Conclusion

In popular culture, "insanity" or "madness" often has a romantic aura. The reality is quite different. Few of us would want to experience schizophrenia, the most common disorder with psychotic symptoms. Auditory hallucinations are often accusatory, insulting, or threatening, and most delusions involve a painful experience, such as being spied on or persecuted. The anxiety and depression that are so common among people who suffer from schizophrenia are often severe, while deficit schizophrenia patients are unable to enjoy interests or relationships with other people. Aside from these more dramatic problems, there is the grinding burden of the cognitive difficulties associated with schizophrenia, which make it difficult to work or manage the problems of daily life.

Although the treatment of schizophrenia has improved with the advent of a second generation of antipsychotic drugs, not all patients respond to these medications, and the psychotic symptoms of many respond only in part. In addition, antipsychotic drugs carry the risk of a wide range of side effects, from stiffness and restlessness to a form of diabetes. Many patients find these side effects so uncomfortable that they stop taking their medications, despite the risk of the reappearance or worsening of their psychotic symptoms. Other patients do not understand that their thinking is impaired and refuse to take medications for that reason. Even among those for whom antipsychotic medications are effective, these drugs do little or nothing for the cognitive impairment that accounts for so much of the difficulty in functioning that patients face.

The severity of the disease and the limitations in current treatments underline the importance of furthering our understanding of this debilitating disorder. Fortunately, there is reason for hope for improvements. New treatments for psychotic symptoms and effective treatments for cognitive impairment are on the horizon. Advanced genetic screening technology, structural and functional brain imaging, sophisticated histological techniques, and other methods will be instrumental in identifying particular features of the disease. The combination of these approaches, coupled with a recognition of the heterogeneity of the disorder, will lead to greater understanding, better treatments, and eventually, prevention of schizophrenia.

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