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Sunday, July 22, 2012

Paranoid Schizophrenia in Aurora, Colorado


I am sad thinking about the Colorado shootings. Victims and survivors. It makes me think about my college days. I can't imagine dying in my 20's. When I was in school, the only time I really went out was to see a movie. I couldn't afford much else. When I was in med school, 2 of my classmates 1 in my first year and 1 in my third year had psychotic breaks. Both were struggling during exams and both became very isolated. One of these classmates I knew well. I even escorted him to the dean's office when he had come to my apartment obviously acting odd. As a psychiatrist I now know both of these men suffered from paranoid schizophrenia. Thinking back I remember how two bright young men seemed isolated at first, then talking very little, then what appeared as an odd way of listening to things that weren't there. We call this in psychiatry responding to internal stimuli, another way of saying "listening to auditory hallucinations". Both men were in their early 20's. Both men had no prior psychiatric history. I don't know their family histories except to say they were from families who were very proud that their sons were going to be doctors. There was probably no legal history. You really can't get into med school if you have one.

Paranoid Schizophrenia is a disease that strikes young people and usually becomes apparent after some initial stressor. It is characterized by delusions, particularly paranoid delusions which are fixed false beliefs that would not make sense to you or me. This is a thought disorder that then includes changes in emotions and behaviors. The affect or emotional expression becomes blunt, flat or inappropriate. For James Holmes the Colorado shooter, the affect was blunted and is now described as inappropriate (his grin).

Mr Holmes does appear to have symptoms consistent with Schizophrenia. I don't know the particulars, I have made no examination. Drug abuse although a possible issue and co-occurance, does not present in this fashion. There are no strange behaviors after intoxication wears off. In fact, Mr. Holmes seemed alert with a clear sensorium during the shootings. Having seen many such patients, the description of events can be interpreted as a psychotic episode. The treatment is actually fairly simple. Depending on the severity, the prognosis is good with medication and psychotherapy that emphasizes treatment compliance.

I am angry thinking about the Colorado shootings. 1 in 4 Americans, right now suffers from mental illness. Yet people continue to minimize mental health issues. I hear statements like, "oh, he'll grow out of it, it's just a phase" or "it's normal to feel like this, it's a part of life". I am tired of psychiatrists and mental health professionals being vilified and scapegoated because of people's refusal to understand their own suffering. Insurance companies don't want to pay for treatment, stereotypes about medications and treatment abound, etc., etc., etc. Even other physicians I know don't understand the value of treatment. Once I see their kids for management and they thrive; all of the sudden I'll get a ton of patient referrals from them. WAKE UP ONE AND ALL. IF THERE HAS BEEN A CHANGE IN HOW YOU OR SOMEONE ELSE IS BEHAVING, THINKING OR FEELING FOR MORE THAN 1 MONTH, GET HELP. PLEASE. PLEASE. PLEASE. JUST ASKING A PROFESSIONAL "IS EVERYTHING OK?" CAN SAVE A LIFE. MAYBE YOURS.

I can't imagine dying in my 20's.