Schizophrenia and Other Psychoses

Perhaps only few other disorders are as cruel as schizophrenia. Recent discoveries suggest that certain deficits, of a soft nature and usually not regarded as ominous by parents and close relations, are present during the developmental years of an individual marked to manifest schizophrenia later in life. But the illness takes its real bite just when the patient reaches late adolescence or early adulthood, as he or she prepares to enter the central stage of life, the years of productivity, independence, family building, and personal creativity. It destroys all dreams, and it truncates the development of new ones for the rest of the patient s existence. 

For the rest of their lives, schizophrenic patients, with a few painfully rare exceptions, will be unable to lead a truly independent existence, will be unable to support themselves, will not raise a family, and will spend frequent periods of time in a hospital, in outpatient programs, and even in jail. All the while, they will be besieged by auditory hallucinations, persecutory delusions, confused thinking, and mood swings. And this existence will be shrouded by discrimination or, at the very least, indifference on the part of a society that by and large acts as if this illness does not exist. 

Most of this chapter focuses on schizophrenia—its epidemiology, pathophysiology, and treatment. Schizophrenia, however, is not the only 

TABLE 5.1. Disorders That Manifest Psychotic Symptoms 

a 53-year-old Caucasian woman, visits her primary care physician, Dr. K, because she feels pain in her arms and pressure around her eyes, and she senses some changes in her vision. Dr. K examines her, finding no medical cause for her complaints. He adds them to the long list of symptoms she has reported over several visits that have no clear medical etiology. She also tells him that she s been feeling very nervous and stressed out over the past several weeks. 

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A new class of medications has been recently introduced for the treatment of mania the atypical antipsychotics. These medications, commonly used for the treatment of schizophrenia and other psychoses, have been found to have powerful antimanic effects. Olanzapine was the first atypical antipsychotic approved for this purpose by the FDA, and others in this class soon followed. 

Schizophrenia and Other Psychoses TABLE 5.2. Some Drugs Known to Induce Psychosis ... 

Keverne, E. B. 1999. GABA-ergic neurons and the neurobiology of schizophrenia and other psychoses. Brain Res. Bull. 48 467-73. 

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