In England, approximately one adult in every 100 will live with a diagnosis of schizophrenia.
Dr Arokia Antonysamy (Samy), Regional Medical Director (South), has answered some common questions about the condition.
What is Schizophrenia?
Schizophrenia is a mental health condition that affects a person’s thinking and perception and this may be reflected in their behaviour and interactions with others.
It is a term that causes a lot of discomfort and panic due to how it is portrayed by the media to describe violence and dangerousness. It can feel as if one is judged to be aggressive and out of control, when clearly that is not the case in most people suffering from this disorder.
What causes Schizophrenia?
The exact cause of schizophrenia isn’t known, but several factors seem to play a role. Genetics is one big factor, as the illness tends to run in families. About 1 in 10 people with schizophrenia have a parent with the condition. Studies on identical twins show that if one twin has schizophrenia, there’s a 50% chance the other twin will also develop it.
The risk factors or triggers for developing psychotic symptoms include excess use of alcohol, heavy use of drugs like cannabis and amphetamines. Additionally, stressful life events such as losing a job, becoming homeless, or the death of a loved one can also raise the risk. Other factors contributing to stress like difficult relationships, issues at work or at school or university, unexpected events like accidents or crisis at home or work can all increase the risks for the illness.
Are there different types of Schizophrenia?
The commonest type of schizophrenia is paranoid schizophrenia. There are other less common types like catatonic and hebephrenic schizophrenia. There is another residual type where people may experience a few symptoms but not of a severe intensity warranting acute treatment or hospital admission.
In most cases they tend to cope with these residual symptoms through focusing on therapeutic activities like arts and crafts, sports, games, gym workouts , swimming or gardening
What symptoms would somebody with Schizophrenia display?
Those with schizophrenia may experience hallucinations for example, hearing or seeing things that aren’t there, and to them it may seem very real and can be quite frustrating when confronted or challenged by others.
They may experience what is described as ‘paranoid delusions’ where they believe their family members or friends or peers or work colleagues may be planning a conspiracy against them or in simple terms talking about them behind their back. Consequently they may feel unsafe and tend to develop plans to protect themselves. They struggle to differentiate between what is real and unreal.
Schizophrenia may sometimes be referred to as psychosis and people may experience positive symptoms like hallucinations and paranoid delusions as described above or may experience negative symptoms like feeling depressed and withdrawn from friends and family, poor sleep, poor appetite and feeling worthless with thoughts of harming themselves.
How is Schizophrenia diagnosed?
A detailed history including; symptoms, onset, duration, impact on daily functioning, impact on studies and work and a thorough physical examination is required. This comprehensive assessment is usually conducted by a specialist in mental health.
Drugs and alcohol and some medical conditions can sometimes present with psychotic symptoms like hallucinations and therefore it is important to rule out any of these conditions.
Someone experiencing psychotic symptoms for the first time as a sudden onset may need further investigations like MRI or CT scans to check for any brain abnormalities like tumour or bleeds. A detailed psychological evaluation is necessary to assess thinking patterns and emotional functioning.
What is the treatment for Schizophrenia?
In most cases, medications are required to help cope with the symptoms. They may reduce the intensity and frequency of the delusional thoughts and hallucinations and can be less distracting or disturbing for the individual. However consultation and frequent reviews with the psychiatric doctor is needed to ensure the right choice of medication and optimum dose. Medications may cause some side effects like stiffness, tiredness, sedation and some can increase appetite and cause weight gain. Usually these side effects settle in a few weeks, however regular physical activity and healthy eating and life style habits are important to maintain a stable weight within the normal BMI (Body Mass Index) range.
In addition to medications, psychotherapy in the form of psycho-education, supportive therapy or CBT (Cognitive Behavioural Therapy) helps in understanding the experiences from an individual perspective trying to make sense of the source of the symptoms and this may help to come to terms with the condition and help develop coping strategies to deal with it.
Social factors like positive relationships, maintaining healthy friendships and engaging in therapeutic activities like arts, painting, gym workouts, physical activity routines like walking and running, adopting healthy life style habits like avoiding tobacco, alcohol and illicit drugs play a crucial role in maintaining recovery. Having pets has also shown to maintain remission for longer.
Can people diagnosed with Schizophrenia live a normal life?
With effective treatment and support, many people with schizophrenia lead fulfilling lives, including working, studying, and maintaining relationships. It is important they engage with their treating team and comply well with the management plan. They need to work with their psychiatrist, therapist and other team members who will help to monitor the treatment response and help maintain recovery in the longer term. They can be successful like anyone else in the community and will be able to fulfil their dreams of a successful career and family life.
What are some common misconceptions about schizophrenia?
There are several myths about schizophrenia that contribute to misunderstanding the condition.
Some people believe it means having multiple personalities. Although the presentation of the condition in some may seem like this, it is clearly not the case. Schizophrenia involves symptoms like hallucinations, delusions, and disorganised thinking, and to loved ones, it may feel like they are a different person, when in fact they are the same person with a different unusual kind of experience which they themselves may struggle to explain or understand.
There seems to be a general perception in the society that people with schizophrenia are violent and dangerous and that it is not safe to be around them. Unfortunately media has created this impression among the public through movies and journals and daily news. The fact is that most people with schizophrenia are not violent. They are more likely to be victims of violence than to commit it. The condition itself does not predispose someone to violence. It affects individuals differently. Symptoms and the severity of the disorder vary widely from person to person. Research has shown that, the earlier people seek help for their unusual experiences from a mental health specialist, the faster they recover and the longer they are able to maintain stability in mental health.
In most cases, people tend to harbour a lot of guilt that schizophrenia is caused by bad parenting or personal weakness. It is important to understand that schizophrenia is a complex mental illness influenced by genetic, biological, and environmental factors. It is not caused by parenting style or personal failings, although difficult childhood experiences like childhood trauma caused by any type of abuse or neglect may be a risk factor for developing the condition. The condition does not develop suddenly . Usually the symptoms develop gradually over time. Early signs can include social withdrawal, unusual behaviour, and a decline in functioning
Some people think that schizophrenia is very rare and cannot be treated. Schizophrenia affects 1% of the global population meaning millions of people around the world are affected by this condition. About 25% of people do not relapse after the first episode. This may be related to good compliance with the treatment plan and adhering to a healthy lifestyle and good coping strategies to stress. While schizophrenia is a chronic condition, many people can manage their symptoms with the right combination of medication, therapy, and support. Early treatment improves the chances of a better outcome.