Wednesday, November 21, 2012

Older Adults with Schizophrenia Can Achieve Remission

The title says schizophrenia can be in remission and that is good news for when we get older. “Many older adults with a history of chronic schizophrenia can have sustained remission if they receive appropriate psychosocial stimulation and support, according to Dr. Dilip V. Jeste.  Schizophrenia is a less important barrier to successful aging than are societal attitudes, health care disparity and scientific or clinical biases, said Dr. Jeste, president of the American Psychiatric Association and chief of geriatric psychiatry at the University of California, San Diego (UCSD).”  To me that sounds good because the last thing I would want is to be a burden because I have this disease.  I would love to live independent for the rest of my life.
They talk about the things that can help: “Optimizing pharmacotherapy, psychosocial interventions, diet, and exercise; curbing substance abuse; and adopting a positive approach on the part of clinicians, patients, and their families can help people with schizophrenia move gently into old age, Dr. Jeste said.” If I keep doing the things I am doing I should be successful.  I am not planning on getting a car.  Walking and taking the bus are important to me.  I would like to continue to be able to walk at least a mile when I would like no matter what age I am.  The article goes on to say: “Currently, people with chronic schizophrenia face many obstacles to successful aging, including stigma, poverty, and lack of insurance.  But they also face long-held biases of some scientists and clinicians who regard schizophrenia as intractable, as well as facing physical comorbidities such as metabolic syndrome, see in one study in 60% of middle-aged and older individuals with schizophrenia (J. Clin. Psychopharmacol. 2009; 29:10-5).In another study, investigators found that the Framingham 10-year risk of coronary heart disease rose by nearly 80% in middle-aged and older patients with schizophrenia (Schizophr. Res. 2001; 125:259-9). Dr. Jeste noted.”  All those obstacles are hard to get rid of when you cannot get out of the house for lack of money is one.  Negative symptoms are another obstacle that is not easy to get rid of.
The article also says: “People with schizophrenia characteristically have higher levels of stress, tobacco use, and alcohol and substance use, and are more likely to have a sedentary lifestyle.  These factors often are exacerbated by poor health care, in addition to the biology of schizophrenia itself.  Also, schizophrenia patients are affected by the adverse effects associated with medications such as atypical antipsychotics, which often are associated with weight gain and increased risk for type 2 diabetes, hyperlipidemia, and other cardio and cerebrovascular disorders.  For these reasons, mortality in schizophrenia is higher than in the general population.” I know schizophrenics smoke because of the calming effect.  I was able to quit, I do not know if it was the side effects from the wellbutrin that I only took for thirty days because they were too much that helped me quit.  The other reasons are I had to have my grandchildren come visit in a smoke free house.
The last of the article says: “UCSD investigators have looked at more than 1,400 middle-aged and older people with schizophrenia, nearly 80% of whom had prodromal symptoms of the disorder before the age of 40.  In longitudinal follow-up with clinical, neuropsychological, and functional evaluations, the investigators found that people with schizophrenia who were adequately treated had a relatively stable course, improvement over time in psychotic symptoms, and a rate of age-related cognitive change similar to that of people without schizophrenia (Acta Psychiatrica Scandinavica 2003; 107:336-43).  As would be expected, people with schizophrenia experienced declines in physical health, but they also reported improvements in mental health, as measured by self-rated quality of life, the authors found. (Schizophr. Res. 2009:108: 207-13).”  It is always good to follow through and do well in treatment.  Still it would be nice once the stigma goes away if it ever does.  We age the same as the rest of the population.  Although it looks like our mental health is better with schizophrenia.

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