Carol Tamminga, M.D. Answers Questions On: Schizophrenia

It can be genetic, but it’s not always. It can also be related to early trauma and neglect, or to adolescent cannabis use.

Long-acting antipsychotic medications are a great new option we can offer patients. Nobody likes to take antipsychotic medication because it can have very unpleasant side effects. Some people, especially young people, will often skip doses of their medication – and sometimes take none of it at all – and that will confound all the rest of the treatment. But with long-acting medications, patients may need to take just one pill that will last a week, or get one shot that lasts for three months – and otherwise not even have to think about it.

It’s important to use medication to address the psychotic symptoms as best we can. But it’s also important to address the psychosocial deterioration that develops as people with psychotic illnesses become more isolated.

If from the beginning we can help these patients maintain the highest level of cognition they can, to maintain relationships with their family, to do productive work in a day, they will have much better outcomes. They don’t have to be able to do a 15-hour-a-day job; even just four hours a day can keep their psychosocial function up. And at that point, even if they are still having a few hallucinations, many people can get along pretty well.

Access to care is a big problem. But another problem is that very few people with early psychosis can detect that they have an illness. They feel perfectly well, and they feel that their psychotic manifestations are true. So one person’s delusion might be that the person who lives across the street from him is trying to poison him. He won’t experience that as delusion; he’ll experience that as a real fact. And if you call it a delusion he’ll get really upset because nobody is watching out for this neighbor who is trying to poison him. So, early on it’s difficult for a person with psychotic illness to understand that his experiences are not reality. It’s hard for the family, too.

So far we’ve been dividing psychotic illnesses into diagnoses – schizophrenia, psychotic bipolar disorder, and schizoaffective disorder – that we based on clinical presentation only. It’s a little bit like trying to solve fever by looking at the qualities of the fever – high spiking, low, undulant. I’m quite confident that’s the wrong way to go about it for psychoses.

We have to look at the brain, not at behavior, in order to properly classify them. We think that in the future we’ll be able to divide psychosis up by its biologic mechanisms, not by its symptoms. And that will give us better ways to identify these illnesses early on, and to find new ways to treat the psychotic symptoms. We don’t know how to do that yet, but we’re working on it.