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Read the text and find out about the relationship between schizophrenia and smoking.






What is it? Schizophrenia is a chronic, severe, and disabling brain disorder. It affects about 1 percent of people all over the world (including 3.2 million Americans) and has been recognized throughout recorded history.

People with schizophrenia may hear voices which other people don’t hear or 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 can seem perfectly fine until they talk about what they are really thinking. Since many people with schizophrenia have difficulty holding a job or caring for themselves, the burden on their families and society is significant as well.

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 the community. Researchers are developing more effective medications and using new research tools to understand the causes of schizophrenia and find ways to prevent and treat it.

When does it start and who gets it? Psychotic symptoms (such as hallucinations and delusions) usually emerge in men in their late teens and early twenties and in women in their mid-twenties to early thirties. They seldom occur after age 45 and only rarely before puberty, although cases of schizophrenia in children as young as five have been reported. In adolescents, the first signs can include a change of friends, a drop in grades, sleep problems, and irritability. Since 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.

What are the symptoms of schizophrenia? The symptoms of schizophrenia fall into three broad categories:

Positive symptoms are unusual thoughts or perceptions that include hallucinations, delusions and thought disorder.

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.

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 they are the most disabling.

Positive symptoms.Positive symptoms are 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 or not 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 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), or feeling things like invisible fingers touching their bodies when no one is close by.

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 a famous historical figure. 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 where the person may have difficulty organizing his thoughts or connecting them logically. Speech may be hard to understand. Another form is " thought blocking" where the person stops abruptly in the middle of a thought. The person says as if the thought had been taken out of his head. Finally, the individual might make up unintelligible words, so-called " neologisms."

Disorders of movement. People with schizophrenia can be clumsy and uncoordinated. They may also show involuntary movements and may show grimacing or 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 that was more common when treatment for schizophrenia was not available, fortunately, it is now rare.

Negative symptoms. The term " negative symptoms" refers to reductions in normal emotional and behavioral states. These include:

· 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 living activities. Because it is not as obvious that negative symptoms are part of a psychiatric illness, people with schizophrenia are often perceived by others as lazy and not willing to better their lives.

Cognitive symptoms. Cognitive symptoms are subtle and are often detected only when neuropsychological tests are performed. They include:

· poor executive functioning (the ability to absorb and interpret information and make decisions based on that information),

· inability to sustain attention, and

· 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, and can cause great emotional distress.

Are people with schizophrenia violent? 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, whether or not the person has schizophrenia. If someone with paranoid schizophrenia becomes violent, their violence is most often directed at family members and takes place at home.

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) 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 and 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. 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. Doctors 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.

What about suicide? People with schizophrenia attempt suicide much more often than people in the general population. About 10 percent (especially younger adult males) succeed. It is hard to predict which people with schizophrenia are prone to suicide, so if someone with schizophrenia talks about or tries to commit suicide, professional help should be sought right away.

What causes schizophrenia? As is the case for many other illnesses, schizophrenia results from a combination of environmental and genetic factors. All the tools of modern science are being used to search for the causes of this disorder.

Can schizophrenia be inherited? 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 40-65 percent chance of developing the problem.

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 currently 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 their genetic material.

Although there is a genetic risk for schizophrenia, genes alone are not likely to be 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.

Do people with schizophrenia have faulty brain chemistry? 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 very promising area of research.

Do the brains of people with schizophrenia look different? 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 grey 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.

Scientists in the U.S. and all over the world are studying schizophrenia and trying to develop new ways to prevent and treat the disorder.

How is schizophrenia treated? Since 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 doctor to find the medications that control their symptoms best with the fewest side effects.

The older antipsychotic medications include chlorpromazine, haloperidol, perphenazine, and fluphenzine. The older medications can cause extrapyramidal side effects, such as rigidity, persistent muscle spasms, tremors, and restlessness.

In the 1990s, new drugs, called atypical antipsychotics, were developed that rarely produced these side effects. The first of these new drugs was clozapine. Clozapine was introduced in 1990. It treats psychotic symptoms effectively even in people who do not respond to other medications, but 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.

Some of the drugs that were developed after clozapine was introduced – such as risperidone, olanzapine, quietiapine, sertindole, and ziprasidone – are effective and don’t produce extrapyramidal symptoms or agranulocytosis; but they can cause weight gain, which increases the risk of diabetes and high cholesterol, together called metabolic syndrome.

People respond very individually to antipsychotic medications, although agitation and hallucinations usually improve within days and delusions in a few weeks. Many people see substantial improvement 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 antipsychotics, they may become drowsy; experience dizziness when they change positions; have blurred vision or a rapid heartbeat, a sensitivity to the sun, or skin rashes. Most of these symptoms will go away after the first days of treatment, but people who are taking atypical antipsychotics should not drive until they adjust to their new medication.


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