FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER'S FRIEND MIGHT BE HELPED BY NEW SCHIZOPHRENIA DRUGS

Question: I have a childhood friend who is, like me, now a middle-aged adult. When we were in high school he developed schizophrenia. Now, he seems fairly normal when he takes his medicine. Unfortunately, after taking any medication for a while, he discontinues it because of side effects. Stopping the medicine brings back his confused thinking. I've heard that there are new medications for schizophrenia that have fewer side effects. Can you tell me anything about them?

Answer: Your friend's battle with schizophrenia is not unusual. About 1 percent of the population in all countries of the world suffers from this chronic mental disorder. It causes hallucinations, delusions and disorganized thoughts along with apathy and other less common symptoms. Schizophrenia which usually develops during adolescence or early adulthood produces significant social and occupational impairment. For a fortunate 25 percent, the symptoms clear within 10 years. However, 75 percent continue to exhibit this behavior throughout their lives, or have episodes of recurrence. It seems your friend is in this less fortunate group.

We currently don't understand the cause of this illness, although it is clear that it tends to run in families. In fact, schizophrenia may eventually be shown to have many causes that all produce the group of symptoms we label as schizophrenia. Although we have a great lack of understanding about its causes, we do have treatment.

Medical science today can't provide a cure, but we can offer medications that improve the individual's mood and ability to think more clearly. Psychosocial services help sufferers and their families learn to function better at home and at work. Unfortunately, as your friend has noted, most of the medications can have significant side effects. And without medication, about 75 percent of individuals will have a return of the disorganized thought processes within a year. Vocational rehabilitation, family therapy, and psychotherapy those psychosocial services I mentioned all require the ability to think rationally, so they lose their effectiveness when the person begins to have schizophrenic episodes once again.

Now to address your question about new medications. There are two relatively new medications for the treatment of chronic schizophrenia. Clozapine (brand name Clozaril) and Risperidone (brand name Risperdal) are both as effective for schizophrenia as the older medications but have fewer side effects. The key word is "fewer" side effects, because each still has side effects.

One of these newer medications may be a good choice for your friend. He should discuss this with his psychiatrist. The average cost of a month's worth of either drug more than $300 may seem like a major drawback. However, this is actually less than one day of hospitalization would cost. That's why I think it makes good financial sense to use one of these drugs when it works and other treatments don't.

Question: The side effects my friend complains about don't seem that noticeable to me, and the medication does help him think much better. I've sometimes wondered if we the collective social services agencies our tax dollars pay for should just force him to take his medications? What do you think?

Answer: On brief consideration, it seems silly to let someone who can't think clearly make decisions about whether or not he or she will take medication. On closer consideration, however, to do otherwise limits the individual's and then soon all of our rights. There would be little difference between your friend being required to take his medication and all reproductive-aged women being required to take birth control pills until some bureaucrat says it is "OK" to have children. Both sound unacceptable to me.

Besides, in the most severe cases of schizophrenia or other causes of dementia, there are legal steps for having the individual judged incompetent. In these cases the court appoints a guardian who is then responsible for making decisions for the individual, including whether or not to take medications recommended by the doctor.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.