Photographs and Illustrations xvii
Preface to the Seventh Edition xix
Acknowledgments xxi
1. The Inner World of Madness: View from the Inside 1
Alterations of the Senses 4
Inability to Interpret and Respond 13
Delusions and Hallucinations 24
Altered Sense of Self 35
Changes in Emotions 37
Changes in Movements 42
Changes in Behavior 44
Decreased Awareness of Illness: Anosognosia 47
The Black-Red Disease 49
Recommended Further Reading 52
2. Defining Schizophrenia: View from the Outside 54
Official Criteria for Diagnosis 55
Subtypes of Schizophrenia 58
The Schizophrenia Spectrum: Do We All Have a Little? 60
Schizoaffective Disorder and Bipolar Disorder 64
Recommended Further Reading 69
3. Conditions Sometimes Confused with Schizophrenia 70
A "Split Personality" 70
Psychosis Caused by Street Drugs: Can Marijuana Use Cause Schizophrenia? 71
Psychosis Caused by Prescription Drugs 74
Psychosis Caused by Other Diseases 74
Psychosis Caused by Head Trauma 78
Psychosis with Mental Retardation 79
Infantile Autism 80
Antisocial Personality Disorders and Sexual Predators 82
Culturally Sanctioned Psychotic Behavior 83
Recommended Further Reading 83
4. Onset, Course, and Prognosis 85
Childhood Precursors 86
Onset and Early Symptoms 87
Childhood Schizophrenia 90
Postpartum Schizophrenia 91
Late-Onset Schizophrenia 92
Predictors of Outcome 93
Male-Female Differences 95
Possible Courses: Ten Years Later 96
Possible Courses: Thirty Years Later 101
Do People with Schizophrenia in Developing Countries Really Have a Better Outcome? 104
The Recovery Model 105
Successful Schizophrenia 107
Causes of Death: Why Do People with Schizophrenia Die at a Younger Age? 110
Recommended Further Reading 113
5. The Causes of Schizophrenia 115
The Normal Brain 116
How Do We Know That Schizophrenia Is a Brain Disease? 118
Structural and Neuropathological Changes 118
Neuropsychological Deficits 119
Neurological Abnormalities 120
Electrical Abnormalities 121
Known Risk Factors 122
Brain Disease Deniers 125
What Parts of the Brain Are Affected? 127
When Does the Disease Process Begin? 128
Theories About the Causes of Schizophrenia 129
Genetic Theories 131
Inflammatory, Infectious, and Immunological Theories 133
Neurochemical Theories 135
Developmental Theories 136
Nutritional Theories 138
Endocrine Theories 139
Childhood Trauma and Stress Theories 140
Obsolete Theories 142
Recommended Further Reading 144
6. The Treatment of Schizophrenia: Getting Started 147
How to Find a Good Doctor 148
What Is an Adequate Diagnostic Workup? 153
Hospitalization: Voluntary and Involuntary 158
Alternatives to Hospitalization 167
Payment for Treatment, Insurance Parity, and Health Care Reform 168
Recommended Further Reading 170
7. The Treatment of Schizophrenia: Medication and Other 171
Do Antipsychotics Work? 172
Whose Information Can You Trust? 173
Which Antipsychotic Should You Use? 174
A Treatment Plan for First-Break Psychosis 181
Dose and Duration 184
Clozapine: The Most Effective Antipsychotic 186
Monitoring: Is the Person Taking the Antipsychotic? 188
Long-Acting Antipsychotic Injections 189
Medications to Try When All Else Fails 190
Drug Costs and the Use of Generics 193
Criticism of Antipsychotics 194
Electroconvulsive Therapy (ECT) and Repetitive Transcranial Magnetic Stimulation (rTMS) 196
Herbal Treatments 197
Psychotherapy and Cognitive-Behavioral Therapy 198
RAISE and the Early Treatment of Schizophrenia 201
Recommended Further Reading 203
8. The Rehabilitation of Schizophrenia 205
Money and Food 206
Housing 210
Employment 214
Friendship and Social Skills Training 217
Medical and Dental Care 220
Exercise 221
Peer Support Groups but Not the Hearing Voices Network 221
Recommended Further Reading 223
9. What Good Services Should Look Like 225
Psychiatric Inpatient Beds 226
The Need for Asylum 227
Outpatient Services 229
Rehabilitation 234
Quality of Life Measures 235
Recommended Further Reading 236
10. Ten Major Problems 238
Cigarettes and Coffee 239
Alcohol and Street Drugs 242
Sex, Pregnancy, and AIDS 246
Victimization 252
Confidentiality 254
Medication Noncompliance 258
Assisted Treatment 264
Assaultive and Violent Behavior 273
Arrest and Jail 277
Suicide 279
Recommended Further Reading 282
11. How Can Patients and Families Survive Schizophrenia? 284
The Right Attitude 285
The Importance of Education 294
Survival Strategies for Patients 294
Survival Strategies for Families 297
Effects of Schizophrenia on Siblings, Children, and Spouses 308
Minimizing Relapses 312
Recommended Further Reading 315
12. Commonly Asked Questions 322
Does Schizophrenia Change the Underlying Personality? 322
Are People with Schizophrenia Responsible for Their Behavior? 324
Does Schizophrenia Affect the Person's IQ? 327
Should People with Schizophrenia Drive Vehicles? 328
How Do Religious Issues Affect People with Schizophrenia? 329
Should You Tell People That Von Have Schizophrenia? 331
Genetic Counseling: What Are the Chances of Getting Schizophrenia? 332
Why Do Some Adopted Children Develop Schizophrenia? 334
What Will Happen When the Parents Die? 335
Recommended Further Reading 337
13. Schizophrenia in the Public Eye 339
Schizophrenia in the Movies 340
Schizophrenia in Literature 348
Schizophrenia, Creativity, and Famous People 355
The Problem of Stigma 360
Recommended Further Reading 363
14. Dimensions of the Disaster 364
How Many People Have Schizophrenia in the United States? 369
Do Some Groups Have More Schizophrenia Than Others? 371
Is Schizophrenia Increasing or Decreasing? 375
Is Schizophrenia of Recent Origin? 376
Deinstitutionalization: A Cradle for Catastrophe 379
What Is the Cost of Schizophrenia? 385
Recommended Further Reading 389
15. Issues for Advocates 390
Advocacy Organizations 391
NIMH and SAMHSA 394
Educating the Public 396
Decreasing Stigma 398
How to Organize for Advocacy 399
Recommended Further Reading 401
Appendix A An Annotated List of the Best and the Worst Books on Schizophrenia 403
Appendix B Useful Online Resources on Schizophrenia (by D.J. Jaffe) 421
Notes 429
Index 461