Diagnosing schizophrenia early might save patients from a lifetime of illness

His name was Barry, and police found him standing on the roof of a 20-story building, ready to fling himself into the air, believing he was Superman and that he could fly. He was 22 years old, and voices in his head were telling him to jump.

When 25-year-old John Hinckley shot then-President Ronald Reagan in 1981, he was trying to impress Jodie Foster, an actress he’d never met but was obsessed with. He spent 34 years in a psychiatric facility after being found not guilty by reason of insanity.

Both men had a severe mental illness called schizophrenia, which can cause psychotic episodes consisting of hallucinations, delusions, paranoia and disordered thinking. Although most schizophrenics are not violent, they can act unpredictably at times, especially if they aren’t being treated.

“Everything about them looks normal, yet their brains are misfiring,” said Kathleen Crapanzano, M.D., associate professor of clinical psychiatry at LSU Baton Rouge. “The diagnosis of schizophrenia is a clinical one based on the symptoms. There is no blood test for this disease. For the most part, the brain is out of touch with reality. Patients can be convinced the sky is orange, and nothing you tell them will dissuade them.”

Disabling symptoms

Psychosis is not the only symptom of schizophrenia. According to Crapanzano, just as disturbing and often more disabling are symptoms such as complete apathy and an inability to experience pleasure. Cognitive issues can also be problematic, like problems with attention, concentration and memory. Three-step commands can be hard to follow. Alongside schizophrenia, patients can also have depression.

Most schizophrenics are diagnosed in their late teens or early twenties, when they have their first psychotic break. One third of patients will spontaneously get better. One third will stay the same. One third will get worse.

There is no single gene associated with schizophrenia, but it does run in families. The risk to the general population is only 1%, but when one parent has the disease, the risk jumps to 10%. With two parents, it’s 50%. Even so, there are other factors.