Schizophrenia

Schizophrenia is thought to affect around 1 in every 100 people. It affects men and women equally, though with men it tends to develop between the ages of 15 to 30, whereas with women it tends to be around 25 to 30.

What is Schizophrenia?

Schizophrenia is a mental illness that has several symptoms. It affects the way a person thinks, feels and behaves. There is a wide- spread misconception that schizophrenia means having a ‘split- personality’, in Greek it means “split mind”. This, however, was long before there was any real understanding of the condition. Schizophrenia is a psychotic illness, which means that a person may not be able to differentiate between reality and their own thoughts or delusions.

The early symptoms of schizophrenia can be very difficult to diagnose. This is because often the early symptoms begin in adolescence; they are usually very subtle and so can be easily confused with normal changes of growing up. Symptoms also tend to develop slowly, making them harder to spot. Lots of sufferers of schizophrenia can go on to lead perfectly normal, functioning lives. Statistics show that of every 5 people with schizophrenia; 1 will make a full recovery within 5 years, 1 will have trouble with it for a long time and 3 will make a recovery but then have times when they ‘dip’ again.

Schizophrenia is usually distinguished between positive (unusual experiences) and negative (deficits of normal emotional responses) symptoms:

Positive Symptoms

• Hallucinations – these can involve any of the senses and are perceptions of things which aren’t really there. The most common kind of hallucination, however, is hearing voices. These voices can be talking to the person affected or talking about them with another voice, giving instructions or describing the situation that they are in. With schizophrenia, these voices can be pleasant and encouraging, but more commonly, abusive, threatening and critical. When studies have been carried out on the brain, they suggest that, to the person hearing the voices, they are actually real as shown by increased activity in the part of the brain affecting speech.
• Delusions – this is when a person believes something and stands by their belief in it, whilst in reality; the belief can be mistaken, unrealistic or strange. With delusions, regardless of whether everyone else thinks the person is mistaken, they still believe it. Delusions can be used to explain hallucinations, for example, if a voice is describing that one is walking down the street and entering the park, this may explain the belief that the person is being tracked by the police or spies. Sometimes, people suffering with delusions believe that they are being communicated with directly via external sources, such as messages through the TV, and that they have special personal significance to this only others will not understand. This is referred to as ‘ideas of reference’.
• Thought disorder/confusion- this causes an inability to concentrate or maintain concentration, some struggle with reading, keeping up a conversation or focussing on a task at work. Thoughts and words may become jumbled and conversations can be very difficult for the person suffering as well as the other person to understand.
• Passivity Feelings- these relate to the feeling that a person is being controlled by something external, or that external things or messages are being passed through their body. This could be via x-rays, laser beams or telepathic thoughts.

Negative Symptoms

These are less dramatic and harder to recognise than positive symptoms, often being mistaken for as laziness. They are often very slow in developing hence being hard to recognise. These symptoms can cause difficulty in relationships and daily life. They describe a gradual change in ones personality, including:

• Loss of motivation to do things that would normally be everyday routine including seeing family or friends
• Social withdrawal and feeling uncomfortable around people
• Turning up late or taking days off work
• Lack of interest in sex and relationships
• Lower standards of personal care
• Feeling flat or indifferent about things

What causes schizophrenia?

It is believed that there are various factors involved as to why one person may suffer with schizophrenia while the next does not. Genetic, social, pre and post- natal and environmental factors are all believed to play a part.

Should a person’s parents have schizophrenia then the chances of developing the condition rises from around 1 in 100 to 1 in 10. For identical twins, if one had schizophrenia, the chances would be 1 in 2, for the other. In the case of non identical twins, the chances would be around 1 in 7. All of these statistics strongly illustrate a genetic link but at the same time suggest that genetics are not the only factor when it comes to schizophrenia.

Unlike most mental illnesses, the number of people affected by schizophrenia appears to be very consistent between one country and another. This suggests that it can’t be entirely down to environmental or social factors. It has been suggested that suffers may have an abnormal brain structure, although the evidence is far from conclusive.

Certain stressors can trigger schizophrenia. They do not cause it but can make it more likely that it will develop it should a person already be vulnerable to schizophrenia. These would include things like bereavement, loss of a job or home, relationship breakdown or being the victim of physical, emotional, racial or sexual abuse.

Drug use can play a big part in the development of schizophrenia. Again, it is not a direct cause of it, but can increase the chances of developing it with prolonged or heavy use, especially to those susceptible. Drugs which are the main aggravators for schizophrenia include;

• Cannabis
• LSD
• Amphetamines
• Cocaine

Cocaine and amphetamines can cause psychosis and should one have already had an acute episode of schizophrenia, these can cause a re-lapse. Usually the psychosis would stop when the drug use is stopped.

Studies show that extensive use of cannabis is thought to double the chances of developing schizophrenia and with the stronger strain of cannabis- ‘skunk’, the risks are even higher. If someone started smoking cannabis in their early teens and then continued to use it heavily, it is thought the risk of developing schizophrenia could even be five times greater than a person did not use cannabis heavily in their early teens.

Treatment Available

Treatment for schizophrenia often involves a combination of medication, psychological therapy and social support.

Medicating schizophrenia is generally done using antipsychotic drugs, which generally relieve the effects of the ‘positive’ symptoms. People tend to respond well to the medication, although as with everything, there are exceptions. Medication for schizophrenia is usually used on a fairly long- term basis and often, upon ceasing medication, the symptoms come back within around 6 months. It is important to reduce the medication gradually, making it easier to spot should symptoms start to come back. Antidepressants are also sometimes used to deal with the negative symptoms, though this should be very carefully managed and a lot of care should be taken should one choose to come off of the medication.

Hospitalisation is sometimes required during an acute episode of schizophrenia. This maybe the case if the affected person is considered a danger to them self or others and would only be for as long as they needed until they were able to look after themselves or be looked after in their home.

An effective psychological therapy for schizophrenia is cognitive based therapy (CBT), this is also recognised by the NICE guidelines. It is especially helpful if taken in conjunction with medication. CBT looks at thoughts, feelings and behaviours that one may have which are negative or that have a negative effect and teaches different ways to approach these thoughts and feelings, looking at them in a different light, thus making them more manageable. CBT can be effective in helping those with hallucinations or thought disorder.

Supportive psychotherapy can also be very useful. This is more of a counselling therapy- giving a person the opportunity to discuss what they are going through and their thoughts, feelings and fears about it and then getting some positive feedback in return.

One very effective yet simple treatment for this condition is support from friends and family. Living with schizophrenia can be very difficult- for both the sufferer and the people around them. Having a good understanding of the condition if a family member or friend has schizophrenia can be very helpful, not only for them, but for those involved too.

Day care or day centres can also help in bringing some structure back to a person’s life with schizophrenia. Going to a day centre could help one socialise with others, get fit, do some creative hobbies and generally integrate back into normal life.

Most people diagnosed with schizophrenia would initially need to be seen by a psychiatrist in order that a treatment plan could be made and managed. The community mental health team (CMHT) for the person’s local area should then be involved in their treatment plan implementation and maintenance.

If you are concerned that you or someone you know may require help and advice please call the Via Clinic on 01372 363939