Schizophrenia: An Overview of Schizophrenia
Guest: Dr. Christopher Pelic – Psychiatry & Behavioral
Host: Dr. Kevin Gray – Psychiatry & Behavioral
Dr. Kevin Gray: Hello.
This is Dr. Kevin Gray, from the Medical University of South
Carolina. Today, I have with me Dr.
Christopher Pelic who’s an inpatient psychiatrist at the medical
university. We’re here to talk about an
often misunderstood and confusing illness, schizophrenia.
Dr. Christopher Pelic: Thanks, Dr. Gray. You’re right, schizophrenia is an illness
that most people don’t fully understand.
In the lay public, most people think of schizophrenia as multiple
personality disorder, which it isn’t.
Multiple personality disorder is something very different. Schizophrenia, on the other hand, is a
disorder of thinking. It’s a disorder
which we often call a psychotic disorder and can be very, very crippling.
Dr. Kevin Gray: What are some of the symptoms? I guess, to begin with, at what age would
someone first begin to have symptoms of schizophrenia, and what would those
Dr. Christopher Pelic: Generally, most patients who develop
schizophrenia have most of their symptoms come on during late adolescence,
early 20s. It’s not impossible that they
could develop symptoms earlier than that, or even later in life, in their 50s,
60’s, or 70s. But most patients develop
their symptoms, generally, around their early 20s. And men tend to develop symptoms a little bit
earlier than women. Women often develop
the illness a little bit later, sometimes even in their late 20s.
Dr. Kevin Gray: And what are the first things that a person
who may be having first signs of schizophrenia, what would they be noticing, or
what would a family member notice?
Dr. Christopher Pelic: Interestingly, most of the symptoms come on
very slowly and they’re often very subtle, and don’t present as full-blown
illness. In fact, most patients who
develop schizophrenia will have what we call almost a prodromal period, which
is a period of very soft symptoms that often include a decreased attention to
hygiene, appearing depressed or very dysphoric, or isolative. They stop taking care of themselves and often
start engaging in, maybe, bizarre behaviors or say bizarre things. So, it can often be a very subtle presentation
Dr. Kevin Gray: And you mentioned, in the early phases, it’s
subtle. That leads to the idea that,
perhaps, it’s less subtle as time goes by.
What are the things that seem to escalate to the point that somebody
comes into your care?
Dr. Christopher Pelic: Well, oftentimes, as those more subtle
symptoms present longer and longer, more severe, which we call positive,
symptoms become apparent. And some of
those symptoms are symptoms of hallucinations, of paranoia, delusions,
disorganized thinking, disorganized behavior, very impairing symptoms, and can
often lead to a significant decline in functioning.
Dr. Kevin Gray: It may be helpful for the audience to hear,
maybe, a specific case so that we can understand more specifics about these
symptoms you’re speaking of.
Dr. Christopher Pelic: It wouldn’t be unusual to have a young
22-year-old Caucasian gentleman present with about a two-year history of
decreased attention to hygiene and parents concerned about depression, but more
recently, in the last several months, had developed what I described earlier as
Dr. Kevin Gray: And what are hallucinations?
Dr. Christopher Pelic: It’s when a patient, or a person, is
receiving some kind of stimuli that isn’t there. For example, they’re hearing a voice or
hearing a noise that isn’t there, or they’re seeing something, a shape of a
person or a figure, that isn’t there.
They’re interpreting this as very real, although there isn’t anything
there for them to see or hear.
Dr. Kevin Gray: I can certainly see that having
hallucinations must be a very distressing symptom, and I would guess that that
probably leads to some other symptoms that are common with the illness. I think you mentioned things like delusions
and paranoia, could you describe that more clearly?
Dr. Christopher Pelic: Sure.
And those are very real parts of the illness. And, I should say, as far as the
hallucinations go, most patients experience what we call auditory
hallucinations. They’re hearing things
that aren’t real, although they can sometimes see things that aren’t real.
With regard to the paranoia, that’s usually a general feeling of being
suspicious, overly concerned that someone is going to get them, or poison them,
or is after them, maybe the CIA or the FBI is following them. And they often change their behavior to
protect themselves because of the fear that something bad is going to
happen. And sometimes patients will not
eat. They’ll put video cameras outside
their home. They will barricade themselves
in the house just because of concerns that someone is going to hurt them.
As far as delusions, that’s what we
call a fixed false belief. When patients
often get fixated on a particular idea, maybe they think that they’re the
President of the United States or that they’ve won the lottery when, in fact,
there’s no evidence to suggest that any of those things are true. And, in fact, no matter what evidence you
present to the patient to suggest that it isn’t true, they don’t believe
you. They’re fixated on an idea that
clearly isn’t true, but they see it as very real and often act on things
because of these delusions.
Dr. Kevin Gray: I can imagine that this is an extremely
distressing illness, not only for the person suffering from it but for the
family that’s involved. What sort of
burden does this have on families?
Dr. Christopher Pelic: It can be incredibly burdensome, especially
since the illness, as it is now, is generally a chronic illness, that we can
often manage with medications, although we don’t have a definitive cure. There’s a subset of patients who,
essentially, most of their symptoms will be in remission, but for the vast
majority, they will have some symptoms even on medications, even when they’re
compliant with treatment. And because of
that, most of these patients, who can’t work or support themselves, are often
too ill to live independently. This puts
an incredible burden on the family to, both, support them emotionally and
financially, and frequently they’ll often live at home even into adulthood.
Dr. Kevin Gray: How common of an illness is schizophrenia?
Dr. Christopher Pelic: It’s more common than most people think. Some studies have suggested that it almost
approaches up to one percent. It could
be as low as a half percent of the population.
But, still, that’s a fairly common illness. And when you combine that with the
debilitating nature of the disease, it has a significant impact on society.
Dr. Kevin Gray: Do we have any idea what causes it?
Dr. Christopher Pelic: As of now, we don’t completely understand the
illness. One of the things I always tell
my patients is that, if you think about
how complex a vehicle, or a car, is and how often you need to take that
vehicle into the shop to get fixed, you think about the human brain and how
many things that, potentially, could go wrong.
What we do know is that somewhere in the brain, and there are probably
several different locations, the neurons, the wiring in the brain isn’t
functioning properly. And we have yet to
fully identify all the areas where that’s happening. We’re just starting, now, to understand that
there are some specific locations in the brain that are probably
malfunctioning. And once we find that,
we can often look for specific medications or treatments to target that. But, as of now, we still don’t fully
understand the illness.
Dr. Kevin Gray: And, certainly, the image in the media is
someone, with schizophrenia, being in an institution or a hospital for their
adult life. Is that realistic, or are
there people who are functioning well with family and work, who have
Dr. Christopher: Generally, the vast majority of patients,
actually, are out in the community now.
Some are more ill than others.
There’s a subset of patients that really responds well to medications,
and there are some medicines, that we can talk about later, that can be very
effective for schizophrenia. There’s
another subset of patients who can function at a modest level and, again, are
outside the hospital. And then I think
there’s a smaller subset of patients who are so ill that, even with medications
and very intense treatment, still find themselves frequently in the
hospital. But I think that is a smaller
subset of the population with schizophrenia.
Dr. Kevin Gray: Dr. Christopher Pelic, thank you so much for
your insights on a very complicated illness.
If you have any questions about the services
or programs offered at the Medical University of South
Carolina or if you would like to schedule an appointment
with one of our physicians, please call MUSC Health Connection: (843) 792-1414.