Posted on June 19, 1998
We are devastated by the news of the terrible tragedy of Caroline Costello’s death. Our hearts break for this young woman and her family. Our compassion and tears over her death also extend to Michael Laudor’s family who showed never-ending love and support for their son since his initial diagnosis of schizophrenia. And, we are profoundly saddened for Michael—who was such a valiant warrior and role model for others struggling with schizophrenia.
Michael Laudor had overcome huge odds to reclaim his life, graduate from Yale Law School, and devote his many talents to helping others. His story inspired thousands of people with severe mental illness, who like my daughter, saw him as a symbol of courage and success in their own battle to overcome stigma and lead independent lives.
Schizophrenia is a chronic and disabling brain disorder that affects approximately two million Americans each year. It impairs a person’s ability to think clearly, manage his or her emotions, make decisions, and relate to others. Great progress has been made in understanding and treating this crippling brain disorder. We now know that people with schizophrenia do best when they receive a combination of medication and intensive, ongoing community support. Recovery is, for the first time, a real possibility for many individuals with schizophrenia.
But we have a long way yet to go. Science has not yet revealed the cause of schizophrenia. Treatments remain imperfect. The treatments and supports that do work are often unavailable. Violence may be the outcome for some people with schizophrenia who are not in treatment, for whom treatment doesn’t work, or who also have a drug or alcohol problem. Families and friends, who are usually the strongest advocates for their loved ones, are unfortunately most often the victims of this aggression.
What does this tragedy teach us? Several things:
- We need to press for more research into the causes and treatments of this costly and too-often deadly disease.
- We need to ensure that the men and women struggling with schizophrenia are able to get the medications and community supports that can make such a life-saving difference to one’s recovery.
- We need to make sure that when individuals become symptomatic they are provided immediate intervention and a network of care. We also need to remove legal barriers which prevent access to immediate treatment when people need it.
- And, as horrific as this situation is, we must realize that people with schizophrenia are people first. They have hopes and dreams. They have families who—like so many NAMI families—want only the best for their loved one. And, they are, like Michael Laudor, capable of such promise.
FACTS ON SCHIZOPHRENIA
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Schizophrenia is a brain disorder that affects approximately two million Americans today, or between one and two percent of the population. Schizophrenia can affect anyone at any age, but most cases develop between adolescence and age 30. Children can be affected by schizophrenia, but this is uncommon.
- Schizophrenia impairs a person’s ability to think clearly, manage his or her emotions, make decisions, and relate to others.
Symptoms of Schizophrenia:
- The symptoms of schizophrenia are generally divided into three categories, including positive, disorganized and negative symptoms.
- Positive Symptoms, or "psychotic" symptoms, include delusions and hallucinations because the patient has lost touch with reality in certain important ways. "Positive" as used here does not mean "good." Rather, it refers to having overt symptoms that should not be there. Delusions cause the patient to believe that people are reading their thoughts or plotting against them, that others are secretly monitoring and threatening them, or that they can control other people’s minds. Hallucinations cause people to hear or see things that are not there.
- Disorganized Symptoms include confused thinking and speech, and behavior that does not make sense. For example, people with schizophrenia sometimes have trouble communicating in coherent sentences or carrying on conversations with others; move more slowly, repeat rhythmic gestures or make movements such as walking in circles or pacing; and have difficulty making sense of everyday sights, sounds and feelings.
- Negative Symptoms include emotional flatness or lack of expression, an inability to start and follow through with activities, speech that is brief and lacks content, and a lack of pleasure or interest in life. "Negative" does not, therefore, refer to a person’s attitude, but to a lack of certain characteristics that should be there.
Diagnosing Schizophrenia:
- To be diagnosed with schizophrenia, a patient must have psychotic, "loss-of-reality" symptoms for at least six months and show increasing difficulty in functioning normally.
- Before diagnosing schizophrenia, it is important for the doctor to rule out other problems that may resemble it, including psychotic symptoms caused by the use of drugs or other medical illnesses; major depressive episode or manic episode with psychotic features; schizoaffective disorder (has features of both mood disorder and schizophrenia); delusional disorder ( no hallucinations, disorganized speech or thought or "flattened" emotions) and autistic disorder or personality disorders (especially schizotypal, schizoid, or paranoid personality disorders).
- Although the cause of schizophrenia has not yet been identified, recent research suggests that schizophrenia involves problems with brain chemistry and brain structure. Scientists are currently investigating viral infections that occur early in life, mild brain damage from complications during birth, and genetic predisposition as possible factors. Brain-imaging technology has demonstrated that schizophrenia is as much an organic brain disorder as is Multiple Sclerosis, Parkinson’s or Alzheimer’s disease.
Treating Schizophrenia:
- While there is no cure for schizophrenia, it is a highly treatable disorder. In fact, the treatment success rate for schizophrenia is 60 percent, compared with 41-52 percent for heart patients.
- It is important to diagnose and treat schizophrenia as early as possible to help people avoid or reduce frequent relapses and re-hospitalizations. Several promising, large-scale studies suggest early intervention may forestall the worst long-term outcomes of this devastating brain disorder.
- People who experience acute symptoms of schizophrenia may require intensive treatment, sometimes including hospitalization. Hospitalization is necessary to treat severe delusions or hallucinations, serious suicidal inclinations, inability to care for oneself, or severe problems with drugs or alcohol.
- It is critical that people with schizophrenia stay in treatment even after recovering from an acute episode. About 80 percent of those who stop taking their medications after an acute episode will have a relapse within one year, whereas only 30 percent of those who continue their medications will experience a relapse in the same time period.
- Medication appears to improve the long-term prognosis for many people with schizophrenia. Studies show that after 10 years of treatment, one-fourth of those with schizophrenia have recovered completely, one-fourth have improved considerably, and one-fourth have improved modestly. Fifteen percent have not improved, and 10 percent have died, usually by suicide or accident.
- Despite media focus on the exceptions, individuals receiving treatment for schizophrenia are no more prone to violence than the general public. Unfortunately, almost one-third of all U.S. jails incarcerate people with severe mental illnesses who have no charges against them, but are merely waiting for psychiatric evaluation or the availability of a psychiatric hospital bed.
- One of the most effective tools in treating schizophrenia is by Programs for Assertive Community Treatment (PACT), an intensive team effort in local communities to help people stay out of the hospital and live independently. Available 24-hours-a-day, seven-days-a-week, PACT professionals meet their clients where they live, providing at-home support at whatever level is needed, for whatever problems need to be solved. Professionals can make sure that clients are taking their medication and help them meet the challenges of daily life – every day tasks ranging from grocery shopping and keeping doctor appointments to managing money and getting along with others.
- PACT programs are now statewide in four states and growing in another 20 states. In these places, PACT is significantly reducing hospital admissions, improving the quality of life, and improving functioning for those it serves.
Antipsychotic Medications:
- Antipsychotic drugs are used in the treatment of schizophrenia. These medications help relieve the delusions, hallucinations, and thinking problems associated with this devastating disorder. These drugs appear to work by correcting an imbalance in the chemicals that help brain cells communicate with each other. As with drug treatments for other physical illnesses, many patients with severe mental illnesses may need to try several different antipsychotic medications before they find the one, or the combination of medications, that work best for them.
- Conventional or Standard Antipsychotics include: chlorpromazine (Thorazine); fluphenazine (Prolixin); haloperidol (Haldol); thiothixene (Navane); trifluoperazine (Stelazine); perphenazine (Trilafon) and thioridazine (Mellaril).
- Atypical Antipsychotics are newer drugs with fewer side effects and include: risperidone (Risperdal); clozapine (Clozaril); olanzapine (Zyprexa) and sertindole (Serlect).
- Since these medications do not work immediately, experts recommend that doctors give the antipsychotic time to take effect and wait at least three weeks after starting one antipsychotic before switching to another.
- Antipsychotic drugs are usually taken daily in tablet or liquid form. Fluphenazine (Prolixin) and haloperidol (Haldol), for example, also can be given in long-acting injections (called "depot formulations") at one- to four-week intervals. With depot formulations, medication is stored in the body and slowly released. This can be especially helpful for patients who have a hard time taking pills on a daily basis.
Possible Antipsychotic Medication Side Effects:
- As a group, antipsychotic drugs are safe, and serious side effects are relatively rare. Some people may experience side effects that are inconvenient or unpleasant, but not serious.
- Most common side effects: dry mouth, constipation, blurred vision, and drowsiness.
- Less common side effects: decreased sexual desire, menstrual changes, stiff muscles on one side of the neck and jaw.
- More serious side effects: restlessness, muscle stiffness, slurred speech, tremors of the hands or feet, and agranulocytosis, which suppresses the production of white blood cells (when taking clozapine) and requires monitoring.
- Tardive Dyskinesia is the most unpleasant and serious side effect of antipsychotic drugs causing involuntary facial movements and sometimes jerking or twisting movements of other parts of the body. This condition usually develops in older patients, affecting 15 to 20 percent of those who have taken older antipsychotic drugs for years.
