Schizophrenia: What It Is And How It Can Be Treated.
Schizophrenia is a serious and chronic mental disorder that transforms a person’s perception of reality. It affects how one thinks, feels, and behaves. Individuals afflicted with this disorder undergo disorganised thinking, hallucinations, trouble with speech, and lack of motivation, and are prone to paranoia and false beliefs. They have trouble distinguishing sights, sounds, and sensations that they are imagining from reality, a condition that is termed ‘psychosis’. For example, they may believe that a strange person is controlling their mind or going to cause them harm. Such psychotic episodes are frightening, perplexing, and isolating.
The symptoms of schizophrenia, if left untreated, can impair the patient’s life and render them incapable of participating in usual activities and social interactions normally. However, there are a range of care options available for people with schizophrenia. Those who receive treatment can achieve normalcy and independence in their personal lives, and resume regular social and occupational functioning.
Myths around Schizophrenia
The disorder is greatly misunderstood. It is frequently confused to be a ‘split personality’, which is closer to Dissociative Identity Disorder. Schizophrenia is also demonised. Often, movies portray schizophrenic people as violent and having criminal tendencies. However, these ideas are misconceptions and far removed from reality. The complexity of schizophrenia can help explain such an understanding of the disease. Most people with schizophrenia are not more dangerous than the general population.
Another myth about people with schizophrenia is that they wind up homeless or in a mental facility. While it is true that stigma and lack of adequate mental health resources in the community may lead to homelessness and frequent hospitalizations, most people live with their families or on their own. The exact causes of schizophrenia are unknown; researchers believe it may be caused by a combination of biological, genetic, and environmental factors. Sometimes, schizophrenia runs in families. Certain life experiences also play a role in the development of the disorder, such as poverty, living in dangerous surroundings, or being exposed to viruses and nutritional problems before birth. Brain structure and function differences may also exist in those with schizophrenia.
Read more myths about Schizophrenia
People with schizophrenia are usually diagnosed in their teenage or young adult years, between the ages of 16 and 30, after the first episode of psychosis. As with any disorder, symptoms vary from person to person and may change in character, duration and severity over time. However, in persons with schizophrenia, the incidence of severe psychotic episodes usually reduces as they grow older. It is of utmost importance to recognize the symptoms of schizophrenia and seek help as early as possible. Not taking medications as prescribed, substance abuse (alcohol or drugs), and exposure to stressful situations worsen symptoms.
As mentioned, symptoms of this disorder commonly show up in adolescence and early 20s. At these ages, the earliest signs may get overlooked because they are similar to typical teenage behaviours. Early symptoms of schizophrenia can include isolating oneself from friends and family, changing friends groups, change in focus and concentration, problems with sleep, increased irritability and agitation, difficulties with schoolwork and poor academic performance, anxiety, and feeling different from others. However, more advanced symptoms of schizophrenia become apparent later when the disease is active. They fall into three major categories:
The word ‘positive’ in the context of schizophrenia symptoms has a different connotation than usual. Positive symptoms are behaviours which are not typical of individuals without the disorder and are abnormally present in those with schizophrenia. Also termed psychotic symptoms, they include alterations in the way a person thinks, behaves, and experiences reality. They involve the person experiencing the world in a distorted manner. Common positive symptoms are:
- Hallucinations: Hallucinations are the experience of hearing, seeing, smelling, tasting, or feeling things that appear real, but do not exist. They are vivid, clear, and very similar to normal perceptions. The most commonly experienced hallucinations in schizophrenia are auditory hallucinations or “hearing voices”.
- Delusions: Delusions are rigid false beliefs that a person holds despite considerable clear evidence that they are not true. Individuals with delusions may be convinced that the government is controlling all electronic devices. The most commonly experienced type of delusions by people with schizophrenia is ‘persecutory’ (or paranoid) delusions. People with paranoia are extremely distrustful of others and firmly believe they are being harmed by another person or group.
- Thought disorder: Thought disorders refer to the condition when a person has unusual or illogical ways of thinking. People with thought disorders may have disorganized thoughts and speech. They may have trouble processing information and using it to make decisions. Sometimes a person will stop talking in the middle of a sentence, jump from one topic to another, or make up meaningless words.
- Movement disorders: These are characterised by abnormal body movements. Abnormal motor behaviour can range from acting silly and childlike to unpredictable agitation. It can also be purposeless repeated movements, or in severe cases, it can manifest in the form of catatonia when a person appears as if in a daze with little to no movement in response to stimulus from the environment.
Negative symptoms refer to those behaviours that are typical of a regular person but are abnormally lacking in a person with schizophrenia. The disorder interrupts a person’s normal functioning, including their emotions, behaviours, and abilities. Negative symptoms can be summarised as:
- A loss of the ability to initiate and follow through plans, having very low energy levels and spending a lot of time engaged in passive activities.
- Reduced speech output or talking in a dull voice with limited facial expressions.
- Impaired emotional expression.
- A decrease in the experience of pleasure derived from everyday life.
- Reduced desire to have social contact, avoidance of social interaction and self-isolation, or interacting in socially awkward ways.
- Trouble engaging in daily activities such as grocery shopping or showering.
- Loss of motivation.
These symptoms are similar to and sometimes mistaken for symptoms of depression or other mental illnesses, and it is the presence of positive symptoms that distinguishes schizophrenia.
Cognition or mental functioning is another area that is affected by schizophrenia. They include problems with attention, concentration and memory, and decline in educational performance. Schizophrenia makes it hard for people to follow a conversation, learn new things, or retain information. A person’s cognitive functioning is considered to be one of the best indicators of their day-to-day functioning. There are specific tests used by mental health care professionals to evaluate cognitive functioning.
Schizophrenia is not entirely curable. However, treatment options are available that focus on eliminating a person’s symptoms, which can significantly improve a person’s day-to-day functioning and can help them lead their lives normally, engage in social activities, pursue a career, and have fulfilling relationships.
Medication can help reduce the intensity and frequency of psychotic symptoms over time. ‘Antipsychotics’, such as Clozapine and Aripiprazole are very effective in treating positive symptoms of schizophrenia, particularly hallucinations and delusions. However, they are not as helpful in reducing negative symptoms. These medications are usually taken every day in pill or liquid form.
In some cases, they may also be administered through injections. They often have unwanted side effects such as weight gain, dry mouth, blurred vision, rapid heartbeat, restlessness, and drowsiness when they start taking these medications. Most of these side effects can be managed by adjusting the dose, it is pertinent that they are monitored carefully by the doctor.
Psychosocial treatments are additional treatments that are generally used together with antipsychotic medication. They help people find solutions to everyday challenges in functioning and managing symptoms while attending school, working, and forming relationships. People who receive regular treatment are more likely to take their medication regularly, and also less susceptible to relapses or being hospitalised. Examples of this kind of treatment include behavioural skills training, psychotherapeutic techniques, and cognitive remediation interventions.
1. Psychotherapeutic Treatment
Psychotherapy is helpful in further improving the condition of people who have already been stabilised on antipsychotic medication. A therapist can help schizophrenia patients better understand the disorder, and adjust to living with it. A positive relationship with a therapist provides a safe space for the patient, acts as a reliable source of information, sympathy, encouragement, and hope, and a sense of control over their condition, all of which are essential for managing the disorder. Cognitive Behavioural Therapy (CBT) is particularly effective, as it helps patients test the reality of their perceptions. They can learn how to “not listen” to the voices in their minds.
2. Coordinated speciality care
Coordinated speciality care (CSC) programs are recovery-focused programs for people who have undergone the first psychotic episode. In CSC programs, healthcare providers and specialists work together as a team to determine a combination of psychotherapy, medication, employment and education support, and family education. This treatment is a collaborative effort of health care professionals and the individual to make treatment decisions. It also involves family members and other persons close to the patient.
3. Assertive community treatment
Assertive community treatment (ACT) is designed for people with schizophrenia who are at risk of multiple hospitalizations or homelessness. It is usually provided by a team of healthcare professionals who work together to provide care to schizophrenia patients in the community. Other Helpful Treatments and Support:
- Treatment for Drug and Alcohol Misuse
People with schizophrenia often develop problems with drugs and alcohol. Substance misuse can interfere with medication and other treatments. If a patient shows signs of drug or alcohol misuse, a simultaneous treatment for the addiction alongside the regular treatment for schizophrenia is pertinent for recovery.
- Vocational rehabilitation
Vocational rehabilitation includes skill building for people with schizophrenia to enter the workforce gain employment and pursue their careers. Rehabilitation helps them develop life-management skills and complete their educational training. Supported employment programs are also helpful in assisting people with schizophrenia to achieve self-sufficiency.
- Family Education
People with schizophrenia, upon being discharged from the hospital, land in the care of their family. Thus, the family members need to understand the disorder, and the difficulties associated with it. Therapists can help them learn coping strategies that minimise the person’s chance of relapsing. Families can be sensitised to the disorder and be taught to treat the patient with empathy. Additionally, they must know where to seek help from in case of a psychotic episode.
- Mutual-Support Groups
Support groups for people with schizophrenia and their families are common. Although not led by a professional therapist, these support groups can be therapeutic because being in the company of other patients can provide the much-needed support and belief that one is not alone in their experience.
The journey of overcoming schizophrenia is full of challenges and undeniably daunting. In addition to the disorder, the social stigma around it leads to discrimination and human rights violations of the patients. A significant portion of those affected by the condition do not receive proper care and lack access to specialist mental health care. It can prove to be extremely disruptive to a person’s life, disabling them from socialising, completing daily tasks, or establishing fulfilling relationships.
However, with the right combination of medication, therapy, and social support, people with schizophrenia can effectively manage their symptoms. In addition to this, it is the responsibility of society to better understand the condition, and sensitise ourselves to treat those with schizophrenia with empathy and kindness, provide them with the support and care they deserve, and recognise their strengths.