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BASIC INFORMATION
DESCRIPTION
Schizophrenia is a chronic, severe, and disabling brain disorder that has been recognized throughout recorded history. It is a disorder that makes it impossible to differentiate between what is imagined and what is real. People with schizophrenia lose, to some degree, their hold on reality and many seem to withdraw into their own worlds. Hallucinations are not uncommon. Schizophrenia affects about 1.1 percent of Americans age 18 and older in a given year.
People with schizophrenia may hear voices other people do not hear or they may believe that others are reading their minds, controlling their thoughts, or plotting to harm them. These experiences are terrifying and can cause fearfulness, withdrawal, or extreme agitation. People with schizophrenia may not make sense when they talk, may sit for hours without moving or talking much, or may seem perfectly fine until they talk about what they are really thinking. Because many people with schizophrenia have difficulty holding a job or caring for themselves, the burden on their families and society is significant as well.
There are 4 basic types of schizophrenia:
1. Catatonic schizophrenia is characterized by unusual rigid postures, lack of movement, or frenzied movement. In this case, the person is extremely withdrawn, negative and isolated, and has marked psychomotor disturbances.
2. Disorganized schizophrenia, which used to be called hebephrenic schizophrenia, is characterized by a lack of normal range of emotions along with speech that displays a disorganized way of thinking. In this case the person is verbally incoherent and may have moods and emotions that are not appropriate to the situation. Hallucinations are not usually present.
3. Paranoid schizophrenia is characterized by hallucinatory and delusional symptoms. These persons are very suspicious of others and often have grand schemes of persecution at the root of their behavior. Hallucinations, and more frequently delusions, are a prominent and common part of the illness.
4. Undifferentiated schizophrenia involves a mixture of different symptoms. Conditions meeting the general diagnostic criteria for schizophrenia but not conforming to any of the above subtypes, or exhibiting the features of more than one of them without a clear predominance of a particular set of diagnostic characteristics.
Other Types of Schizophrenia Include:
Residual Schizophrenia: In this case the person is not currently suffering from delusions, hallucinations, or disorganized speech and behavior, but lacks motivation and interest in day-to-day living.
Schizoaffective Disorder: These people have symptoms of schizophrenia as well as mood disorder such as major depression, bipolar mania, or mixed mania.
For more information about the types of schizophrenia:
MentalHealth.com: Schizophrenia
Available treatments can relieve many of the disorder's symptoms, but most people who have schizophrenia must cope with some residual symptoms as long as they live. Nevertheless, this is a time of hope for people with schizophrenia and their families. Many people with the disorder now lead rewarding and meaningful lives in their communities. Researchers are developing more effective medications and using new research tools to understand the causes of schizophrenia and to find ways to prevent and treat it.
SYMPTOMS
The characteristic symptoms include:
- Disordered thinking, perception and speech.
- A lack of curiosity.
- Lethargy.
- Diminishing emotional contact with others.
- Emotional changes such as tension and/or depression.
- More dramatic behavioral disturbances, ranging from catatonia to violent outbursts and delusions.
The symptoms of schizophrenia fall into 3 broad categories:
POSITIVE SYMPTOMS
Positive symptoms are unusual thoughts or perceptions, including hallucinations, delusions, thought disorder, and disorders of movement.
Positive symptoms are easy-to-spot behaviors not seen in healthy people and usually involve a loss of contact with reality. They include hallucinations, delusions, thought disorder, and disorders of movement. Positive symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether the individual is receiving treatment.
Hallucinations. A hallucination is something a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel. "Voices" are the most common type of hallucination in schizophrenia. Many people with the disorder hear voices that may comment on their behavior, order them to do things, warn them of impending danger, or talk to each other (usually about the patient). They may hear these voices for a long time before family and friends notice that something is wrong. Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects (although this can also be a symptom of certain brain tumors), and feeling things like invisible fingers touching their bodies when no one is near.
Delusions. Delusions are false personal beliefs that are not part of the person's culture and do not change, even when other people present proof that the beliefs are not true or logical. People with schizophrenia can have delusions that are quite bizarre, such as believing that neighbors can control their behavior with magnetic waves, people on television are directing special messages to them, or radio stations are broadcasting their thoughts aloud to others. They may also have delusions of grandeur and think they are famous historical figures. People with paranoid schizophrenia can believe that others are deliberately cheating, harassing, poisoning, spying upon, or plotting against them or the people they care about. These beliefs are called delusions of persecution.
Thought Disorder. People with schizophrenia often have unusual thought processes. One dramatic form is disorganized thinking, in which the person has difficulty organizing his or her thoughts or connecting them logically. Speech may be garbled or hard to understand. Another form is "thought blocking," in which the person stops abruptly in the middle of a thought. When asked why, the person may say that it felt as if the thought had been taken out of his or her head. Finally, the individual might make up unintelligible words, or "neologisms."
Disorders of Movement. People with schizophrenia can be clumsy and uncoordinated. They may also exhibit involuntary movements and may grimace or exhibit unusual mannerisms. They may repeat certain motions over and over or, in extreme cases, may become catatonic. Catatonia is a state of immobility and unresponsiveness. It was more common when treatment for schizophrenia was not available; fortunately, it is now rare.
NEGATIVE SYMPTOMS
Negative symptoms represent a loss or a decrease in the ability to initiate plans, speak, express emotion, or find pleasure in everyday life. These symptoms are harder to recognize as part of the disorder and can be mistaken for laziness or depression.
The term "negative symptoms" refers to reductions in normal emotional and behavioral states. These include the following:
- Flat affect (immobile facial expression, monotonous voice).
- Lack of pleasure in everyday life.
- Diminished ability to initiate and sustain planned activity.
- Speaking infrequently, even when forced to interact.
People with schizophrenia often neglect basic hygiene and need help with everyday activities. Because it is not as obvious that negative symptoms are part of a psychiatric illness, people with schizophrenia are often perceived as lazy and unwilling to better their lives.
COGNITIVE SYMPTOMS
Cognitive symptoms (or cognitive deficits) are problems with attention, certain types of memory, and the executive functions that allow us to plan and organize. Cognitive deficits can also be difficult to recognize as part of the disorder but are the most disabling in terms of leading a normal life.
Cognitive symptoms are subtle and are often detected only when neuropsychological tests are performed. They include the following:
- Poor "executive functioning" (the ability to absorb and interpret information and make decisions based on that information).
- Inability to sustain attention.
- Problems with "working memory" (the ability to keep recently learned information in mind and use it right away).
Cognitive impairments often interfere with the patient's ability to lead a normal life and earn a living. They can cause great emotional distress.
Psychotic symptoms (such as hallucinations and delusions) usually emerge in men in their late teens and early 20s and in women in their mid-20s to early 30s. They seldom occur after age 45 and only rarely before puberty, although cases of schizophrenia in children as young as 5 have been reported. In adolescents, the first signs can include a change of friends, a drop in grades, sleep problems, and irritability. Because many normal adolescents exhibit these behaviors as well, a diagnosis can be difficult to make at this stage. In young people who go on to develop the disease, this is called the "prodromal" period.
Research has shown that schizophrenia affects men and women equally and occurs at similar rates in all ethnic groups around the world.
SCHIZOPHRENIA & VIOLENCE
People with schizophrenia are not especially prone to violence and often prefer to be left alone. Studies show that if people have no record of criminal violence before they develop schizophrenia and are not substance abusers, they are unlikely to commit crimes after they become ill. Most violent crimes are not committed by people with schizophrenia, and most people with schizophrenia do not commit violent crimes. Substance abuse always increases violent behavior, regardless of the presence of schizophrenia (see sidebar). If someone with paranoid schizophrenia becomes violent, the violence is most often directed at family members and takes place at home.
SCHIZOPHRENIA & SUICIDE
People with schizophrenia attempt suicide much more often than people in the general population. About 10 percent (especially young adult males) succeed. It is hard to predict which people with schizophrenia are prone to suicide, so if someone talks about or tries to commit suicide, professional help should be sought right away.
SCHIZOPHRENIA & SUBSTANCE ABUSE
Some people who abuse drugs show symptoms similar to those of schizophrenia, and people with schizophrenia may be mistaken for people who are high on drugs. While most researchers do not believe that substance abuse causes schizophrenia, people who have schizophrenia abuse alcohol and/or drugs more often than the general population.
Substance abuse can reduce the effectiveness of treatment for schizophrenia. Stimulants (such as amphetamines or cocaine), PCP, and marijuana may make the symptoms of schizophrenia worse, and substance abuse also makes it more likely that patients will not follow their treatment plan.
SCHIZOPHRENIA & NICOTINE
The most common form of substance abuse in people with schizophrenia is an addiction to nicotine. People with schizophrenia are addicted to nicotine at three times the rate of the general population (75-90 percent vs. 25-30 percent).
Research has revealed that the relationship between smoking and schizophrenia is complex. People with schizophrenia seem to be driven to smoke, and researchers are exploring whether there is a biological basis for this need. In addition to its known health hazards, several studies have found that smoking interferes with the action of antipsychotic drugs. People with schizophrenia who smoke may need higher doses of their medication.
Quitting smoking may be especially difficult for people with schizophrenia since nicotine withdrawal may cause their psychotic symptoms to temporarily get worse. Smoking cessation strategies that include nicotine replacement methods may be better tolerated. Health care providers who treat people with schizophrenia should carefully monitor their patient's response to antipsychotic medication if the patient decides to either start or stop smoking.
CAUSES
While the onset of the disorder is often related to a stressful life event, the underlying cause or causes of schizophrenia are not known. Like many other illnesses, schizophrenia is believed to result from a combination of environmental and genetic factors. Research is ongoing to find the causes for this disorder.
Other researchers theorize that schizophrenia results from external factors, such as complications during birth, head injury, a reaction to a virus, including the influenza virus, or environmental poisons that reach and damage the brain. There is a high incidence of childhood head injuries and birth complications among people with schizophrenia. A wide range of drugs also can cause schizophrenic-type symptoms.
Yet another theory focuses on nutritional factors. There is some indication that schizophrenia might be associated with high copper levels in body tissues. When copper levels are too high, the levels of vitamin C and zinc in the body drop. A zinc deficiency may result in damage to the pineal area of the brain, which normally contains high levels of zinc, which in turn may make an individual vulnerable to schizophrenia or other psychoses. Other clues come from the seasonality of the disorder. The incidence of schizophrenic episodes tends to peak in cold-weather months, which zinc intake tends to be lower. Magnesium deficiency could also be a factor. Some research has shown that magnesium levels in the blood of people with active schizophrenia are lower than normal and that the levels are higher in persons whose schizophrenia is in remission. It has been hypothesized that a type of vicious cycle may be at work here; the high level of stress experienced by those with severe psychiatric disorders may lead to magnesium deficiency, which in turn would exacerbate symptoms such as anxiety, fear, hallucinations, weakness, and physical complaints.
GENETICS
Some researchers believe that schizophrenia is hereditary, and there is evidence that some cases of schizophrenia are the result of an inherited defect in body chemistry in which the brain chemicals called neurotransmitters function abnormally.
Scientists have long known that schizophrenia runs in families. It occurs in 1 percent of the general population but is seen in 10 percent of people with a first-degree relative (a parent, brother, or sister) with the disorder. People who have second-degree relatives (aunts, uncles, grandparents, or cousins) with the disease also develop schizophrenia more often than the general population. The identical twin of a person with schizophrenia is most at risk, with a 40 to 65 percent chance of developing the disorder.
Our genes are located on 23 pairs of chromosomes that are found in each cell. We inherit two copies of each gene, one from each parent. Several of these genes are thought to be associated with an increased risk of schizophrenia, but scientists believe that each gene has a very small effect and is not responsible for causing the disease by itself. It is still not possible to predict who will develop the disease by looking at genetic material.
Although there is a genetic risk for schizophrenia, it is not likely that genes alone are sufficient to cause the disorder. Interactions between genes and the environment are thought to be necessary for schizophrenia to develop. Many environmental factors have been suggested as risk factors, such as exposure to viruses or malnutrition in the womb, problems during birth, and psychosocial factors, like stressful environmental conditions.
BRAIN CHEMISTRY
Levels of, and the balance between, the neurotransmitters dopamine, serotonin, epinephrine, norepinephrine, and the way in which the brain responds to these substances, is thought to play a profound role in the development of schizophrenia.
It is likely that an imbalance in the complex, interrelated chemical reactions of the brain involving the neurotransmitters dopamine and glutamate (and possibly others) plays a role in schizophrenia. Neurotransmitters are substances that allow brain cells to communicate with one another. Basic knowledge about brain chemistry and its link to schizophrenia is expanding rapidly and is a promising area of research.
BRAIN CHANGES & DIFFERENCES
The brains of people with schizophrenia look a little different than the brains of healthy people, but the differences are small. Sometimes the fluid-filled cavities at the center of the brain, called ventricles, are larger in people with schizophrenia; overall gray matter volume is lower; and some areas of the brain have less or more metabolic activity. Microscopic studies of brain tissue after death have also revealed small changes in the distribution or characteristics of brain cells in people with schizophrenia. It appears that many of these changes were prenatal because they are not accompanied by glial cells, which are always present when a brain injury occurs after birth. One theory suggests that problems during brain development lead to faulty connections that lie dormant until puberty. The brain undergoes major changes during puberty, and these changes could trigger psychotic symptoms.
Worldwide, the incidence of the disorder was once thought to be 1 in 100 people. The actual incidence is now known to be much lower, between 7 and 8 per 1,000 people, according to the University of Queensland, Australia, professor of psychiatry John McGrath, M.D., Ph.D. Furthermore, it used to be thought that men became more disabled by this condition than women, which gave rise to a hypothesis that the hormone estrogen might protect the brain. When women reached the age of diminishing estrogen in their late 40s, the incidence and severity of schizophrenic episodes appeared to increase. There is no compelling scientific evidence that this estrogen hypotheses is, in fact, true, however. As a matter of fact, recent research in Australia that reviewed 188 other studies taken from 46 countries has concluded that there is not significant difference in the incidence of the disease between men and women, and no significant difference in the incidence of the disease between people living in urban and rural areas, as previous research had appeared to suggest. One interesting thing that was found is that there seems to be more schizophrenia in the developed countries than in developing nations. Researchers advise extreme caution in drawing any conclusions from this, however, as there could be numerous social and economic factors skewing the results.
DIAGNOSIS & TREATMENT
DIAGNOSIS
The first step in getting treatment for schizophrenia is getting a correct diagnosis. This can be a more difficult than it might seem because the symptoms of schizophrenia can be similar at times to other major brain disorders such as bipolar disorder (Manic/Depression) or even major depression, or because a person with schizophrenia may be paranoid or believe that nothing is wrong and may not want to go to see a health care practitioner. Because many regular family health care providers may not be very familiar with schizophrenia it is important to see a good psychiatrist that is experienced in the diagnosis and treatment of schizophrenia. One way to do this is to contact a local support group that deals with brain disorders such as schizophrenia and talk to the other members that already have experience with the local psychiatrists. If that is not convenient, we recommend you join in online discussion forums and ask there if anyone can recommend a good psychiatrist in your area. Local members may be able to recommend a good psychiatrist experienced in schizophrenia that they have worked with. As with most serious illnesses, its important to get diagnosis and treatment as quickly as possible.
DIAGNOSIS FROM SYMPTOMS
Schizophrenia is characterized by profound disruption in cognition and emotion, affecting the most fundamental human attributes: language, thought, perception, affect, and sense of self. The array of symptoms, while wide ranging, frequently includes psychotic manifestations, such as hearing internal voices or experiencing other sensations not connected to an obvious source (hallucinations) and assigning unusual significance or meaning to normal events or holding fixed false personal beliefs (delusions). No single symptom is definitive for diagnosis; rather, the diagnosis encompasses a pattern of signs and symptoms, in conjunction with impaired occupational or social functioning.
(Source: Diagnostic & Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition (Text Revision)).
Symptoms are typically divided into positive and negative symptoms because of their impact on diagnosis and treatment. Positive symptoms are those that appear to reflect an excess or distortion of normal functions. The diagnosis of schizophrenia, according to DSM-IV, requires at least 1-month duration of two or more positive symptoms, unless hallucinations or delusions are especially bizarre, in which case one alone suffices for diagnosis. Negative symptoms are those that appear to reflect a diminution or loss of normal functions. These often persist in the lives of people with schizophrenia during periods of low (or absent) positive symptoms. Negative symptoms are difficult to evaluate because they are not as grossly abnormal as positives ones and may be caused by a variety of other factors as well (e.g., as an adaptation to a persecutory delusion). However, advancements in diagnostic assessment tools are being made.
Diagnosis is complicated by early treatment of schizophrenia's positive symptoms. Anti-psychotic medications, particularly the traditional ones, often produce side effects that closely resemble the negative symptoms of affective flattening and avolition. In addition, other negative symptoms are sometimes present in schizophrenia but not often enough to satisfy diagnostic criteria (DSM-IV): loss of usual interests or pleasures (anhedonia); disturbances of sleep and eating; dysphoric mood (depressed, anxious, irritable, or angry mood); and difficulty concentrating or focusing attention.
Currently, discussion is ongoing within the field regarding the need for a third category of symptoms for diagnosis: disorganized symptoms. Disorganized symptoms include thought disorder, confusion, disorientation, and memory problems. While they are listed by DSM-IV as common in schizophrenia - especially during exacerbations of positive or negative symptoms (DSM-IV) - they do not yet constitute a formal new category of symptoms. Some researchers think that a new category is not warranted because disorganized symptoms may instead reflect an underlying dysfunction common to several psychotic disorders, rather than being unique to schizophrenia.
DIAGNOSTIC CRITERIA FOR SCHIZOPHRENIA (USA criteria)
A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):1. Delusions - false beliefs strongly held in spite of invalidating evidence, especially as a symptom of mental illness: for example:
- Paranoid delusions, or delusions of persecution, for example believing that people are "out to get" you, or the thought that people are doing things when there is no external evidence that such things are taking place.
- Delusions of reference - when things in the environment seem to be directly related to you even though they are not. For example it may seem as if people are talking about you or special personal messages are being communicated to you through the TV, radio, or other media.
- Somatic Delusions are false beliefs about your body - for example that a terrible physical illness exists or that something foreign is inside or passing through your body.
- Delusions of grandeur - for example when you believe that you are very special or have special powers or abilities. An example of a grandiose delusion is thinking you are a famous rock star.
2. Hallucinations - Hallucinations can take a number of different forms - they can be:
- Visual (seeing things that are not there or that other people cannot see).
- Auditory (hearing voices that other people cannot hear.
- Tactile (feeling things that other people do not feel or something touching your skin that is not there.)
- Olfactory (smelling things that other people cannot smell, or not smelling the same thing that other people do smell).
- Gustatory experiences (tasting things that is not there).
3. Disorganized speech (e.g., frequent derailment or incoherence) - these are also called "word salads".
4. Grossly disorganized or catatonic behavior (An abnormal condition variously characterized by stupor/inactivity, mania, and either rigidity or extreme flexibility of the limbs).
5. Negative symptoms, these are the lack of important abilities. Some of these include:
- Lack of emotion - the inability to enjoy activities as much as before.
- Low energy - the person sits around and sleeps much more than normal.
- Lack of interest in life, low motivation.
- Affective flattening - a blank, blunted facial expression or less lively facial movements or physical movements.
- Alogia (difficulty or inability to speak).
- Inappropriate social skills or lack of interest or ability to socialize with other people.
- Inability to make friends or keep friends, or not caring to have friends.
- Social isolation - person spends most of the day alone or only with close family.
Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person?s behavior or thoughts, or two or more voices conversing with each other.
Cognitive Symptoms of Schizophrenia
Cognitive symptoms refer to the difficulties with concentration and memory. These can include:
- Disorganized thinking.
- Slow thinking.
- Difficulty understanding.
- Poor concentration.
- Poor memory.
- Difficulty expressing thoughts.
- Difficulty integrating thoughts, feelings and behavior.
B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).
C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
D. Schizoaffective and mood disorder exclusion: Schizoaffective disorder and mood disorder with psychotic features have been ruled out because either (1) no major depressive, manic, or mixed episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.
E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
F. Relationship to a pervasive developmental disorder: If there is a history of autistic disorder or another pervasive developmental disorder, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).
Source: U.S. Surgeon General
CONVENTIONAL MEDICAL TREATMENT
Because the causes of schizophrenia are still unknown, current treatments focus on eliminating the symptoms of the disease.
ANTIPSYCHOTIC MEDICATIONS
Antipsychotic medications have been available since the mid-1950s. They effectively alleviate the positive symptoms of schizophrenia. While these drugs have greatly improved the lives of many patients, they do not cure schizophrenia.
Everyone responds differently to antipsychotic medication. Sometimes several different drugs must be tried before the right one is found. People with schizophrenia should work in partnership with their health care providers to find the medications that control their symptoms best with the fewest side effects.
The older antipsychotic medications include chlorpromazine (Thorazine), haloperidol (Haldol), perphenazine (Etrafon, Trilafon), and fluphenazine (Prolixin). The older medications can cause extrapyramidal side effects, such as rigidity, persistent muscle spasms, tremors, and restlessness.
In the 1990s, new drugs, called atypical anti-psychotics, were developed that rarely produced these side effects. The first of these new drugs was clozapine (Clozaril). It treats psychotic symptoms effectively even in people who do not respond to other medications, but it can produce a serious problem called agranulocytosis, a loss of the white blood cells that fight infection. Therefore, patients who take clozapine must have their white blood cell counts monitored every week or two. The inconvenience and cost of both the blood tests and the medication itself has made treatment with clozapine difficult for many people, but it is the drug of choice for those whose symptoms do not respond to the other antipsychotic medications, old or new.
Some of the drugs that were developed after clozapine was introduced - such as risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), sertindole (Serdolect), and ziprasidone (Geodon) - are effective and rarely produce extrapyramidal symptoms and do not cause agranulocytosis; but they can cause weight gain and metabolic changes associated with an increased risk of diabetes and high cholesterol.
People respond individually to antipsychotic medications, although agitation and hallucinations usually improve within days and delusions usually improve within a few weeks. Many people see substantial improvement in both types of symptoms by the sixth week of treatment. No one can tell beforehand exactly how a medication will affect a particular individual, and sometimes several medications must be tried before the right one is found.
When people first start to take atypical anti-psychotics, they may become drowsy; experience dizziness when they change positions; have blurred vision; or develop a rapid heartbeat, menstrual problems, a sensitivity to the sun, or skin rashes. Many of these symptoms will go away after the first days of treatment, but people who are taking atypical anti-psychotics should not drive until they adjust to their new medication.
If people with schizophrenia become depressed, it may be necessary to add an antidepressant to their drug regimen.
A large clinical trial funded by the National Institute of Mental Health (NIMH), known as CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness), compared the effectiveness and side effects of five antipsychotic medications-both new and older anti-psychotics-that are used to treat people with schizophrenia. For more information, visit the NIMH CATIE page.
NIH Booklet: Medications For Treating Mental Disorders
LENGTH OF TREATMENT
Like diabetes or high blood pressure, schizophrenia is a chronic disorder that needs constant management. At the moment, it cannot be cured, but the rate of recurrence of psychotic episodes can be decreased significantly by staying on medication. Although responses vary from person to person, most people with schizophrenia need to take some type of medication for the rest of their lives as well as use other approaches, such as supportive therapy or rehabilitation.
Relapses occur most often when people with schizophrenia stop taking their anti-psychotic medication because they feel better, or only take it occasionally because they forget or do not think taking it regularly is important. It is very important for people with schizophrenia to take their medication on a regular basis and for as long as their health care providers recommend. If they do so, they will experience fewer psychotic symptoms.
No anti-psychotic medication should be discontinued without talking to the health care provider who prescribed it, and it should always be tapered off under a health care provider's supervision rather than being stopped all at once.
There are a variety of reasons why people with schizophrenia do not adhere to treatment. If they do not believe they are ill, they may not think they need medication at all. If their thinking is too disorganized, they may not remember to take their medication every day. If they do not like the side effects of one medication, they may stop taking it without trying a different medication. Substance abuse can also interfere with treatment effectiveness. Health care providers should ask patients how often they take their medication and be sensitive to a patient's request to change dosages or to try new medications to eliminate unwelcome side effects.
There are many strategies to help people with schizophrenia take their drugs regularly. Some medications are available in long-acting, injectable forms, which eliminate the need to take a pill every day. Medication calendars or pillboxes labeled with the days of the week can both help patients remember to take their medications and let caregivers know whether medication has been taken. Electronic timers on clocks or watches can be programmed to beep when people need to take their pills, and pairing medication with routine daily events, like meals, can help patients adhere to dosing schedules.
MEDICATION INTERACTIONS
Anti-psychotic medications can produce unpleasant or dangerous side effects when taken with certain other drugs. For this reason, the health care provider who prescribes the anti-psychotics should be told about all medications (over-the-counter and prescription) and all vitamins, minerals, and herbal supplements the patient takes. Alcohol or other drug use should also be discussed.
CONVENTIONAL PSYCHOSOCIAL TREATMENTS
Numerous studies have found that psychosocial treatments can help patients who are already stabilized on anti-psychotic medications deal with certain aspects of schizophrenia, such as difficulty with communication, motivation, self-care, work, and establishing and maintaining relationships with others. Learning and using coping mechanisms to address these problems allows people with schizophrenia to attend school, work, and socialize. Patients who receive regular psychosocial treatment also adhere better to their medication schedule and have fewer relapses and hospitalizations. A positive relationship with a therapist or a case manager gives the patient a reliable source of information, sympathy, encouragement, and hope, all of which are essential for managing the disease. The therapist can help patients better understand and adjust to living with schizophrenia by educating them about the causes of the disorder, common symptoms or problems they may experience, and the importance of staying on medications.
ILLNESS MANAGEMENT SKILLS
People with schizophrenia can take an active role in managing their own illness. Once they learn basic facts about schizophrenia and the principles of schizophrenia treatment, they can make informed decisions about their care. If they are taught how to monitor the early warning signs of relapse and make a plan to respond to these signs, they can learn to prevent relapses. Patients can also be taught more effective coping skills to deal with persistent symptoms.
INTEGRATED TREATMENT FOR CO-OCCURRING SUBSTANCE ABUSE
Substance abuse is the most common co-occurring disorder in people with schizophrenia, but ordinary substance abuse treatment programs usually do not address this population's special needs. Integrating schizophrenia treatment programs and drug treatment programs produces better outcomes.
REHABILITATION
Rehabilitation emphasizes social and vocational training to help people with schizophrenia function more effectively in their communities. Because people with schizophrenia frequently become ill during the critical career-forming years of life (ages 18 to 35) and because the disease often interferes with normal cognitive functioning, most patients do not receive the training required for skilled work. Rehabilitation programs can include vocational counseling, job training, money management counseling, assistance in learning to use public transportation, and opportunities to practice social and workplace communication skills.
FAMILY EDUCATION
Patients with schizophrenia are often discharged from the hospital into the care of their families, so it is important that family members know as much as possible about the disease to prevent relapses. Family members should be able to use different kinds of treatment adherence programs and have an arsenal of coping strategies and problem-solving skills to manage their ill relative effectively. Knowing where to find outpatient and family services that support people with schizophrenia and their caregivers is also valuable.
COGNITIVE BEHAVIORAL THERAPY
Cognitive behavioral therapy is useful for patients with symptoms that persist even when they take medication. The cognitive therapist teaches people with schizophrenia how to test the reality of their thoughts and perceptions, how to "not listen" to their voices, and how to shake off the apathy that often immobilizes them. This treatment appears to be effective in reducing the severity of symptoms and decreasing the risk of relapse.
SELF-HELP GROUPS
Self-help groups for people with schizophrenia and their families are becoming increasingly common. Although professional therapists are not involved, the group members are a continuing source of mutual support and comfort for each other, which is also therapeutic. People in self-help groups know that others are facing the same problems they face and no longer feel isolated by their illness or the illness of their loved one. The networking that takes place in self-help groups can also generate social action. Families working together can advocate for research and more hospital and community treatment programs, and patients acting as a group may be able to draw public attention to the discriminations many people with mental illnesses still face in today's world.
SUPPORT & ADVOCACY GROUPS
Support groups and advocacy groups are excellent resources for people with many types of mental disorders.
SUPPORT, CAREGIVING & PATIENT RIGHTS
Support for those with mental disorders can come from families, professional residential or day program caregivers, shelter operators, friends or roommates, professional case managers, or others in their communities or places of worship who are concerned about their welfare. There are many situations in which people with schizophrenia will need help from other people.
Getting Treatment: People with schizophrenia often resist treatment, believing that their delusions or hallucinations are real and psychiatric help is not required. If a crisis occurs, family and friends may need to take action to keep their loved one safe.
civil Rights: The issue of civil rights enters into any attempt to provide treatment. Laws protecting patients from involuntary commitment have become very strict, and trying to get help for someone who is mentally ill can be frustrating. These laws vary from state to state, but, generally, when people are dangerous to themselves or others because of mental illness and refuse to seek treatment, family members or friends may have to call the police to transport them to the hospital. In the emergency room, a mental health professional will assess the patient and determine whether a voluntary or involuntary admission is needed.
A person with mental illness who does not want treatment may hide strange behavior or ideas from a professional; therefore, family members and friends should ask to speak privately with the person conducting the patient's examination and explain what has been happening at home. The professional will then be able to question the patient and hear the patient's distorted thinking for themselves. Professionals must personally witness bizarre behavior and hear delusional thoughts before they can legally recommend commitment, and family and friends can give them the information they need to do so.
Caregiving: Ensuring that people with schizophrenia continue to get treatment and take their medication after they leave the hospital is also important. If patients stop taking their medication or stop going for follow-up appointments, their psychotic symptoms will return. If these symptoms become severe, they may become unable to care for their own basic needs for food, clothing, and shelter; they may neglect personal hygiene; and they may end up on the street or in jail, where they rarely receive the kind of help they need.
Family and friends can also help patients set realistic goals and regain their ability to function in the world. Each step toward these goals should be small enough to be attainable, and the patient should pursue them in an atmosphere of support. People with a mental illness who are pressured and criticized usually regress and their symptoms worsen. Telling them what they are doing right is the best way to help them move forward.
How should you respond when someone with schizophrenia makes statements that are strange or clearly false? Because these bizarre beliefs or hallucinations are real to the patient, it will not be useful to say they are wrong or imaginary. Going along with the delusions will not be helpful, either. It is best to calmly say that you see things differently than the patient does but that you acknowledge that everyone has the right to see things in his or her own way. Being respectful, supportive, and kind without tolerating dangerous or inappropriate behavior is the most helpful way to approach people with this disorder.
PROGNOSIS
The outlook for people with schizophrenia has improved over the last 30 years or so. Although there still is no cure, effective treatments have been developed, and many people with schizophrenia improve enough to lead independent, satisfying lives. This is an exciting time for schizophrenia research. The explosion of knowledge in genetics, neuroscience, and behavioral research will enable a better understanding of the causes of the disorder, how to prevent it, and how to develop better treatments to allow those with schizophrenia to achieve their full potential.
SCHIZOPHRENIC RESEARCH PROGRAMS
Scientists worldwide are studying schizophrenia so they will be able to develop new ways to prevent and treat the disorder. The only way it can be understood is for researchers to study the illness as it presents itself in those who suffer from it. There are many different kinds of studies. Some studies require that medication be changed; others, like genetic studies, require no change at all in medications. To receive information about federally and privately supported schizophrenia research, go to ClinicalTrials.gov. The information provided should be used in conjunction with advice from your health care professional.
NIMH conducts a Schizophrenia Research Program, which is located at the National Institute of Mental Health in Bethesda, Maryland. Travel assistance and study compensation are available for some studies. A list of outpatient and inpatient studies conducted at NIMH can be found at patientinfo.nimh.nih.gov. In addition, NIMH staff members can speak with you to help you determine whether their current studies are suitable for you or your family member. Simply call the toll free line at 1-888-674-6464. You can also indicate your interest in research participation by sending an e-mail to Schizophrenia@intra.nimh.nih.gov. All calls remain confidential.
DIETARY & HOLISTIC RECOMMENDATIONS
CONSIDERATIONS
Sometimes extremely high doses of certain vitamins are needed to keep the mind functioning well.
Hair analysis reveals mineral imbalances that may contribute to mental difficulties.
Some experts believe that many suicides among the young may be related to undiagnosed schizophrenia.
Psychiatrists found a link between schizophrenia and pellagra, a vitamin B-3 (niacin) deficiency disease. Taking several grams of niacinamide daily (under a health care provider's supervision) has been tried with good results.
Undiagnosed celiac disease, caused by an intolerance to gluten, can cause symptoms similar to those of schizophrenia. Gluten intolerance can also cause severe depression.
Drug therapy is usually the medical treatment of choice for schizophrenia. However, there is no single medication that is effective for all cases. It may be necessary to try several different drugs in order to find the one that works best to keep symptoms under control.
A newer drug, olanzapine (Zyprexa), has been used since the mid-1990s to treat schizophrenia. This drug was supposed to reduce tremors associated with older drugs such as haloperidol (Haldol). However, a recent study that tested olanzapine against a two-drug combination of haloperidol and a tremor-reducing drug, benztropine (Cogentin), showed little difference between the two therapies. Olanzapine also has a potential unwanted side effect - weight gain - plus the cost is considerably higher at approximately $8.00 or more per day compared to 10 cents per day.
If you are taking prescription drugs for schizophrenia, do not stop taking your medication without first consulting with your health care provider. Do not take any of the supplements listed below that might affect dopamine, serotonin, or norepinephrine synthesis without consulting a health care provider.
Some cases of schizophrenia have been linked to food allergies. Many people find their symptoms improve after they fast.
For more information concerning schizophrenia, you can consult www.schizophrenia.com.
RECOMMENDATIONS
Eat a high fiber diet containing plenty of quality proteins, fresh vegetables, fruits, nuts, seeds, beans and legumes. Whole grains and whole-grain products are recommended, except for those that contain gluten, which should be consumed in moderation only. See the links below for more information on a gluten-restricted diet.
Try eating more frequent small meals rather than 3 larger ones each day. This helps to keep blood sugar levels stable, which in turn has a stabilizing influence on mood and behavior.
Include the following in your diet: Breast of chicken or turkey, brewer's yeast, halibut, peas, sunflower seeds, and tuna. Eat white fish and turkey twice a week. Also eat foods rich in niacin, such as broccoli, carrots, corn, eggs, fish, potatoes, tomatoes and whole wheat.
Consume no sugar or products containing sugar (read food product labels carefully). Also avoid alcohol, dairy products, caffeine, carbonated beverages, and all foods with colorings, flavorings, preservatives, and other additives. Caffeine promotes the release of unwanted norepinephrine, a stimulating neurotransmitter. Alcohol consumption depletes the body of zinc. Many psychological disorders are known to be adversely affected by zinc deficiencies.
Take high doses of B-complex vitamins, approximately 100 mg of each major B vitamin 3 times daily (amounts of individual vitamins in a complex will vary). The B complex is very important for all mood disorders. Use injections (under a health care provider's supervision) or a sublingual form for best absorption. Persons with manic-depressive disorder do not absorb the B-complex vitamins easily, and often have deficiencies of these vitamins.
Do not take any drugs except for those prescribed by your health care provider.
As much as possible, keep environmental pressures under control. Avoid situations that cause stress, such as a turbulent relationship or a difficult working environment. Stress is a major contributor to serious problems for people with schizophrenia. Over-stimulation from very strong emotions or an excessive workload can exacerbate symptoms. Also avoid under-stimulation.
HERBS
Ginkgo Biloba improves brain function and cerebral circulation, and enhances memory.
Herbal Remedies: Ginkgo Leaf Powder (Ginkgo Biloba), 4 oz. Bulk
Herbal Remedies: Irwin Naturals Advanced Ginkgo Smart, 90 Gel Caps
Herbal Remedies: Ginkgo Biloba Extract, Standardized, Nature's Way, 60 mg, 120 Caps
Herbal Remedies: Ginkgold MAX, Gingko Biloba Extract, Vegetarian, Nature's Way, 120 mg, 60 Tabs
Herbal Remedies: Ginkgold, Gingko Biloba Extract, Vegetarian, Standardized, Nature's Way, 60 mg, 150 Tabs
Kava Kava and Passionflower are good for relief of stress and depression.
Herbal Remedies: Kava Kava Root, Maximum Strength, Standardized to 90% Kavalactones, 175 mg, 60 Caps
Herbal Remedies: Kava Kava Root Extract, Standardized to 30% Kavalactones, NOW Foods, 250 mg, 120 Caps
Herbal Remedies: Kava Root Powder, Melomelo Vanuatu, Pure Premium Kava Root, Organic, Vegetarian, 1/2 lb.
Herbal Remedies: Kava Root Powder, Sampler Pack, Pure Premium Kava Root, Organic, Vegetarian, 1 lb.
Herbal Remedies: Kava Root Powder, Taveuni Kava, Pure Premium Kava Root, Organic, Vegetarian, 1/2 lb.
Herbal Remedies: Kava Root Powder, Piper Methysticum, 4 oz. Bulk
Herbal Remedies: Kava Root Extract Tincture, Herbal Remedies USA, 2 fl. oz.
Herbal Remedies: Kava Tea, Stress Relief, Natural Anxiety Relief, Certified Organic, Yogi Tea, 16 Tea Bags
Herbal Remedies: Kava Powder, Papua New Guinea, More Potent Than Premium, 8 oz.
Herbal Remedies: Kava kava Supplement, Vegetarian, Herbal Remedies USA, 1,500 mg, 60 Liquid VCaps
Herbal Remedies: Passionflower Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Passionflower Powder (Passiflora Incarnata), 4 oz. Bulk
NUTRITIONAL SUPPLEMENTS
Unless otherwise specified, the dosages recommended here are for adults. For a child between the ages of 12 and 17 years, reduce the dose to 3/4 the recommended amount. For a child between the ages of 6 and 12, use 1/2 the recommended dose, and for a child under the age of 6, use 1/4 the recommended amount.
SCHIZOPHRENIA SUPPLEMENTS
Information, supplements and products for schizophrenia, a mood disorder that results in difficulty differentiating between the imaginary and the real.
Amino 1000 Complete, NOW Foods, 120 Caps.
Amino 1000 Complete contains a balanced blend of 20 essential and non-essential amino acids.Anti-Anxiety Herbal Formula, 100% Natural, 2 fl. oz.
Use this anti-anxiety herbal formula daily to reduce the occurrence of anxiety attacks.Avea Mood Liquid Extract, 30 ml.
Via the proprietary extraction and enhancement process utilized to produce Avea, the product has been enhanced to address the majority of the causes of endogenous depression.Blue Scullcap (Scutellaria Lateriflora), Standardized, Nature's Way, 100 mg, 60 VCaps
Scullcap is most commonly used as a sedative and it can take the edge off anxiety and promote sleep for those who struggle with insomnia.Chromium Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.
WaterOz Ionic Chromium is a pure liquid chromium supplement. Chromium helps the body regulate metabolism, regulate insulin and blood sugar levels, helps the body lose weight by stimulating enzymes that metabolize glucose, burns fat. Chromium deficiencies may contribute to Infertility and decreased sperm count.Emotional Balance Wellness Oil, Nature's Inventory, 2 fl. oz.
Not only does Emotional Balance Wellness Oil smell incredible, it also calms and centers those who use it.5-HTP Supplement, Hydroxy Tryptophan Natural Serotonin With Vitamin B-6 & C, Nature's Way, 50 mg, 60 Tabs
Nature's Way 5-HTP Supplement is available in an easy to swallow enteric coated tablet.GABA (Gamma Aminobutyric Acid) Supplement, NOW Foods, 500 mg, Plus B-6, 2 mg, 100 Caps
GABA is a non-essential amino acid found mainly in the human brain and eyes. It is considered an inhibitory neurotransmitter, which means it regulates brain and nerve cell activity by inhibiting the number of neurons firing in the brain. GABA is referred to as the brain's natural calming agent.GABA Powder (Gamma Aminobutyric Acid), NOW Foods, 100% Pure, Vegetarian, 500 mg, 6 oz.
GABA is a non-essential amino acid found mainly in the human brain and eyes and it is considered an inhibitory neurotransmitter, which means it regulates brain and nerve cell activity by inhibiting the number of neurons firing in the brain - GABA is referred to as the brain's natural calming agent.Garlicin Cholesterol Control, Odor Free, Nature's Way, 350 mg, 90 Enteric-Coated Tabs
SmartRelease Garlicin odor free garlic supplement is the most effective garlic supplement on the market today.Ginkgo Biloba Extract, Standardized, Nature's Way, 60 mg, 120 VCaps
Nature's Way Ginkgo biloba extract is a technically and scientifically advanced herbal extract standardized to 24% Ginkgo flavone glycosides and 6% terpene lactones, supported by whole Gotu Kola herb.Ginkgo Leaf Tincture, 2 fl. oz.
Preliminary studies show that Gingko Leaf is helpful in ordinary age-related memory loss as well.Grape Seed Extract, Standardized, Nature's Way, 100 mg, 30 Caps
Nature's Way Standardized Grape Seed Extract are technically and scientifically advanced herbal product.Hops Herb Tincture, 2 fl. oz.
The German Commission E recommends the use of Hops herb for discomfort due to restlessness or anxiety and sleep disturbances.Irwin Naturals Advanced Ginza Plus, Multi-Adaptogen, 75 Gelcaps
Irwin Naturals Advanced Ginza-Plus is a balanced formula combining five powerful adaptogens, including one of the highest potency ginseng extracts on the market.Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz.
Just An Ounce, Calcium and Magnesium Liquid can help with the development of strong bones and teeth, also prevents muscle cramping, risk of colon cancer, maintain regular heart beat, protects against osteoporosis and helps relax the central nervous system.L-Cysteine, Structural Support, With Vitamin B-6 & C, Vegetarian, NOW Foods, 500 mg, 100 Tabs
L-Cysteine functions as an antioxidant and is a powerful aid to the body in protecting against radiation and pollution. Hair and skin are made up 10-14% Cystine.Lemon Balm Tincture, 100% Organic, 2 fl. oz.
Lemon Balm is a sedative that elevates the mood an antidepressant.L-Glutamine, Amino Acid Supplement, NOW Foods, 500 mg, 120 Caps
L-Glutamine is an important amino acid and natural Growth Hormone Releaser that helps brain function, and may be used for combating effects of alcoholism, alleviating hypoglycemia, fatigue reduction, improving exercise endurance, benefiting the liver and intestines, maintaining a healthy gastrointestinal tract, and strengthening the immune system.L-Methionine, Plus B-6, NOW Foods, 500 mg /10 mg, 100 Caps
L-Methionine is an essential sulfur amino acid. The body cannot produce L-Methionine, which must be obtained from food or supplement sources.L-Phenylalanine, Free Form, NOW Foods, 500 mg, 60 Caps
L-Phenylalanine is an Essential Amino Acid that helps to elevate positive mood and may be used in the treatment of some forms of depression. It is essential for the production of adrenalin.Magnesium Citrate Complex, Nature's Way, 250 mg, 100 Caps
Nature's Way Magnesium Citrate is an advanced chelate form which enhances absorption of magnesium by providing excellent solubility.NerveEase, Balanceuticals, TCM Stress Formula, 100% Natural, 60 Caps
Chinese medicine uses this time-honored formula to strengthen and pacify the nervous system, inhibit spontaneous activities of the brain, enhance memory, eliminate stress, nurture and maintain healthy functions of the heart, supplement the blood and nourish the Yin.Nerve & Tension Tincture, 2 fl. oz.
To soothe the nervous system, which may help reduce stress and benefit Hyperactivity/Hyperkinetic, Mental Fatigue, Migraine Headache, Muscular Problems (Aches, Pain & Spasms), Nervous Disorders, Neuralgia, Palsy, Parkinson's Disease, Schizophrenia, Spasms, Stress, and Tension among other things.Niacinamide, Non-Flushing Niacin, 100% Natural, Vitamin B-3, Nature's Way, 500 mg, 100 Caps
The benefits of Niacin without the discomforts associated with a Niacin flush. Nature's Way Niacinamide is 100% natural.Omega 3 Fish Oil Supplement, Mood Aid, EFA Gold, Enteric Coated, Nature's Way, 60 Softgels
Mood Aid Fish Oil Supplement is a highly concentrated source of EPA (Eicosapentaenoic acid) from pure cold water fish oil.Passionflower Tincture, 100% Organic, 2 fl. oz.
Passion Flower is a powerful relaxant to the nervous system important in the treatments of anxiety, tension and insomnia.Pycnogenol With Vitamin E, 100% Natural, Nature's Way, 50 mg, 30 Tabs
Pycnogenol is an extract made from the bark of the European coastal pine. Pycnogenol is a concentrated source of proanthocyanidins, organic acids and other biologically active components.St. John's Wort, Perika, 200 mg, 60 Tabs
Nature's Way St. John's Wort is scientifically advanced to maintain a healthy emotional outlook.St. John's Wort Tonic (Formerly Depression Tincture), 2 fl. oz.
St. John's Wort Supplement is found to help alleviate depression and strengthen the nervous system.Super Omega 3-6-9, NOW Foods, 1200 mg, 90 Softgels
Super Omega 3-6-9 Softgels are a blend of Fish, Borage and Organic Flax Seed Oils.Vitamin B-100 Complex, With Coenzyme B-2, Nature's Way, 631 mg, 100 Caps
A complete Vitamin B complex of 8 essential vitamins. B Vitamins are precursors of coenzymes involved in the conversion of cellular energy, manufacture of hormones and proteins, and repair and maintenance of nerve structures.Vitamin B-12 (Cyanocobalamin), 2000 mcg, 100 Sublingual Lozenges
Nature's Way Sublingual Vitamin B-12 is 100% natural from cyanocobalamin concentrate.Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.
HerbalRemedies: Schizophrenia Information
HerbalRemedies: Schizophrenia Supplements & Products
HerbalRemedies: Generalized Anxiety Disorder (GAD) Supplements & Products
RECOMMENDED BOOKS
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member have any symptoms or an increase of symptoms or other signs of schizophrenia.
You have any unexpected or unusual symptoms. Medications prescribed for this disorder often have side effects and the medication or dosage may need to be evaluated, changed or adjusted. Some people may have sensitivity, allergies, or other health conditions which would prevent them from using certain drugs or other treatments.
If you are feeling suicidal or thinking about harming yourself or know someone who is:
- Call a health care provider, emergency room, or 9-1-1 right away to get immediate help.
- Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to be connected to a trained counselor at a suicide crisis center nearest you.
As a family member or friend to help you make these calls or take you to the hospital.
IF YOU OR A FAMILY MEMBER OR A FRIEND ARE IN A SUICIDAL CRISIS:
- Make sure you, or the suicidal person, are not left alone.
- Make sure that access is prevented to large amounts of medication, weapons, or other items that could be used for self-harm.
- Try to get the person to seek help immediately from a health care professional (emergency room, health care provider or mental health professional).
- Take seriously any comments about suicide or wishing to die. Even if you do not believe your family member or friend will actually attempt suicide, the person is clearly in distress and can benefit from your help in receiving mental health treatment.
GETTING HELP & LOCATING SERVICES
If unsure where to go for help, talk to someone you trust who has experience in mental health - for example, a health care provider, social worker, or religious counselor. Ask their advice on where to seek treatment. If there is a university nearby, its departments of psychiatry or psychology may offer private and/or sliding-scale fee clinic treatment options. Otherwise, check the Yellow Pages under "mental health," "health," "social services," "crisis intervention services," "hotlines," "hospitals," or "physicians" for phone numbers and addresses. In times of crisis, the emergency room practitioner at a hospital may be able to provide temporary help for a mental health problem, and will be able to tell you where and how to get further help.
Listed below are the types of people and places that will make a referral to, or provide, diagnostic and treatment services. Do not be afraid to "shop around" until you find the services and/or the practitioner that can work with you and/or the schizophrenic patient effectively on all levels of their care.
- Family health care providers.
- Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors.
- Religious leaders/counselors.
- Health maintenance organizations.
- Community mental health centers.
- Hospital psychiatry departments and outpatient clinics.
- University- or medical school-affiliated programs.
- State hospital outpatient clinics.
- Social service agencies.
- Private clinics and facilities.
- Employee assistance programs.
- Local medical and/or psychiatric societies.
Additional Resources for Getting Information and Assistance:
- Locate Mental Health Services in Your Area
Within the Federal government, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a Services Locator for mental health and substance abuse treatment programs and resources nationwide.
- Centers for Medicare and Medicaid Services (CMS)
CMS is the federal agency responsible for administering the Medicare, Medicaid, State Children's Health Insurance (SCHIP) and several other programs that help people pay for health care.
- Locate Affordable Healthcare in Your Area
Within the Federal Government, a bureau of the Health Resources and Services Administration (HRSA) provides a Health Center Database for a nationwide directory of clinics to obtain low or no-cost healthcare.
- Locate NIMH Clinical Trials currently seeking participants.
- Mental Health Information & Organizations from NLM's MedlinePlus (en Espanol).
If You Are in a Crisis and Need Immediate Help
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HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
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