ON THIS EPISODE OF CYCLE OF HEALTH: SCHIZOPHRENIA.

JOIN ME FOR AN INTIMATE CONVERSATION WITH A MAN DIAGNOSED WITH THIS BRAIN DISORDER AS HE TALKS ABOUT HIS EXPERIENCE AND THE STEPS HE'S TAKEN TO CARE FOR HIMSELF AND OTHERS.

AND HEAR FROM DOCTORS WHO TREAT SCHIZOPHRENIA AND LEARN ABOUT THE COMPLEX SCIENCE BEHIND THIS DISEASE THAT AFFECTS 1 IN 100 OF US.

WE HOPE YOU'LL JOIN US FOR THE DISCUSSION, COMING UP ON CYCLE OF HEALTH.

♪ ♪ >> HELLO AND WELCOME TO CYCLE OF HEALTH, I'M DR. RICH O'NEILL.

ON TONIGHT'S SHOW, WE'RE TALKING ABOUT SCHIZOPHRENIA.

ACCORDING TO THE WORLD HEALTH ORGANIZATION, SCHIZOPHRENIA AFFECTS ABOUT 24 MILLION PEOPLE WORLDWIDE.

IN FACT, DESPITE IT BEING A LESS COMMON MENTAL HEALTH DISORDER, SCHIZOPHRENIA IS ONE OF THE TOP 15 CAUSES OF DISABILITY WORLDWIDE.

THE RESEARCH ALSO SHOWS THAT NEARLY 5% OF PEOPLE WITH SCHIZOPHRENIA DIE BY SUICIDE, A RATE FAR EXCEEDING THE GENERAL POPULATION.

I'M JOINED HERE TODAY BY THE PEOPLE WHO SEE SCHIZOPHRENIA UP CLOSE, IN HOPES TO EXPLORE THIS COMPLEX DISEASE EVEN FURTHER.

DR.

SUNNY ASLAM, PROFESSOR OF PSYCHIATRY AND BEHAVIORAL SCIENCES AT SUNY UPSTATE MEDICAL AND DR. SEETHA RAMANATHAN, ASSOCIATE PROFESSOR OF PSYCHIATRY AND BEHAVIORAL SCIENCES AT SUNY UPSTATE MEDICAL.

DIDN'T I JUST SAY THAT.

THANK YOU BOTH FOR BEING HERE.

Dr. ASLAM, WHAT IS SCHIZOPRHENIA AND WHAT ARE THE COMMON SYMPTOMS.

>> SCHIZOPRHENIA IS A CHRONIC MENTAL ILLNESS THAT CAN BE DEVASTATING FOR BOTH THE PERSON SUFFERING AND THEIR FAMILY.

SYMPTOMS THAT CAN HAPPEN OFTEN RELATE WITH LOSING TOUCH WITH REALITY.

SO PEOPLE CAN EXPERIENCE HEARING VOICES, WE CALL THEM HALLUCINATIONS.

OR THEY CAN EXPERIENCE A LACK OF MOTIVATION, LACK OF MOVEMENT OR SPEECH AND THEY CAN HAVE WHAT WE CALL A FLATTENING OF THEIR AFFECT, WHERE THEY LOOK LIKE THEY'RE HAVING LITTLE TO NO FACIAL EXPRESSION.

>> SO WHEN SOMEBODY FIRST STARTS TO EXPERIENCE THESE SYMPTOMS, WHAT'S GOING ON IN THEIR BRAIN THAT CAUSES THAT?

>> THE HONEST ANSWER IS WE DON'T FULLY KNOW OR UNDERSTAND.

WE HAVE SOME IDEAS ABOUT WHAT IS HAPPENING WITH PEOPLE'S CHEMISTRY IN THEIR BRAIN, THE ELECTRICITY THAT'S, YOU KNOW, THE WIRING IN THEIR BRAIN THAT MAY HAVE DEVELOPED IN A WAY THAT IT HASN'T DEVELOPED NORMALLY THAT IT WOULD FOR OTHERS BUT WE DON'T FULLY UNDERSTAND.

WE DO HAVE THEORIES THAT IT RELATES WITH NEUROTRANSMITTERS LIKE SEROTONIN, DOPAMINE OR GLUTE MATE AND HOW THOSE SYMPTOMS AND RECEPTORS HAVE GONE OUT OF WHACK.

>> WE ARE ALSO LOOKING AT BEYOND THE BRAIN THESE DAYS.

WE ARE LOOKING AT THE GUT MICROBIOME AND IMMUNE SYSTEM AND ALL THAT STUFF.

BUT WE HAVEN'T BEEN ABLE TO FIGURE OUT ONE SPECIFIC ANSWER FOR THIS OR EVEN MANY ANSWERS FOR THIS CONDITION.

>> THERE IS SOME RESEARCH I KNOW SUGGESTING A GENETIC COMPONENT AND MAYBE A ROLE OF DRUG ABUSE.

WHAT DO YOU KNOW?

>> I WOULD SAY IT'S MULTIFACTOR.

THERE IS A GENETIC COMPONENT TO IT.

THERE IS ALSO THE ENVIRONMENT AND GENETICS.

THERE IS CERTAINLY THE ROLE OF DRUG USE.

>> WHAT ABOUT DRUG USE?

WHAT DO PEOPLE DO THAT MIGHT TRIGGER A FIRST BREAK?

I KNOW YOU WORK WITH PEOPLE WHO ARE HAVING FIRST PSYCHOTIC BREAKS.

>> WE DON'T KNOW IF DRUG USE TRIGGERS OR DRUG USE PRECIPITATES AN UNDERLYING ILLNESS.

TYPICALLY IT'S CANNABIS.

THERE HAVE BEEN LOTS OF STUDIES IN THE ROLE OF CANNABIS AND PSYCHOSIS THAT PRECIPITATES AN UNDERLYING PSYCHOTIC EPISODE.

>> PEOPLE WHO SMOKE POT MY SUBSEQUENTLY DEVELOP PSYCHOTIC.

THIS IS THE HYPOTHESIS.

>> IT IS ALSO POSSIBLE THAT DRUG IS LEADING TO A LONG STANDING PSYCHOTIC ILLNESS.

>> AND IF YOU HAVE SCHIZOPRHENIA AND YOU CONTINUE TO USE STIMULANTS, COCAINE, CANNABIS, IT CAN INCREASE THE FREQUENCY.

>> WHAT DOES THE FIRST PSYCHOTIC EPISODE LOOK LIKE?

>> PRETTY SCARY.

SIMILAR SYMPTOMS WHAT WAS TALKED ABOUT EARLIER.

SOMETIMES THE FIRST EPISODE MANIFESTS WITH A COUPLE OF SYMPTOMS LIKE I'M HEARING VOICES.

I'M SEEING SHAPES THAT ARE DIFFERENT.

I FEEL LIKE SOMEONE IS COMING TO HARM ME.

AND THEN YOU START NOTICING A DETERIORATION IN ACADEMIC AND SOCIAL FUNCTIONING.

BUT IT'S A VERY CONFUSING PERIOD WHERE THE YOUNG PERSON DOES NOT KNOW WHAT IS GOING ON.

ALL THEY KNOW IS SOMETIMES IT'S DIFFERENT AND SOMETIMES IT'S NOT.

>> WHEN YOU SAY YOUNG PERSON, WHAT IS THE TYPICAL AGE RANGE FOR SCHIZOPHRENIC SYMPTOMS TO BEGIN?

>> SO USUALLY THERE IS A GENDER DIFFERENCE IN THE ONSET FOR SCHIZOPRHENIA.

TYPICALLY 15-25 FOR YOUNG MEN AND 25-35 FOR YOUNG WOMEN.

BUT THAT BEING SAID, A YOUNG WOMAN COULD CERTAINLY HAVE SYMPTOMS EARLIER AND IT IS NOT THAT 15 IS THE CUTOFF.

THEY-- WE HAVE SEEN PEOPLE AS YOUNG AS 12 AND EIGHT OR NINE HAVING SYMPTOMS OF PSYCHOSIS.

>> CONFUSING AT TIMES BECAUSE SOMETIMES OTHER MENTAL ILLNESSES OR THINGS LIKE TRAUMA, PHYSICAL, SEXUAL OR EMOTIONAL ABUSE, CHILDREN ADOLESCENTS CAN REPORT HEARING A VOICE SO THIS IS PART OF THE SYMPTOMOLOGY THAT WE THAT WE HAVE TO PEEL APART.

WHAT IS DUE TO TRAUMA, WHAT IS AN EMERGING PSYCHOTIC ILLNESS AND THE TIME PERIOD AS WELL.

IN ORDER TO BE DIAGNOSED WITH SCHIZOPHRENIA, YOU NEED MULTIPLE EPISODES OF SYMPTOMS OVER A SIX-MONTH PERIOD OF TIME.

>> I RECENTLY SAT DOWN TO TALK WITH A PERSON WITH SCHIZOPRHENIA Mr. PAUL TUCCI.

PAUL FIRST STARTED EXPERIENCING SCHIZOPRHENIA SYMPTOMS AT 18 YEARS OLD, NEARLY 40 YEARS AGO.

PAUL IS PLEASED TO SHARE HIS STORY.

HE HAS MADE A CAREER OUT OF HELPING OTHERS INTO RECOVERY.

LET'S TAKE A LOOK.

PAUL TUCCI.

WELCOME TO THE SHOW.

>> THANK YOU.

>> I UNDERSTAND THAT YOU WERE DIAGNOSED WITH SCHIZOPRHENIA BACK WHEN YOU WERE ABOUT 18 YEARS OLD.

>> YES.

>> CAN YOU TELL US WHAT WAS THAT EXPERIENCE LIKE WHEN YOU FIRST STARTED TO HAVE SYMPTOMS?

>> WELL, TO START OUT WITH, WHEN I WAS A TEENAGER, I ABUSED DRUGS AND ALCOHOL.

AND I'M NOT SURE IF THE DRUGS AND ALCOHOL CAUSED MY MENTAL ILLNESS OR IF I WAS SELF MEDICATING.

>> TO DEAL WITH THE EXPERIENCE DEVELOPING SYMPTOMS.

>> AND THE DEVELOPING-- THE SYMPTOMS THAT I DEVELOPED WAS I COULDN'T SLEEP, RACING THOUGHTS, AND THEN LATER ON, YOU KNOW, VOICES.

>> THE VOICES, WHAT WOULD THEY SAY?

WHAT WAS THAT LIKE?

>> VOICES FOR ME ARE HOW I RATIONALIZE THINGS HOW MY MIND GOES OVER THINGS AND REHEARSES THEM IN MY MIND.

I DO IT WITH LIKE SOMETIMES I'LL HOLD CONVERSATIONS IN MY HEAD WITH A PERSON.

>> SO PAUL, AS YOU SAY THAT, I THINK I DO THAT, TOO.

IN MY MIND, I'M REHEARSING CONVERSATIONS I HAVE WITH PEOPLE OR HOW THEY MIGHT GO OR HOW THEY WENT.

I WISH I SAID THIS.

HOW IS WHAT YOU ARE TALKING ABOUT DIFFERENT FROM WHAT EVERYBODY DOES?

>> THE VOICES WOULD COME OUT OF MY MOUTH.

THE ANSWERS FROM THE OTHER PEOPLE THAT I WOULD HOLD CONVERSATIONS WITH.

>> SO YOU WOULD BE HAVING A CONVERSATION AND THE OTHER PERSON WOULD BE-- YOU WOULD BE SAYING, TOO.

SO SOMETIMES WHEN YOU SEE PEOPLE ON THE STREET, THEY'RE HAVING A CONVERSATION WITH THEMSELVES OUT LOUD.

>> EXACTLY.

>> AND THAT WAS PART OF-- >> YEAH.

>> DID YOU KNOW THAT THAT WAS UNUSUAL?

>> OH YEAH.

>> YOU DID?

>> YEAH.

>> AND YOU COULDN'T STOP IT.

>> I COULDN'T STOP IT.

>> UH-HUH.

SO THAT COMBINATION OF THINGS, DID YOUR FAMILY HAVE A SENSE THAT THERE WAS, LIKE THIS WAS SOMETHING THAT NEEDED ATTENTION?

>> YES.

>> WHAT DID THEY DO?

>> TRIED TO FIND HELP.

PRIVATE PSYCHIATRISTS, DIFFERENT THINGS.

IT WASN'T UNTIL I GOT TO HUTCHINGS WHERE I FINALLY GOT THE HELP I NEEDED.

>> HUTCHINGS PSYCHIATRIC CENTER.

WHAT DID THEY DO WHEN YOU GOT THERE?

THEY TREATED ME WITH DIGNITY AND RESPECT.

IT TOOK A WHILE, YOU KNOW, BECAUSE THEY HAD TO STUDY ME TO FIND OUT EXACTLY WAS WAS GOING ON WITH ME.

>> SURE, THEY HAD TO DIAGNOSE, YEAH BACK THEN THAT WAS LIKE MAYBE 30 YEARS AGO.

>> YES.

>> THERE WAS QUITE A STIGMA.

>> OH BACK THEN, DEFINITELY.

AS FAR AS LIKE STIGMA GOES, I THINK THAT THE COMMUNITY IS MORE EDUCATED ON MENTAL ILLNESS.

AND THERE IS A LOT OF IT.

I MEAN EVERY PERSON DEALS WITH SOME TYPE OF MENTAL ILLNESS IN THEIR LIFETIME IN SOME WAY.

>> YEAH, I THINK THERE IS A MYTH, PERCEPTION THAT PEOPLE WHO ARE SCHIZOPHRENIC NEVER RECOVER.

>> THAT'S NOT TRUE.

>> TELL US ABOUT THAT.

>> AFTER YOU REACH A CERTAIN POINT IN YOUR LIFE, WHERE YOU BEGIN RECOVERY, RECOVERY DOESN'T END.

IT'S AN ONGOING POINT.

FROM RECOVERY, ALL THE WAY FOR THE REST OF YOUR LIFE.

YOU WORK AND DEVELOP YOUR LIFE.

>> NOW YOU SAID YOU THOUGHT OR THINK IT'S POSSIBLE THAT YOUR ALCOHOL AND DRUG USE PRE-18 WHEN YOU FIRST HAD THE SYMPTOMS AND GOT TREATMENT, MAY HAVE CONTRIBUTED.

>> YES.

>> AND THERE IS SOME RESEARCH ABOUT THAT.

BUT DID YOU CHANGE YOUR-- YOU DON'T LOOK LIKE A GUY WHO IS HEAVY IN ALCOHOL AND DRUGS NOW.

>> I HAVE BEEN CLEAN FOR OVER 30 YEARS.

NOT EVEN A CUP OF COFFEE OR A CIGARETTE.

>> WOW.

>> I JUST FEEL COMFORTABLE.

>> TELL US ABOUT THE MEDICATION CLOZOPINE.

>> IT WAS CHEMICALLY ENGINEERED FOR ME.

ALL THE OTHER MEDICATIONS THAT THEY HAD ME ON, I WAS ALLERGIC TO SOME OF THEM OR THE OTHER ONES DIDN'T WORK.

AND JUST... >> THERE WAS A SERIES WHEN YOU FIRST GOT TREATED.

AND THEN CLOZAPIN WAS DEVELOPED AFTER YOUR FIRST TREATMENT.

>> YEAH.

>> AND THAT WAS A GAME CHANGER.

>> OH YES.

>> HOW SO?

WHAT DIFFERENCE... >> HERE I AM.

RIGHT?

I'M HIGH FUNCTIONING.

I LIVE A FULL LIFE.

I GOT NO COMPLAINTS.

>> SO CLOZOPINE AND THERAPY.

WAS THERAPY HELPFUL TO YOU.

>> OH YES.

I DEVELOPED A LOT OF FRIENDSHIPS WITH MY THERAPISTS AND DOCTORS.

THEY'RE JUST THE PEOPLE THAT I HAVE AT HUTCHINGS, NOT ONLY DO I WORK THERE, I'M A STATE EMPLOYEE FOR HUTCHINGS PSYCHIATRIC CENTER.

BUT I'M ALSO A PATIENT THERE.

>> SO TELL US ABOUT YOUR WORK THERE.

I UNDERSTAND YOU ARE A PEER SPECIALIST.

WHAT DOES PEER SPECIALIST MEAN?

>> WE WERE ONCE PATIENTS AND IN SOME CASES STILL PATIENTS BUT WE'VE DONE SO WELL IN OUR RECOVERY THEY ASKED US TO COME BACK TO TEACH AND ASSIST PEOPLE IN RECOVERY.

>> SO WHEN SOMEBODY COMES IN, NEW PATIENT COMES INTO HUTCHINGS, AND THEY ARE REFERRED TO YOU AS PART OF THEIR TREATMENT PLAN, WHAT DO YOU DO WITH THOSE FOLKS?

>> WE CALL IT PEER BRIDGING.

WHEN A PERSON IS FIRST ADMITTED, WE GET A REFERRAL AND WE START TO MEET WITH THAT PERSON.

AND WE BUILD A RELATIONSHIP BASED ON TRUST, RIGHT?

TRUST IS THE BASIS OF EVERY RELATIONSHIP, I THINK.

>> ABSOLUTELY.

I TOTALLY AGREE.

THEY KNOW YOU WERE DIAGNOSED WITH SCHIZOPRHENIA.

>> AND I SHARE MY STORY WITH THEM ALSO.

>> LIKE YOU ARE DOING RIGHT NOW.

>> LIKE I'M DOING RIGHT NOW.

AND I ASK FOR THEIR INPUT.

TO SEE IF MAYBE SOME OF MY EXPERIENCES WERE SIMILAR TO THEIRS.

SO THE REASON THEY CALL IT PEER BRIDGING IS BECAUSE I BRIDGE THE GAP BETWEEN INPATIENT AND DISCHARGE INTO THE COMMUNITY.

>> SO WHEN SOMEBODY COMES IN, YOU GET TO KNOW THEM, THEY GET TO KNOW YOU.

YOU SHARE COMMON EXPERIENCES AND THEN YOU ARE WORKING WITH THEM TO HELP THEM REALIZE, OKAY, I CAN RECOVER AND THEN I CAN GET BACK OUT INTO LIFE.

>> I COULDN'T TELL YOU HOW MANY PEOPLE THAT I HAVE HELPED GET DISCHARGE BACK INTO THE COMMUNITY SUCCESSFULLY.

I MEAN A LOT.

>> THAT MUST FEEL GOOD.

>> I HAVE BEEN DOING THIS JOB FOR-- IT'S BEEN A LITTLE OVER 11 YEARS NOW.

>> CONGRATULATIONS.

>> THANK YOU.

THERE WERE 10 OF US.

NOW WE ARE DOWN TO FIVE.

>> YIKES.

>> BUT WE ARE HOPING TO HIRE MORE AGAIN.

>> IS THAT BECAUSE OF FUNDING CUTS?

>> WELL, THAT'S A GOOD QUESTION.

I WANTED TO MENTION THAT AS FAR AS FUNDING, GOVERNOR HOCHUL AND OFFICE OF MENTAL HEALTH HAVE SECURED $4 MILLION FOR THE PEER SERVICES PROGRAMS.

EVIDENCE HAS PROVEN THAT PEER SERVICES ARE A VITAL PART OF THE MENTAL HEALTH WORKFORCE.

>> ANY ADVICE TO SOMEBODY WHO MIGHT BE GOING THROUGH SOME SYMPTOMS?

WHAT WOULD YOU TELL SOMEBODY?

>> GO FOR HELP.

IF YOU FEEL THAT YOU ARE HAVING PROBLEMS, DON'T BE ASHAMED.

GO FOR HELP.

EVERYBODY IS DOING IT NOW.

SO IF YOU NEED HELP, GO FOR IT.

JUST START WORKING ON YOUR LIFE AND, YOU KNOW, GO FOR THE HELP.

>> Mr. TUCCI REFERRED TO VOICES IN HIS HEAD.

WHAT ARE TIP TYPICAL VOICES THAT PEOPLE HAVE WHEN THEY HAVE A FIRST BREAK?

>> VOICES CAN BE SOMEBODY TALKING TO YOU OR SOMEBODY HAVING A CONVERSATION IN THE BACK.

THESE VOICES ARE WHAT MAKE THEM VERY SCARY.

YOU ASK THIS QUESTION IN THE CLIP, WHAT IS THE DIFFERENCE.

THE DIFFERENCE IS THAT THIS INDIVIDUAL IS NOT ABLE TO SAY THIS IS NOT MY VOICE.

THEY SEE THEM AS REAL VOICES, LIKE A TAPE RECORDING IN YOUR HEAD.

AND THAT'S THE DIFFERENCE BETWEEN US HEARING OR TALKING ABOUT VOICES IN OUR HEAD AND AN INDIVIDUAL WITH PSYCHOSIS TALKING ABOUT VOICES IN THEIR HEAD.

>> VOICES CAN OFTEN BE DESCRIBED SOMETIMES AS SOOTHING OR EVEN HEALING BUT MANY TIMES THEY'RE TORTUROUS AND PATIENTS WILL DESCRIBE VOICES COMMENTING ON HOW TERRIBLE THEY ARE AND IT CAN ESCALATE TO THE POINT WHERE THEY TELL THEM TO DO THINGS LIKE HURT THEMSELVES OR OTHERS WHICH CAN BE VERY, VERY FRIGHTENING.

>> LET'S TALK ABOUT THAT FOR A MINUTE BECAUSE I THINK THERE IS A COMMON MISPERCEPTION THAT PEOPLE WITH SCHIZOPRHENIA ARE VIOLENT.

WHAT IS THE DATA ABOUT THAT?

>> I THINK OF PEOPLE WITH SCHIZOPRHENIA AS ONE OF THE MOST VULNERABLE AND MARGINALIZED POPULATIONS.

THEY'RE MUCH MORE LIKELY TO BE VICTIMS OF VIOLENCE THAN TO PERPETRATE IT.

SUBSTANCE USE IS THE WILD CARD.

THAT CAN SHUFFLE THE DECK IN THE WAY WE CAN'T PREDICT THINGS BUT WE KNOW FROM THE DATA THAT PEOPLE TEND TO LIVE IN POVERTY OR LOWER SOCIOECONOMIC STATUS AND ARE PREYED UPON BY OTHERS INCLUDING BY PEOPLE SELLING DRUGS BECAUSE IT IS AN AREA THAT TARGETS MARGINALIZED POPULATIONS.

>> WHEN SOMEBODY HAS THEIR FIRST PSYCHOTIC EPISODE AND THEIR FRIENDS AND FAMILY SEE SOMETHING IS WRONG, WHAT DO YOU SUGGEST PEOPLE DO.

I KNOW THIS IS ONE OF YOUR AREAS OF EXPERTISE.

>> FAMILIES STRUGGLE A LOT WHEN THEY SEE THEIR YOUNG CHILD, IT IS NOT JUST SCARY TO THE YOUNG PERSON BUT TO THE FAMILY THERE ARE A NUMBER OF REASONS FOR PSYCHOSIS, NOT JUST SCHIZOPHRENIA.

WE DO A DIAGNOSTIC AND THEN START WORKING WITH THE FAMILIES.

FAMILIES ARE AN IMPORTANT SUPPORT SYSTEM FOR THE YOUNG PERSON.

AND THERE ARE A NUMBER OF THINGS THAT, A NUMBER OF DYNAMICS AND EMOTIONS THAT FAMILIES GO THROUGH THAT WE HAVE TO WORK WITH OR WORK WITH THEM ON.

>> I IMAGINE IT WOULD BE TERRIFYING FOR THE FAMILY AS WELL AS THE PERSON.

>> RIGHT.

>> NOW, IN THE WORLD OF SCIDZ, WE CALL-- IN THE WORLD OF SCHIZOPHRENIA, EXPRESSED EMOTIONS, THE FAMILY CAN BE VERY CRITICAL OR THE FAMILY IS OVER PROTECTIVE AND AS Mr. TUCCI POINTS OUT, RECOVERY IS POSSIBLE AND WE HAVE TO HELP FAMILIES NAVIGATE THE BALANCE.

>> WHAT OTHER THINGS ARE KEY TO RECOVERY BESIDE HAVING A SUPPORTIVE GROUP OF FAMILY MEMBERS AND FRIENDS?

>> WELL CERTAINLY MEDICATIONS ARE ONE OF THE PRIMARY TREATMENTS.

WE LIKE TO FOCUS TREATMENT AROUND WHAT THE PATIENT'S GOALS ARE.

WE FIND TREATMENT WORKS MUCH BETTER IF WE ARE FOCUSING ON WHAT THE PATIENT'S GOALS ARE.

MAYBE IT'S TO GO BACK TO SCHOOL OR RECONNECT WITH FAMILY, HAVE A ROMANTIC PARTNER.

>> SOUNDS LIKE YOU AND ME AGAIN.

LIKE EVERYBODY, IF YOU CAN GET BACK ON TO THE GOALS THAT YOU REALLY HAVE FOR YOUR LIFE, YOU FOCUS ON THOSE WITH PEOPLE WITH SCHIZOPHRENIA.

>> THEY'RE MUCH MORE INTERESTED-- THE MEDICATIONS MAY NOT BE INTERESTING TO THEM AT ALL EVEN THOUGH WE KNOW THAT'S ONE OF THE MORE POWERFUL TOOLS THAT WE HAVE, BUT IF WE CAN TIE TAKING MEDICATIONS TO THEIR GOAL OF WORKING, I CAN'T WORK BECAUSE EVERY TIME I GO TO WORK I HEAR VOICE THAT ARE DISTRACTING.

I'LL SAY LET'S TRY A LOW DOSE OF THIS OR THAT SO IT HELPS WITH THE VOICES SO YOU CAN WORK OR GO ON A DATE OR DO WHAT IT IS YOU WANT TO DO WITH YOUR LIFE.

>> IS THERE A RANGE OF SYMPTOMS FOR PEOPLE WITH SCHIZOPHRENIA.

>> THAT WOULD BE CORRECTED.

>> I MENTIONED BRIEFLY IN THE PAST EARLIER THAT THERE IS POSITIVE, NEGATIVE AND COMPLICATIVE SYMPTOMS THAT P RANGE FROM PEOPLE HEARING VOICES TO BEING APATHETIC OR JUST THE DETERIORATION IN FUNCTIONING THAT CAN RANGE.

WE ALSO FIND THAT PEOPLE RESPOND TO MEDICATIONS DIFFERENTLY.

WE HAVE PATIENTS RESPONDING TO MEDICATIONS VERY QUICKLY FROM THE BEGINNING AND THEN WE GO ON THE TREATMENT RESISTANT PART OF MEDICATIONS, WHICH IS CLOZOPINE.

>> RELATIVELY NEW MEDICATION.

>> WE HAVEN'T BEEN ABLE TO FIND BETTER THAN CLOZAPINE FOR TREATMENT RESISTANT SCHIZOPHRENIA.

IT'S AN OLDER MEDICATION.

>> WHEN THINGS ARE NOT WORKING, YOU TURN TO CLOZAPINE AND THAT WORKS FOR SOME PEOPLE.

>> YES.

>> IS THERE AN OVERLAP WITH OTHER MENTAL HEALTH ISSUES?

LIKE IS IT TOUGH TO SORT OUT IS THIS SCHIZOPHRENIA FROM SOMETHING ELSE?

>> IN THE WORLD OF FIRST EPISODIC PSYCHOS, YES, BECAUSE THE FIRST EPISODE OF SIGH COSES IS MIXES A LOTTED WITH MANIA AND SOMETIMES IT'S HARD FOR US TO TEASE OUT IF IT IS SCHIZOPHRENIA OR BIPOLAR AFFECTIVE DISORDER.

>> IF I STARTED HEARING VOICES, THAT WOULD BE PRETTY DEPRESSING, MY WHOLE LIFE IS FALLING APART AND I MIGHT TURN TO DRUGS AND ALCOHOL TO HELP ME FEEL BETTER.

HOW IMPORTANT IS PSYCHO THERAPY FOR PEOPLE WITH SCHIZOPHRENIA?

>> THERAPY IS VERY IMPORTANT.

WE WERE TRAIN THAT PEOPLE WITH SCHIZOPHRENIA WERE NOT PSYCHO THERAPY CANDIDATES BUT WE HAVE LEARNED THAT THEY CAN BENEFIT FROM MULTIPLE TIMES OF PSYCHO SOCIAL INTERVENTIONS WHETHER IT'S CASE MANAGEMENT OR COGNITIVE BEHAVIORAL THERAPY.

SITTING WITH PEOPLE AND LISTENING TO THEIR STORY AND UNDERSTANDING IT BETTER AND HELPING THEM UNDERSTAND AND EXPRESS THEIR EMOTIONS, THESE ARE ALL VITAL PARTS NOT ONLY FOR OUR PATIENTS THEMSELVES BUT THEIR FAMILIES AS WELL.

SO I'M OFTEN ENCOURAGING DISTRESSED FAMILY MEMBERS WHO COME AND SPEAK WITH ME, YOU KNOW, WHAT ARE YOUR THOUGHTS ABOUT GETTING YOUR OWN THERAPIST?

YOU ARE SUFFERING GREATLY.

YOUR EMOTIONS ARE OVERWHELMING.

>> TO THE FAMILY.

>> TO THE FAMILY MEMBER.

>> THEY MIGHT BENEFIT FROM THERAPY AS WELL.

>> ABSOLUTELY.

FAMILY THERAPY OR INDIVIDUAL THERAPY.

GOING TO A GROUP LIKE THE NATIONAL ALLIANCE FOR THE MOTOR OIL MENTALLY ILL.

THERE ARE A LOT OF DIFFERENT OPTIONS.

YOU CAN SEE AN INDIVIDUAL THERAPIST OR A 12 STEP GROUP.

>> HAVE YOU NOTICED AN INCREASE OR A DECREASE IN SCHIZOPHRENIA SYMPTOMS SIPS THE PANDEMIC BEGAN?

>> THE PANDEMIC HAS BEEN VERY DIFFICULT I THINK ON MANY MARGINALIZED AND VULNERABLE POPULATIONS AND CERTAINLY PEOPLE WITH SCHIZOPHRENIA, THERE IS PUBLISHED DATA SHOWING HIGHER RISK OF ACQUIRING COVID, HAVING PROGRESSIVE ILLNESS, YOU KNOW, BEING INTUBATED IN THE ICU AND DEATH FROM COVID AS WELL SO ONE OF THE THINGS-- I'M AN OUTREACH PSYCHIATRIST.

MY WORK IS ON THE STREETS OR IN THE COMMUNITY WITH PEOPLE WHO DON'T PARTICIPATE IN TRADITIONAL CLINICS.

WE REALIZED OUR FOLKS WERE NOT GETTING VACCINATED SO WE STARTED TO VACCINATE THEM ON OUR OWN AND WE STARTED OUR OWN OUTREACH VACCINATION PROGRAM AND WE WOULD GO TO THEM WITH VACCINES AND VACCINATED THEM.

WE RECENTLY STARTED DOING THAT AGAIN.

AND THE NEED FOR PEOPLE WHO HAVE CHRONIC MENTAL ILLNESS, WHO JUST, WHO LIVE IN POVERTY AND SHELTERS AND ON THE STREETS DON'T PARTICIPATE IN TRADITIONAL TREATMENT IS GREAT.

AND PEOPLE ARE OVERDOSING FROM DRUGS.

THERE ARE 100,000 OVERDOSES FROM DRUGS LAST YEAR, THE HIGHEST NUMBER EVER.

WE SAW THAT IN THE SCHIZOPHRENIA COMMUNITY.

WE DIDN'T KNOW OR THEY DIDN'T KNOW FENTANYL WAS PUT INTO THEIR DRUGS, PUT INTO MARIJUANA.

IT HAS BEEN A VERY DIFFICULT TIME, ESPECIALLY FOR THE PATIENTS I WORK WITH TO NAVIGATE EXTREME ISOLATION AND FEELING CUT OFF FROM SERVICES AND TREATMENT AND THE WORLD.

>> ANY LAST THING YOU WANT TO SAY?

>> AS SOMEBODY WHO WORKS IN THE AREA FIRST EPISODE OF PSYCHOSIS, I WOULD ENCOURAGE PEOPLE TO REACH OUT FOR HELP EARLY THE MORE WE HAVE THE UNTREATED PSYCHOSIS, THE TIME OF ONSET TO THE TIME OF TREATMENT, THE FASTER RECOVERY.

>> DON'T DELAY.

>> JUST LIKE IN ANY PHYSICAL ILLNESS, DON'T DELAY SEEKING FOR HELP.

SECOND MESSAGE IS THAT RECOVERY IS POSSIBLE.

PEOPLE CAN RECOVER AND GET BACK ON TRACK WITH THEIR DREAMS.

THE KEY IS TO COME AND ASK FOR HELP.

>> TERRIFIC MESSAGE.

THAT'S ALL THE TIME WE HAVE, I AGAIN FOR JOINING US.

DR.

SUNNY ASLAM, PROFESSOR OF PSYCHIATRY AND BEHAVIORAL SCIENCES AT SUNY UPSTATE MEDICAL AND DR. SEETHA RAMANATHAN, ASSOCIATE PROFESSOR OF PSYCHIATRY AND BEHAVIORAL SCIENCES AT SUNY UPSTATE MEDICAL.

BE SURE TO VISIT WCNY.ORG/CYCLEOFHEALTH FOR MORE INFORMATION ABOUT THIS AND OTHER EPISODES.

FOR CYCLE OF HEALTH.

I'M DR. RICH O'NEILL.

THANKS FOR CHECKING IN.