Schizophrenia as a Disabling Condition

At the O’Ryan Law Firm, we have represented several clients who have become disabled due to the severe symptoms of Schizophrenia.

According to the National Institute of Mental Health[1], schizophrenia is described as follows:

Schizophrenia is a chronic and severe disorder that affects how a person thinks, feels, and acts. Although schizophrenia is not as common as other mental disorders, it can be very disabling. Approximately 7 or 8 individuals out of 1,000 will have schizophrenia in their lifetime.

People with the disorder may hear voices or see things that aren’t there. They may believe other people are reading their minds, controlling their thoughts, or plotting to harm them. This can be scary and upsetting to people with the illness and make them withdrawn or extremely agitated. It can also be scary and upsetting to the people around them.

People with schizophrenia may sometimes talk about strange or unusual ideas, which can make it difficult to carry on a conversation. They may sit for hours without moving or talking. Sometimes people with schizophrenia seem perfectly fine until they talk about what they are really thinking.

Families and society are impacted by schizophrenia too. Many people with schizophrenia have difficulty holding a job or caring for themselves, so they may rely on others for help. Stigmatizing attitudes and beliefs about schizophrenia are common and sometimes interfere with people’s willingness to talk about and get treatment for the disorder.

People with schizophrenia may cope with symptoms throughout their lives, but treatment helps many to recover and pursue their life goals. Researchers are developing more effective treatments and using new research tools to understand the causes of schizophrenia. In the years to come, this work may help prevent and better treat the illness.

Positive Symptoms

Positive symptoms are psychotic behaviors not generally seen in healthy people. People with positive symptoms may “lose touch” with some aspects of reality. For some people, these symptoms come and go. For others, they stay stable over time. Sometimes they are severe, and at other times hardly noticeable. The severity of positive symptoms may depend on whether the individual is receiving treatment. Positive symptoms include the following:

Hallucinations

Delusions

Thought disorders

Movement disorders

Negative Symptoms

Flat affect (reduced expression of emotions via facial expression or voice tone)

Reduced feelings of pleasure in everyday life

Difficulty beginning and sustaining activities

Reduced speaking

Schizophrenia and substance use disorders

Substance use disorders occur when frequent use of alcohol and/or drugs interferes with a person’s health, family, work, school, and social life. Substance use is the most common co-occurring disorder in people with schizophrenia, and the complex relationships between substance use disorders and schizophrenia have been extensively studied. Substance use disorders can make treatment for schizophrenia less effective, and individuals are also less likely to engage in treatment for their mental illness if they are abusing substances. It is commonly believed that people with schizophrenia who also abuse substances are trying to “self-medicate” their symptoms, but there is little evidence that people begin to abuse substances in response to symptoms or that abusing substances reduces symptoms.

Nicotine is the most common drug abused by people with schizophrenia. People with schizophrenia are much more likely to smoke than people without a mental illness, and researchers are exploring whether there is a biological basis for this. There is some evidence that nicotine may temporarily alleviate a subset of the cognitive deficits commonly observed in schizophrenia, but these benefits are outweighed by the detrimental effects of smoking on other aspects of cognition and general health. Bupropion has been found to be effective for smoking cessation in people with schizophrenia. Most studies find that reducing or stopping smoking does not make schizophrenia symptoms worse.

Cannabis (marijuana) is also frequently abused by people with schizophrenia, which can worsen health outcomes. Heavy cannabis use is associated with more severe and earlier onset of schizophrenia symptoms, but research has not yet definitively determined whether cannabis directly causes schizophrenia.

Drug abuse can increase rates of other medical illnesses (such as hepatitis, heart disease, and infectious disease) as well as suicide, trauma, and homelessness in people with schizophrenia.

It is generally understood that schizophrenia and substance use disorders have strong genetic risk factors. While substance use disorder and a family history of psychosis have individually been identified as risk factors for schizophrenia, it is less well understood if and how these factors are related.

When people have both schizophrenia and a substance abuse disorder, their best chance for recovery is a treatment program that integrates the schizophrenia and substance abuse treatment.

Men tend to get develop schizophrenia slightly earlier than women; whereas most males become ill between 16 and 25 years old, most females develop symptoms several years later, and the incidence in women is noticeably higher in women after age 30. The average age of onset is 18 in men and 25 in women[2].

Due to the early age onset of this disease, insurance companies may be reluctant to issue benefits in these types of cases. We find the insurance companies often wrongfully classify this condition under a ‘Mental Disorder’ and terminate benefits after 12-24 months, or deny the benefits altogether.

In addition, substance use is the most common co-occurring disorder in people with schizophrenia. A common tactic of insurance companies, if they see alcohol, drug, or substance abuse in the medical file, is to overlook the diagnosis of Schizophrenia and highlight the alcohol, drug, or substance abuse to limit their liability.

If you have been diagnosed with Schizophrenia and are considering applying for short term or long term disability benefits, it is important to obtain confirmation of the diagnosis and seek regular treatment from a psychologist or psychiatrist.

During the claim process, the insurance company will request that your psychologist complete forms explaining the severity of your condition and why you are restricted from working. Make sure that your psychologist is comfortable completing disability forms and has no problem certifying your disability.  Otherwise, it may be difficult for you to prove that your condition keeps you from working.

Schizophrenia can be a horribly disabling condition. If you are suffering from Schizophrenia and your short term or long term disability benefits have been denied by any of the major insurance companies such as Cigna, Prudential, MetLife, Hartford, Aetna, Liberty Mutual or Sedgwick, please contact the O’Ryan Law Firm so we can discuss a strategy for overcoming the denial of your claim.

[1]http://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Scleroderma_(also_known_as_systemic_sclerosis)/

[1] https://www.nimh.nih.gov/health/publications/schizophrenia-booklet/index.shtml

[2] http://www.schizophrenia.com/szfacts.htm