Q: My 19-year-old nephew was just diagnosed with schizophrenia. My sister says he doesn't want to take the medication. Does he need to start medication immediately? What else can he do?

A: Schizophrenia is a devastating psychiatric condition. It is a major cause of disability with huge human and financial costs. If your nephew's doctors have made the correct diagnosis, he probably does need to start medication. But medication is not the only treatment he needs.

Two important features of schizophrenia are psychosis and what psychiatrists call negative symptoms. Psychosis is the inability to recognize reality - for example, delusions (false beliefs) and hallucinations (false perceptions). The negative symptoms of schizophrenia include a restriction of emotional range, a tendency to be inexpressive, and the inability to be active and productive.

These problems almost always result in significant functional decline.Early treatment is best, because affected patients respond better to treatment during their first psychotic episode. Also, the greatest decline in functioning is seen within the first few years of making a diagnosis. Symptoms get worse and are harder to treat with each subsequent episode.