Schizophrenia is a serious and often misunderstood mental illness that affects how a person thinks, feels, and behaves. It involves a combination of symptoms, including hallucinations, delusions, disorganized thinking, and social withdrawal.
“Though not curable, schizophrenia is treatable, and many individuals can lead meaningful lives with the right combination of medication, therapy, and support,” said Adrienne C. Lahti, M.D., Heman E. Drummond Professor and Chair of the UAB Department of Psychiatry and Behavioral Neurobiology and Director of the Comprehensive Neuroscience Center. “Early diagnosis and targeted treatment are key to better outcomes.”
Lahti discusses schizophrenia, current treatments, and how research at UAB is advancing understanding and reducing stigma.
Schizophrenia vs. other psychological disorders
Schizophrenia shares some features with other serious mental health conditions, such as bipolar disorder and schizoaffective disorder. However, schizophrenia is primarily characterized by persistent psychosis, including hallucinations, delusions, and disorganized thinking.
“In contrast, other disorders often center around mood episodes, such as mania or depression,” Lahti said. “Despite these differences, they are all chronic illnesses that typically require long-term medication and support to manage symptoms and maintain stability.”
Unfortunately, public perception of schizophrenia is often shaped by inaccurate portrayals in film and media.
“The most common misconception is that the illness is not treatable and leads to violent behaviors, homelessness, and poor quality of life,” Lahti shared. “This is what I call the ‘Hollywood schizophrenia,’ as movies tend to portray schizophrenia in that way.”
Why early diagnosis matters
Schizophrenia is diagnosed based on clinical evaluation, as there are currently no definitive lab tests or imaging tools for detection. The disorder most often begins in late adolescence or early adulthood.
“Early diagnosis is essential, as a longer Duration of Untreated Psychosis (DUP) is associated with worse outcomes,” Lahti stated.
In the United States, the average DUP is approximately 14 months. The UAB First Episode Psychosis Program, led by Lahti, focuses on early intervention for psychosis, aiming to improve patient outcomes and quality of life. It provides specialized care by a multidisciplinary team of psychiatrists, psychologists, and social workers.
Early detection remains a primary focus, with researchers leveraging neuroimaging, machine learning, and artificial intelligence tools to identify high-risk individuals before full-blown symptoms emerge.
“Because of the progress made by machine learning techniques and AI, I am optimistic that one day we will be able to detect those who are at very high risk of developing a psychotic disorder,” Lahti shared.
Current treatments and emerging therapies
Treating schizophrenia requires a comprehensive approach that often begins with antipsychotic medication but extends well beyond it. Antipsychotic medications remain the foundation of care for psychotic disorders, with most working by blocking dopamine receptors in the brain.
“For patients who do not respond to this first line of treatment, another drug named clozapine is used,” Lahti explained. “Although a decent drug, clozapine is not used as a first line because its use must be monitored for potentially severe side effects.”
Looking ahead, researchers are working to develop medications that act on different neurotransmitter systems and have fewer side effects.
“There is a need not only for medications with different mechanisms of action, but also medications with better tolerability, as many present medications induce weight gain and metabolic changes, such as hypertriglyceridemia,” Lahti said.
There are promising new treatments targeting neurotransmitters beyond dopamine, including glutamate, GABA, and acetylcholine. Still, medication alone is not enough.
“While medication is the cornerstone of treatment for psychotic disorders, other approaches, such as therapy and peer support, are key when assigned in addition to medication,” Lahti stated.
Individuals living with schizophrenia often face additional health risks, including obesity, diabetes, and substance use, making lifestyle support around nutrition, exercise, and general wellness an essential part of long-term care.
Unraveling the complexity of schizophrenia
Current efforts to better understand schizophrenia are focused on unraveling the complexity of the disorder to improve diagnosis, personalize treatment, and reduce stigma. Schizophrenia is understood as a heterogeneous illness involving multiple underlying biological mechanisms, which has made it difficult to identify precise therapeutic targets.
“As medications with new mechanisms of action are being developed, it will be important to develop biomarkers that match each patient with the appropriate medication,” Lahti stated.
Advances in non-invasive brain imaging are critical in this effort, offering insights into brain function, regional connectivity, and even neurochemical and metabolic states.
“The goal is to obtain an image of a patient’s brain and determine the optimal treatment strategy for that specific patient.”
At UAB, faculty also play an educational role when it comes to schizophrenia and related disorders.
“All UAB mental health providers not only treat psychotic disorders but also educate patients and family about the illness,” Lahti said.
Events such as the Neuro-café presentations of the UAB Comprehensive Neuroscience Center (CNC) and collaboration with national groups like the National Alliance on Mental Illness (NAMI), with a local chapter in Birmingham, bring awareness to those with severe mental illnesses.