Schizophrenia

Schizophrenia is a serious mental illness that interferes with a person’s ability to think clearly, manage emotions, make decisions and relate to others. It is a complex, long-term medical illness, affecting about 0.7% - 3.7% Indian population (WHO,2003). Although schizophrenia can occur at any age, the average age of onset tends to be early 20s for men, and early 30s for women.

Symptoms:

With any condition, it's essential to get a comprehensive medical evaluation in order to obtain the best diagnosis. For a diagnosis of schizophrenia, some of the following symptoms are present in the context of reduced functioning for a least 6 months:

• Hallucinations:These include a person hearing voices, seeing things, or smelling things others can’t perceive. The hallucination is very real to the person experiencing it, and it may be very confusing for a loved one to witness. The voices in the hallucination can be critical or threatening. Voices may involve people that are known or unknown to the person hearing them.
• These are false beliefs that don’t change even when the person who holds them is presented with new ideas or facts. People who have delusions often also have problems concentrating, confused thinking, or the sense that their thoughts are blocked. Some of the delusions they tend to experience are that someone is trying to harm them, someone is against them etc. Sometimes the patients have bizarre beliefs that their thoughts are being controlled by others or their actions are being controlled by others. These eventually result in reduced social interaction and consistent suspicion against others.
• Negative symptoms: Negative symptoms are ones that diminish a person’s abilities. Negative symptoms often include being emotionally flat or speaking in a dull, disconnected way. People with the negative symptoms may be unable to start or follow through with activities, show little interest in life, or sustain relationships.
• Cognitive issues/disorganized thinking. People with the cognitive symptoms of schizophrenia often struggle to remember things, organize their thoughts or complete tasks. 

Causes

Research suggests that schizophrenia may have several possible causes:

• Genetics. Schizophrenia isn’t caused by just one genetic variation, but a complex interplay of genetics and environmental influences. A family history of psychosis or schizophrenia increases the risk of occurrence of schizophrenia.
•  Environment. Exposure to viruses or malnutrition before birth, particularly in the first and second trimesters has been shown to increase the risk of schizophrenia. Inflammation or autoimmune diseases can also lead to increased immune system. Stress also tends to act as triggering factor in the vulnerable individuals.
• Brain chemistry.  Neurotransmitters allow brain cells to communicate with each other. Problems with certain brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia.
• Substance use. Some studies have suggested that excessive use of drugs can increase the risk of schizophrenia. A growing body of evidence indicates that smoking marijuana, LSD and excessive alcohol use increases the risk of psychotic incidents and the risk of ongoing psychotic experiences.

Treatment:

Schizophrenia is treatable and manageable. Treatment can do much to reduce and even eliminate the symptoms. Treatment should generally include a combination of medication and community support. Both are usually essential for the best outcome. Along with the treatment, 1/3 of the patients do completely well, 1/3 are able to manage their symptoms and only remaining 1/3 are resistant to treatment.

• Medication
  Certain medications help the brain to restore its usual chemical balance. Medication called antipsychotics may help reduce the severity of symptoms like hallucinations and delusions, and may eliminate these symptoms all together for many people. Continuing medication after you feel well again may help reduce the risk of relapse (when symptoms come back). There are many different kinds of antipsychotics, so it may take time and patience to find the best one for you.
•  Psychological treatments 
  Psychological treatments can help with some of the life impacts associated with schizophrenia. Family interventions can play a valuable role in treatment and have been shown to help reduce the chance of relapse. Cognitive Behavioural Therapy is increasingly used for people with schizophrenia and there is evidence to suggest it can reduce positive symptoms.
• Early intervention 
  Treating psychosis early can help prevent future episodes and the development of a chronic disorder. It is increasingly becoming available to young people who are displaying early signs of psychosis. 

FAQs

• Is there a cure for schizophrenia?
  While no cure exists for schizophrenia, it is treatable and manageable with medication and behavioral therapy, especially if diagnosed early and treated continuously. Those with acute symptoms, such as severe delusions or hallucinations, suicidal thoughts or the inability to care for oneself, may require hospitalization. 

• Is a person with schizophrenia dangerous?

Most people with schizophrenia are never violent and indeed do not display any dangerous behaviour. However a small number do become violent when they are suffering from the acute symptoms of psychosis because of the influence of the hallucinations and delusions on their thinking. 

• What are the most common reasons for relapse?

Two common mistakes that lead to the re-emergence of schizophrenia symptoms again are for the individual (1) to stop taking prescribed medication or (2) to use alcohol or drugs. 

• What is the prognosis? How likely is it that a person with schizophrenia will ever have a "normal" life?

With treatment, rehabilitation therapy, and lots of social support and understanding, many schizophrenia patients can recover to the point where their symptoms are more or less completely controlled. Many are living independently, have families and jobs, and lead happy lives. 

• Can a schizophrenic go back to daily routine work once treated?
  Yes, given the adequate encouragement and occupational therapy the patient can employ himself in a suitable occupation. 

• Can a schizophrenic patient lead a successful marital life? 

Marriage is not a cure for schizophrenia. People with schizophrenia can have a satisfying and successful marriage.  But it depends upon how well the person's schizophrenic illness is under control. If a person is compliant to treatment, he can lead a normal married life. To some degree the disorder passes genetically but not entirely. There are 10% increased chances that the child of schizophrenic will have schizophrenia. 

• How safe is pregnancy in schizophrenic mothers?

 Having schizophrenia in no way makes you infertile or less likely to conceive a child. However, it is recommended to have a detailed discussion with your psychiatrist and gynaecologist. Medications taken for psychiatric illnesses may pass through the placenta and into the bloodstream of an unborn baby. They may also pass from a mother to her infant in breast milk. For these reasons, some doctors may recommend that women discontinue taking psychiatric medications before trying to conceive. Others may advise a woman to stop her medications during the first trimester, increasing the medications to a small dose once the first trimester ends. 

• Is Schizophrenia caused by black magic or evil spell?

Schizophrenia is not caused by black magic.It is not caused by a devil.Its not the result of any sin in this life or the previous ones.It is not caused due to immoral acts or deeds of the patient or his family. It is caused by imbalance in certain brain chemicals and is likely to be triggered by stress and excessive drug use. 

• Is bad parenting the cause of schizophrenia?

No, parenting has no role in the development of schizophrenia.  Schizophrenia is a mental illness. It has many causes, including genes, trauma, and drug abuse. Mistakes you've made as a parent won't give your child this condition. 

• Can a patient recover from schizophrenia?

Schizophrenia can be hard to treat, but it's not impossible. With the right medicine and therapy, about 25% of people with this disease will recover completely.

Another 50% will see some improvement in their symptoms. Many people with the condition can live full, productive lives.About 30℅ can have resistant illness

do  schizophrenics only belong to a mental hospital?

There was a time when people with mental illnesses were sent to asylums or even prisons. But now that experts know more about this disease, fewer people need to be placed in long-term mental health facilities. Most people with schizophrenia live with family or in supportive housing in the community.

How you can help someone with schizophrenia?

If a loved one has schizophrenia, you may be struggling with any number of difficult emotions, including fear, guilt, anger, and frustration. You may feel helpless in the face of your loved one’s symptoms, be worried about the stigma of schizophrenia, or confused and embarrassed by strange behaviours. You may even be tempted to hide your loved one’s illness from others. 
To help someone with schizophrenia, it’s important to:

• Educate yourself with the facts about schizophrenia.
• Accept the illness and its difficulties
• Do not criticize the patient always and neither become overinvolved.Strike a balance.Being overinvolved or critical increase chances of worsening illness.
• Don’t buy into the myth that someone with schizophrenia can’t get better or live a meaningful life
• Empower the patient and do not be over critical.
• Set realistic expectations for the patient.
• Help him to be compliant to the treatment.
• Do your best to help your loved one feel better and enjoy life
• Pay attention to your own needs
• Maintain a sense of humor and remain hopeful