmental, and psychological risk factors for developing a psychotic disorder. Usually with any psychotic disorder, the person's inner world and behavior have notably changed. When assessing a person suffering from psychotic symptoms, health care professionals will take a careful history of the symptoms from the person and loved ones as well as conduct a medical evaluation including necessary laboratory tests and a mental health assessment. Most effective treatments for psychotic disorders are comprehensive, involving appropriate medications, mental health education, and psychotherapy for the sufferer of psychosis and his or her loved ones. It will also include the involvement of community supportive services when needed. Prevention of psychosis primarily involves preventing or decreasing the impact of factors that put the person at risk for developing a psychotic disorder.

DIFFERENT TYPES OF PYSCHOTIC DISORDER Schizophrenia: People with this illness have changes in behavior and other symptoms -- such as delusions and hallucinations -- that last longer than six months, usually with a decline in work, school, and social functioning. Schizoaffective disorder: People with this illness have symptoms of both schizophrenia and a mood disorder, such as depression or bipolar disorder. Etiology: Most theories suggest a biological component for this disorder, much like for schizophrenia. Symptom: The term schizoaffective implies a combination of schizophrenia and an affective (or mood) disorder, which is actually quite accurate. Symptoms include those for schizophrenia (see above) as well as a Major Depressive, manic, or mixed episode (see mood disorders). The psychotic (or schizophrenic like symptoms) must be present without any disturbance in mood for a minimum of two weeks. Treatment: Treatment typically involves medication to treat both the psychotic and affective symptoms. Therapy can be helpful in terms of increasing interpersonal skills, insight into the illness and need for medication. Assistance with occupational issues can also be beneficial. Prognosis: There is no cure for this disorder so prognosis is poor. However, medication has been shown to be quite effective against the psychotic symptoms and therapy can help the

individual cope with the illness better and improve social functioning. Absence of what is termed the negative symptoms (flatted affect, avolition, and poor social interaction) improves the prognosis significantly. Schizophreniform disorder: People with this illness have symptoms of schizophrenia, but the symptoms last between one and six months. Etiology: Schizophreniform is typically used as a preliminary diagnosis for schizophrenia. Due to the complexities of schizophrenia, an initial diagnosis is very often tentative and schizophreniform is therefore used. Symptoms: Same as with Schizophrenia Treatment: Medication is the most important part of treatment as it can reduce and sometimes eliminate the psychotic symptoms. Case management is often needed to assist with daily living skills, financial matters, and housing, and therapy can help the individual learn better coping skills and improve social and occupational skills. Prognosis: If the symptoms are not significantly reduced in the first six months after diagnosis, a change of diagnosis to schizophrenia is warranted. By definition, schizophreniform cannot be diagnosed for a period longer than six months. Brief psychotic disorder: People with this illness have sudden, short periods of psychotic behavior, often in response to a very stressful event, such as a death in the family. Recovery is often quick -- usually less than a month. Etiology: The cause of this disorder is typically an extremely stressful event or trauma. Symptoms : Presence of psychotic symptoms (delusions, hallucinations, disorganized speech, and/or disorganized behavior) which lasts at least one day but no more than one month. Treatment: Supportive therapy or interpersonal relationships and at times medication. Prognosis: Very good. By definition, the disorder will resolve itself within one month. If the symptoms last more than one month, the diagnosis needs to be reconsidered as does prognosis. Delusional disorder: People with this illness have a delusion (a false, fixed belief) involving reallife situations that could be true, such as being followed, being conspired against, or having a disease. These delusions persist for at least one month.

Etiology: The cause of delusional disorder is not known. Some studies suggest a biological component due to increased prevalence in first degree relatives of individuals with the disorder. Symptoms: Non-bizarre delusions including feelings of being followed, poisoned, infected, deceived or conspired against, or loved at a distance. Non-bizarre referred to real life situations which could be true, but are not or are greatly exaggerated. Bizarre delusions, which would rule out this disorder, are those such as believing that your stomach is missing or that aliens are seeking you out to be their leader. Delusional disorder can be subtyped into the following categories: erotomanic, grandiose, jealous, persecutory (most common), somatic, and mixed. Treatment: Medications can be helpful but are often refused due to the nature of the disorder. Some individuals function quite normally, while others may react to their delusion in ways that can greatly disrupt their life. Prognosis: Ranges from good to very poor depending on the individual, subtype, and life circumstances. Shared psychotic disorder: This illness occurs when a person develops delusions in the context of a relationship with another person who already has his or her own delusion(s). Etiology: Also referred to as Folle a` Deux, the cause is not well understood. Symptoms: Primary symptoms are delusions such as in delusional disorder which are similar in content to those of an individual who already has an established delusion. Treatment: The course of this disorder is widely variable. Often the best course of action is separation from the other individual. Prognosis: The disorder can be chronic depending on the dynamics of the relationship, but with separation, it can disappear, sometimes rather quickly. Substance-induced psychotic disorder: This condition is caused by the use of or withdrawal from some substances, such as alcohol and crack cocaine, that may cause hallucinations, delusions, or confused speech. Psychotic disorder due to a medical condition: Hallucinations, delusions, or other symptoms may be the result of another illness that affects brain function, such as a head injury or brain tumor. Paraphrenia: This is a type of schizophrenia that starts late in life and occurs in the elderly population.

WARNING SYMPTOMS AND SIGNS: - Social withdrawal - Agitation or anxiety - Depersonalization ( intense anxiety and a feeling of being unreal ) - Loss of appetite - Worsened hygiene - Disorganized speech and behaviors - Catatonic behavior, in which the affected persons body may be rigid and the person may be unresponsive CHANGES/PROBLEMS WITH THINKING THAT MAY OCCUR IN A PSYCHOTIC DISORDER INCLUDE: - Delusions ( beliefs with no basis in reality ) - Hallucinations ( for example, hearing , seeing , or perceiving things not actually present ) - The sense of being controlled by outside forces - Disorganized thoughts * People with psychosis vary widely in their behavior as they struggle with an illness beyond their control. Characteristics of a psychotic disorder may also include phases in which the affected individuals seem to lack personality, movement, and emotion (also called a flat affect). In order to better understand psychotic disorders, the concept of clusters of symptoms is often used. Thus, people with psychosis can experience symptoms that may be grouped under the following categories: - Positive symptoms: hearing voices or otherwise hallucinating, suspiciousness, feeling under constant surveillance , delusions or making up words without a meaning (neologisms) - Negative (or deficit) symptoms: social withdrawal, difficulty in taking care of themselves, inability to feel pleasure (these symptoms cause severe impairment) - Cognitive symptoms : difficulties attending to and processing of information , in understanding the environment, and in remembering simple tasks - Affective (or mood) symptoms: often manifested by depression, accounting for a very high rate of attempted suicide in people suffering from schizophrenia and other psychotic disorders. CAUSES PSYCHOTIC DISORDERS The exact cause of psychotic disorders is not known, but researchers believe that many factors may play a role. Some psychotic disorders tend to run in families, suggesting that the

tendency, or likelihood, to develop the disorder may be inherited. Environmental factors may also play a role in their development, including stress, drug abuse, and major life changes. In addition, people with certain psychotic disorders may have an imbalance of certain chemicals in the brain. They may be either very sensitive to or produce too much of a chemical called dopamine. Dopamine is a neurotransmitter, a substance that helps nerve cells in the brain send messages to each other. An imbalance of dopamine affects the way the brain reacts to certain stimuli, such as sounds, smells, and sights, and can lead to hallucinations and delusions. How Common Are Psychotic Disorders? 1% of the population worldwide suffers from psychotic disorders. These disorders most often first appear when a person is in his or her late teens, 20s, or 30s. They tend to affect men and women about equally. How Are Psychotic Disorders Diagnosed? If symptoms of a psychotic disorder are present, the doctor will perform a complete medical history and physical exam to determine the cause of the symptoms. Although there are no laboratory tests to specifically diagnose psychotic disorders -- except those that accompany a physical illness, such as a brain tumor -- the doctor may use various tests, such as blood tests and brain imaging (e.g., MRI scans), to rule out physical illness as the cause of the symptoms. If the doctor finds no physical reason for the symptoms, he or she may refer the person to a psychiatrist or psychologist, mental health professionals who are trained to diagnose and treat mental illnesses. Psychiatrists use specially designed interview and assessment tools to evaluate a person for a psychotic disorder. TREATMENT FOR PSYCHOTIC DISORDERS Most psychotic disorders are treated with a combination of medications and psychotherapy (a type of counseling). Medication: The main medications used to treat psychotic disorders are called antipsychotics. These medicines do not cure the illnesses, but are very effective in managing the most troubling symptoms of psychotic disorders, such as delusions, hallucinations, and thinking problems. Antipsychotics include older medications such as Haldol, Thorazine, and Mellaril and newer medications (often called atypicals) such as Abilify, Clozaril, Geodon, Invega, Risperdal, Saphris, Seroquel, and Zyprexa. The newer medications -- sometimes referred to as atypical antipsychotics -- are considered first-line treatments because they have fewer and more tolerable side effects.

Psychotherapy: Various types of psychotherapy, including individual, group, and family therapy, may be used to help support the person with a psychotic disorder. Most patients with psychotic disorders are treated as outpatients. However, people with particularly severe symptoms, those in danger of hurting themselves or others, or those unable to care for themselves because of their illness, may require hospitalization to stabilize their condition.

Individual psychotherapy: This involves regular sessions between just the patient and a therapist focused on past or current problems, thoughts, feelings, or relationships. Thus, via contact with a trained professional, people with psychosis become able to understand more about the illness, to learn about themselves, and to better handle the problems of their daily lives. They can become better able to differentiate between what is real and, by contrast, what is not and can acquire beneficial problem-solving skills. Rehabilitation: Rehabilitation may include job and vocational counseling, problem solving, social skills training, and education in money management. Thus, patients learn skills required for successful reintegration into their community following discharge from the hospital. Family education: Research has consistently shown that people with a psychotic disorder who have involved families have a better prognosis than those who battle the condition alone. Insofar as possible, all family members should be involved in the care of their loved one. Self-help groups: Outside support for family members of those with any psychotic disorder is necessary and desirable. The National Alliance for the Mentally Ill (NAMI) is an in-depth resource. This outreach organization offers information on all treatments for psychosis, including home care.

How Long Does It Take to Recover From a Psychotic Disorder? Each person being treated for a psychotic disorder may respond to therapy differently. Some will show improvement quickly. For others, it may take weeks or months to get symptom relief. Some people may need to continue treatment for an extended period of time, and some, such as those who have suffered several severe episodes, may need to take medication indefinitely. In these cases, the medication usually is given in as low a dose as possible to control side effects. What Is the Outlook for People With Psychotic Disorders?

The outlook varies depending on the type of psychotic disorder and the individual. However, these disorders are treatable and most people will have a good recovery with treatment and close follow-up care. What are complications of psychotic disorders? That men seem to develop these illnesses at younger ages may contribute to men having more episodes of the illness that are more severe compared to women. What is the prognosis for people with a psychotic disorder? While more than two-thirds of people who have a psychotic disorder may suffer a return of those symptoms sometime, the combination of medications, psychosocial treatment, and education of the psychotic disorder sufferer and their loved ones tends to greatly improve how well the person is able to function. The shorter the amount of time from when the person begins having psychotic symptoms to when comprehensive treatment begins, the better the prognosis. Can Psychotic Disorders Be Prevented? In general, there is no known way to prevent most psychotic disorders, but many of the related symptoms can be prevented with early detection and treatment. Seeking help as soon as symptoms appear can help decrease the disruption to the person's life, family, and friendships. Avoiding drugs and alcohol can prevent psychotic disorders associated with these substances.

REFERENCES: http://psychcentral.com/ MICHAEL BENGSTON, M.D. MARGARITA TARTAKOVSKY, M.S.

http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml http://www.webmd.com/schizophrenia/guide/mental-health-psychotic-disorders WebMD Medical Reference http://www.medicinenet.com/schizophrenia_pictures_slideshow/article.htm All Psych ONLINE