Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, July 15, 1990 TAG: 9007130451
SECTION: EXTRA PAGE: E-4 EDITION: METRO
SOURCE: CHARLES HITE MEDICAL WRITER
DATELINE: LENGTH: Long
For two weeks they accused, cajoled and teased him. He talked to the voices and pleaded with them to leave him alone. But they wouldn't go away. He became convinced the voices were the work of the devil.
Chandler, never a religious person, began carrying a cross and a picture of Jesus. He read constantly from a book of Bible verses. But the voices never relented. He had trouble sleeping. He couldn't concentrate.
On a Saturday morning, Chandler told his mother he wanted to be baptized that day.
"He said he wanted to get rid of the voices," Elinor Holmes recalls. "He thought the devil was after him and that if he got baptized that would get rid of the devil."
Later that day, Holmes took her son to church. She was the only witness as Steven - who was just finishing his sophomore year in high school - was immersed three times in the water by their minister.
For a few days, Steven was quiet and calm. But one day Steven appeared in the kitchen and announced that he had seen a "war pig" in the mirror of his bedroom dresser. The war pig was saying all kinds of mean things to him, Steven said.
When Holmes first sought psychiatric treatment for her son, he was diagnosed as being slightly mentally retarded and having a drug abuse problem. It wasn't until seven months after the voices appeared that Steven was diagnosed as having schizophrenia.
Schizophrenia is a baffling and debilitating mental disorder that typically strikes during adolescence or young adulthood. It affects an estimated 3 to 4 million Americans. Anywhere from $12 billion to $20 billion is spent each year to treat its victims.
Schizophrenics suffer from delusions, hallucinations and thought disorders. They may believe someone is spying on them or is able to control their feelings. They may hear voices that comment on their behavior or give them commands. They may shift from one topic to a subject completely unrelated without realizing they are making no sense.
These so-called "positive" symptoms have gotten the most attention and been the focus of most treatments. But schizophrenics also suffer from equally incapacitating "negative" symptoms: apathy, loss of curiosity, and emotional and social withdrawal.
The illness follows no distinct pattern. It is best viewed as a range of disorders, says Dr. Frank Tellian, director of psychiatric research at the Salem Veterans Affairs Medical Center. He compares schizophrenia to high blood pressure, a disease that can manifest itself in perhaps two dozen different symptoms.
But unlike high blood pressure, which can be traced to specific causes, schizophrenia's roots are still obscure. There is evidence it is genetically related, that it could be triggered by some stressful event or even a viral infection and that it is tied to biochemical deficiencies in the brain.
As many as half of all schizophrenics eventually recover, apparently spontaneously, after intermittent episodes of the disease. Another large group - perhaps 25 percent or more - can be treated with such drugs as Haldol, Thorazine, Prolixin and Mellaril. These medications, however, usually don't help schizophrenia's negative symptoms and can cause bothersome side-effects, including severe twitching and involuntary body movements.
As many as 20 percent of schizophrenics - about 500,000 people in the U.S. - don't respond to drugs or psychotherapy. Their disease becomes worse over the years. Many live in adult homes or with their families. Some end up living out their lives in a state mental hospital.
Elinor Holmes feared that was where her son was headed.
Steven became increasingly hostile and suspicious. He would spit on the floor and threaten to beat his mother. He got little sleep and lost weight. He thought his father was rock singer Alice Cooper. Another rock singer - Jon Bon Jovi - was an imaginary brother.
Two years ago, Holmes decided to place Steven in an adult home. She worried that he might harm her two daughters. She didn't want to leave him alone for extended periods.
The drugs Steven took didn't help his behavior. They gave him a bad twitch in his legs and made his hands draw up.
Several months ago, Holmes began getting calls nearly every night from the staff at the adult home: If Steven's disruptive behavior didn't stop, they warned, he would have to find another place to live.
One day Steven took off and hitchhiked to Bland County to visit relatives. After returning to Monticello Manor, he argued continually with staff members and other residents. He became obsessed with washing his face.
During the last few months of 1989 and early this year, Steven was admitted five times to the psychiatric ward at Roanoke Memorial Hospital's rehabilitation center. He was seen as an outpatient three times.
His life became an endless routine of eating, sleeping and watching television. "Momma, I'm going to be stuck here the rest of my life. There's no hope for me," he said on several occasions.
In March, adult home officials told Holmes they couldn't handle Steven any longer. She would have to find him another place to live.
At the same time, Steven's psychiatrist mentioned a new drug that had just come on the market the month before. Dr. George Hull thought Steven would be an ideal candidate for Clozaril.
Holmes noticed a change in her son within a couple of weeks. His hostility vanished. The wild look in his eyes was gone. He stopped hearing voices. His mind stopped wandering and he listened to people. He realized he had a family.
"Now he really has feelings for other people. He has the ability to put others ahead of himself. He cares," Holmes said. "It's like he's coming back to us after being away for five years."
Clozaril has made Steve less paranoid, Hull says. "His thinking has improved. He's not as preoccupied with fantasies and hallucinations and delusions. These have receded to the background and he can focus his attention to the outside world. I'm impressed."
Clozaril - known generically as clozapine - is not a new drug. It was developed by Sandoz Pharmaceuticals Corp. in the early 1960s and marketed in Europe a decade later. But after several patients in Finland died from a side-effect that drops the body's white cell count, Sandoz yanked it off the market temporarily. Tests in the United States were canceled.
But in the mid-1980s, the Food and Drug Administration agreed to let clozapine be studied in this country. After a 1988 study showed the drug produced dramatic improvements in some previously untreatable schizoprhenics, Sandoz had additional studies conducted. It later decided that it would market the drug, but only with a strict monitoring system that tested patients weekly for a low white blood count.
"It's the most important advancement in the treatment of schizophrenia in 25 years," says Dr. Glenn Yank, a pyschiatrist who is heading a clozapine study group for Virginia's state mental health department.
Yank was formerly director of medical services at Western State Hospital in Staunton, where 20 schizophrenic patients started Clozaril treatment last year.
Half of those patients showed improvement and several responded remarkably, Yank said. One patient was discharged, another was able to leave the hospital during the day to work, and another was able to give up the use of a walker because Clozaril lacked the disabling side-effects caused by other drugs.
"There's a real difference in these patients," Yank says. "We're very encouraged."
What sets Clozaril apart from other drugs used to treat schizophrenia is the way it affects a chemical that helps nerves transmit impulses in the brain, says Tellian, director of psychiatric research at the Salem VA center.
Schizophrenics are known to have abnormally high levels of nerve receptors that bind with the chemical transmitter dopamine. Their brains are thought to be extraordinarily sensitive to dopamine or produce too much of it.
The classic drugs work by blocking one of two types of dopamine receptors. But Clozaril, Tellian says, blocks both types of receptors.
Other research may reveal a drug that blocks the receptor the classic drugs don't touch, he says.
"It's not the cure-all for schizophrenia," Tellian says of Clozaril. "It's not the final answer."
For Steven Chandler, however, the drug is certainly a new beginning.
"It's changed my personality," says Chandler.
"I'm more alert. I understand things more clearly. I feel good about myself now," he says. He's getting to know more people and making friends, he adds.
Chandler has been participating regularly in a program run by the local mental health agency that teaches basic skills in getting along in the world, such as managing money and shopping. He wants to complete high school, and he recently applied for a job, matters that would never have concerned him a few months ago.
"Schizophrenia is suffering," Steve says. "It's hard to explain. It's like you are in a different world. I feel like if I keep taking this medicine, I'll never have to go back."
by CNB