Clozaril: Schizophrenia Drug : Part 3

by Food and Drug Administration (FDA)

(Page 3 of 3)

Schizophrenia strikes about 1 out of every 100 persons — usually young people.

Patients with schizophrenia are unable to think coherently and often misinterpret the meaning of events. Consequently, they are often incapable of caring for themselves and living independently. Moreover, many live in continual fear and distress, threatened by hallucinations and plagued by paranoid delusions. It's "as if our brain began playing tricks on us, [as] if unseen voices shouted at us, [as] if we lost the capacity to feel emotions, and [as] if we lost the ability to reason logically," says E. Fuller Torrey, M.D., a psychiatrist, in his book Surviving Schizophrenia.

Descriptions of a disorder thought to be schizophrenia have been found among civilizations predating the Greeks. Physicians didn't begin to focus on schizophrenia as a distinct disorder, however, until around the 1900s, when psychiatrist Emil Kraepelin coined the term "dementia praecox" to distinguish schizophrenia-like symptoms from the depressive illnesses. A decade later, Swiss psychiatrist Eugen Bleuler coined the term "schizophrenia."

Although scientists were finally able to describe the disease, they still couldn't treat it. Dentists pulled some patients' teeth because psychiatrists thought the teeth produced a toxin that caused psychiatric symptoms. Other patients were injected with colloidal gold or deactivated horse serum, or dropped down wells in vain efforts to remove supposed toxins.

It wasn't until the 1930s that minor successes were first achieved. At that time, physicians began treating schizophrenic patients with electroconvulsive shock therapy. Although some improved, the changes often didn't last.

The first big breakthrough in schizophrenia treatment came from an unlikely event — the French-Indochinese War in the early 1950s. Dr. Pierre Laborit, a French navy surgeon, accidentally found that chlorpromazine, a drug he gave wounded soldiers to control shock during surgery, also soothed them. He persuaded psychiatric colleagues to try the drug on schizophrenic patients and found it controlled the thought disorders and agitation experienced by many of them.

Chlorpromazine became the first antipsychotic drug used to treat schizophrenia. Laborit's discovery ushered in the use of drugs in treatment. His discovery also prompted doctors to examine more carefully the notion that schizophrenia has a physiologic basis and is not caused by poor toilet training, domineering mothers, or, in the words of the late psychiatrist R.D. Laing, "a sane response to an insane world."

There is ample evidence that the brains of persons who have schizophrenia are as a group different from the brains of persons who don't have the disease, comments Torrey.

For instance, some studies using brain imaging techniques in schizophrenics show a loss of brain tissue, abnormalities in brain density, brain asymmetry, and atrophy of the cerebellum (the part of the brain involved in muscular and motor activity). Other studies have shown an excessive number of receptors for dopa-mine (a brain chemical involved in controlling body movements), abnormal electrical responses, abnormal EEGs (electroencephalograms), and abnormal eye movements in schizophrenic patients compared to healthy controls. By all brain measures — gross pathology, neurochemistry, and microscopic pathology — it can be shown that schizophrenia ranks with multiple sclerosis, Parkinson's disease, and Alzheimer's disease as a major brain disease, Torrey says.

Less is known about causes of schizophrenia. The disease runs in families; but how it is transmitted remains unclear. There have been reports that obstetrical complications are associated with a higher risk of schizophrenia, and that more babies born in late winter and early spring eventually become schizophrenic. Why this happens, though, no one is sure.

Researchers have also been intrigued by theories linking nutritional and immunological deficiencies to development of schizophrenia. It has been reported that schizophrenic patients have immune system abnormalities, but researchers don't agree on what these changes are. A viral cause for the disease has also been suggested. Among babies born during the 1957 flu epidemic in Finland, a greater number developed schizophrenia than would normally be expected in the general population.

Schizophrenia is a devastating disease, but some individuals do get better. About half become at least moderately independent. A summary of 25 studies in which schizophrenic patients were followed for 10 years showed that 25 percent completely recovered (whether or not they were treated), 25 percent improved and were able to live a moderately independent life, 25 percent improved somewhat but required an extensive support network, 15 percent did not improve and remained hospitalized, and 10 percent died — usually by suicide.

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