schizophrenia famous case study

Module 11: Schizophrenia Spectrum and Other Psychotic Disorders

Case studies: schizophrenia spectrum disorders, learning objectives.

• Identify schizophrenia and psychotic disorders in case studies

Case Study: Bryant

Thirty-five-year-old Bryant was admitted to the hospital because of ritualistic behaviors, depression, and distrust. At the time of admission, prominent ritualistic behaviors and depression misled clinicians to diagnose Bryant with obsessive-compulsive disorder (OCD). Shortly after, psychotic symptoms such as disorganized thoughts and delusion of control were noticeable. He told the doctors he has not been receiving any treatment, was not on any substance or medication, and has been experiencing these symptoms for about two weeks. Throughout the course of his treatment, the doctors noticed that he developed a catatonic stupor and a respiratory infection, which was identified by respiratory symptoms, blood tests, and a chest X-ray. To treat the psychotic symptoms, catatonic stupor, and respiratory infection, risperidone, MECT, and ceftriaxone (antibiotic) were administered, and these therapies proved to be dramatically effective. [1]

Case Study: Shanta

Shanta, a 28-year-old female with no prior psychiatric hospitalizations, was sent to the local emergency room after her parents called 911; they were concerned that their daughter had become uncharacteristically irritable and paranoid. The family observed that she had stopped interacting with them and had been spending long periods of time alone in her bedroom. For over a month, she had not attended school at the local community college. Her parents finally made the decision to call the police when she started to threaten them with a knife, and the police took her to the local emergency room for a crisis evaluation.

Following the administration of the medication, she tried to escape from the emergency room, contending that the hospital staff was planning to kill her. She eventually slept and when she awoke, she told the crisis worker that she had been diagnosed with attention-deficit/hyperactive disorder (ADHD) a month ago. At the time of this ADHD diagnosis, she was started on 30 mg of a stimulant to be taken every morning in order to help her focus and become less stressed over the possibility of poor school performance.

After two weeks, the provider increased her dosage to 60 mg every morning and also started her on dextroamphetamine sulfate tablets (10 mg) that she took daily in the afternoon in order to improve her concentration and ability to study. Shanta claimed that she might have taken up to three dextroamphetamine sulfate tablets over the past three days because she was worried about falling asleep and being unable to adequately prepare for an examination.

Prior to the ADHD diagnosis, the patient had no known psychiatric or substance abuse history. The urine toxicology screen taken upon admission to the emergency department was positive only for amphetamines. There was no family history of psychotic or mood disorders, and she didn’t exhibit any depressive, manic, or hypomanic symptoms.

The stimulant medications were discontinued by the hospital upon admission to the emergency department and the patient was treated with an atypical antipsychotic. She tolerated the medications well, started psychotherapy sessions, and was released five days later. On the day of discharge, there were no delusions or hallucinations reported. She was referred to the local mental health center for aftercare follow-up with a psychiatrist. [2]

Another powerful case study example is that of Elyn R. Saks, the associate dean and Orrin B. Evans professor of law, psychology, and psychiatry and the behavioral sciences at the University of Southern California Gould Law School.

Saks began experiencing symptoms of mental illness at eight years old, but she had her first full-blown episode when studying as a Marshall scholar at Oxford University. Another breakdown happened while Saks was a student at Yale Law School, after which she “ended up forcibly restrained and forced to take anti-psychotic medication.” Her scholarly efforts thus include taking a careful look at the destructive impact force and coercion can have on the lives of people with psychiatric illnesses, whether during treatment or perhaps in interactions with police; the Saks Institute, for example, co-hosted a conference examining the urgent problem of how to address excessive use of force in encounters between law enforcement and individuals with mental health challenges.

Saks lives with schizophrenia and has written and spoken about her experiences. She says, “There’s a tremendous need to implode the myths of mental illness, to put a face on it, to show people that a diagnosis does not have to lead to a painful and oblique life.”

In recent years, researchers have begun talking about mental health care in the same way addiction specialists speak of recovery—the lifelong journey of self-treatment and discipline that guides substance abuse programs. The idea remains controversial: managing a severe mental illness is more complicated than simply avoiding certain behaviors. Approaches include “medication (usually), therapy (often), a measure of good luck (always)—and, most of all, the inner strength to manage one’s demons, if not banish them. That strength can come from any number of places…love, forgiveness, faith in God, a lifelong friendship.” Saks says, “We who struggle with these disorders can lead full, happy, productive lives, if we have the right resources.”

You can view the transcript for “A tale of mental illness | Elyn Saks” here (opens in new window) .

Candela Citations

• Modification, adaptation, and original content. Authored by : Wallis Back for Lumen Learning. Provided by : Lumen Learning. License : CC BY: Attribution
• A tale of mental illness . Authored by : Elyn Saks. Provided by : TED. Located at : https://www.youtube.com/watch?v=f6CILJA110Y . License : Other . License Terms : Standard YouTube License
• A Case Study of Acute Stimulant-induced Psychosis. Authored by : Ashley Henning, Muhannad Kurtom, Eduardo D. Espiridion. Provided by : Cureus. Located at : https://www.cureus.com/articles/17024-a-case-study-of-acute-stimulant-induced-psychosis#article-disclosures-acknowledgements . License : CC BY: Attribution
• Elyn Saks. Provided by : Wikipedia. Located at : https://en.wikipedia.org/wiki/Elyn_Saks . License : CC BY-SA: Attribution-ShareAlike
• A case report of schizoaffective disorder with ritualistic behaviors and catatonic stupor: successful treatment by risperidone and modified electroconvulsive therapy. Authored by : Yuanhan Bai, Xi Yang, Zhiqiang Zeng, and Haichen Yangcorresponding. Located at : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851085/ . License : CC BY: Attribution
• Bai, Y., Yang, X., Zeng, Z., & Yang, H. (2018). A case report of schizoaffective disorder with ritualistic behaviors and catatonic stupor: successful treatment by risperidone and modified electroconvulsive therapy. BMC psychiatry , 18(1), 67. https://doi.org/10.1186/s12888-018-1655-5 ↵
• Henning A, Kurtom M, Espiridion E D (February 23, 2019) A Case Study of Acute Stimulant-induced Psychosis. Cureus 11(2): e4126. doi:10.7759/cureus.4126 ↵

20 Famous Schizophrenics

• By Kristen Fescoe: BA Psychology; MS Clinical and Forensic Psychology
• Published November 25, 2015
• Last Updated February 7, 2024
• Read Time 24 mins

Famous People With Schizoaffective Disorder and Schizophrenia

Schizophrenia is a severe, chronic mental health disorder that affects the brain and behavior in about 1 percent of the general population. The diagnosis is a heritable trait that is passed down through DNA. Throughout history, this seriously debilitating disease has affected people of all walks of life. People with schizophrenia often report hearing voices, seeing things that are not really there and having delusional thoughts. They may believe other people are reading their minds, controlling their thoughts, or plotting to harm them or someone they love. Schizophrenics that do not receive treatment can become withdrawn or agitated as a result of their disease. In some cases, people with schizophrenia may not make sense and in some cases may even sit for hours without moving or talking (catatonic schizophrenia). At other times people with schizophrenia may appear to be perfectly “normal” until they express their delusional thoughts.

Schizophrenia affects millions of people from all walks of life. This disease affects the rich, the poor, men and women, and even the famous. There are even celebrities with schizophrenia . What famous person has schizophrenia ? This list outlines 20 famous people with schizophrenia who battled the disease throughout their lifetimes. Some of these people are known to have battled the mental illness, while others may be more surprising. Medications and treatments can mitigate the affects of the disease and allow an individual to appear more “normal.” In some cases these individuals were famous for what seemed to be eccentricities but, were in reality, symptoms of schizophrenia. Here are some celebs with schizophrenia .

Lionel Aldridge – 1941-1998

Professional football player.

Age of Diagnosis: 33

Individual History: Lionel Aldridge was an All-Skyline tackle and co-captain of the Utah State Aggies. He was drafted in 1963 after a standout college career at Utah State. Lionel Aldridge was among the few rookies to start for coach Vince Lombardi. Aldridge, defensive end, enjoyed an 11-year career in the NFL playing for the Green Bay Packers and the San Diego Chargers. As a Green Bay Packers player, he played a role in three straight NFL Championships (1965-66-67) and in Green Bay Packers victories in Super Bowls I and II. Traded to the San Diego Chargers, Lionel Aldridge played two seasons in San Diego before retiring from professional football in 1973. Upon his retirement he worked as a sports analyst until being diagnosed in the late 1970’s with paranoid schizophrenia — a sub-type of schizophrenia and the most common type. His diagnosis led to him becoming homeless and he eventually regained some sense of mental health. He became an advocate for the homeless and the mentally ill until his death in 1998. His advocacy work included serving as a board member for the Mental Health Association of Milwaukee and working as a speaker for the National Alliance on Mental Illness. Lionel Aldridge is one example of modern celebrities with schizophrenia .

Syd Barrett – 1946 – 2006

Musician and founder of pink floyd.

Age of Diagnosis: Unknown

Individual History: Syd Barrett is another example of famous people with psychosis . He was an English songwriter, guitarist and artist, most notably the founder of the rock band Pink Floyd. Barrett was the lead singer, guitarist and principal songwriter in the band’s early years and is credited with naming the band. Barrett was excluded from Pink Floyd in April 1968 after David Gilmour took over as their new frontman. He left amidst stories of him having mental illness coupled with serious drug abuse. There were many reports that Barrett was schizophrenic, although he never publicly admitted this. He eventually suffered a severe burnout and cut out all social aspects of his life while remaining in constant isolation. With time Barrett stopped contributing to music and avoided conversation about his association with Pink Floyd. In 1978, when his money ran out, he moved back to Cambridge to live with his mother. He returned to live in London again in 1982, but lasted only a few weeks and soon returned to Cambridge for good. He lived with serious diabetes for several years, and died at his mother’s home in Cambridge on in July of 2006 at the age of 60. The cause of death was pancreatic cancer.

Charles “Buddy” Bolden – 1877-1931

Jazz music pioneer.

Age of Diagnosis: 30

Individual History: One of the most historic cases of famous schizophrenic people is Buddy Bolden. While there is a great deal of first hand oral history about Bolden, facts about his life continue to be lost amongst colorful myth. There have been stories saying that he was a barber by trade or that he published a scandal-sheet called the “Cricket.” However, much of this has been refuted. What is known about him is that he is regarded by music contemporaries as a key figure in the development of a New Orleans style of rag-time music, or Jass, which later came to be known as jazz. He was referred to as King Bolden and a king of Jazz. His band was a top draw in New Orleans from about 1900 until 1907. He left no known recordings He was known for his very loud sound and constant improvisation. Bolden suffered an episode of “acute alcoholic psychosis” in 1907 at the age of 30. Upon further investigation of this diagnosis he was given the full diagnosis of dementia praecox (now known as schizophrenia). He was admitted to the Louisiana State Insane Asylum at Jackson, where he spent the rest of his life.

Eduard Einstein – 1910-1965

Son of albert einstein.

Age of Diagnosis: 20

Individual History: Eduard Einstein was born in Zürich, Switzerland, the second son of famous physicist Albert Einstein and his first wife Mileva Marić. Albert Einstein and his family moved to Berlin in 1914 shortly after the parents separated.  Marić returned to Zürich, taking Eduard Einstein and his older brother Hans Albert with her. His father remarried in 1919 and in the 1930s emigrated to the United States under the threat of the German Nazi regime. Eduard Einstein was extremely intelligent and a successful student throughout his education. During his youth Eduard wanted to be a psychoanalyst but was began showing signs of schizophrenia by the age of 20. This led to him to be institutionalized several times. Eduard Einstein died in an asylum at age 55 and his family lineage has been used to raise public awareness of schizophrenia.

Zelda Fitzgerald – 1900-1948

Writer, dancer, artist, wife of writer f. scott fitzgerald.

Individual History: Zelda Fitzgerald is included on this list of famous people with schizophrenia, in large part due to her fame as the wife of the F. Scott Fitzgerald. F. Scott Fitzgerald is the author of The Great Gatsby. She was an American novelist, dancer, and socialite. She became iconic in the 1920s after being dubbed by her husband as “the first American Flapper.” After the success of his first novel, This Side of Paradise (1920), the Fitzgeralds became celebrities. Zelda Fitzgerald was known to go into fits of paranoia, especially regarding her husband’s alleged unfaithfulness. In 1930, she was diagnosed with schizophrenia at the age of 30. After years as the face of the Jazz Age, the Roaring Twenties, and the Lost Generation, Zelda Fitzgerald posthumously gained further celebrity with the publication of Nancy Milford’s best-selling Zelda: A Biography in 1970. Milford’s biography portrayed Zelda Fitzgerald as a victim of an overbearing husband, and she soon became a feminist icon.  In April 1930, Zelda Fitzgerald was admitted to a sanatorium in France where, after months of observation and treatment, she was diagnosed as a schizophrenic. She was initially admitted to a psychiatric hospital outside Paris, then later moved to a clinic in Switzerland. As her psychological symptoms progressed, she was moved to a psychiatric facility in Prangins on the shores of Lake Geneva. She was released in September 1931, and Zelda and F. Scott Fitzgerald returned to Montgomery, Alabama, where her father was dying. By February 1932, she had returned to living in a psychiatric clinic.

Peter Green – 1946 –

Guitarist and founder of fleetwood mac.

Age of Diagnosis: 31

Individual History: Peter Green, founder of Fleetwood Mac, is a British blues-rock guitarist. Fleetwood Mac is an American band. Peter Green played lead in Peter Bardens’ band, Peter B’s Looners, in 1966. After a three-month stint, he had the opportunity to fill in for Eric Clapton in John Mayall & the Bluesbreakers for three gigs. Upon Clapton’s permanent departure not long after, he was hired full-time. He was inducted into the Rock and Roll Hall of Fame in 1998 for his work with the group. Peter Green has written such songs as “Albatross”, “Black Magic Woman”, “Oh Well” and “Man of the World.” The songs have been recorded by artists such as Santana, Aerosmith, Status Quo, Black Crowes, Midge Ure, Tom Petty, Judas Priest and Gary Moore. Green’s playing was noted for its idiomatic string bending and vibrato and “economy of style.” Peter Green was ranked 38th in Rolling Stone’s list of the “100 Greatest Guitarists of All Time.” Along with a lifetime of success has come a lifetime of struggling with mental illness. Peter Green was eventually diagnosed with schizophrenia and spent time in psychiatric hospitals undergoing electroconvulsive therapy during the mid-1970s.

Darrell Hammond – 1955 –

Comedian and saturday night live actor.

Age of Diagnosis: During Childhood

Individual History: There are also schizophrenic actors . Darrell Hammond is an American actor, stand-up comedian and impressionist. He was a Saturday Night Live cast member from 1995 to 2009, one of the longest-standing actors in the show. Darrell Hammond was a regular member of “The Not Ready For Prime Time Players Company” on Saturday Night Live from 1995 to 2009, the longest tenure of any cast member in the show’s history. When he left the show at the age of 53 he was the oldest cast member in the show’s history. Darrell Hammond made more SNL appearances than any other cast member and impersonated more than 107 celebrities, with Bill Clinton as his most frequent impression. On September 19, 2014, Darrell Hammond became the new announcer of SNL, replacing Don Pardo, who had died the month before. What is lesser known about the comedian is that he is on the list of famous people with schizophrenia. During an 2011 interview with CNN, Darrell Hammond revealed that his mother had brutally abused him throughout his childhood. Darrell Hammond stated that this trauma from abuse led to cutting, several hospitalizations due to psychiatric issues, and diagnoses that include bipolar disorder , schizophrenia, and borderline personality disorder. Hammond is among famous actors with schizophrenia .

Tom Harrell – 1946 –

Composer and jazz musician.

Age of Diagnosis: In His 20’s

Individual History: Tom Harrell is an American composer and arranger and a jazz trumpeter and flugelhornist. Harrell has won awards and grants, including multiple Trumpeter of the Year awards from Down Beat magazine, SESAC Jazz Award, Broadcast Music Incorporated Composers Award, and Prix Oscar du Jazz. He received a Grammy nomination for his big band album, Time’s Mirror. Harrell’s success is quite a story, given that he is a famous person with schizophrenia. His disability profoundly affects his life when off stage. He suffers from paranoid schizophrenia, which affects every aspect of his life. On stage he stands away from the microphone, off to the side, his head bowed and his hands clutching his trumpet. When called upon to play, he walks slowly to the microphone, head still lowered, raising it only to play. When finished, he bows his head and resumes his original place. He has been recorded on over 260 albums. He continues to compose, record and tour around the world.

John Hinckley, Jr. – 1955 –

Failed american assassin.

Individual History: John Hinckley, Jr. was the man who attempted to assassinate U.S. President Ronald Reagan in 1981, making him one of the most infamous people with schizophrenia. He shot Reagan with a revolver as the president left the Hilton Hotel in Washington, D.C., after he addressed an AFL-CIO conference. The act was said to be the culmination of an effort to impress actress Jodie Foster. Reported to have been driven by an obsessional fixation on Foster, Hinckley’s lawyer claimed he was schizophrenic and he had been diagnosed with schizoid personality disorder. Hinckley is a famous person with schizoid personality disorder . The disorder has many of the same symptoms as schizophrenia. Hinckley was found not guilty by reason of insanity, and remained under institutional psychiatric care since then. Public outcry over the verdict led to the Insanity Defense Reform Act of 1984. The Act altered the rules for consideration of mental illness of defendants in federal criminal court proceedings in the United States. Hinckley was confined at St. Elizabeth’s Hospital in Washington, D.C. He was released from St Elizabeth’s Hospital in Washington, D.C. in 2016.

Jack Kerouac – 1922-1969

Novelist and poet.

Age of Diagnosis: 21

Individual History: Jack Kerouac was a American novelist and poet. He’s the author of the classic On the Road. Kerouac is recognized for his method of spontaneous prose. His writing covers a wide range of topics such as Catholic spirituality, jazz, promiscuity, Buddhism, drugs, poverty, and travel. He became somewhat of a quiet celebrity and, along with other “beats”, became a founding member of the hippie movement. Kerouac spent a short time enlisted in the United States military. During his stint a Navy doctor diagnosed him with what was then called “dementia praecox,” today known as schizophrenia. His enlistment lasted just 10 months and Kerouac left the military to start his career as one of the greatest writers of the Beat Generation. When he was discharged from his service the diagnosis was formally changed and noted that he might display some “schizoid tendencies.” He died on October 20, 1969 from an internal hemorrhage caused by cirrhosis of the liver. It was the result of a lifetime of heavy drinking. Some say the drinking was a type of self-medication to stop hearing voices, which are often heard by most schizophrenics.

Veronica Lake – 1922-1973

Film noir actress.

Individual History: Veronica Lake was a famous film noir actress in the 1940’s. She was diagnosed with schizophrenia as a child. Veronica Lake was known for some dramatic and even violent outbursts in adulthood. She won acclaim for her role in Sullivan’s Travels and for her femme fatale roles in noir films with Alan Ladd. Veronica Lake was also well known for her “peek-a-boo” hairstyle. By the late 1940’s, her career began to decline largely due to her struggles with mental illness and alcoholism. Veronica Lake made only one film in the 1950s but appeared in several guest-starring roles on television. Veronica Lake returned to the screen in 1966 in the film Footsteps In the Snow, but the role did not revitalize her career. Veronica Lake died in July 1973 from hepatitis and acute kidney injury at the age of 50.

Mary Todd Lincoln – 1818 – 1882

Wife of abraham lincoln and first lady of the united states.

Individual History: Mary Todd Lincoln, first lady, was the wife of America’s 16th President Abraham Lincoln.  Abraham Lincoln was highly motivated to pursue his increasingly successful law career. Mary Todd Lincoln had the same fierce ambition for success. She was a member of a large, wealthy Kentucky family. She was well educated. Before she married Lincoln, Mary was courted by his long-time political opponent Stephen Douglas. She and Lincoln had four sons together, only one of whom outlived her. In February 1862 her son Willie died at the age of 11 years old. After his death Mary Todd Lincoln spent a considerable amount of money to pay for mediums and spiritualists to try and contact her dead son.  Mary Todd Lincoln supported her husband throughout his presidency. She witnessed his fatal shooting when they were together in the President’s Box at Ford’s Theatre on Tenth Street in Washington. The First Lady had a history of migraines, mental illness, mood swings, fierce temper, public outbursts throughout Lincoln’s presidency, as well as excessive spending. Many historians and psychologists speculate that Mary suffered from bipolar disorder and/or schizophrenia.

Rufus May – 1968 –

Clinical psychologist.

Age of Diagnosis: 18

Individual History: An interesting inclusion on the list of famous people with schizophrenia is Rufus May, a British clinical psychologist. He is most widely known for using his own experiences as a psychiatric patient to promote alternative recovery approaches for those experiencing psychotic symptoms. Upon completion of his clinical psychology training, he disclosed that he had spent time in the hospital due to a diagnosis of schizophrenia. He was diagnosed with schizophrenia in 1986 at age 18 and was compulsorily detained in a psychiatric hospital on three occasions. What makes May so interesting is his personal understanding of psychotic experiences as a reaction to experiences of emotional loss and social isolation. In his teens he reports to have begun day dreaming intensely and became preoccupied with the worlds he was imagining. He also began to experience sleep serious deprivation. He developed ideas he was an apprentice spy for the British secret service. He also experienced messages from the radio and television. This eventually led to three admissions to Hackney Hospital within 14 months. After a year of receiving psychiatric drug treatment May decided to stop being involved with psychiatric services and stop taking the drugs he was being prescribed. He then used exercise, creative activities, social relationships and voluntary work to regain his wellbeing. He currently works as a clinical psychologist in an assertive outreach team in Bradford, England. He is actively involved in consumer recovery groups such as the Hearing Voices Network and the Bradford mental health discussion and campaign group, Evolving Minds.

John Nash – 1928 – 2015

American mathematician.

Individual History: John Nash is an American mathematician working in differential geometry, game theory and partial differential equations. The nationally acclaimed Hollywood movie “A beautiful Mind” was made representing John Nash’s life and was nominated for 8 Oscars. The movie was based on his mathematical genius and his struggles with Schizophrenia. He was often rejected by his classmates and would typically laugh it off with practical jokes and intellectual superiority. John Nash viewed everyday life as little more than distractions from his scientific work. John Nash’s work has provided insight into the factors that govern chance and decision-making inside complex systems found in daily life. His theories are used in economics, computing, evolutionary biology, artificial intelligence, accounting, computer science, games of skill, politics and military theory. Serving as a Senior Research Mathematician at Princeton University during the latter part of his life, John Nash shared the 1994 Nobel Memorial Prize in Economic Sciences with game theorists Reinhard Selten and John Harsanyi. In 2015, he was awarded the Abel Prize for his work on nonlinear partial differential equations. John Nash was awarded the John von Neumann Theory Prize for his invention of non-cooperative equilibria, now called Nash equilibria. Between 1945 and 1996 he had published a total of 23 scientific studies. Nash’s mental illness first began to manifest in the form of paranoia, his wife later describing his behavior as erratic. John Nash seemed to believe that all men who wore red ties were part of a communist conspiracy against him. He was admitted to McLean Hospital in April 1959, staying through May of the same year. There, John Nash was diagnosed with paranoid schizophrenia.

Ingo Schwichtenberg – 1965-1995

Individual History: One of the many sad tales of famous people with schizophrenia is the short life of Ingo Schwichtenberg. He was a German-born drummer and one of the founding members of German power metal band Helloween. Schwichtenberg was known throughout the international music community for his high-energy drumming and ear-to-ear smile. His driving rhythm and proficiency on the drums has been imitated by many power metal bands throughout the 1990s to present. Schwichtenberg was fired from the band in 1993 during the tour of the album Chameleon. The dismissal was reportedly due to Schwichtenberg’s dependence on alcohol and drugs (most notably cocaine and hashish). Schwichtenberg also suffered from schizophrenia, and his refusal to take his medication would lead to bizarre episodes such as uncontrollable sobbing, which made it impossible for him to perform on stage. After his ejection from the band, Schwichtenberg slid further and further into his schizophrenic episodes, culminating in his suicide in 1995 by jumping in front of a subway train.

Skip Spence – 1946 – 1999

Musician and singer songwriter.

Age of Diagnosis: 23

Individual History: Alexander Lee “Skip” Spence was a Canadian-born American musician and singer-songwriter. He began his career as a guitarist in an early line-up of Quicksilver Messenger Service, and was the drummer on Jefferson Airplane’s debut album, Jefferson Airplane Takes Off. He was one of the co-founders of Moby Grape, and played guitar with the group until 1969. He released one solo album, Oar, and then withdrew from the music industry. His career was plagued by drug addiction and mental health problems. In the late 1960s, Spence became delusional after taking too much acid. He was found marching around his hotel room with an axe, bashing down doors and claiming he was the anti-Christ. At that point he was taken to Bellvue Hospital where he was formally diagnosed as schizophrenic. Spence died in 1999 from lung cancer, two days before his 53rd birthday.

Gene Tierney – 1920 – 1991

American actress.

Individual History: Gene Eliza Tierney was an American film and stage actress. She was acclaimed as a great beauty and became established as a leading lady in a short period of time. Tierney was best known for her portrayal of the title character in the film Laura (1944). She was nominated for an Academy Award for Best Actress for her performance as Ellen Berent Harland in Leave Her to Heaven (1945). There were several difficult events in her personal life. She struggled for years with episodes of what was thought to be manic depression or schizophrenia. In 1943, she gave birth to a daughter who was deaf and mentally disabled, the result of a fan breaking out of rubella quarantine and infecting the pregnant Tierney while she volunteered at the Hollywood Canteen. In 1953, she suffered problems with concentration, which affected her film appearances. She consulted a psychiatrist and was admitted to Harkness Pavilion in New York. After being in New York, she went to The Institute of Living in Hartford, Connecticut. After some 27 shock treatments, intended to alleviate severe depression, Tierney fled the facility. She was caught and returned. She later became an outspoken opponent of shock treatment therapy, claiming it had destroyed significant portions of her memory. Tierney died of emphysema in 1991 in Houston.

Vincent van Gogh – 1853 – 1890

Individual History: Vincent van Gogh was a famous artist with schizophrenia. Among the most famous schizophrenic people is world renowned artist Vincent van Gogh. Van Gogh was a Post-Impressionist Dutch painter, whose work had a far-reaching influence on 20th-century art. His work included portraits, self portraits, landscapes and still life of cypresses, wheat fields and sunflowers, and Starry Night. He was reported to have drawn as a child but did not paint until his late twenties. He completed many of his best-known works during the last two years of his life. In a short period of time, he produced more than 2,100 works of art, including 860 oil paintings and more than 1,300 watercolors, drawings, sketches and prints. The artist lived in a time when schizophrenia had not yet been identified as a disorder, but many medical professionals today believe Vincent van Gogh suffered from it. His unstable moods and a  eccentric personality led 150 doctors to hypothesize a posthumous diagnoses. Vincent van Gogh had recurring psychotic episodes in the last two years of his life, and at age 37, he committed suicide by shooting himself in the chest with a revolver.

Wesley Willis – 1963 – 2003

Singer songwriter.

Age of Diagnosis: 26

Individual History: Wesley Willis was a singer and songwriter as well as a visual artist, appearing on widely viewed shows on MTV and on The Howard Stern Show. In 1989, Willis began hearing what he called “demons” and was diagnosed as having paranoid schizophrenia. He was institutionalized for two months after his diagnosis. He often mentioned that his demons were named “Heartbreaker”, “Nervewrecker”, and “Meansucker”. Willis is among the list of famous people with schizophrenia to use his symptoms and put them to his advantage. He called his psychotic episodes “hell rides”, and alternatively, he declared rock and roll to be “the joy ride music”. It was only after his diagnosis and honesty about his diagnosis and symptoms of schizophrenia that his career took flight. Willis gained a cult following that enjoyed his strange and comical lyrics, largely inspired by his disorder. He was diagnosed with chronic leukemia and died in 2003 at age 40.

Brian Wilson – 1942 –

Musician and member of the beach boys.

Age of Diagnosis: In His 30’s

Individual History: Brian Wilson was born in 1942 and became an American musician, singer, songwriter, and record producer best known for being the co-founder of the Beach Boys. He formed the band in 1961 and had a long string of hits. Moving beyond the cheery harmonies and catchy hooks that characterized his early music, Brian Wilson elevated himself and the Beach Boys to the status of rock legends with the release of the acclaimed album Pet Sounds in 1966. He used unorthodox approaches to song composition and arrangement and was a master of recording techniques. He is widely acknowledged as one of the most innovative and influential creative forces in popular music by critics and musicians alike. His childhood was tumultuous which led to years of battling drug and alcohol abuse and mental illness. After his father died in 1973, his addiction and mental illness took a turn for the worse and he spent nearly two years secluded in the chauffeur’s quarters of his home. He slept, abused alcohol, drugs (including heroin), overate, and exhibited self-destructive behavior. He attempted to drive his vehicle off a cliff, and at another time, demanded that he be pushed and buried into a grave he had dug in his backyard. During this period, his voice deteriorated significantly as a result of his mass consumption of cocaine and incessant chain smoking. Brian Wilson also admitted to having auditory hallucinations, meaning he hears voices, and has been diagnosed with schizophrenia. Wilson revived his career and released several solo albums in the 1990s. He was inducted into the Rock and Roll Hall of Fame in 1988. He was honored by the Kennedy Center in 2007 for lifetime contribution to the performing arts.

20 Famous People with Schizophrenia Schizophrenia is a serious mental health diagnosis that can lead to a lifetime of suffering for the individual with the diagnosis, as well as those around them. While the disease is treatable with medication and mental health treatment, it is not curable. The causes of the disease are largely unknown, with studies pointing to a genetic predisposition. This list has shown that schizophrenia affects people from all walks of life. Fame and money are often not enough to take away the seriousness of the illness. While some of these people lived healthy, traditional lives, many did not. This disease is not discriminatory and affects even those with fame and fortune as you can tell by reading about these schizophrenic celebs .

About the Author

After earning a Bachelor of Arts in Psychology from Rutgers University and then a Master of Science in Clinical and Forensic Psychology from Drexel University, Kristen Fescoe began a career as a therapist at two prisons in Philadelphia. At the same time, she volunteered as a rape crisis counselor, also in Philadelphia. After a few years in the field, she accepted a teaching position at a local college where she currently teaches online psychology courses. Kristen began writing in college and still enjoys her work as a writer, editor, professor, and mother.

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8 Clinical Cases of Schizophrenia (Extremes)

Knowing the 8 cases of schizophrenia that I will show you in this article article will help you to better understand this mental illness; Its symptoms, characteristics and the people who have it.

The schizophrenia Is a chronic mental disorder that affects approximately 1% of the population. When it appears it is characterized by hallucinations, delusions, disorganized thinking, altered language, attention problems, lack of motivation and emotional distress (American Psychiatric Association).

The tendency to develop schizophrenia is inherited genetically and may or may not arise depending on many more factors, such as lifestyle, personality or experiences.

Currently there is no cure for this condition, but it can be greatly improved if adequate therapy is found for each person, including always pharmacological treatment (usually antipsychotics or neuroleptics).

For a better understanding of the symptoms of this disease, I recommend reading these 8 real cases:

1. The case of Stuart

It all started in 1991, when Stuart traveled to Moscow to go to a march against communism. It was a rather tense moment in history, as the communists were attempting to stage a coup against Mikhail Gorbachev, the president of the Soviet Union at the time.

Stuart claims that a very angry Russian man called him that night at dawn. The unknown man cursed and shouted at him, asking him why he had gotten into his affairs. Stuart, very frightened, hung up the phone.

From that moment on, he began to feel fear because he could not stop thinking that he was being investigated. When he returned to London, he was always stressed because he felt persecuted, over time developing a depression .

Stuart lost his job shortly before his first psychotic outbreak, which he described as: "It was horrible, I think it appeared out of sheer stress and anxiety. I was lying on the bed when suddenly I felt a pressure on my head, and then, a total darkness. It was as if my own mind had aspired to me, losing all sense of reality. I screamed, and suddenly I went back to my room with that strange feeling in my head."

Later he moved a couple of times, in order to flee from those who were supposedly chasing them. Desperate, one day he went to the family doctor, who did not hesitate to send him quickly to a psychiatric team.

He was diagnosed with schizophrenia, and after testing several treatments, they found a drug that helped him. Stuart stopped experiencing the symptoms: he discovered that no one was chasing him, it was only the result of his illness. He felt much better, with new life plans and goals, like climbing Everest.

He wants to convey to the world that, despite what they say, recovering from schizophrenia is possible.

2. The man who feared being homosexual

The origin of this history can be located in 1972, when a patient with 23 came to consult for fear of being homosexual. He indicated that he was very scared since he heard voices that spoke to him of the subject.

He was diagnosed homosexual panic and paranoid schizophrenia, and a treatment was started to eliminate his fears and hallucinations. Over time, he managed to accept his homosexuality, presenting a double identity: masculine and feminine, which fluctuates according to the time in which he is. Sometimes he would dress in women's clothes or wear women's underwear, surprising why people did not look at him from the street.

Subsequently, he began to have promiscuous relationships with homosexuals, drug addicts, thieves and exploiters. One day, while he was drunk, he pushed one of these into the void from his house, dying on the spot. He was detained for 6 months. However, they declared it unimpeachable.

This patient had problems with alcohol, and although he received financial aid, he had numerous debts because he spent much more than he received.

He spent most of his time writing about the"Principality of Naranjo Bay,"a place he claimed existed. He keeps a daily record of what was happening in the principality and gave it to the doctor after each consultation to be kept in the library of the Psychiatric Institute. The objective of this patient was to demonstrate that, within 100 years, psychiatrists read and confirm that he does not have schizophrenia.

The curious thing about this case that surprised the psychiatrists was the absence of hallucinations and the predominance of inventions, fantasies and delusions. In addition, he reasoned adequately on any subject that was not related to his delusions. For this reason, many classified it as a rare form of schizophrenia called schizophrenia, or Paraphrenia .

It seems that this man remained in treatment, with stable results.

3. Antonio, the boy who thinks he's an alien

At age 14 Antonio appeared in consultation accompanied by his parents. They said the beginning was when Antonio, 12, started talking to his friends about aliens.

From then on they began to see him sad, frightened and suspicious; And before long he was convinced that both he and his family were aliens. For this reason, he received medication , Although his obsession with UFOs remained.

He presented a rather strange way of speaking, which is associated with schizophrenia: unorganized language, jumping from one subject to another that has nothing to do with it, difficulty in finding the word he wants to say, or not responding concretely to what he is told Question.

In addition, it is not expressive, does not usually look at the face, and has A very low self-esteem .

Together with this, Antonio began to develop a Obsessive compulsive disorder , Which can be identified through"manias"and rituals. For example, washing your hands continuously, watching your body a lot, thinking that something terrible is going to happen if you do not turn off the lights or close the door to your room... which sometimes does not leave you To fall asleep .

He was diagnosed with disorganized type schizophrenia, establishing a treatment with his family to strengthen ties, Cognitive therapy , Training in social skills , Techniques to avoid relapse, Neuroleptic medications Y Antidepressants , among others.

4. Jack's Case

Jack graduated from high school and got a job at a video store. After six months of being there, he began to hear voices telling him that he was not doing things right.

In addition, he began to think that his boss was placing small cameras in the movies that clients returned to verify if he did his job well. Thus, Jack was becoming more worried and anxious in his work, especially the days when the store was fuller.

Little by little he began to talk strangely to clients, even told one of them that he could not book the movie he wanted because he had pictures of him that the CIA was reviewing.

A year later Jack could not stand it anymore and quit his job, shouting to his boss that he was sick of watching over all the screens in the store and even in his own house.

He returned to live in the house of his parents, and a while later he was admitted to the hospital. They tried to treat him with various drugs, but he was not persistent, since they had many side effects.

During the next 7 years he was hospitalized 5 times, until he found a treatment that was able to help him.

Finally, he began attending a club for people with mental illness 3 times a week, attending the telephone and participating in the local newspaper. In addition, he feels totally qualified and motivated to look for a work related to the cinema.

5. Susana, the girl of the robots

Susana is a 15 year old girl who her teachers describe as difficult, violent, underperforming in school, and who often interrupts in class telling stories and making animal sounds.

It seems that the problem manifested itself from the age of 12, having been from a girl something different from the others. Since going to the movies to watch Star Wars, he has a great obsession with robots, so he spends the day talking about related topics and drawing futuristic spaceships and inventions.

Susana explains that she has an incredible gift that no one has yet discovered. She says that she makes robots with pieces of computers, and that she once almost caused a catastrophe with one of them, although she managed to stop it in time.

However, when asked how it works or how it was built, it does not know how to respond accurately. She begins to relate random mathematical procedures that make no sense, considering herself as a genius. In psychology, this is called delirium .

In addition, he presumes to have the gift of hearing voices that no one hears and speaks with beings from another world. Experts rate this as Auditory hallucinations .

However, the family did not clearly appreciate the problem and thought they were minor children's stories.

A pharmacological intervention, cognitive therapy, psychoeducation, family intervention and social skills Surely the state of Susana improved.

6. Eva, a girl with paranoid schizophrenia

Eva was 10 when she claimed she could hear voices. The voices told her she was going to die soon because other people have committed crimes because of her.

And he also thinks that, through his breathing, he is able to handle other people. On the other hand, he believes that they record it on video continuously with the aim of putting them on sale.

To make matters worse, she is convinced that others can read her mind, look at her and pursue her. This gives you discouragement and sadness.

Eva presented problems from the age of two, more specifically, developmental delay and communication disorder.

As for her family, her mother apparently had schizophrenia, and when Eva was five, her parents separated and a new family welcomed her. At this age developed many phobias, problems to relate to others, developmental delay and hypersexual behaviors for their age. Surely that form of upbringing was not healthy for the little girl.

After being diagnosed paranoid schizophrenia , A very complete treatment was carried out which probably made her improve in all aspects.

7. Schizophrenia is discovered in a boy who demanded therapy for pain in the shoulder

A 19-year-old boy was referred to physical therapy because of chronic pain in the shoulder, elbow and wrist. It seems that he had bruises since in his spare time he used to skate, snowboard, and break dance, as well as weight training.

In the past, he had gone more than 10 times to the same clinic of sports medicine, diagnosing a great amount of physical affections provoked by the sport.

The pain was real, however, this indicated that the discomfort was due to an electronic device that the United States government had implanted two years ago to control him. He was convinced that the electromagnetic impulses of the device had caused them to fall and injure.

In addition, he said that when he was doing something that the government did not like (according to the patient, his sports activities), his joints cooled or began to hurt. On the other hand, he began to hear voices ordering him to harm his friends or relatives, but he blamed it on the electrical device.

He also thought that other people around him had implants similar to his own to be controlled. He indicated that these people emotionally abused him, gesturing to him to make him understand that they were being watched.

The therapist was able to identify that it was a mental condition and immediately sent it to the psychiatrist. He was diagnosed with schizophrenia and prescribed Risperdal , a known Antipsychotic medication .

Through this case, Shah and Nakamura (2010), insist on the importance of all health professionals to know the signs and symptoms of schizophrenia and other mental health problems. And of course, they stress the importance of in-depth interviews in patients with musculoskeletal discomfort.

8. Álvaro, a young man with behavior problems

Did you know that schizophrenia also alters the way you talk, gestures and movements?

These are the main symptoms of schizophrenia presented by Alvaro, a 17-year-old boy who came to Mental Health for behavioral disorders. For example, he was so aggressive with his mother that she had to call the police several times.

Álvaro left the studies and seems to be a young retired, distrustful and of lost look.

What appeals to the psychiatrist is his gestures: he presents Stereotyped movements (Repetitive movements that are not useful, such as touching clothes, or any part of the body, or swinging). In addition to involuntarily imitating the movements of the people around him ( Ecopraxia ) And making strange grimaces.

Other symptoms of schizophrenia that it presents are reduced language, with phrases made and, above all, to repeat what the examiner says (what is called echolalia).

• Escobar M, Enrique, & Barra C, Bernardo. (2011). History of a case with schizophrenia, or fantastic and systematized paraphrenia. Revista chilena de neuro-psiquiatría, 49 (2), 177-181.
• Childhood schizophrenia. Clinical cases. (S.f.). Retrieved on October 28, 2016, from Paidopsychiatry Portal.
• Rose, M. (s.f.). Schizophrenia: Case study. Retrieved on October 28, 2016, from Collin College.
• Schizophrenia - Stuart's story. (S.f.). Retrieved on October 28, 2016, from NHS Choices.
• Shah, N., & Nakamura, Y. (2010). Case Report: Schizophrenia Discovered during the Patient Interview in a Man with Shoulder Pain Referred for Physical Therapy. Physiotherapy Canada, 62 (4), 308-315.
• What Is Schizophrenia? (S.f.). Retrieved on October 28, 2016, from the American Psychiatric Association.

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Schizophrenia case studies: putting theory into practice

This article considers how patients with schizophrenia should be managed when their condition or treatment changes.

DR P. MARAZZI/SCIENCE PHOTO LIBRARY

Treatments for schizophrenia are typically recommended by a mental health specialist; however, it is important that pharmacists recognise their role in the management and monitoring of this condition. In ‘ Schizophrenia: recognition and management ’, advice was provided that would help with identifying symptoms of the condition, and determining and monitoring treatment. In this article, hospital and community pharmacy-based case studies provide further context for the management of patients with schizophrenia who have concurrent conditions or factors that could impact their treatment.

Case study 1: A man who suddenly stops smoking

A man aged 35 years* has been admitted to a ward following a serious injury. He has been taking olanzapine 20mg at night for the past three years to treat his schizophrenia, without any problems, and does not take any other medicines. He smokes 25–30 cigarettes per day, but, because of his injury, he is unable to go outside and has opted to be started on nicotine replacement therapy (NRT) in the form of a patch.

When speaking to him about his medicines, he appears very drowsy and is barely able to speak. After checking his notes, it is found that the nurses are withholding his morphine because he appears over-sedated. The doctor asks the pharmacist if any of the patient’s prescribed therapies could be causing these symptoms.

What could be the cause?

Smoking is known to increase the metabolism of several antipsychotics, including olanzapine, haloperidol and clozapine. This increase is linked to a chemical found in cigarettes, but not nicotine itself. Tobacco smoke contains aromatic hydrocarbons that are inducers of CYP1A2, which are involved in the metabolism of several medicines [1] , [2] , [3] . Therefore, smoking cessation and starting NRT leads to a reduction in clearance of the patient’s olanzapine, leading to increased plasma levels of the antipsychotic olanzapine and potentially more adverse effects — sedation in this case.

Patients who want to stop, or who inadvertently stop, smoking while taking antipsychotics should be monitored for signs of increased adverse effects (e.g. extrapyramidal side effects, weight gain or confusion). Patients who take clozapine and who wish to stop smoking should be referred to their mental health team for review as clozapine levels can increase significantly when smoking is stopped [3] , [4] .

For this patient, olanzapine is reduced to 15mg at night; consequently, he seems much brighter and more responsive. After a period on the ward, he has successfully been treated for his injury and is ready to go home. The doctor has asked for him to be supplied with olanzapine 15mg for discharge along with his NRT.

What should be considered prior to discharge?

It is important to discuss with the patient why his dose was changed during his stay in hospital and to ask whether he intends to start smoking again or to continue with his NRT. Explain to him that if he wants to begin, or is at risk of, smoking again, his olanzapine levels may be impacted and he may be at risk of becoming unwell. It is necessary to warn him of the risk to his current therapy and to speak to his pharmacist or mental health team if he does decide to start smoking again. In addition, this should be used as an opportunity to reinforce the general risks of smoking to the patient and to encourage him to remain smoke-free.

It is also important to speak to the patient’s community team (e.g. doctors, nurses), who specialise in caring for patients with mental health disorders, about why the olanzapine dose was reduced during his stay, so that they can then monitor him in case he does begin smoking again.

Case 2: A woman with constipation

A woman aged 40 years* presents at the pharmacy. The pharmacist recognises her as she often comes in to collect medicine for her family. They are aware that she has a history of schizophrenia and that she was started on clozapine three months ago. She receives this from her mental health team on a weekly basis.

She has visited the pharmacy to discuss constipation that she is experiencing. She has noticed that since she was started on clozapine, her bowel movements have become less frequent. She is concerned as she is currently only able to go to the toilet about once per week. She explains that she feels uncomfortable and sick, and although she has been trying to change her diet to include more fibre, it does not seem to be helping. The patient asks for advice on a suitable laxative.

What needs to be considered?

Constipation is a very common side effect of clozapine . However, it has the potential to become serious and, in rare cases, even fatal [5] , [6] , [7] , [8] . While minor constipation can be managed using over-the-counter medicines (e.g. stimulant laxatives, such as senna, are normally recommended first-line with stool softeners, such as docusate, or osmotic laxatives, such as lactulose, as an alternative choice), severe constipation should be checked by a doctor to ensure there is no serious bowel obstruction as this can lead to paralytic ileus, which can be fatal [9] . Symptoms indicative of severe constipation include: no improvement or bowel movement following laxative use, fever, stomach pain, vomiting, loss of appetite and/or diarrhoea, which can be a sign of faecal impaction overflow.

As the patient has been experiencing this for some time and is only opening her bowels once per week, as well as having other symptoms (i.e. feeling uncomfortable and sick), she should be advised to see her GP as soon as possible.

The patient returns to the pharmacy again a few weeks later to collect a prescription for a member of their family and thanks the pharmacist for their advice. The patient was prescribed a laxative that has led to resolution of symptoms and she explains that she is feeling much better. Although she has a repeat prescription for lactulose 15ml twice per day, she says she is not sure whether she needs to continue to take it as she feels better.

What advice should be provided?

As she has already had an episode of constipation, despite dietary changes, it would be best for the patient to continue with the lactulose at the same dose (i.e. 15ml twice daily), to prevent the problem occurring again. Explain to the patient that as constipation is a common side effect of clozapine, it is reasonable for her to take laxatives before she gets constipation to prevent complications.

Pharmacists should encourage any patient who has previously had constipation to continue taking prescribed laxatives and explain why this is important. Pharmacists should also continue to ask patients about their bowel habits to help pick up any constipation that may be returning. Where pharmacists identify patients who have had problems with constipation prior to starting clozapine, they can recommend the use of a prophylactic laxative such as lactulose.

Case 3: A mother is concerned for her son who is talking to someone who is not there

A woman has been visiting the pharmacy for the past 3 months to collect a prescription for her son, aged 17 years*. In the past, the patient has collected his own medicine. Today the patient has presented with his mother; he looks dishevelled, preoccupied and does not speak to anyone in the pharmacy.

His mother beckons you to the side and expresses her concern for her son, explaining that she often hears him talking to someone who is not there. She adds that he is spending a lot of time in his room by himself and has accused her of tampering with his things. She is not sure what she should do and asks for advice.

What action can the pharmacist take?

It is important to reassure the mother that there is help available to review her son and identify if there are any problems that he is experiencing, but explain it is difficult to say at this point what he may be experiencing. Schizophrenia is a psychotic illness which has several symptoms that are classified as positive (e.g. hallucinations and delusions), negative (e.g. social withdrawal, self-neglect) and cognitive (e.g. poor memory and attention).

Many patients who go on to be diagnosed with schizophrenia will experience a prodromal period before schizophrenia is diagnosed. This may be a period where negative symptoms dominate and patients may become isolated and withdrawn. These symptoms can be confused with depression, particularly in younger people, though depression and anxiety disorders themselves may be prominent and treatment for these may also be needed. In this case, the patient’s mother is describing potential psychotic symptoms and it would be best for her son to be assessed. She should be encouraged to take her son to the GP for an assessment; however, if she is unable to do so, she can talk to the GP herself. It is usually the role of the doctor to refer patients for an assessment and to ensure that any other medical problems are assessed. 

Three months later, the patient comes into the pharmacy and seems to be much more like his usual self, having been started on an antipsychotic. He collects his prescription for risperidone and mentions that he is very worried about his weight, which has increased since he started taking the newly prescribed tablets. Although he does not keep track of his weight, he has noticed a physical change and that some of his clothes no longer fit him.

What advice can the pharmacist provide?

Weight gain is common with many antipsychotics [10] . Risperidone is usually associated with a moderate chance of weight gain, which can occur early on in treatment [6] , [11] , [12] . As such, the National Institute for Health and Care Excellence recommends weekly monitoring of weight initially [13] . As well as weight gain, risperidone can be associated with an increased risk of diabetes and dyslipidaemia, which must also be monitored [6] , [11] , [12] . For example, the lipid profile and glucose should be assessed at 12 weeks, 6 months and then annually [12] .

The pharmacist should encourage the patient to attend any appointments for monitoring, which may be provided by his GP or mental health team, and to speak to his mental health team about his weight gain. If he agrees, the pharmacist could inform the patient’s mental health team of his weight gain and concerns on his behalf. It is important to tackle weight gain early on in treatment, as weight loss can be difficult to achieve, even if the medicine is changed.

The pharmacist should provide the patient with advice on healthy eating (e.g. eating a balanced diet with at least five fruit and vegetables per day) and exercising regularly (e.g. doing at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity per week), and direct him to locally available services. The pharmacist can record the adverse effect on the patient’s medical record, which will help flag this in the future and thus help other pharmacists to intervene should he be prescribed risperidone again.

*All case studies are fictional.

Useful resources

• Mind — Schizophrenia
• Rethink Mental Illness — Schizophrenia
• Mental Health Foundation — Schizophrenia
• Royal College of Psychiatrists — Schizophrenia
• NICE guidance [CG178] — Psychosis and schizophrenia in adults: prevention and management
• NICE guidance [CG155] — Psychosis and schizophrenia in children and young people: recognition and management
• British Association for Psychopharmacology — Evidence-based guidelines for the pharmacological treatment of schizophrenia: updated recommendations from the British Association for Psychopharmacology

About the author

Nicola Greenhalgh is lead pharmacist, Mental Health Services, North East London NHS Foundation Trust

[1] Chiu CC, Lu ML, Huang MC & Chen KP. Heavy smoking, reduced olanzapine levels, and treatment effects: a case report. Ther Drug Monit 2004;26(5):579–581. doi: 10.1097/00007691-200410000-00018

[2] de Leon J. Psychopharmacology: atypical antipsychotic dosing: the effect of smoking and caffeine. Psychiatr Serv 2004;55(5):491–493. doi: 10.1176/appi.ps.55.5.491

[3] Mayerova M, Ustohal L, Jarkovsky J et al . Influence of dose, gender, and cigarette smoking on clozapine plasma concentrations. Neuropsychiatr Dis Treat 2018;14:1535–1543. doi: 10.2147/NDT.S163839

[4] Ashir M & Petterson L. Smoking bans and clozapine levels. Adv Psychiatr Treat 2008;14(5):398–399. doi: 10.1192/apt.14.5.398b

[5] Young CR, Bowers MB & Mazure CM. Management of the adverse effects of clozapine. Schizophr Bull 1998;24(3):381–390. doi: 10.1093/oxfordjournals.schbul.a033333

[6] Taylor D, Barnes TRE & Young AH. The Maudsley Prescribing Guidelines in Psychiatry . 13th edn. London: Wiley Blackwell; 2018

[7] Oke V, Schmidt F, Bhattarai B et al . Unrecognized clozapine-related constipation leading to fatal intra-abdominal sepsis — a case report. Int Med Case Rep J 2015;8:189–192. doi: 10.2147/IMCRJ.S86716

[8] Hibbard KR, Propst A, Frank DE & Wyse J. Fatalities associated with clozapine-related constipation and bowel obstruction: a literature review and two case reports. Psychosomatics 2009;50(4):416–419. doi: 10.1176/appi.psy.50.4.416

[9] Medicines and Healthcare products Regulatory Agency. Clozapine: reminder of potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus. 2020. Available from: https://www.gov.uk/drug-safety-update/clozapine-reminder-of-potentially-fatal-risk-of-intestinal-obstruction-faecal-impaction-and-paralytic-ileus (accessed April 2020)

[10] Leucht S, Cipriani A, Spineli L et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet 2013;382(9896):951–962. doi: 10.1016/S0140-6736(13)60733-3

[11] Bazire S. Psychotropic Drug Directory . Norwich: Lloyd-Reinhold Communications LLP; 2018

[12] Cooper SJ & Reynolds GP. BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment. J Psychopharmacol 2016;30(8):717–748. doi: 10.1177/0269881116645254

[13] National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management. Clinical guideline [CG178]. 2014. Available from: https://www.nice.org.uk/guidance/cg178 (accessed April 2020)

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Case Study: Schizophrenia and Work: Martin’s Story

Martin had been out of work for several years following a prolonged psychotic episode which began when he was studying at university. He desperately wanted to get into work but found that employers treated his prolonged absence “on the sick” with suspicion. He thought that if he could do a period of work experience that would show prospective employers that he was capable of working again but he was afraid that if he did it might affect his benefits.

So Martin made an appointment to see the Disability Employment Advisor at the Jobcentre to discuss his plans. She was understanding and helpful and explained that a work placement would not affect his benefits as long as it was done as part of the Jobcentre’s own scheme. She also told him that the scheme would pay his travel-to work expenses while he was on the placement.

Job-searching

Next Martin researched local employers using the internet and the local press, looking for companies that might have vacancies in the sort of clerical and administrative work he thought he could do. Then he called the companies by ‘phone and speaking to the person on the switchboard checked that he had the correct postal address for them and asked the name of the person in charge of recruiting. It is vital to be able to write to a named person rather than just the Human Resources Manager.

Martin had already spent a lot of time on his CV so now he compiled a covering letter to go with it. It took him about a month to work up his CV and covering letter using books that he got from the local library. He also managed to get advice from a local back-to-work scheme recommended by the Disability Employment Advisor at the Jobcentre. Martin knew that it was essential that his letter and CV had the maximum impact.

Martin sent his CV and letter off to six employers and then waited about a week before calling them up on the ‘phone. He asked to speak to the person he had written to but if the person on the switchboard asked the reason for his call he simply said that he was calling to follow up a letter he had written.

After approaching about 20 employers in this way he finally found one who said there could be an opening for work experience in a couple of months time. So over the next three months Martin kept in touch with the company by ‘phone once a month just to let them know that he was still keen on coming to work for them.

The interview

Finally the company asked him in for an interview. Before going to the interview Martin prepared really well in advance by researching the company well and trying to anticipate the sorts of questions he would be asked. He also went to the local library and took out some books on interview techniques and managed to get on a one day course on interview skills that the Jobcentre had told him about. This included a mock interview which he found particularly useful.

The day of the interview arrived and Martin was very nervous but he was up early and washed and dressed. To be sure of being on time he left an hour early and checked out the location of the office. Then he went to Starbucks for a coffee while he waited. This gave him an opportunity to flick through his notes and prepare on some of the answers he had been working on. He made sure that he was punctual and well groomed and did his best to present himself well at the interview.

Despite being really well prepared walking through the front door of the office was one of the hardest things that he had done for years. But the receptionist was polite and could not have been more helpful. She made him feel welcome and even offered him a coffee (which he declined).

The Human Resources Manager who interviewed Martin was very professional but quickly put him at his ease. He asked questions about his education at school, his hobbies and pastimes and his qualifications and then came the bit that Martin had been dreading when the HR Manager asked him why he had dropped out of college. Martin explained that he had had a breakdown caused by too much stress while he was at college. He went on to explain that although it was a bad breakdown it was behind him now and that with the help of his family and friends and his doctor he had been able to make a really strong recovery. He also explained that in some ways the experience had made him a stronger person and that he had matured as a result of it.

As the end of the interview approached Martin was sure that he had flunked it but the interviewer told him that he had been successful and asked him to start on Monday. Martin was delighted to be offered a period of three months unpaid work experience during which he would work for two days a week at their local office doing clerical and administrative work.

Martin was walking on air when he left the office. All his hard work had been worth it.

The next day Martin called the Disability Employment Advisor at the local Jobcentre to tell them about the offer and see how his benefits would be affected. She confirmed that his benefits wouldn’t be affected as long as he only worked for 16 hours a week.

The placement

For the next three months Martin worked hard at his placement. He made sure that he got all the basics right: being punctual and well groomed every day. At work he was helpful and got on well with the other workers. Although he was very shy at first he soon learned the importance of making small talk with his colleagues and building good working relationships.

As the end of his placement approached Martin wondered if he would be offered a permanent position. He asked the HR Manager about this but sadly he was told that there were no permanent vacancies at that time so when the end of his placement came Martin had mixed feelings. On the one hand he was disappointed that the work experience had not turned into a permanent job but on the other hand he had had three months experience in the workplace and had something to put on his CV to demonstrate to other employers that he could work. And most importantly he had that all important reference from a well respected local employer.

But that isn’t quite the end of the story. Martin continued searching for a job without success for another six months but continued to keep in touch with the HR Manager he had worked for during his work experience. One day he saw in the local press that they were advertising for a clerical assistant so he called them and explained that he was still jobsearching and would be available for this position. The HR Manager was very pleased to hear from him and said that he would call him back. The next day Martin got a call asking him to go in for an interview straight away and was offered the job.

Martin called the Jobcentre Plus helpline and found out what benefits he would be entitled to while he was working and was pleased to find out that he would be better off in work.

Martin has now been employed in his new job for two years and is delighted to be living an independent lifestyle free of the benefits culture he was in before. It has had its difficulties though. For instance Martin found that his illness had left him emotionally very sensitive and that he found it difficult to cope if his work was criticised. But he knew that this was something he had to learn to live with and gradually he managed to learn new social skills that helped him to cope better and at the same time helped him in other areas of his life.

Martin has enjoyed the structure that the new job has brought to his life. He enjoys the work and the social contact that the job entails. He has made new friends and above all his self-esteem has grown vastly. Now when people ask him what he does for a living he no longer has to say that he is unemployed.

Some Key Points from Martin’s Story:

• Research the local job market really well
• Before writing to a firm call to check the postal address.
• Find out the name of the person in charge of recruitment. Writing to a named person makes sure your letter gets read.
• You can’t spend enough time preparing your CV and cover letter. Get as much help as you can from books, the library etc.
• When making follow up calls avoid Mondays and Fridays as these are busy days for people in business. Similarly don’t call too early in the morning or after 3.30 pm and don’t call around lunchtime.
• When making follow up calls be prepared for few false starts but use these to develop your technique. Treat the first half a dozen calls as practice calls.
• Don’t pester firms with too frequent follow up calls. Once every three weeks is about right.
• Be prepared for disappointment and don’t feel let down by it.
• Before going for an interview research the firm really well. Google and Google News and the local press are useful sources.
• It is perfectly normal to be nervous at an interview. Try to minimise the nerves by making sure you have planned and prepared well and getting a good night’s sleep beforehand.
• At the interview you may be asked about your illness. Be honest but there is no need to disclose your diagnosis at this stage unless you are asked directly: a broad brush explanation such as “a breakdown” is sufficient.

LWS Speaking Out

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Schizophrenia and Cancer

Out of area placements, schizophrenia and heat related deaths, schizophrenia is a major cause of homelessness, shortage of doctors in the nhs, speaking out archives.

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• Famous People with Schizophrenia

John Nash is an American mathematician working in differential geometry, game theory and partial differential equations. A Hollywood movie has been made representing Nash, the movie itself name “A beautiful Mind” which was later nominated for 8 Oscars. The movie was based on his mathematical genius and his struggle with Schizophrenia.

Syd Barrett was an English artist, songwriter, guitarist and artist being in the renowned rock band of Pink Floyd. He left the band in 1968 among stories of mental illness during his drug abuse.

Jack Kerouac was an American novelist, poet, writer and artist responsible for very popular work that received little critical acclaim during his lifetime. He inspired many other novelist and artists such as The Beatles, Tom Robbins and Bob Dylan.

James Beck Gordon is a songwriter and Grammy Award winning musician. Being one of the most requested session drummers in the late 1960’s and 1970’s. James is now incarcerated in Atascadero State Hospital after killing his mother following a demand from one of the voices in his head. He was sentenced to 16 years to life in prison, and was diagnosed with Schizophrenia during the trial. Lionel Aldridge played American football professionally as a defensive end on the historic Green Bay Packers teams of the sixties. After retiring, Aldridge worked as sports analyst in Milwaukee until manifesting a mental illness called paranoid schizophrenia during the early seventies. “There was extreme paranoia and irritability and it was difficult for me to get along with others. I was unable to work. It was a rough setting” Lionel explained. After 10 years of being untreated and several years of being homeless Lionel finally fought the illness when he finally accepted treatment with the help of some of his friends.

Mary Todd Lincoln was the wife of America’s 16th President Abraham Lincoln and was the first lady of the United States. Abraham Lincoln always pursued his increasingly successful career and Mary Todd Lincoln was well educated and she shared the same fierce ambitions. In February 1862 her son Willie died at the age of 11 years old. After his death Mary spent a considerable amount of money to pay for mediums and spiritualists to try and contact her dead son, spending a lot of money the family did not have. She was known to suffer from Schizophrenia.

Joe Meek was a pioneering English record producer and songwriter acknowledged as one of the world’s first and most imaginative independent producers. Meek was obsessed with the occult and the paranormal, especially the idea of the “other side”. He sometimes used to set up tape recorders at graveyards to try and hear the voices of the dead, at one point he claimed that a cat that was recorded was actually imitating a human’s voice calling for help.

Tom Harrell was a renowned American post bop jazz trumpeter and composer. He suffers from paranoid schizophrenia. It is reported that on stage he stands away from the microphone, off to the side, his head bowed and his hands clutching his trumpet. When called upon to play, he walks slowly to the microphone, head still lowered, raising it only to play. When finished, he bows his head and resumes his original place.

Alexander “Skip” Spence was a musician, singer and songwriter. Spence’s past was unhappy; he was diagnosed as suffering from schizophrenia, was an alcoholic and lived as a derelict on the streets of Santa Cruz, although reports suggest that he had finally managed to stop drinking a few years before his death from cancer.

Meera Popkin – A star of Cats and Miss Saigon on Broadway and in London’s West End was diagnosed with schizophrenia. Her life went from center stage and limos to waiting tables at Wendy’s, but she’s now back and is doing well. “I’ve had quite a year. I thought the highlight would be getting married. I thought the highlight would be having my baby girl. Now it looks like the highlight is being completely recovered from schizophrenia. Did I ever have it? Was I misdiagnosed? Am I the one in a thousand that recovers from this illness? These are the questions my doctor is asking.”

Bob Mosley – Singer/songwriter and bassist James Robert Mosley was born December 4, 1942,and developed his musical abilities to a professional level. In 1969 Mosley joined the U.S. Marines, making it through basic training, only to be diagnosed as a paranoid schizophrenic. Bob Mosley descended into schizophrenia and was homeless in the mid-1990s. But he rejoined his band for its New York show in August 1997.

Roger Kynard – Roky Erickson (born Roger Kynard Erickson on July 15, 1947) is an American singer, songwriter, harmonica player, and guitarist from Texas. In 1968, while doing a stint at Hemisfair, Erickson started speaking nonsense. He was diagnosed as a paranoid schizophrenic and sent to a Houston psychiatric hospital, where he involuntarily received electroconvulsive therapy.

Rose Williams – Sister of Tennessee Williams. Tennessee was close to his sister Rose, a slim beauty whose sad life had perhaps the greatest influence on him. She was diagnosed with schizophrenia at a young age. As was common then, Rose was institutionalized and spent most of her adult life in mental hospitals. When therapies were unsuccessful, she showed more paranoid tendencies.

Health Topics

• About Paranoid Schizophrenia
• History of Schizophrenia
• Schizophrenia Medication and Side Effects
• Types of Schizophrenia
• The Center for Whole Psychiatry + Brain Recovery and Schizophrenia