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Schizophrenia - a national tragedy.

The National Institute of Mental Health estimates that 2.8 million Americans are afflicted with schizophrenia at some time in their lives. Among the most common of mental diseases, it devastates the lives of its victims, their families and friends.

Schizophrenia respects no one, affecting people from all backgrounds and occupations. Although it usually begins in adolescence, its early signs often go unrecognized. At first, the teenager may show only minor "personality changes" that parents may assume to be just part of "growing up." Although the outward signs may not be severe, the inner turmoil generated by the disease can be overwhelming. Friends and associates often become alienated by the patient's marked mood swings; eventually, the patient may end up withdrawing from social contacts. Hallucinations and delusions are common, often in the form of voices that lead the patient into inappropriate behavior, acts of violence, and even to suicide.

The sufferer may manage to contain the inner turmoil and function somewhat normally for years. However, coping becomes increasingly difficult for most schizophrenics. Delusions of grandeur (e.g., imagining oneself to be some notable person of past or present) may lead to recognition of the disease, as may paranoia--the inescapable feeling that someone is "out to get you." As the disease progresses, hallucinatory outbursts may become common.

Suicide attempts are also common, but they may be more of an effort to seek help than to do oneself in. Less serious behavior of an erratic or irrational sort is more likely to occur. Whatever the course of the disease, hospitalization usually becomes necessary. Unfortunately, the treatment of schizophrenia, whether on an inpatient or out-patient basis, has been notably difficult. All kinds of drugs, electroshock therapy, and psychotherapy have had only limited success. Often, the patient seems to improve, is discharged from the hospital, and then ends up on the street, unable to hold a job or assume an otherwise normal role in society.

The cause of the disease is unknown. It often runs in families, but whether this is due to genetic disorders is not clear. Stress can certainly trigger the disease or worsen it, but is not believed to be a cause.

The success of a new drug, clozapine, tends to support the view that there are biochemical disturbances in the brain. Clozapine has been used experimentally in the United States since the mid-'70s, but a potentially dangerous side effect delayed its approval by the FDA until fairly recently. Because clozapine may produce agranulocytosis, which seriously affects the body's immune system, the patient receiving the drug must undergo regular laboratory blood testing. This requirement is the cause of much controversy between its manufacturer and those who must pay for its use.

The Sandoz Pharmaceuticals Corporation strictly regulates the distribution of clozapine, which it manufactures under the name "Clozaril." The patient may receive only a one-week supply of the drug at a time and must be tested before taking the next week's supply. The resulting cost of as much as $10,000 a year has prevented many schizophrenics from receiving the drug. The company claims that its charge for the drug is reasonable, based on the required extensive testing program. Others disagree, noting that the actual cost of the drug itself is far below the current charge and that laboratory monitoring of the patient can be done for much less.

For the nearly 60 percent of schizophrenics who respond well to it, clozapine is truly a miracle drug. Patients have been able to return to responsible jobs and normal family situations. Until the manufacturer decides to reduce the price of this singularly effective therapy, most schizophrenics will simply be unable to afford it.
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Publication:Medical Update
Date:Jan 1, 1993
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