American Medical Association Family Medical Guide - American Medical Association [468]
Diagnosis
If you suspect that someone in your family has schizophrenia, try to get him or her to see a doctor, although this may not be easy. If your loved one seems to go out of control, try to stay with him or her to prevent self-destructive behavior until help arrives. People who exhibit the symptoms of schizophrenia may be admitted to a hospital for a preliminary period of observation. In the hospital or at the doctor’s office, a doctor will perform a physical examination, order relevant tests, and ask you questions about the person’s behavior to rule out any physical disorders that might be contributing to the person’s behavior. For a diagnosis of schizophrenia to be confirmed, the person must show signs of the disorder for at least 6 months and have at least one display of delusions, hallucinations, or significant abnormalities in thinking.
Treatment
Treatment of schizophrenia usually involves the use of medications, psychotherapy (see page 710), and rehabilitation. Severe cases are treated in a hospital. The person is given antipsychotic medication (see page 713) to reduce the hallucinations and delusions. As the symptoms gradually subside, doses of the medication are usually reduced, although some people need long-term medication therapy. They may take medication by mouth daily or be given an injection every 2 to 4 weeks to ensure that they are getting the medication. Injections are usually given to people with schizophrenia who fail to take their medication consistently and correctly.
As soon as the person’s symptoms are controlled by medication, he or she starts psychotherapy. Techniques of psychotherapy vary, but the goal is the same—to help the person and his or her family understand the emotional factors that can worsen the effects of schizophrenia.
The final stage of treatment is rehabilitation, which helps recovering people regain their normal behavior patterns. In the early stages of hospital treatment, people with schizophrenia are generally given increasingly complex tasks that eventually approximate the routine demands of life. People with schizophrenia often benefit from assistance from community care centers once they are released from the hospital. Many people recover from an episode of schizophrenia enough to return to relative independence. But further episodes may occur, especially if the person does not take the medication as prescribed. In some people, schizophrenia becomes long term. However, most people with schizophrenia do well if they take their prescribed medication regularly and if their family is involved and supportive.
Delusional Disorder
Delusional disorder is a form of mental illness in which a person develops a persistent belief that seems very real to him or her but is not shared by others. The delusion usually is about a situation in the person’s life, such as being deceived by a spouse. Apart from the delusion, the person functions normally; a person with delusional disorder does not have the incoherent speech, altered mood, or auditory hallucinations (such as hearing voices) that are characteristic of schizophrenia. Delusional disorder affects men and women equally and tends to appear in midlife, although it can occur at a younger age. The disorder is more common in people who have a family history of schizophrenia and in those diagnosed with a personality disorder (see page 722). For unknown reasons, the incidence of delusional disorder also is higher among people with impaired hearing or sight and among refugee populations and minorities. In vulnerable people, the disorder can be triggered by stress or alcohol or drug abuse.
Symptoms
The prominent symptom of delusional disorder is a false belief about some aspect of a person’s personal