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By Rodrigo Muņoz, M.D.
APA President
Patients with a diagnosis of schizophrenia challenge every aspect of psychiatry. Often misunderstood, misdiagnosed, and undertreated, these patients look to researchers and clinicians to give them hope for a richer future by providing more effective treatments with fewer side effects. Today many schizophrenia patients are indeed living fuller lives, benefiting from the numerous advances made in this field in the last 20 years.
The rare patient with schizophrenia who commits a violent act attracts much attention, eliciting demands that extreme measures be taken to isolate such patients. Few people realize, however, that schizophrenic patients are at high risk to be victims of violence themselves. Even when isolated and friendless, they are often generous and giving to the extreme, and many contribute to their communities in a number of ways.
Our understanding of schizophrenia's etiology is growing exponentially, along with new questions waiting to be answered. We can no longer attribute all the varied clinical manifestations of schizophrenia to the same psychopathologic process. An example is the frequent presence of irritability and anxiety typical of patients with paranoid schizophrenia. Are these symptoms independent? Are they secondary reactions to delusional thinking? Are they "normal" reactions to pathological perceptions?
Patients who have both schizophrenia and depression kill themselves, but many patients with schizophrenia alone do not. How does the schizophrenic process itself increase the risk of suicide? The exploration of suicide prevention is high on our agenda.
As many as half-maybe more-of the patients admitted to acute psychiatric units for treatment of schizophrenia are chemically dependent. Moreover, many suffer from water intoxication, involuntary interruption of breathing, and bizarre compulsions. The course and characteristics of these disorders all need further study as well.
We have advanced in our multiaxial diagnostic formulations of schizophrenia; in our ability to identify family, social, and cultural problems; and in our understanding of disability indicators, comorbidity, and factors leading to early death. The treatment of schizophrenia is changing in front of our eyes. Neuropharmacology is breaking the chains that prevented many of our patients from rejoining their communities. Now they are regaining the right to be healthy, happy, and productive. Somatic treatments hold the promise of full psychosocial rehabilitation. We want to demonstrate to ourselves, to our patients, to their families, and to our communities that psychiatry can be at its most effective and successful when dealing with the once mysterious schizophrenic process.
Herb Meltzer has focused a great deal of his career on the treatment of patients with schizophrenia. He has agreed to lead our initiative on schizophrenia. His words speak of the tasks ahead.