About Mental Illness
Diagnosis and Medication
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How Schizophrenia Is Diagnosed
Most people with schizophrenia are not diagnosed until a serious event or crisis happens. Diagnosis of schizophrenia is complex and can change over time as symptoms change. There are several factors doctors consider in making a diagnosis of schizophrenia. By far, your symptoms provide the most important clues in diagnosing your illness. Your doctor may consider the following:
- The types of symptoms you're having
- How severe your symptoms are
- How long you've had your symptoms
- What your life was like before your symptoms appeared
- If you've ever had medication to treat your symptoms
- If you did take medication:
- Did the symptoms improve?
- If your symptoms improved, how soon after you started treatment?
- Did any of your symptoms disappear completely?
Your doctor may use blood tests and brain scans to eliminate other possible causes of your symptoms. Tests to identify alcohol or street drugs in your body are also used because these substances can cause symptoms that resemble schizophrenia or can make symptoms of schizophrenia worse.
Common Symptoms of Your Illness
You may have heard your doctor describe some of your symptoms as "positive," "negative," and "cognitive." Positive symptoms refer to thoughts, beliefs, and sensations that you may experience that other people do not experience. Hallucinations, which are disturbances of perception, are examples of positive symptoms. Hearing voices that others do not hear is the most common type of hallucination in schizophrenia. Another form of positive symptoms are delusions, which are false, irrational beliefs you have that are not based in reality. Examples of delusions are: believing that someone is trying to harm you or is conspiring against you (paranoid delusions); believing that you are a famous person or have special powers (delusions of grandeur); and believing that someone or something is controlling your thinking or behavior.
Negative symptoms may be described as social withdrawal and a lack of energy or motivation to do the things you used to do when you were well. This type of symptom may be hard to explain to other people. Examples of negative symptoms include:
- You don't feel like talking to other people
- You don't have enough energy to do things
- You don't care much about how you look
Cognitive symptoms refer to problems with learning and concentration. It may be harder for you to concentrate on things like reading a book or watching TV, and you may find it hard to learn new information the first time, like getting directions to a new place. You may find it hard to focus on what someone else is saying, or it may be hard for you to get your thoughts together to explain how you feel.
How medications can help
Without treatment, symptoms of schizophrenia tend to get worse over time. Most people probably can't recall when they started to feel symptoms, and most people aren't diagnosed with schizophrenia and related illnesses until something serious happens. They may have a crisis situation, or they may not be able to care for themselves. When they're admitted to the hospital, they discover they have an illness and that treatment can help them feel better. Other people have a harder time accepting their illness - they may be hospitalized several times before they realize they have an illness and that they can help themselves feel better with treatment.
Medicine may help relieve symptoms of schizophrenia such as fears, suspicions, and sleeplessness. As your treatment continues, it may become easier for you to focus on your daily activities. Overall, your medicine can help you reach your goals by:
- Relieving symptoms you may be having
- Helping you feel more relaxed
- Improving your concentration
Depending on your needs, your overall treatment may involve some of the following:
One or more medicines - to improve your concentration and relieve symptoms such as insomnia, nervousness, depression, fears, voices, feelings of suspicion, and confused thinking
Counseling sessions - for emotional support on a regular basis and to help you learn how to cope with problems caused by your illness, how to solve problems you're concerned about, and how to structure your time and activities
Psychoeducation - to help you learn about your illness, how to manage it, how to recover, how to maintain recovery, and how to avoid relapse
Therapeutic recreation - to help you learn how to keep stress at a comfortable level, communicate your thoughts more easily, enhance your friendships and relationships with others, and find activities you think you may enjoy in your free time
Rehabilitation - to assist you in learning the skills you need to be successful in the living, working, and learning environments of your choice
Support groups - to work with and learn from others who have similar problems; to give and receive support from others
Community resources - to help you find community activities and resources that may be helpful to you
What Would Happen If You Stopped Taking Your Medicine?
With every dose, your medicine works to improve your symptoms and help prevent your symptoms from returning. Therefore, if you stop taking your medicine, your symptoms are very likely to return. You may have a relapse and might have to go to the hospital.
Your medicine cannot cure the problem that's causing the imbalance. Your medicine can only help to adjust the imbalance while itís in your system, so it's very important to continue taking your medicine every day, as long as your doctor recommends it.
About Your Medicines
Your doctor may have told you to take your medicine a certain way, such as "at bedtime." It's important to follow your doctor's instructions exactly, to get the best results from your treatment. Here's why:
- For your medicine to work the right way, there must be enough of it in your system. If your dosage is too low, or if you miss doses, there may not be enough medicine to keep the brain chemicals balanced, and your symptoms may not improve. Or, if your symptoms have improved and you stop your medicine, your symptoms could come back again or get worse.
- If your dosage is too high, you may get more unwanted effects from your medicine. Some unwanted effects can happen even at the right dosage.
- Some nonprescription (over-the-counter) medicines can interfere with the medicine(s) you're taking for schizophrenia. Some can make your illness worse. If you need to take a medicine for another health problem such as a cold, talk to your doctor or pharmacist first. Your doctor or pharmacist can help you find a medicine that won't interfere with your condition or with other medicines.
Knowing About Your Medicine's Unwanted Effects
The term "side effects" usually means a drug's unwanted effects. People often wonder if they'll have side effects from their medicine. Some people may have a few side effects from their medicine. Others may not have any side effects at all, even if they are taking the same medicine in the same dosage. That's because medicines affect people in different ways. The kind of reaction you may have to your medicine depends on many things - your age, sex, weight, and the way the medicine is broken down in your body. Also, the amount of medicine youíre taking (your dosage) and other medicines you're taking can affect the way you react to your medicine.
Many side effects can be annoying, but may not be serious. Other side effects can be more serious - you should call your doctor right away if you have a serious side effect from your medicine. There are ways to handle these side effects so they don't bother you as much.
Your doctor may order lab tests for you (such as blood tests, an EKG, etc.) to screen for side effects you may not be aware of. If you think you may be having a side effect from your medicine, tell your doctor. Do not try to make changes in your medicine yourself. Only your doctor is trained to find the treatment that's right for you.
The table below lists some possible side effects that may be associated with treatments for schizophrenia.
|Body Part/Organ System
Unusual involuntary movements of the tongue and mouth (tardive dyskinesia)
Increased sensitivity to the sun (sunburn)
||Tremors or shaking|
Unusual involuntary movements of the hands, fingers, feet, or toes (tardive dyskinesia)
Being forced to look upward
Difficulty walking normally
Having a feeling of restlessness (akathisia)
Feeling slowed down (akinesia)
||Less sexual desire (men and women)|
Difficulty having orgasm (men and women)
Difficulty with erections or ejaculating (men)
Leaking of milk from breasts (women)
Missed menstrual periods (women)
How to Manage Side Effects That May Be Bothering You
Many side effects may be annoying, but are not serious. Sometimes people think they should stop their medicine if they get a side effect, but this is not true in many cases. Always talk to your doctor if you think youíre having side effects with your medicine. More common side effects are listed below, with some suggestions for how to manage them.
Blurry Vision - If your vision is blurred, contact your doctor right away. He may want to adjust your dosage or give you another medicine to correct the problem.
Constipation - Your doctor might suggest drinking plenty of fluids (6 to 8 cups of water daily), eating more of certain foods (such as bran cereals, fruits, and vegetables), or taking a type of laxative to relieve this problem.
Dizziness - If you sit up or stand up too quickly, you may become very dizzy. To prevent dizziness, rise slowly. If you are lying on your bed, first put your feet over the edge of the bed, and then sit up slowly. Wait a moment before standing up. This side effect usually improves as you continue with your treatment.
Drowsiness - Your medicine may make you feel drowsy - you may want to see how your medicine affects you before you do any activity that requires you to be alert. You might want to start your medicine on a day that you're going to be at home, just to see how you react to it. This side effect is usually temporary, so you are likely to feel less drowsy as you continue your treatment with your medicine.
Dry Mouth - If your mouth feels dry, suck on sugar-free, hard, sour candy. Chewing sugarless gum or sipping water may also help.
Restlessness - You may feel like you have to keep moving - it's hard to sit still. This side effect is called akathisia, and it can be managed with other medicines. Be sure to tell your doctor if this side effect is bothering you.
Sexual Difficulties - If you think you may be having any sexual side effects from your medicine (less sexual desire, fewer orgasms, difficulty with ejaculations, etc.), tell your doctor.
Skin Rash - Skin rash may be caused by an allergy you may have to the medicine. If you get a skin rash, call your doctor immediately.
Slowed Body Movements - People who have this side effect may feel tightness in their muscles, and may walk with short steps and not be able to swing their arms naturally. They may have a tremor in their hands or walk slowly. If you feel any of these symptoms, tell your doctor, who may want to adjust your dosage or change your medicine.
Feeling Slowed Down - Some people describe this side effect as "feeling like a zombie." If this side effect happens to you, tell your doctor. Your doctor may want to adjust your dosage or prescribe another medicine to relieve this side effect.
Sunburn - Some medicines can make you more sensitive to the sun; so use clothing and a sunscreen to protect skin that's not covered - even if you plan to stay in the shade.
Difficulty Urinating - You may have the urge to urinate but may not be able to empty your bladder completely. If you have difficulty urinating, call your doctor as soon as possible.
Weight Gain - Some people may gain weight after several weeks or months of treatment. If you start to gain weight, ask your doctor to recommend a balanced, low-calorie diet that will provide good nutrition. Also, exercise regularly to prevent yourself from gaining weight, but be sure to talk to your doctor before beginning an exercise program.
Serious Side Effects
The following side effects can be serious, but occur at different rates with various medicines and in different people. Although these side effects rarely occur, it's important to be familiar with them so that you'll know what to do if you experience a serious side effect. If you've ever had any of these side effects, be sure to tell your doctor and the other members of your treatment team. Also keep in mind that your medicine may not cause all of the side effects listed in this section. Check with your doctor to find out which side effects may occur with the medicine you're taking.
Low White Blood Cell Count (Agranulocytosis) - Agranulocytosis means low white blood cell count. Without enough white blood cells, your body may not be able to fight infection. Since this side effect can be dangerous, be sure to report high fevers and painful sore throats to your doctor as soon as possible.
Involuntary Muscle Movements - This side effect, known as tardive dyskinesia, usually occurs after months or years of taking antipsychotic medicine. It is serious and can cause involuntary movements of the tongue and mouth (eg, chewing and sucking motions), lip smacking, and sometimes the arms and legs can be affected. Tell your doctor immediately if you have any of these symptoms.
Overheating (Hyperthermia) - Some medicines can cause you to get overheated, especially in hot weather. Drinking plenty of water can help you avoid getting overheated.
Neuroleptic Malignant Syndrome - This is a rare but very serious side effect. Muscles get very stiff over one to three days, a high fever develops, and you may feel very confused. If you start to feel these symptoms, get medical help immediately. Go the emergency room if you cannot reach your doctor.
Seizures - Some medicines make people more prone to having seizures. If you do have a seizure, get medical help immediately.
Uncontrolled Muscle Spasms (Dystonia) - This side effect feels like a charley horse or writer's cramp. It may start with a neck spasm that leads to a stiff neck and stiff tongue. The eye muscles may be involved, causing the eyes to roll up and back. If you have this side effect, call your doctor immediately or go to the emergency room. Your doctor can prescribe another medication to prevent this reaction from occurring again.
A Word About Drug Interactions
One of the most dangerous things that can happen with medicines is having a bad reaction when you take two or more drugs at the same time. Thereís no need to worry about this if you are just taking the medicines your doctor prescribed, but problems can occur when you start taking medicines your doctor didnít prescribe. If you are getting prescription medicines from more than one doctor (such as your psychiatrist and family doctor), or if you are taking over-the-counter or herbal remedies, be sure to tell each doctor about all of the medicines you are taking.
Some non-prescription drugs can interact with your medicine, affecting the way your medicine works. Be sure to talk to your doctor or pharmacist before taking any other drugs with the medicines your doctor prescribed for you.
Alcohol and street drugs are especially dangerous when combined with your medicine. These substances block the way your medicine works and cause bad side effects such as drowsiness, tremors, low blood pressure, and the return of symptoms such as hallucinations.