Decoding Schizophrenia:
Steep Social Costs of Schizophrenia

By Daniel C. Javitt and Joseph T. Coyle

Schizophrenia, which affects about two million Americans, takes an enormous toll on society. Because it tends to arise in young adulthood and persist, it rings up a huge tally in health care bills and lost wages and ranks among the costliest illnesses in the U.S.

Treatment and strong social support enable some individuals to lead relatively productive and satisfying lives, but most are not so lucky. Fewer than a third can hold a job, and half of those do so only because they have intensive assistance. Men (who tend to become symptomatic earlier than women) usually do not marry, and women who tie the knot frequently enter into marriages that do not last. Because individuals with schizophrenia often isolate themselves and lack jobs, they constitute a disproportionate share of the chronically homeless population.

People with schizophrenia also have a high likelihood of becoming substance abusers. About 60 percent of symptomatic individuals smoke cigarettes, and half abuse alcohol, marijuana or cocaine. Such activities can lead to poor compliance with treatment and can exacerbate psychotic symptoms, increasing propensities toward violence. (Abstainers, however, behave no more violently than the general population.) Homelessness and substance abuse combine to land many with schizophrenia in prisons and county jails, where they often fail to get the treatment they require.

The grim figures do not end there: roughly 10 percent of people with schizophrenia commit suicide (usually during the illness's early stages), a higher rate than results from major depression. But there is one bright note: clozapine, the atypical antipsychotic introduced in 1989, has recently been shown to reduce the risk of suicide and substance abuse. Whether newer atypical agents exert a similar effect remains to be determined, however.

DANIEL C. JAVITT and JOSEPH T. COYLE have studied schizophrenia for many years. Javitt is director of the Program in Cognitive Neuroscience and Schizophrenia at the Nathan Kline Institute for Psychiatric Research in Orangeburg, N.Y., and professor of psychiatry at the New York University School of Medicine. His paper demonstrating that the glutamate-blocking drug PCP reproduces the symptoms of schizophrenia was the second-most cited schizophrenia publication of the 1990s. Coyle is Eben S. Draper Professor of Psychiatry and Neuroscience at Harvard Medical School and also editor in chief of the Archives of General Psychiatry. Both authors have won numerous awards for their research. Javitt and Coyle hold independent patents for use of NMDA modulators in the treatment of schizophrenia, and Javitt has significant financial interests in Medifoods and Glytech, companies attempting to develop glycine and D-serine as treatments for schizophrenia.

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