Schizophrenia

Schizophrenia affects people regardless of race, culture, social class, or gender. The causal factors are unknown.

For patients
Schizophrenia typically starts in early adulthood, but can start at any age from late teens and up.

Early signs of the disorder are unspecific, but months or years before developing psychotic symptoms, an affected person can appear changed. These early signs often include increasing withdrawal from social situations, odd thinking, odd behaviour, egocentricity, or ideas of reference.

Sometimes, these signs slowly increase until the person loses the ability to take care of himself, study, or work. Other times, there is a marked shift and the person develops what are called “psychotic symptoms”. These include hearing voices or having paranoid delusions.

Typical symptoms of schizophrenia

Symptoms of social withdrawal and emotional changes are called “negative” symptoms. These symptoms are those most often responsible for problems relating to social interactions and daily activities. Typical negative symptoms include:

• Affective flattening – reduced span and intensity in experienced emotions
• Alogia – reduced flow of speech, poverty of speech
• Avolition – reduced capacity to plan, initiate and/or persist in goal-directed activities
• Anhedonia – reduced capacity to feel pleasure or interest

Even though these negative symptoms are very troublesome, one could argue that the so-called “positive” symptoms are more prominent. Positive, in this context, means that these symptoms are extra or exaggerated functions. As such, they are more easily noticed. Positive symptoms, which are also called “psychotic” symptoms, include:

• Formal thought disorder – skipping around between subjects, looser associations, speaking grossly off-topic, or even talking completely incoherently
• Delusions – often a belief of being watched, spied upon, or plotted against. Can include bizarre thoughts, thoughts of imminent disaster, etc.
• Hallucinations – mainly hearing voices or thoughts. Sometimes seeing things that are not there.

These symptoms of schizophrenia are often accompanied by:

• Anxiety
• Depression
• Motoric over-activity – moving around constantly, agitation (it should be noted that this is also a typical side effect with older antipsychotic drugs.)

Course of schizophrenia

Schizophrenia is a severe disorder that can have a huge impact on a person’s life. Most people who develop schizophrenia will spend time in hospital at least once during their lives. Often, it will be necessary to leave school or work for a considerable period of time – months or even years.

Despite the severity of the disorder, many people will only experience a single schizophrenic episode. After treatment and rehabilitation, many of these people will be able to regain many of their former pleasures and participate in important aspects of their lives.

Unfortunately, many others develop a chronic disorder with recurrent psychotic episodes separated by periods marked by troublesome symptoms. Even so, those with a chronic disorder will, with treatment, rehabilitation and support, be able to lead fulfilling and active lives.

Treatment

Despite intensive ongoing research, a cure for schizophrenia has yet to be found. Even so, it is now possible to effectively treat the psychotic symptoms and thus help patients lead more normal lives. Antipsychotic medicines are thought to work by normalising the communication between certain brain cells and thus help reduce hallucinations and delusions.

Like many other medications, antipsychotics can have bothersome side effects. The specific side effects vary from drug to drug. Therefore, always discuss the specific treatment with a psychiatrist to determine the most suitable medication.

Some drugs increase the risk for weight gain. Others can cause muscle stiffness. Many antipsychotic medications have a sedative effect and can thereby decrease energy levels. This tends to reduce the ability work, travel, and pursue social activities. Happily, current treatments demonstrate very few side effects – if any.

In addition to drug treatment, access to psycho-social treatments, occupational therapy, and physiotherapy is vital. Family support treatment and education are also valuable.

Due to the increased risk for physical illness, the physical health of the patient should also be checked regularly.

For patients and relatives

The symptoms described in the preceding section can cause patients with schizophrenia to periodically have a perception of reality that is very different from the reality experienced by those around them. Living in a world constantly distorted by delusions, unfocused thoughts, and hallucinations, will cause confusion, fear, and anxiety. This situation can also cause altered behaviour. A person with schizophrenia may seem distant, detached, or preoccupied.

The person with schizophrenia will often be sensitive to stressful situations. Such situations may increase symptoms. It is important for both the person with schizophrenia as well as relatives to familiarise themselves with the “risk symptoms” or “warning signs” of a pending relapse into a new episode. These warning signs are often very specific to the individual. Thus, it is useful to discuss these with the physician in charge. As a relative or carer, you can be of great help in supporting a relative with schizophrenia by participating in these discussions.

Remember, stopping medication seriously increases the risk of developing symptoms or triggering a new episode. Stopping any treatment should never be done without consulting the psychiatrist. Most people with schizophrenia will be urged to continue treatment for many years or even for the rest of their lives.

Despite the fact that schizophrenia affects as many as 1% of the population, it is not well understood. For example, there is a general misconception that patients with schizophrenia are dangerous, which is not true. In reality, aggressive behaviour is very unusual.