SCHIZOPHRENIA

Schizophrenia is a brain disorder that often makes it difficult to distinguish between what is real and unreal, to think clearly, manage emotions, relate to others, and function normally. It affects the way a person behaves, thinks, and sees the world. The disorder typically becomes evident during late adolescence or early adulthood.

People with schizophrenia often have decreased ability to function at school, at work, and in social settings. Disordered thinking and concentration, inappropriate emotional responses, erratic speech and behavior, and difficulty with personal hygiene and everyday tasks can also occur. People with schizophrenia may have diminished facial expression and animation (flat affect), and in some cases become unresponsive (catatonic). Substance abuse and suicidal thoughts and actions are common in people with schizophrenia.

What causes Schizophrenia?

The exact causes of schizophrenia are unknown. Research suggests a combination of physical, genetic, psychological and environmental factors can make a person more likely to develop the condition.

A number of factors have been identified which can put someone at increased risk of developing schizophrenia:

• Having a close relative with schizophrenia.
• Experiencing problems during pregnancy and birth.
• Use of illegal drugs, including cannabis and amphetamines.
• Traumatic life events (especially in childhood).

In most cases, exactly how these things increase the risk is not yet known.

What are the symptoms of Schizophrenia?

The symptoms of schizophrenia are commonly described as positive symptoms or negative symptoms. ‘Positive symptoms’ are the symptoms that are experienced in addition to reality. They are usually called “psychotic symptoms” or “psychosis”.

The following are some examples of positive symptoms:

• Hallucinations (these are when you see, smell, hear or feel things that other people don’t such as hearing voices; seeing things which other people don’t see; feeling someone touching you who is not there; or smelling things which other people cannot)
• Delusions (these are beliefs that are not based on reality. Even though they feel real to you, others are likely to disagree with your beliefs such as that something has been planted in your brain to monitor your thoughts; you have special powers, are on a special mission or in some cases that you are god; that you are being followed by secret agents or members of the public; that people are out to get you or trying to kill you; or your food or water is being poisoned)
• Disorganised thinking (means you might start talking quickly or slowly; things you say might not make sense to other people; you may switch topics, or your words may become jumbled, making conversations difficult for other people to understand)

“Negative symptoms” are the symptoms that involve loss of ability and enjoyment in life.

The following are some examples of negative symptoms:

• Lack of motivation
• Losing interest in life and activities
• Poor grooming or hygiene
• Losing your normal thoughts and feelings
• Feeling uncomfortable with people
• Cognitive impairment (when you have problems with remembering things, learning new things, concentrating, making decisions)

How common is Schizophrenia?

The lifetime prevalence of schizophrenia appears to be approximately 0.3%-0.7%, although there is reported variation by race/ethnicity, across countries, and by geographic origin for immigrants and children of immigrants.

How is Schizophrenia diagnosed?

There is no single test for schizophrenia and the condition is usually diagnosed after assessment by a specialist in mental health such as a psychiatrist. Determining a diagnosis of schizophrenia may include: physical exam (to rule out other problems that could be causing symptoms), tests and screenings (to rule out conditions with similar symptoms and screenings for alcohol and drugs) and psychiatric evaluation (to check mental status by observing appearance and demeanour and asking about thoughts, moods, delusions, hallucinations, substance use, and potential for violence and suicide).

What is the treatment for Schizophrenia?

There is no cure for schizophrenia but in most people, symptoms can be either controlled or improved a lot by treatment. Many people with the illness go on to live a stable life, work and have relationships. It is recommended that people with schizophrenia should be offered a combination of medicine and talking therapies.

• Medication – A group of medicines called antipsychotics are often used to reduce symptoms of psychosis. There is evidence that these medicines work well for large number of people, especially in controlling hallucinations and delusions. A small number of people may not benefit very much from these treatments. It may take a trial of a few different medications to find which works best for an individual and to balance benefits with side effects.

• Cognitive Behavioral Therapy (CBT) – CBT works by helping the person to identify unwanted thoughts and feelings and change them. In order to change unwanted feelings or problematic behaviors, the therapist teaches strategies to modify negative thoughts and respond to them differently.

• Family Intervention Therapy – Other kinds of support such as Family intervention therapy can be very useful too. This focuses on helping families understand schizophrenia, and how best to support their relative. It also tries to identify and reduce things in the person’s environment, such as stress, that can cause relapses or prevent the best possible recovery.

In severe cases, people with schizophrenia may need to spend time in hospital until they recover from symptoms of psychosis. Others may need a lot of support in their day-to-day lives on a longer term basis.

Tips for people with Schizophrenia

• It’s important to keep taking your medication unless your doctor advises otherwise. This is true even if you feel well, as the medicine dampens down the symptoms. Stopping the medicine can lead to symptoms returning. Stopping suddenly can have other negative effects too, depending on your specific treatment.
• If you have any worries about your medication or its side effects, speak to your doctor. There are usually ways of managing side effects, but if not then other tablets may be available.
• Talk to other people with experience of schizophrenia. It can help to know you’re not the only one, and they might be able to offer advice on managing the condition.
• Symptoms vary a lot between different people. Learn to recognise what happens when you become unwell and be aware of the warning signs. This should be a part of your care plan and it can be useful to share these details with your family.
• Consult your GP, psychiatrist, or pharmacist before taking any new over-the-counter drugs, and avoid illegal ones altogether – they will almost certainly make things worse.
• Try to stay as physically healthy as possible – eating healthily, exercising and getting enough sleep are also good for keeping mentally well. Some medications can cause weight gain as a side effect, so keep an eye on your weight after starting a new treatment – the team looking after you should do this too.
• Becoming stressed and using alcohol or drugs to make yourself feel better can make the condition worse and lead to becoming unwell.
• Lifestyle changes, such as giving up smoking, can make a real difference to your health. If you planning to cut down or give up smoking, ask advice from your doctor and mental health team.

Tips for partners, families and carers

• The symptoms of schizophrenia can be a difficult for partners, families and carers to understand, so it’s important to learn as much as you can about it. Find out about the symptoms and the warning signs of a relapse.
• Build up a good relationship with the health professionals treating the person with schizophrenia. Don’t be afraid to ask questions or share your concerns with them.
• Make a plan with the person with schizophrenia so you know what to do if they show signs of becoming unwell.
• Go to appointments with the person with schizophrenia whenever possible, and encourage them to ask questions for themselves.
• Let them know they are doing well. Coping with schizophrenia can be a huge challenge, and a positive approach can really help.
• Where possible try to do things with the person rather than for them. This will help them to be independent and empower them to do things for themselves.

Myths v/s Facts about Schizophrenia

Useful websites

• NCMH

This website has a dedicated schizophrenia section, including details on research, suggested reading and links to medication information. ncmh.info/schizophrenia

• Royal College of Psychiatrists

This site provides a detailed patient information leaflet about schizophrenia in several languages as well as other mental health information. Search ‘schizophrenia’ from the homepage. rcpsych.ac.uk

• Rethink

Detailed information on the condition including types of schizophrenia, treatments, the risks and more. rethink.org/schizophrenia

• Mind

Information and support along with downloadable leaflets and real stories. Search ‘schizophrenia’ from the homepage. mind.org.uk

• com

News, information and resources dedicated to the condition, along with support and discussion forums. schizophrenia.com