In This Chapter
Recognizing the symptoms and signs of schizophrenia
Understanding why diagnosis is tricky
Looking for warning signs
Taking action when it’s needed
If you’re like most people, you probably know little about schizophrenia aside from what you’ve seen on TV or in the movies — much of which was probably sensationalistic and inaccurate. You’re more likely to be familiar with stereotypes than facts. Yet, there’s no denying it: The symptoms associated with schizophrenia can be truly frightening, especially if the disorder isn’t accurately diagnosed and treated.
As is the case in general medicine, appropriate treatment requires an accurate diagnosis. Chapter 4 outlines the criteria that professionals use to diagnose schizophrenia — including the specific signs and symptoms that need to be present for a defined period of time, and that lead to functional impairments. That chapter also describes exclusion criteria — criteria that diminish the likelihood of a diagnosis of schizophrenia and suggest something else.
In this chapter, we describe the wide range of symptoms and signs that are seen in people with schizophrenia, as well as some of the telltale warning signs.
Recognizing the Symptoms and Signs of Schizophrenia
Like other medical disorders, schizophrenia is an illness that is characterized by symptoms and signs. Symptoms are descriptions of what a person is experiencing (often verbalized in the form of complaints). Typically, when patients visit their doctors, they freely volunteer descriptions of their symptoms (although this isn’t always the case with people with schizophrenia who often lack insight; see Chapter 6):
I feel confused and can’t think straight. I feel so depressed and have no energy. I haven’t been able to sleep or get out of bed.
Other times (when people aren’t aware of what they’re feeling), a friend, family member, or doctor may ask one or more questions designed to elicit symptoms — for example:
You look very pale. Are you feeling okay? ‘ How is your mood? You seem so sad.
You look like you’re distracted. Are you hearing voices?
I’m worried about you. Are you thinking of hurting yourself?
Signs are observations that are made about a person based upon what others see, without the individual necessarily verbalizing his problems. For example:
You see someone crying. You see someone sweaty and shaky. You see someone refusing to eat or drink. You see someone staring into space.
Not every person with a particular disorder will have the same symptoms and signs. And no person will have all of them. For each individual, symptoms and signs may change in severity, reappear, or disappear over time.
The primary symptoms associated with schizophrenia fall into three broad categories: positive symptoms, negative symptoms, and cognitive symptoms. And some other symptoms don’t fall neatly into any of these categories. We cover these in the following sections.
Positive symptoms: What’s there
Positive symptoms are the easiest to see, the most dramatic, and, in general, the ones that demand attention. One reason they’re referred to as positive symptoms is that they add to, or alter reality. Twenty years ago, positive symptoms were the only symptoms that were noticed because they’re the ones that are most closely tied to psychosis.
The term psychosis doesn’t refer to a specific disorder (such as schizophrenia, depression, or bipolar disorder) but rather to the condition of being out of touch with reality. Psychosis is usually a temporary state — one in which a person is having positive symptoms like delusions, hallucinations, or other grossly abnormal distortions of thinking and perception, which we cover in more detail later in this chapter.
Before the availability of antipsychotic medications, persons with schizophrenia, and those who cared for them, spent most of their energies trying to control the tormenting positive symptoms that made patients agitated and unapproachable.
Symptoms may appear slowly over time, or may come on suddenly and intensely like an acute fever. In either case, it’s important to recognize when something seems wrong and to seek immediate professional medical and/or mental-health help.
Hallucinations
Hallucinations are false sensory perceptions. They’re probably the most dramatic or frightening symptoms of schizophrenia, both to the person with the disorder and to those around her. These false perceptions can affect all the senses:
Hearing, in the form of auditory hallucinations: The person hears voices or sounds that aren’t there. Auditory hallucinations are the most common type.
Sight, in the form of visual hallucinations: The person sees something that isn’t really there. Visual hallucinations may be visions or signs to which the individual with schizophrenia attaches great meaning or significance.
Smell, in the form of olfactory hallucinations: The person smells odors, usually bad ones, like rotting organic matter, that no one else smells.
Touch, in the form of tactile hallucinations: The person feels the presence or touch of someone or something when no one is actually present. People with both mental illness and substance-use disorders commonly feel bugs crawling over their bodies (sometimes as a result of using cocaine).
Hallucinations are perceptions that are experienced only by the individual with schizophrenia and are not shared by others. Most hallucinations are frightening, especially initially, but then the individual may find some way to incorporate the hallucination into his altered reality in an effort to make it more understandable.
Auditory hallucinations are, by far, the most common type of hallucination. They are experienced differently by different patients, but often, they begin with whispers or mumbling and then become clearer. The person experiencing the voices is unable to recognize that they’re coming from within her own head; instead, she attributes them to coming from outside her, like other voices or sounds people hear.
The voices are often threatening or accusatory, blaming the individual for having done something bad. When the voices persistently order a person to do something that he wouldn’t ordinarily do, or wouldn’t even think of doing, these are called command hallucinations. Sometimes a person will initially reject the voices or complain about them, but may later become convinced that the voices are “real” and even try to talk back to them.
Someone who’s experiencing auditory hallucinations may seem to be in a world of her own, not listening to others or staring into space. Other times, a person experiencing auditory hallucinations may try to listen to the real person she’s with, but “the voices” make it seem as if she’s listening to two or more people speaking at the same time, which makes it hard to respond correctly or quickly.
The voices may be very persistent (even interfering with sleep), or they may come and go, with the individual unable to predict when they’ll recur — a frightening experience. Stressful situations can make auditory hallucinations worsen, but they can intensify for no reason at all. If a person with schizophrenia is confronted with the reality that no one else hears the same voices, the individual may simply stop talking about them or not tell others that she’s hearing them. Treatment with antipsychotic medication usually decreases or removes the voices entirely, or reduces the individual’s concern about or fear of them.
Delusions
Delusions are false beliefs that the person with schizophrenia accepts as true; no amount of evidence or explanation can change the person’s belief. Most frequently, delusions take the form of a belief that some individual or group is after the person with schizophrenia or wants to harm or control him. Delusions are often accompanied by feelings of suspiciousness, which are then referred to as paranoid delusions.
Sometimes the delusions are not clearly formed, and the person feels suspicious or threatened but doesn’t attribute it to a particular individual or group. Other times, the individual may believe she has been given great or unusual powers and is able to do things that normal humans cannot do. These delusions are referred to as delusions of grandeur, which are often, but not always, associated with religious beliefs. For example, someone may believe that he is Jesus Christ, the devil, or some important person in history.
Voices may tell the person that he has great powers. There may be accompanying visions and signs, which “prove” to the individual that what the voices are saying is true. Generally, no rational discussion can dissuade someone from his false belief. In fact, confronting the individual with the truth often angers the person with schizophrenia and convinces him that anyone who doesn’t share his beliefs is against him.
Directly confronting delusional thoughts or beliefs often worsens the situation. Just not agreeing to or not directly confirming the false belief may be a wiser approach.
Because psychotic thinking is the result of a brain disorder, trying to make sense of the content of the hallucination or delusion is as useless as trying to understand the meaning of a kidney stone! Instead of wasting time and energy trying to understand what it means, recognize it as a sign of disturbed thinking and focus on getting your loved one the help he needs.
Antipsychotic medications often lessen or eliminate delusional thinking to the point where a skilled therapist can then discuss the problem of the false belief with the person.
The 2002 Academy Award-winning film A Beautiful Mind vividly portrays the delusions and visual hallucinations experienced by mathematician John Nash, who was diagnosed with schizophrenia. It has played a pivotal role in raising awareness about the symptoms of schizophrenia for a generation of moviegoers.
Disorganized thinking
Less dramatic, but just as damaging to a person’s ability to function in reality is another positive symptom known as disorganized thinking, which can affect speech and/or writing. Instead of being able to hold an organized and logical conversation (thinking about one topic or one issue in a proper sequence), the person with schizophrenia may:
Jump from one topic to another.
Make up words that don’t exist. These words are known as neologisms. ‘ Repeat words or thoughts.
Jump from one word to another that sounds alike but really has no relationship to the first word.
The individual may sound very earnest, and feel like he’s making sense, but other people are unable to follow his train of thought or logic. This situation may be just as frustrating to the speaker as it is to the listener.
When you think about hallucinations, delusions, and disorganized thinking, you realize how severe these positive symptoms can be and how they undermine an individual’s ability to think coherently and rationally. (See Chapter 12 for techniques for coping with these symptoms.)
Negative symptoms: What’s missing
Negative symptoms are what’s missing or lacking in an individual’s mind and behavior as a result of schizophrenia. Negative symptoms often aren’t as well defined or clear cut as positive ones, so they’re often confused with depression or laziness — but they’re part of schizophrenia and can be just as debilitating.
No matter how they look from the outside, negative symptoms are part of a brain disorder. They aren’t due to a lack of moral fiber on the part of the person with the illness.
An individual with negative symptoms of schizophrenia may have a blank stare that looks “spacey.” She may seem unresponsive to other people and things in the environment. Also, the individual’s speech may be monotone or flat, without any inflection offering you a hint of her true feelings. The person with negative symptoms of schizophrenia may also display the following symptoms:
An inability to experience simple pleasure from people or things around him: This is known as anhedonia.
Lack of initiative, motivation, or willfulness: This is known as avolition.
Lack of or limited speech: The person may be slow in responding, have only a limited range of response, or not even respond at all. This is known as alogia.
A lack of emotions or feelings: The person may look expressionless — not showing any signs of happiness, excitement, or anger. This is known as flat or blunted affect. Some research suggests that this may be more a matter of appearance rather than a reflection of the individual’s inability to feel emotions.
After treatment, many families complain that while their relative is no longer psychotic, the person is “wasting her life” watching television in a room with few outside interests. They feel very frustrated because nothing they do or say motivates the person to become more engaged in the world around her. Families need to understand that this isn’t something the person has control over or is doing to annoy them — it’s part of the illness.
People used to think that these symptoms were the result of the side effects of medication or of institutional treatment (which, in the past, often included long hospital stays). But today, most experts agree that negative symptoms
are probably due to brain dysfunction. Some researchers have studied people with schizophrenia early in the course of their illness and found that they had motivational deficits even then. Many believe, in fact, that negative symptoms may emerge before positive ones do.
Although medication is highly effective in treating positive symptoms, it has been less successful in treating negative symptoms, which can remain unchanged or only marginally improved even when positive symptoms go away. It is generally believed that newer antipsychotic medications (see Chapter 8) are just as effective as older ones in controlling positive symptoms, but may be slightly more successful in minimizing negative symptoms.
Approximately one in four patients with schizophrenia may have deficit syndrome, persistent negative symptoms that are not secondary or due to other causes (such as depression or medication side effects). The importance of finding ways to treat negative symptoms can’t be underestimated. Failure to do so can compromise an individual’s quality of life and impair her ability to work and maintain meaningful social ties.
Cognitive symptoms: Changes in mental functioning
Unfortunately, even when positive symptoms are controlled, people with schizophrenia may have severe problems with cognitive (thinking) tasks. A person with schizophrenia may be unable to remember things he’s been told, and he may have problems following directions or keeping track of time or appointments. For example, a person with schizophrenia may not be able to remember or follow simple instructions like “If you feel agitated, don’t drink coffee.” Following directions about which prescribed medications to take in the morning and which to take in the evening can be just as difficult.
If the person returns to school or work, tasks that were in the past very doable, can now seem insurmountable. For example, the person may be unable to focus or concentrate. Neuropsychologists have devised and administered very specific tests to identify the particular thinking problems and where they occur in the brain.
Working memory (the ability to hold a fact in mind to be used later — for example, to remember that the 4 p.m. train will be on track no. 5 has been found to be impaired in many people with schizophrenia, as have verbal abilities. Cognitive symptoms make it extremely difficult for some people with schizophrenia to carry out what seem like simple tasks or to be able to hold down a job. For example, people with this type of cognitive problem should choose jobs that maximize their skills and minimize the need for working memory. (It might be difficult for them to be waiters who have to remember complex orders in a busy restaurant.)
In fact, it has been found that cognitive symptoms and negative symptoms (see the “Negative symptoms: What’s missing” section, earlier) are more difficult for people to overcome than positive ones, and that they prevent recovery and a return to normal life in a more profound way than the more dramatic positive symptoms.
Because of the importance of cognitive symptoms in preventing recovery, the National Institute of Mental Health (NIMH) is supporting the development of a standard battery of neuropsychological tests to assess the severity of these problems in individuals. The NIMH is also supporting research to discover medications to treat cognitive impairments like the antipsychotic drugs used to treat hallucinations and delusions.
Negative symptoms and cognitive symptoms may sometimes get better or worse together — but they are really separate features of schizophrenia related to different areas and circuitry in the brain. Thus, positive, negative, and cognitive symptoms have to be treated separately, but concurrently, for a truly comprehensive approach to the treatment of schizophrenia. Many people now believe that negative and cognitive symptoms are really the core symptoms of schizophrenia and that, until there are effective treatments, schizophrenia will remain a major public-health problem.
Although there are currently no known effective medications to treat cognitive symptoms, various psychosocial interventions may be of help.
Other disturbing symptoms and behaviors
In addition to the three major categories of symptoms — positive, negative, and cognitive — other symptoms are frequently seen in people with schizophrenia. These symptoms are not specific to schizophrenia — in fact, if these symptoms are seen alone (without the positive, negative, and cognitive symptoms we describe earlier), they probably indicate that the illness being seen is not schizophrenia. Typically these other symptoms are more likely to fluctuate in severity than positive, negative, and cognitive symptoms do.
As treatment progresses, these other symptoms tend to emerge, as the more obvious positive symptoms of schizophrenia tend to recede.
Again and again: Obsessive-compulsive behaviors
It is not uncommon for people with schizophrenia to engage in repetitive behaviors like rocking, rubbing their hands together, or getting up and down over and over. Likewise, individuals may complain that the same thought or idea keeps going through their minds even though they don’t want it to.
Some of these repetitive unwanted behaviors are made worse when a particular antipsychotic medication, clozapine, is used to treat schizophrenia. Reducing the dosage of clozapine (brand name: Clozaril) will sometimes help. Adding an antidepressant medication like fluoxetine hydrochloride (brand name: Prozac), a selective serotonin uptake inhibitor (SSRI), may also help reduce the behavior.
Sometimes the need to move around and pace is not a compulsive behavior, but a side effect called akathisia, which is usually associated with high-potency, first-generation antipsychotic medications like haloperidol (brand name: Haldol). (See Chapter 8 for a more in-depth discussion of psychotropic medications and their side-effects.)
Ups and downs: Mood swings
Shifts in mood, more often in the direction of sadness or depression rather than mania, are fairly common in schizophrenia. Depressive symptoms can be so severe and persistent that the diagnosis may change from schizophrenia to schizoaffective disorder (which includes elements of both a thought disorder and a mood disorder). The diagnosis of schizoaffective disorder is even more likely if mood varies between depression and elation (known as hypomania). When this is the case, a mood stabilizer such as lithium or val-proate (brand name: Depakote) will generally be added to the antipsychotic medication.
Depression sometimes becomes apparent when the person with schizophrenia is showing fewer positive symptoms, and he realizes how sick he’s been and how his life has been disrupted by the illness. Depression can become so severe that suicidal thoughts and behavior can occur. If suicidal thoughts become prominent, clozapine (brand name: Clozaril) has been found to be the most effective antipsychotic medication.
If sadness, loss of appetite, and sleeping difficulties become the prominent symptoms, treatment with an antidepressant drug is often indicated. Your loved one’s psychiatrist must be careful when starting someone on an antide-pressant — they need to make sure that positive symptoms are not made worse or that your loved one isn’t moved toward manic behavior. Careful and accurate reporting — by the person with schizophrenia, as well as family and friends — will help the psychiatrist adjust the medication dosage.
Wired: High anxiety
A person with schizophrenia may sometimes feel excessively anxious or nervous, sometimes for no apparent reason. Anxiety may be so severe that it interferes with the person’s ability to fall asleep. Then the sleeplessness may exacerbate positive symptoms (especially paranoia). On a very short-term basis, for severe anxiety, an anti-anxiety medication like Valium may be used, but an anti-anxiety med should not be used regularly or long term.
Be sure to report back to the psychiatrist whether your loved one’s anxiety (nervousness, worry, sweating) is getting better, getting worse, or staying the same.
Sometimes if an individual is becoming increasingly anxious and positive symptoms are getting worse, the person may begin to display catatonic behavior, which is characterized by holding fixed positions for a long period of time. When the catatonic person’s arms are moved, there is a feeling of resistance, called waxy flexibility. The treatment for catatonic behavior usually entails increasing the dosage of antipsychotic medication.
Sleepless: Going on empty
Sleep problems are very common in people with psychiatric disorders. No one should be allowed to become truly sleep-deprived, because sleep deprivation can worsen the symptoms of schizophrenia. Instead of just prescribing a sleeping pill, the psychiatrist should try to understand why your loved one is not sleeping (for example, she may be afraid of symptoms, hearing noises, or sleeping too much during the day) and recommend an appropriate remedy.
Knowing Why Diagnosing Schizophrenia Is Tricky
If you ask families to describe the onset of schizophrenia, no two stories will be exactly the same. One reason that you’re likely to get widely divergent descriptions is because sometimes schizophrenia creeps in slowly until its appearance becomes blatant, and other times it appears to come on suddenly, like a bolt of lightning out of the blue.
The earliest signs of schizophrenia can be subtle and nonspecific, tending to wax and wane over the course of weeks, months, or even years. A person can be fine one morning, overtly psychotic the same evening, and fine again the next morning. When you’re living with an individual or seeing him every day, the changes taking place can be so subtle that you may not even realize that something is wrong. Another factor that comes into play: You’re always hoping for the best — that the symptoms will disappear on their own. Even looking back, you may be unable to mark the precise time when you could no longer deny that your loved one was ill and desperately needed help.
The term first break is used to define the onset of schizophrenia. It’s usually marked by both positive and negative symptoms that are serious enough that they obviously necessitate some form of treatment, which may or may not include hospitalization. (For an example of a first break that came on suddenly, check out the “It happened all of a sudden” sidebar, in this chapter. We’ve changed the names and details to protect people’s privacy.)
It happened all of a sudden
Marge Faber, a homemaker and part-time real-estate agent, breathed a sigh of relief when the last of her three boys was ready to go off to college. She and her husband, Frank, would have more time to travel and to visit their first grandchild, whose parents had escaped the brutal winters of Buffalo, New York, and relocated to Tampa, Florida.
Marge’s youngest, 19-year-old Brett, was an easy-going kid who was always popular with his peers. Except for the usually sibling rivalry and competitiveness common among boys, the brothers got along exceptionally well. Brett admired his brothers, who were two and four years older than he was.
Brett was always a solid student, so he had his choice of schools to attend. When he was offered a soccer scholarship at a large university in the Southwest, he enrolled in a program in the university’s College of Education. The summer before his freshman year, Brett worked at a local day camp as a swim instructor.
A week after Brett arrived on campus, he locked himself in his dorm and refused to eat. His roommates, who had only met him on Facebook (www.facebook.com), were concerned and told the resident assistant in the dorm. That same evening, Marge and Frank got a call from the school’s student health services alerting them to what had happened. They called Brett and couldn’t get a coherent story — he was whispering so low that they could barely hear him.
After a sleepless night, Marge and Frank flew out to check on Brett. When they arrived at the school, he was pacing and looked very nervous. He told them that he hadn’t been able to sleep or leave the dorm for meals because people in the next room were plotting a Columbine-style attack on campus. They asked questions, but Brett’s answers made no sense. They knew something was wrong.
This was the first time that Brett had been away from his close and very supportive family. Maybe he was having difficulty adjusting, Marge thought. So they stayed at a hotel close to campus for another week and visited Brett every day. But the situation didn’t improve. Brett still refused to eat or leave the room. He insisted on doing 250 push-ups to build up his strength, in case he needed to protect himself and his roommates. After doing just 20 push-ups, he fell to the floor in exhaustion. His parents called 911 and accompanied Brett to the emergency room of the local hospital. A psychiatrist on call met with Brett when they arrived. Brett confided to the doctor that voices had been telling him to build his strength to ward off the attackers.
He was diagnosed with paranoid schizophrenia, and the doctor prescribed olanzapine (brand name: Zyprexa), which Brett agreed to take. Marge and Frank took him back to their hotel room for a week to watch over him. He told them that the voices weren’t as loud, but they were still there. The Fabers decided to take their son back to Buffalo for care until the next semester.
They were stunned. “He was the perfect child until he became ill,” Marge said, as she recounted the story 15 years later. At the age of 34, Brett was never able to complete his education and still lives at home in the same bedroom where he grew up, spending most of his time listening to music or watching TV. Over the years, he has been on a variety of medications, each with different side effects, but none has been able to completely quell the voices.
We always knew something was wrong
“She always seemed different,” said Liz Turner as she began to tell us about her daughter Erin, now 41 years old. “Something wasn’t right,” she said. Erin was Liz’s first child, so she really had no yardstick to gauge things by until her daughter Meg was born, ten years later. “There were signs I didn’t see or didn’t want to see,” Liz said.
Erin was oxygen-deprived at birth but “sort of” met all the milestones her mom faithfully chronicled in her baby topic. Her speech was a bit delayed, and she wasn’t that responsive to other people. Everything annoyed her — from the labels on her clothes to the noise of the vacuum cleaner. By second grade, Erin was afraid to go to school and clung to her mother’s apron strings. By fifth grade, she tested high in certain subjects but was lower in others, especially mathematics. Erin was always considered a “cry-baby” by the other kids at school. In fact, she seemed to prefer to be alone and was never invited on play dates or to parties.
By the time Erin was a teen, she looked a bit eccentric — she’d dyed her hair pink and sported a tattoo on her ankle. She suddenly became very outgoing and began hanging out with a group of kids who were always getting into trouble. Liz found some marijuana in Erin’s room and knew she had been smoking but figured that kids would be kids — Erin wasn’t the only one of her peers smoking pot. Her moods changed on a dime, and her parents were baffled — unsure whether it was the drug use or something else.
One night, Erin stole several $20 bills and a gold necklace from a neighbor’s home. She let herself in the open back door and helped herself without thinking about the consequences. When the neighbor returned home and found her exiting the house, she was caught red-handed. The neighbor, who was always irritated by the loud music coming from the Turners’ house, pressed charges.
A kind-hearted police officer said he would get the neighbors to drop the charges if the Turners took Erin for a psychiatric evaluation. They were humiliated by the thought of mental illness in their family, but they had no choice. The doctor met with Erin several times, and Erin admitted that she had been hearing voices — they had been such an integral part of her existence since she was a child that she thought everyone else heard them, too. She said that smoking pot made them go away, even for an hour or so.
The doctor spoke to the family and explained that Erin had a diagnosis of schizoaffective disorder. Liz’s husband, Tim, said that an aunt on his side of the family had some problems, but people didn’t talk about them much at the time. As stunned as they were, the family was happy that they finally could attach a name to what was wrong and get the proper medication to help treat the illness.
Diagnosing schizophrenia is complicated by the fact that the typical age of onset of the disorder overlaps with the tumultuous roller-coaster years of adolescence. In teens, the first symptoms of schizophrenia tend to emerge so slowly or so vaguely that they mimic or overlap “normal” adolescent behaviors. With surging hormones and pressures to fit in with their peers, most teens tend to be moody and restless. Also, the typical teen is often prone to engage in risky behaviors, including experimentation with drugs and/or alcohol.
The average parent — and even the average teacher or pediatrician — usually can’t differentiate between the typical turmoil of adolescence and the first warning signs of schizophrenia, especially when the symptoms or signs are masked by illicit substance use. For this reason, most parents of people with schizophrenia say they never understood the disease or recognized its symptoms until long after it hit. (For an example of this, check out the sidebar, “We always knew something was wrong,” in this chapter. We’ve changed the names and details to protect people’s privacy.)
When to Worry: The Warning Signs
Before any overt signs of psychosis appear (in a period known as the prodromal phase), people with schizophrenia may experience some non-psychotic symptoms that are the very first signs of the disorder. Here are some of the warning signs of schizophrenia:
Social withdrawal and an increased tendency to remain alone A decline in performance at school or work Loss of motivation and an inability to concentrate Increased irritability, depression, and/or anxiety Suspiciousness
Neglect of physical appearance Changes in sleep patterns
Talking about or actually trying to hurt or kill oneself isn’t a warning sign. It is a red flag that should be taken seriously. If your loved one is talking about suicide, you should take immediate action — have him evaluated by a mental-health clinician.
One study in Australia followed a group of approximately 100 young people with symptoms that didn’t quite meet the criteria for diagnosis, but who had a family history of schizophrenia, to see if they could predict those who would go on to develop the disorder. One-third of the group developed psychotic symptoms within a year, which was predicted with a high level of accuracy based on the research participants’ initial symptoms.
There is increasing recognition that the public, in general, needs to become mental-health literate and be able to recognize the earliest signs and symptoms of a mental-health problem. A 12-hour training program called Mental Health First Aid was developed in Australia to help the public identify, understand, and respond to a mental-health problem or crisis. The program is being brought to communities across the United States under the sponsorship of the National Council for Community Behavioral Healthcare. To find out more about the program, contact the National Council at 301-984-6200 or go to www. thenationalcouncil.org.
Taking Action: Getting Treatment for Your Loved One Right Away
The duration of untreated psychosis (DUP) is the period of time between the onset of the first psychotic symptoms and the time a person receives treatment. According to a recent study commissioned by the National Alliance on Mental Illness (NAMI), the average duration of untreated psychosis is more than eight years. This lag is due to a number of factors, including:
Stigma related to mental illnesses
Lack of health insurance coupled with the high cost of care
The limitations of mental-health literacy (the general public’s knowledge and beliefs concerning mental disorders)
Unlike many other physical or mental disorders, schizophrenia is a disorder that is rarely over-diagnosed or diagnosed too quickly. Even when family members are aware of symptoms and signs of the illness, they may fail to do anything, hoping the symptoms will resolve on their own. Plus, family doctors and pediatricians are often uncomfortable suggesting that a patient may have schizophrenia — it isn’t something they’re used to diagnosing or treating. And even psychiatrists may be reluctant to deliver the message.
If you suspect that someone you know may have schizophrenia, have the individual seen by a psychiatrist who specializes in the disorder. If you’re a parent or close relative, have confidence in your gut instinct that something is wrong and get it checked out; you’ve probably known the person longer and better than anyone else.
Getting a diagnosis is the first step in getting help. In most cases, your fears and suspicions will be allayed by someone who is expert and knowledgeable about diagnosis and treatment of the disorder. (Turn to Chapter 4 for more information on getting a diagnosis.)
