Emilio is a 40-year-old man who came to the hospital with his mother. He is dressed in a dirty coat, bedroom slippers, and a baseball cap and has several medals hanging around his neck. He appears to be angry at his mother, claiming that she is poisoning him. Sometimes he giggles and acts seductively toward the interviewer. He talks like a child and walks with a swing in his step and exaggerated hip movements.

His mother tells the interviewer that Emilio stopped taking his medication a month ago and that since then, he has begun to hear voices and act more and more bizarrely. When he is asked what he has been doing lately, he responds, “eating wires and lighting fires.” His speech is difficult to understand and he often rhymes his words even if the rhymes do not make sense.

Emilio dropped out of high school when he was 16. He was hospitalized because he was hearing voices telling him that the principal of his high school was trying to kill him. Emilio receives medications for his symptoms during every hospitalization. Within a few months, however, he often stops taking his medications and eventually returns to the hospital. He lives with his mother but occasionally leaves her house and disappears for months at a time.

On these occasions, Emilio has been picked up by the police for his behavior and returned to a psychiatric hospital.

Emilio’s behaviors worry his mother.  Like many patients with schizophrenia, Emilio was first brought to the hospital at an early age. Although many patients receive psychiatric treatment early, it often takes many visits over many years for a psychiatrist to determine the proper diagnosis of schizophrenia and decide on an appropriate treatment regimen. In fact, according to one study, there is an average delay of 10 years from the first onset of symptoms to correct diagnosis and treatment of psychiatric disorders.

For schizophrenia specifically, the time lag between the appearance of the first sign of a mental disorder and the first hospital admission with the diagnosis of schizophrenia averages over six years. In order for a patient with schizophrenia to receive proper treatment, mental health professionals must be able to identify a pattern of behaviors, or symptoms, of the disease. Once the symptoms are identified, a diagnosis is made and treatment can begin.

Heather Barnett Veague, Ph.D.
Heather Barnett Veague attended the University of California, Los Angeles, and received her Ph.D. in psychology from Harvard University in 2004. She is the author of several journal articles investigating information processing and the self in borderline personality disorder. Currently, she is the Director of Clinical Research for the Laboratory of Adolescent Sciences at Vassar College. Dr. Veague lives in Stockbridge, Massachusetts, with her husband and children.

References

1. National Alliance on Mental Illness, "About Mental Illness." Available online. URL: http://www.nami.org/template.cfm?section=By_Illness. Accessed February 22, 2007.
2. American Experience, "People and Events: Recovery from Schizophrenia." Available online. URL: http://www.pbs.org/wgbh/amex/nash/ peopleevents/e_recovery.html. Accessed February 22, 2007.
3. John F. Nash Jr., "Autobiography." Availalable online. URL: http://nobelprize.org/economics/ laureates/1994/nash-autobio.html. Accessed May 10, 2007.
4. Sylvia Nasar, A Beautiful Mind. New York: Simon and Schuster, 1998, 335.
5. American Experience,"Transcript." Available online. URL: http://www.pbs.org/wgbh/amex/nash/filmmore/pt.html. Accessed February 22, 2007.
6. See note 2.
7. Robert L. Spitzer et al., eds., DSM-IV-TR Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Text Revision. (Washington, DC: American Psychiatric Publishing, 2004), 189 - 90.
8. H. Hafner et al., "The Influence of Age and Sex on the Onset and Early Course of Schizophrenia." British Journal of Psychiatry 162 (1993): 80 - 86.
9. E. Fuller Torrey, Surviving Schizophrenia: A Manual for Families, Consumers and Providers, 3rd ed. New York: Harper Perennial, 1995, p. 79.
10. G.A. Fava and R. Kellner, "Prodromal Symptoms in Affective Disorders." American Journal of Psychiatry 148 (1991): 828 - 830.
11. British Columbia Schizophrenia Society, "Basic Facts about Schizophrenia," Available online. URL: http://www.mentalhealth.com/book/ p40-sc02.html#Head_4. Downloaded on November 13, 2006.
12. Quoted in J.N. Butcher, S. Mineka, and J.M. Hooley, Abnormal Psychology. Pearson: Boston, 2004.
13. Harrison et al., "Recovery from Psychotic Illness: A 15- and 25-year International Follow-up Study." British Journal of Psychiatry 178 (2001): 506 - 517.
14. N.C. Andreasen, "The Role of the Thalamus in Schizophrenia." Canadian Journal of Psychiatry 42 (1997): 27 - 33.
15. J. Hooley and S. Candela, "Interpersonal Functioning in Schizophrenia." In Oxford Textbook of Psychopathology, edited by T. Million, P.H. Blaney, and R.D. Davis. New York: Oxford University Press, 1999.
16. J.D. Hegarty et al., "One Hundred Years of Schizophrenia: A Meta Analysis of the Outcome Literature." American Journal of Psychiatry 151, no. 10 (1994): 1409 - 1416.
17. E.Q. Wu et al., "The Economic Burden of Schizophrenia in the United States in 2002." Journal of Clinical Psychiatry 66, no. 9 (2005): 1122 - 1129.
18. C. Wallace, P.E. Mullen, and P. Burgess, "Criminal Offending in Schizophrenia over a 25-year Period Marked by Deinstitutionalization and Increasing Prevalence of Comorbid Substance Use Disorders." American Journal of Psychiatry, 161 (2004): 716 - 727.
19. Suicide and Mental Health Association International, "NARSAD Publishes Top 10 Myths About Mental Illness Based on Nationwide Survey." Available online. URL: http://suicideandmentalhealth associationinternational.org/factsmythsment.html. Accessed February 22, 2007.