Treating Schizophrenia: New Strategies

Article excerpt

Schizophrenia is a complex disease of uncertain etiology, afflicting approximately 1% to 2% of all populations worldwide, including three million Americans. It causes untold suffering for patients as well as their families. In the United States, direct and indirect costs of schizophrenia are more than $30 billion annually, and this figure does not include the costs associated with homelessness (an estimated 33% to 50% of homeless Americans are schizophrenic).

Schizophrenia is a psychotic disorder that is poorly understood and often mistaken by the public as a more debilitating dementia. Many people erroneously believe that schizophrenia involves a divided psyche or multiple personalities and that schizophrenics are prone to violence. The fact is that schizophrenics do not suffer from multiple personalities, and although their behavior may sometimes become violent, they are far more likely to withdraw from society. Although there is no known cure for schizophrenia, many of the newer antipsychotic (AP) agents have allowed many patients to live relatively normal lives.

Because schizophrenia usually appears early in life (most commonly between the ages of 16 and 30) and can often be chronic, the costs of the disorder are substantial.

With the varying chemical therapies and side effects associated with the treatment of schizophrenia, the pharmacist can play an important role in overall successful treatment of these patients. For example, the pharmacist can help the patient and family better understand the disease, its early signs and symptoms (Table 1), and, most important, the side effects associated with drug therapy.

Epidemiology and etiology

The prevalence of schizophrenia varies, but the results of most studies suggest a rate of slightly less than 2% of the population. The disorder appears to be uniformly distributed worldwide, although pockets of high or low prevalence may exist.

The etiology of schizophrenia is not fully understood; however, it appears that approximately 10% of the patients with schizophrenia will have a parent who suffers from the illness. This is believed to indicate a genetic basis rather than an environmental one. Nevertheless, stress can precipitate the illness and is well implicated in people who are genetically predisposed to the disease (Table 2).

If there is no family history of schizophrenia, the chances of being diagnosed with the disease are only 1 in 100. If the disease exists within the immediate family, the chances increase to approximately 1 in 10. If both parents are schizophrenic, there is a 1-in-4 chance of being diagnosed with the disease. If a person's parents or siblings have schizophrenia, the chances of the person's children acquiring the illness are only slightly increased (3 in 100).

Scientists have identified a number of genes that may be linked to schizophrenia. This suggests that different kinds of biochemical problems may lead to schizophrenia in different people (just as there are different kinds of arthritis). Nevertheless, many factors besides genetics are also involved. Research is currently under way to identify these factors and learn how they affect one's chances of developing the illness. Although many studies have looked for a correlation, there is no evidence to suggest that schizophrenia is caused by bad parenting, trauma, abuse, or personal weakness.

Drug treatment allows many patients suffering from schizophrenia to be symptom free, but approximately one-- fifth to one-third of schizophrenic patients do not respond adequately to drug treatment. The proportion of patients with this "drug-- resistant" schizophrenia has remained consistent over time, and the treatment of these patients is a persistent public health problem. Unfortunately, treatment-resistant patients are often highly symptomatic and generally require extensive periods of hospital care.

The dysfunction of several neurotransmitter systems like dopamine (DA), 5-hydroxytryptamine (5-HT; serotonin), and glutamate (GLU) are thought to play a part in schizophrenia. …