Schizophrenia: An Overview of Schizophrenia

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Schizophrenia:  An Overview of Schizophrenia




Guest:  Dr. Christopher Pelic – Psychiatry & Behavioral Sciences

Host:  Dr. Kevin Gray – Psychiatry & Behavioral Sciences


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 symptoms be?


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 early on.


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 hallucinations.


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 schizophrenia?


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.


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