(This article is sponsored by The Boston Group)

Managing Schizophrenia

What is schizophrenia?
Schizophrenia is a severe mental disorder that is characterized by disturbed behavior, mental confusion, personality change, delusions, and hallucinations.  Additionally, it is one of the most distressing of all mental illnesses, and about twenty five percent of schizophrenic patients are depressed.  Furthermore, it increases the risk of suicidal behavior. 

It has been estimated that approximately one percent of the population of the world is affected by schizophrenia irrespective of race, culture, or religion.  In an effort to find a cure for the disease, a number of countries have established various government and community programs. However, the cost of schizophrenia to society remains huge.  For example, the annual cost of schizophrenia in the United States alone is thirty-two billion dollars. 

What are symptoms of schizophrenia?
Symptoms of schizophrenia vary in nature and severity. Some examples are listed below:

·    Positive symptoms of schizophrenia are hallucinations, delusions, severe excitement, disorganized thinking and unusual behavior.
·    Negative symptoms of schizophrenia are apathy, lack of drive, depressive mood and social withdrawal.  In extreme cases, people with negative symptoms of schizophrenia may be totally unresponsive, and will not speak or move.
·    Cognitive symptoms are generally associated with working memory and attention problems.

Scientific rationale:
Although the pathophysiology of schizophrenia is not fully understood, its symptoms are well characterized.  Early on it was postulated that positive symptoms of schizophrenia are caused by hyperactivity of dopamine in the brain.  These positive symptoms can be treated effectively with haloperidol, which is a dopamine D-2 antagonist.  However, there are complications with haloperidol since it is less effective in the treatment of negative symptoms.

Later it was suggested that in addition to dopamine, serotonin may also be involved in etiology of schizophrenia. This hypothesis generated a second generation of antipsychotic drugs which are quite successful in managing both positive and negative symptoms.

Recent clinical studies provided new information regarding schizophrenia’s pathophysiology.  These studies suggest that hypofunction of glutamate neurotransmission in the brain may be responsible in the modulation of mood, cognition, and motor behavior. 

Treatment of schizophrenia:
Antipsychotic drugs are used for the treatment of schizophrenia.  Until mid 1980, haloperidol was used extensively for the treatment of schizophrenia, and it was quite successful in reducing positive symptoms.  However, this prototype drug is less effective in the treatment of negative symptoms and possesses extrapyramidal side effects.   Recently, new drugs such as Risperidone, Aripiperazole, Olanzapine (ZyprexaTM) and Quetiapine (Seroquele) have been developed for the treatment of schizophrenia.  These new drugs have balanced dopamine and serotonin activities, and are more effective for the treatment of positive and negative symptoms with a lower incidence of extrapyramidal side effects

Antipsychotic market has grown significantly in the recent years and sales for antipsychotics were 12 billion dollars in 2003.  For example, ZyprexaTM is a blockbuster drug for the treatment of schizophrenia generating 4.8 billion dollars annually, which was developed and marketed by Lilly Laboratories.

Schizophrenic’s research is growing rapidly, and new hypotheses are being explored in a number of research laboratories. We hope that results from these studies will provide a new insight about this disease, which will lead to generate next generation of antipsychotic drugs for the treatment of schizophrenia with minimal side effects.

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