Learn About Schizophrenia

What is Schizophrenia?

Schizophrenia is a disorder of thought and perception, usually with an onset in young adulthood and a chronic, deteriorating course. The hallmarks of the disorder include delusions, hallucinations, and a deterioration in functioning, sometimes severe. Hallucinations are a disorder of perception in which one hears voices not heard by others or sees things that others cannot see. Delusions are a disorder of thought in which a false belief is rigidly held against all evidence to the contrary. Other disorders of thought include loosening of associations, in which one thought loses its logical connection to the next; thought blocking, in which the flow of thought is abruptly derailed; and poverty of thought, in which the content of the mind is relatively vacuous. In the context of these disorders of perception and thought the person with schizophrenia becomes increasingly preoccupied with his interior world to the exclusion of the larger reality in which we all find ourselves. This leads to a neglect of the ordinary demands of daily life, especially concerning interpersonal relatedness.

Of necessity, the foregoing is a simplification but captures the essence of the disorder. It usually has an insidious onset, with increasingly odd behaviors and beliefs, together with a loss of function. Even with treatment the person with schizophrenia rarely recovers to the point they were when at their best. Modern treatments for schizophrenia have come a long way in terms of helping with the disorders of perception and some of the disorders of thought content (e.g., delusions) with improved tolerability. However, even these treatments fall short of rehabilitating the problems of thinking and behavior characteristic of the illness and imparting the greatest impairment. For more information on the challenge posed by these persisting illness features see the companion article What is Negative Symptom Schizophrenia in these health topics.

Most people know schizophrenia as an illness with hallucinations (hearing or seeing things that aren’t there), delusions (unshakable belief in things that are untrue) and bizarre, unpredictable behaviors – the so-called “productive” symptoms of the illness. But modern medications have played a major role in diminishing and even eliminating these productive symptoms, yet patients are far from “well.” Even with treatment, many patients with schizophrenia continue to experience the illness in its “deficit” form, characterized by social isolation and withdrawal, lack of caring and motivation, poor attention to personal appearance and hygiene, impoverished thought and speech content, and a preoccupation with the unusual or even bizarre to the exclusion of attending to those things that are appropriate to one’s circumstances. These “negative symptoms” confer substantial impairment and severely undermine the attempts to rehabilitate the person with treated schizophrenia. Consequently, many such patients end up in residential settings where they basically exist – rarely if ever do they work, attend school, or have substantive relationships – the sort of things that would be expected of someone who was responding positively to treatment.

What’s Happening In Research

Medical research is ongoing to identify how to address the neurobiology of negative symptoms. Neurotransmitters such as glycine and glutamate appear to be involved, and medications in development such as the Genentech/Roche compound bitopertin seek to optimize the functioning of the brain circuits utilizing these neurochemicals. North Star Medical Research is hopeful that clinical trials testing some of these new medications will be successful, and for our part, we expect to be conducting some of these trials. Watch this space for further developments!

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