Q&A: Living With Schizophrenia
I'm sorry to hear about your situation! I can't imagine it's
easy to deal with. I hope that my answers can help you both and
ease your suffering a bit.
The short answers to your questions are yes, maybe, it depends,
yes, and it depends. Ok, I'll amplify that. Let me take these
questions one at a time.
Can Schizophrenia Be Treated?
Schizophrenia has been pretty effectively managed with antipsychotic
prescription medications and most schizophrenics can return to
a fairly normal life. 25% return completely to normal. 20-50%
of them can lead normal active lives with some symptoms. Research
in China has demonstrated beyond doubt that acupuncture helps
schizophrenics recover. They've found that acupuncture can be
utilized as the primary treatment in any mental disorder. That
conclusion was made way back in 1987 when Michael Jackson was
still cool. Yeah, a long time ago! :)
Schizophrenic Personality Changes
Schizophrenics experience interpersonal difficulties due to what
has been described as a "disconnectedness from common sense."
They have trouble understanding others' states of mind. They experience
"schizophrenic vulnerability" which can be divided into
- Sensory disorders: Incorrect views of self, body, and world.
- Conceptualization disorders: Attributing the wrong meanings
and intentions to people and situtations.
- Attitudinal disorders: Holding strange values and beliefs
while distrusting conventional knowledge.
Schizophrenia affects women differently than men:
- They have more emotional symptoms.
- They are more likely to hear things that aren't there (auditory
hallucinations), and to believe people are persecuting them.
- They respond more quickly to antipsychotics, but have more
side effects than men do.
Factors that Influence Recovery
Your girlfriend has a good chance of returning to her previous
self. There are a number of factors that influence these chances.
She will do better if:
- There is a known trauma, either physical or emotional, that
triggered the first episode
- The onset of schizophrenia was late (later than teens or early
- The onset was sudden rather than gradual
- There was good social functioning before the onset
- Treatment is begun early in the course of illness
- She combines multiple types of treatment; antipsychotics,
cognitive behavioral therapy, acupuncture, the right herbal
medicine, proper nutrition and exercise
- She avoids stress and instability in work, personal relations,
She must do these things not just to get better faster, but for
her own safety as well. Schizophrenics are at risk for both suicide
and life-threatening disease. I don't mean to alarm you; I only
want to emphasize that doing everything she can will ensure her
return to active, normal and long life.
Antioxidants for Schizophrenics
Interestingly, schizophrenics do better in developing countries.
It's not clear why this is, but patients in developed countries
have more lipid peroxidation and lower levels of membrane phospholipids.
This implies greater oxidative stress. You've heard all the hype
about antioxidants? Schizophrenics appear to do much better when
given antioxidants (e.g., vitamins E, C and A; beta-carotene, Q-enzyme,
flavons, etc.) and essential polyunsaturated fatty acids (EPUFAs).
Schizophrenics' lifestyles are often very oxidative; they smoke,
drink, eat high calorie foods, but do not exercise. For this reason,
antioxidants and EPUFAs are very important.
Antipsychotic Effectiveness and Side Effects
Antipsychotic medications clearly work. They get rid of the hallucinations
and delusions. However, the side effects cause problems and slow
down or stop recovery. The side effects are:
- weight gain
- endocrine disturbances
- anticholinergic effects
- extrapyramidal symptoms (potentially painful and disfiguring
abnormalities of body movement... even parkinsonism)
One of the biggest problems is the weight gain. For patients
who are already susceptible to weight gain, gaining 50 pounds
or so can have a horrible effect on self-image and mood, and the
patient may decide to stop taking the antipsychotics. It's as
if they're saying, "I'd rather be a skinny crazy-woman than
a sane overweight one."
Alternatives to antipsychotic-only treatment are:
- Acupuncture and herbal medicine as primary treatment with
a lower dose of antipsychotics (there is research in China to
back this up), or
- Antipsychotic primary treatment combined with acupuncture
and herbs to manage the side effects.
More on Schizophrenic Weight Gain Management
Your girlfriend may not have a great understanding of nutrition
(a lot of people don't!). She may also not be able to afford healthy
foods (who can?)... just avoiding the wrong foods can be a cheap
way to make progress. In Chinese Medicine, the foods to avoid
would depend upon her pattern diagnosis. If she can see a Chinese
Medicine herbalist/nutritionist, she should!
Weight management isn't just about looking good; it's a matter
of life and death! Statistics show that life-threatening diseases
come from obesity and smoking combined with poor diet, lack of
exercise, and pharmaceutical side effects.
Schizophrenics Must Avoid...
These things put schizophrenics at risk for suicide or disease.
They should at least cut down on them, if not avoid them entirely.
- Smoking. It makes sense that schizophrenics love to
smoke; research shows nicotine improves attention and memory
tasks. It's better if they use a nicotine patch. Ear acupuncture
helps here, not only for reducing the mental obsession associated
with addiction, but also in restoring the nervous system and
reducing desire (and perhaps need) for nicotinic agonists.
- High calorie diets and inactivity. This increases oxidative
stress. Oxidative stress on neurons in the brain may be responsible
for schizophrenics' mental problems.
- Changing their dosage and medications themselves, prescribing
themselves herbs. They should be advised by medical professionals
(psychiatrists, CM doctors, etc.). Not following medical advice
can lead to relapse, degeneration, and longer recovery times.
- Stress and Sensory Overload. Schizophrenics have been
known to improve dramatically in natural environments. This
may be due to the lower sensory stimulation. That means she
should avoid much of our high-energy, stressed-out, fast-paced
modern lifestyle (I'd love to do that too). If she can get out
and walk around in nature, great, because she's exercising at
the same time. Full water immersion is another way to decrease
sensory input. Have her take baths and go fully underwater every
once in a while. Hopefully, she is functioning well enough to
be safe in a bathtub. If not, she may need to be watched. This
is also a great maintenance therapy during remission.
I think I hit all your questions there, Ralph. Hope that helps!
(All available on PubMed with the exception of #4):
1. Vulnerability to schizophrenia and lack of common sense.
2. Sex differences in schizophrenia, a review of the literature.
3. National Schizophrenia Fellowship. (UK)
4. Soothing the Troubled Mind (1987), translated from the Chinese
by Thomas Dey, 1999.
5. The early stages of schizophrenia: speculations on pathogenesis,
pathophysiology, and therapeutic approaches.
6. Culture and schizophrenia and other psychotic disorders.
7. Iatrogenic disorders associated with conventional vs. atypical
8. Schizophrenia, a neurodegenerative disorder with neurodevelopmental
9. Oxidative stress and role of antioxidant and omega-3 essential
fatty acid supplementation in schizophrenia.
10. Antipsychotic-associated weight gain and clinical outcome
11. Management of weight gain in patients with schizophrenia.
12. Improving the physical health of patients with schizophrenia:
therapeutic nihilism or realism?
13. Integrating pharmacological and psychosocial treatments for
14. Cognitive effects of nicotine.
15. Patient compliance with drug therapy in schizophrenia. Economic
and clinical issues.
16. Some adverse effects of antipsychotics: prevention and treatment.
17. Extrapyramidal symptoms (EPS)