Living with schizophrenia
What is schizophrenia?
Schizophrenia is a severe mental disorder which is characterized by distortions in thinking, perceptions, emotions, language, sense of self and behaviour (WHO).
How common is it?
According to the World Health Organisation, schizophrenia affects more than 21 million people worldwide. It is more common in males (12 million) than females (9 million) and tends to start earlier among males. Schizophrenia seems to be more common in urban locations and among some ethnic groups (RCPsy). It is more likely to start between the ages of 15-38 (RCPsy). Compared to other mental disorders, it is less common.
The symptoms of schizophrenia
Schizophrenia can cause significant disruption to an individual’s life affecting a person’s ability to function. It can affect an individual’s ability to assess reality and this in turn is known as a psychotic disorder - impairment in assessing internal and external reality. Individuals experience various symptoms to differing extents and everyone is different.
There are symptoms which are categorised as ‘positive’ and ‘negative’.
These are the changes in thinking and perception including;
These are disturbances of your senses. You may see, smell, feel or taste something that isn’t caused by anything. People most commonly experience hearing voices when there are no sound audible to others. It can be like over hearing a conversation, talking about you or maybe aimed directly at you. These can be pleasant word or rude and critical which maybe upsetting or aggravating. The voices are not imaginary; they are real and are created by the mind (RCPsy). The brain mistakes some of your thoughts for voices coming from outside of you. In response you may choose to ignore them or respond and even act on what they say, doing as they tell you.
These are fixed beliefs or suspicions which are viewed as false by external observers but are believed to be true to you. These beliefs could be religious, related to physical health, grandiose or involve a fear due to feelings of persecution or of being controlled by others. If you try and share your ideas with someone else, you do not make sense to them and you appear unrealistic or strange to them. ‘Paranoid’ delusions are ideas that make you feel persecuted or harassed (RCPsy). They can range from feeling like you are being spied on by agencies or being suspicious that your partner being unfaithful. These feelings can make you withdrawn or overly defensive, you may find the need to escape and therefore keep on the move.
It is common that individuals find it significantly difficult to perform everyday tasks or engage in goal directed activities. You may have muddled thinking and find it hard to focus or maintain concentration for very long. Speech and thoughts can be incoherent and you are unable of forming a logical sequence of thought. Conversations can then become fragmented and it is harder for others to understand you. Unpredictable outbursts or agitated responses could arise which are not triggered by an outside event. Other behaviour could include mumbling or laughing to self, wandering aimlessly and self-neglect.
The other types of symptoms are called ‘negative’ symptoms and include a lack of emotional expression and emotional responsiveness. To people around you, it can be mistaken as laziness and that need pull yourself together. You have a lack lose the ability to take part in any goal directed activity. This can include losing interest and enthusiasm for life, unable to concentrate, no desire to wash or keep tidy and cannot be bothered to get up or interact with others. A person may experience ‘alogia’ or else known as ‘poverty of speech’ is the lack of thought reflected by lack of speech. Reponses may be brief, empty in content or completely non-existent.
Throughout a person’s life, it is not unusual to experience some of symptoms from time to time and they need not be a problem. In schizophrenia they tend to be much more intense, frequent and distressing. Someone experiencing schizophrenia may not have all of these symptoms for instance those with delusional ideas seem to have very few negative symptoms (RCPsy). It can sometimes be confusing to determine what your symptoms mean. When experiencing your first episode of schizophrenia there is a 50% chance you will feel depressed before getting the more obvious symptoms. Around 1 in 7 people with continuing symptoms will become depressed. This can be mistaken for negative symptoms (RCPsy).
People with schizophrenia are 2-2.5 times more likely to die early than the general population. This is often due to physical illnesses, such as cardiovascular, metabolic and infectious diseases. Schizophrenia is associated with disability and can affect educational and occupational performance.
Suicide is more common in schizophrenia. The symptoms are distressing and without treatment or seeking the appropriate help, depression can develop.
There is often a stigma attached as well as discrimination and violation of human rights of people. Discrimination can limit access to general health care, education, housing, employment and impact social circumstances.
The causes of schizophrenia
The causes of schizophrenia remain unclear but it is thought that a variety of genetic influences play a significant role as well as a range of environmental factors. Psychosocial factors may also contribute. Although only 1 in 100 people get schizophrenia, about 1 in 10 people with the illness have a parent with schizophrenia (RCPsy). This suggests there is an association with genetic factors. Substance misuse has also been associated with triggering schizophrenia. Strong cannabis has been linked with increasing the risk especially if it is heavily consumed in the teen years (RCPsy). Amphetamines can give people psychotic symptoms but usually stop once the drug taking ceases. Some people use drugs or alcohol to cope with symptoms but this can make things worse. As with other mental disorders if a person experienced a traumatic childhood, schizophrenia is more likely to develop.
How can schizophrenia be treated?
Schizophrenia is treatable. It is advised that if you do experience the symptoms of schizophrenia to go and see a doctor. Evidence suggests that if schizophrenia is identified and treated early especially if help is obtained within the first episode, you are more likely to overcome the illness, less likely to come into hospital, requiring intensive support and more likely living an independent life (RCPsy). Most likely you will have to see a psychiatrist and a community mental health team to plan treatment and managing the illness.
The most effective treatment is medicines and psychosocial support. Medications known as antipsychotics can help to alleviate the immediate symptoms and in some cases reduce the likelihood of them reoccurring. A complicating factor in medication treatment is that the individual may be using drugs and/or alcohol in attempt to self-medicate. This makes diagnoses and treatment more complex. There are wide ranges of social and vocational rehabilitation treatments which assist with the coping with daily life, both at home and at work. Psychotherapy can be beneficial in long term treatment. Cognitive Behavioural Therapy (CBT) can help to take control of schizophrenia symptoms by problem solving and addressing the triggers head on. This can be delivered by a clinical psychologist, a psychiatrist or nurse therapist. Usually people have 8-20 sessions, each lasting one hour (RCPsy).
There is evidence to suggest that a long term relationship with an individual carer or a support team can result in better outcomes for the person. Support from the family, friends and the wider community is very important. Care is shifting from mental health institutions into the community which is considered a better environment for individuals. WHO describes programmes set up in several low and middle income countries which have provided support via the primary care system. This has required a trained primary care workforce, access to essential medicines, carer and families support at home, educating the public to reduce stigma, enhancing life skills through recovery orientated psychosocial interventions and the promotion of independent living. Management strategies include assisted living and support with housing and in the workplace.
According to the Royal College of Psychiatrists, for every 5 people with schizophrenia,
1 will get better in 5 years of their first obvious symptom
3 will get better but will have times when they get worse
1 will have troublesome symptoms for long periods of time
Many people living with schizophrenia are not receiving appropriate care. The majority of people who are untreated live in low and middle income countries (WHO). The two main reasons for this includes lack of access to mental health services and treatment plus the fact that people living with schizophrenia are less likely to seek help.
Ways to stay well
Learn to recognise the early signs and triggers
Take time to address the symptoms and managing them. This could include;
Avoiding stressful situations
Avoiding drugs or alcohol
Learn about schizophrenia and understand your medication. Talk about any concerns or advice needed with your nurse, psychiatrist, mental health worker
Maintain healthy relationships with friends and family
Identify someone you can trust who you can tell if you feel you are becoming unwell again
Join a self-help group to listen to others with similar experiences to yours
Perform relaxation techniques such as yoga and meditation
Do something you enjoy such a hobby or sport. This could include;
Art therapy. Art is a great form of therapy for helping individuals express themselves, social networking and a way of obtaining a sense of achievement in the art produced.
Look after your physical health, eat well and exercise regularly. Twenty minutes of moderate exercise can help. Both your GP and psychiatrist can help you with this. Attend regular health checks, monitor your weight, blood pressure and try to stop smoking entirely.
‘WPA Public Education Initiative’
Dr. Avdesh Sharma, International Lead, WPA; Consultant Psychiatrist, India
Dr. Sujatha Sharma, Consultant Psychologist, India
Stefanie Radford, Senior Project Manager, United Kingdom
Rajeev Verma, Administrator, India
Pragya Mehra, Media Specialist, India
Jatin Kumar, Media Editor, India
Supported by Unrestricted Educational Grant by SUN Pharma
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