What we’ve said about Schizophrenia

“Psychosis is not one thing. It's simply syndrome. And like many things in psychiatry, it probably reflects a wide, wide range of different entities that tend to present syndrome. more or less similarly or often less similar”

“schizophrenia is a syndrome that comes with positive symptoms, negative symptoms, and cognitive symptoms. So when you're treating schizophrenic patients, you're not just stopping hallucinations and then saying your job's done”

“maybe the most common symptom of schizophrenia is a almost neurological, if not entirely neurological, inability to have insight into yourself having a disease”

“I strongly and uniformly believe that the proper psychotic disorders are not psychological in their origin. They're more biological in their origin. It's a disruption in the reasoning network of the brain, the perceptive network of the brain, but the way the symptoms manifest are still psychologically rooted, even if the cause is not psychological”

“I think of schizophrenia as a neurodevelopmental disorder that may or may not have progressive neurodegeneration. But the fact that it's a neurodegenerative disease is a little bit more controversial”

“the schizotypal and schizoid and the delusional, paranoid, these people who don't meet criteria for schizophrenia and schizoaffective, they have the genes, they have the biology. uh for a psychotic disorder”

“having a psychotic disorder is a risk factor for interpersonal violence. The risk is about 4 to 10 times higher than the general population. At the same time, it is still very rare”

“what's most valid? Well, certainly the organic diseases like Alzheimer's disease. But beyond the organic conditions in psychiatry, I think we have to begin with schizophrenia. With manic depressive illness, which is not necessarily equivalent to bipolar disorder”

“you have to look at the long-term trajectory And you should be able to identify a point where functioning, especially mental functioning, begins to decline and stays declined, can be rescued partially with antipsychotic treatment”

“he was one of the first people that didn't just take symptoms at face value. So when he saw patients, he would keep a track of their symptoms, notice how the diagnosis would change over time after treatment, and then on discharge, observe how they were doing”

“On top of delusions and hallucinations, we have disorganized speech, disorganized behavior, and negative symptoms. then there's catatonia which is actually not uh only seen in psychosis”

“you don't need anything more than two out of four of these schizophrenia criteria today to have schizophrenia. Only one of them has to be delusions or hallucinations or disorganized behavior or speech”

“for people who have primarily delusions and hallucinations without negative symptoms or disorganization, Many of them will not tell you about the hallucinations or they don't perceive the hallucinations to be hallucinations. So all you're left with is delusions”

“it's i think much more likely in today's era many decades past the institutionalization for someone that has primarily paranoid features to escape hospitalization and treatment”

“in true psychotic disorders, is that sometimes in this discussion, somebody with schizophrenia will actually start to deny that they believe the delusion. Uh, because they, their ability to detect your social judgment is not impaired”

“American psychiatrists were diagnosing schizophrenia basically twice as often as their British counterparts. A lot of what we would now call bipolar disorder and borderline personality disorder was being called schizophrenia at that time”

“the biggest ones that I saw is definitely substance use, chronic substance use, or patients who come in with a substance-induced psychosis and they get tacked on with schizophrenia. Other big ones are PTSD is another big one. Patients with borderline personality disorder”

“A lot of voice hearing is not the product of a schizophrenia spectrum disorder. A lot of voice hearing experience is the product of a cultural background, a personality trait or syndrome, or PTSD. You can experience flashbacks, dissociations as a parent voices, even when it doesn't seem to be directly related to the incident trauma”

“In borderline states, the preoccupation is around, you know, typically around relationships or a more general sort of sense that people are going to hurt me, you know, sort of the persecutory object relation”

“When you consider schizophrenia, especially of childhood onset, you will have some period of normal or near normal development before the onset of the prodrome. And in the prodromal psychotic state, you can definitely see atypical interests, beliefs, social impairment, and that can look like the social deficits and fixated interests seen in autism spectrum”

“I have seen numerous cases now of Autism Spectrum Disorder being diagnosed in adults after the onset of schizophrenia. I'm not kidding. I am not kidding. The first testing and evaluation for autism is taking place after the clear onset of schizophrenia”

“Autism and schizophrenia can also co-occur, and actually there's probably a shared gene risk pool here, so it gets very, very confusing, and I've treated numerous individuals with both, and it can get so confusing about which one you're dealing with at a particular time”

“In my clinical, non-scientific experience, they seem to have more positive symptoms than negative. But in the end, what we're trying to determine most of the time as a clinician is not what caused this, but what's going to help treat this”

“they share a third of their, a third of associated genes. They diverge on two thirds of their associated genes. They share some symptoms, but their courses are different. They have completely different longitudinal courses”

“So what I would say is that please, please consider first the metabolic side effects when you pick your antipsychotics. Rather than what works or what doesn't, try to spare your patients the weight gain, cholesterol problems, diabetes”

“if you treat enough schizophrenia and bipolar disorders, you're going to find that everyone is an individual. And one medication that works really, really great in 90% of people may work terribly in one person”

“with schizophrenia, if you treat the positive symptoms, it's not like the other things kind of fix in themselves. So you really do address those things separately”

“schizophrenia is this collection of symptoms, and they all funnel into the person's social and occupational functioning. And we need to be treating – that's what we should really be focusing on, maximizing the person's functioning”

“I thought their baseline was their baseline, but once we tried bringing down the sedation a little bit, they almost changed their personality a bit. One of them even got worried was getting manic, but no, she was just getting back to normal”

“if you have any schizophrenia spectrum disorder and you have any hint of mood problems on either pole, add a mood stabilizer. If it's agitation, probably try Depakote first along with impulsivity. That may help. And if it's anything else, lithium, lithium, lithium”

“And I am willing to take it up to 90 milligrams or so, but you have to look out for the sedation orthostasis. And I actually think it's quite a good augmenting agent in the direct treatment Of schizophrenia spectrum disorders and bipolar disorders for the people who can tolerate it”

“You can dose it all at night. That's fine. And you're going to help them stay active and less sedated during the daytime and more sleeping better during the night”

“mindfulness is not going to treat mania. It's not going to treat a bipolar depression. That said, it's still something worth teaching to someone who has bipolar or who has schizophrenia”

“it doesn't count as a trial if someone just doesn't take the medication. So I would see this all the time in the hospital. We would call it, someone would call it treatment resistant schizophrenia because the patient kept coming back to the hospital”

“Clozapine is great. It works great. It's a miracle drug. if you can actually get someone to take it and do the monitoring”

“most of the other antipsychotics cause problems with regards to the fact they worsen negative symptoms, something that we call neurolepsis. So clozapine actually helps in that regard”

“schizophrenia with persistent aggression, which is related to the fact that it helps with violence, it's independent of its antipsychotic defect. So it's not just that you're treating the psychosis and then the aggression goes away”

“whereas all the other antipsychotics block at least 60% of the D2 receptor in order to work, clozapine still works when it's only blocking like 30% to 40%. So we know that something else is involved”

“If you can reasonably identify a classical primary psychotic disorder or a serious bipolar disorder, tapering is actually quite dangerous. Generally speaking, in my opinion, those conditions do require lifetime medications”

“psychosis is like a fire in your brain and once the initial treatment's done there's still some kindling and that like there's still a little bit of uh you know little tiny flames going on so if you were to stop treatment one of those little flames could catch fire”

“LAI medication has been proven to decrease hospitalizations, decrease non-adherence. I think the choice to take a shot once a month is infinitely easier than choosing to take your medications every day”

“the LAIs often cannot achieve the right dose. Some patients do respond with higher effective serum levels than what is possible in the LAI. And you may be depriving them of that”

“if a patient comes to you with what's clearly a neurobiological condition that responds handily to medications, And then you say, well, why don't you try this? It would be like going to an oncologist, having a malignant cancer and saying, well, you could try fasting”

“I'd rather have a patient who says, doc, I don't have schizophrenia, but I take my clozapine than a patient who says I have schizophrenia, but I hate antipsychotics and refuse to take them”

“explaining that to the patient is not going to make them say, oh yeah, totally. I have schizophrenia and I should take Haldol, right? I mean, how many times does that work for you? It doesn't work, right? And so instead, it's more important to say, OK, what's a problem for you”

“It seems as though when you take the medications, you stay out of the hospital. When you're off the medications, you end up in the hospital. I think we should just make our treatment goal keeping you out of the hospital”

“we know medically that these medications are going to help with things like fear stress level sleep and thinking process okay the thinking process will be more organized and less disrupted and therefore you'll be able to concentrate better and live your life better”

“So you really have to come to a shared agreement for what it is that you're targeting and the reasons that you're making these changes”

“don't sugarcoat things um and also like allow like empathize with patients for how annoying these medications can be. I think it's helpful. I think you have to stay hopeful but also stay realistic”

“you need to make sure to establish from the outset and to maintain that the patient is the primary agent in the treatment, even if they're conserved, okay? even if they're concerned, because ultimately we do want people to take medications voluntarily and knowingly”

“I think in the majority of cases, they simply learn to go along socially. And you can actually test this. You can say, so do you have schizophrenia? And they go like, yes. Why do you believe that? Well, that's what the doctors tell me”

“That patient may then project or rather attribute their paranoia. fear, aggression to you. They may start acting in a way that's maybe a little dicey or maybe even overtly aggressive, maybe yelling or being very oppositional”

“I don't think that the people writing about the, quote, schizophrenia, schizophrenogenic mothers, et cetera, et cetera, developmental contributors to schizophrenia, I don't think, A, they demonstrated that that's actually causal”