folks! Hope you are all in splendid health. Sorry for the delay in preparing
this issue. Sometimes we are not aware of the events, which life has
lined up for us, which throws us off balance. As I mentioned in my last
issue, it is time for us to be a little bit more knowledgeable on various
mental illnesses. To start off with we will discuss the illness Schizophrenia.
Schizophrenia is a mental illness that affects about one out
of every hundred people. There are many popular myths and misunderstandings
about it. That makes it all the more important to get the facts straight.
What it is like to have schizophrenia
· What may cause it
· What can be done to help
today is much brighter than it used to be. There are now better ways
of helping someone to cope with schizophrenia. Many people with schizophrenia
live independently, and more and more are able to work and have family.
common is it?
Schizophrenia affects one in every hundred people. This is about the
same for many different places and peoples across the world. It seems
to be more common in city areas.
does it affect?
Schizophrenia affects men and women equally. It rarely starts
before the age of 15, but can develop at any time after this. Men with
schizophrenia usually notice the first signs in their late teens or
early twenties. Women are often first affected a little later, in their
twenties or thirties.
are the symptoms of schizophrenia
You may hear people talk about positive and negative symptoms of schizophrenia.
These are the unusual experiences that are part of schizophrenia. They
sometimes happen in other severe mental illnesses.
A hallucination happens when you hear, smell, feel or see something
when there isn't anything, or anybody, actually there to hear, smell
feel or see. In schizophrenia, the commonest hallucination is hearing
voices. The voices can sound so real that you become convinced they
truly are coming from outside you. It may be hard to work out why other
people can't hear them. They may seem to be coming out of thin air,
or you may hear them coming from the television or some other object.
You may try to find an explanation for them - that they are coming from
hidden microphones, loudspeakers, or the spirit world. The voices can
be so real that you find yourself talking back to them, or even shouting
at them. You may feel that you have to do what they say, even if they
are telling you to harm yourself. The voices are not imaginary, but
they are created by our own minds. The brain mistakes our own thoughts
for real experiences happening outside us.
with other kinds of mental illness, such as severe depression, may also
hear voices that talk directly to them. In schizophrenia, the voices
seem to talk to each other, as well as talking to you. It can sound
as if you are over-hearing a conversation, as though you can hear people
talking about you. Visions and hallucinations of smell, taste or being
touched can also happen - these are less common.
A delusion is a particular kind of unusual belief. It
can be unusual because it is uncommon or unknown in your culture. It
can be unusual because you believe it very strongly without having any
evidence to support it. Either way, other people find that they can't
really discuss it with you. If someone asks you to explain why you've
come to believe this, you can't say why, or your reasons don't make
sense to him or her - you " just know".
does it start? A delusion may sometimes come out of the blue,
often after a few weeks or months when you have felt that there has
been something strange going on that you couldn't explain. You may come
to believe it by trying to explain hallucinations, or other strange
experiences (see below). They feel so real that you have to find some
reason for them.
often talk about 'paranoid' delusions. 'Paranoid' is just
another word for feeling persecuted or harassed. You may have ideas
of persecution that, at first sight, seem quite reasonable. For example,
you may start to believe your partner is unfaithful, even though other
people can see nothing to suggest that this is true. On the other hand,
you may have ideas that are more unusual, like feeling that MI5 or the
government is spying on you. You may believe that you are being harassed
by the neighbours who are using special rays, or that you are God's
special messenger. Delusions of persecution can be especially upsetting
for your family, if you see them as your persecutors.
have "delusions of reference". This is where
you start to see special meanings in ordinary, day-to-day events. You
may find yourself believing that radio or TV programmes are about you,
or that people are communicating with you through the colours of cars
passing in the street.
be difficult to discuss your ideas with other people, because you realise
that they won't understand. Often, delusions won't affect the way you
behave. However, if you feel that other people are trying to harm or
harass you, you may feel so threatened that you want to retaliate. More
commonly, you will just keep away from other people.
Thinking (or "Thought Disorder")
You may find that it is becoming harder to concentrate - you can't finish
an article in the newspaper or watch a TV programme to the end. If you
are at college, you will find it difficult, or impossible, to keep up
with your studies. If you are working, you just can't keep your mind
on the job.
things that make it difficult to concentrate is the way that your thoughts
connect with each other. They seem to wander off on their own. You can
drift from one idea to another one that doesn't seem to have any connection
with the first. After a minute or two you can't remember what you were
originally trying to think about. Some people describe their thoughts
as being "misty" or "hazy"
when this is happening.
ideas are disconnected in this way, it can be hard for other people
to understand you. You may notice that other people look a bit baffled
when you are trying to tell them something.
of Being Controlled
When this happens, it can feel as though someone is taking thoughts
out of your mind, or putting their thoughts into it. It can feel as
though someone is trying to take you over or control you - this is extremely
unpleasant and disturbing. You may feel as though your body is being
taken over, or that you are being controlled like a puppet or a robot.
It may get to the point where your whole personality seems under the
influence of an alien force or spirit. This is a terrifying experience,
which people explain in different ways. In 'high-tech' societies, people
tend to blame radio, television or laser beams, or believe someone has
installed computer chip in their brain. In traditional and religious
communities, people may blame witchcraft, angry spirits, God or the
"Negative symptoms" are less obvious than positive
Your interest in life, energy, emotions and 'get-up-and-go'
just seem to drain away. It's more difficult to feel excited or enthusiastic
about anything. You can't concentrate. You may not bother to get up
or go out of the house. It can be difficult to wash or tidy up, or to
keep your clothes clean. You may feel more uncomfortable with people,
and feel that you have nothing to say.
can find it hard to understand that negative symptoms are actually symptoms,
and that you are not just being lazy. This can be upsetting, both for
the family and for someone with schizophrenia. The family can feel that
you just need to pull yourself together. You can't explain that you
seem to them as if you have changed, you don't seem like the same person
anymore. It is important for the family to understand that this is as
much a part of a crippling illness as are any delusions and hallucinations.
Negative symptoms are much less dramatic than positive symptoms, but
they can be just as troublesome.
everyone with schizophrenia have all these symptoms?
No. someone can hear voices and have negative symptoms, but may not
have thought disorder. Some people with delusional ideas seem to have
very few negative symptoms. If someone has mainly thought disorder and
negative symptoms, the problem may not be recognised for years.
We don't yet know for sure what causes schizophrenia. It is likely to
be a combination of several different factors, which may be different
for different people.
About one in ten people with schizophrenia have a parent with the illness.
If neither of your parents has schizophrenia, your chance of developing
it is more like one in a hundred. This difference is probably caused
by heredity (genes), not upbringing.
identical twins have exactly the same genetic make-up as each other,
down to the last molecule of DNA. If one identical twin has schizophrenia,
the brother or sister has about a 50:50 chance of having it too, even
if they are brought up in different families.
twins don't have the same genetic make-up as each other. If one of them
has schizophrenia, the risk to the other twin is just slightly greater
than for any other brother or sister. Research suggests that heredity
provides about half the explanation of the illness. We have not yet
discovered the gene, or combination of genes, responsible for schizophrenia.
New ways of producing pictures of the brain show that some people with
schizophrenia have larger spaces in the brain than people who don't
suffer from the illness. This suggests that some parts of the brain
may not have developed quite normally. Problems during birth might be
responsible - these can affect the supply of oxygen to the baby's brain.
It is also possible that, during the early months of pregnancy, virus
infections can cause subtle brain damage.
Stress often seems to happen shortly before an episode of schizophrenia.
This could be a sudden event like a car accident, bereavement or moving
home. It can be part of everyday problems, such as difficulty with work
or studies. Stress is not the cause of schizophrenia, but it may help
to bring it on in someone who is vulnerable. Long-term stress, such
as family tensions, can also make it worse.
Drugs and Alcohol
Sometimes, the use of street drugs like ecstasy (e), LSD (acid), amphetamines
(speed), and cannabis (hash, marijuana, pot, ganja, skunk, dope, spliffs,
joints) seems to bring on schizophrenia. We know that amphetamines can
bring on symptoms just like those of schizophrenia, but they usually
stop when you stop taking the amphetamines. We don't yet know whether
these drugs can trigger off a long-term illness but they may do in someone
with a predisposition. It does seem that using street drugs and alcohol
can make matters worse in some people who already suffer from the illness.
Many people use street drugs or alcohol to cope with their symptoms
or, sometimes, the side effects of anti-psychotic medication as a form
Problems - At one time, it was fashionable to believe that schizophrenia
was caused by problems within the family. There is no evidence to support
this idea. However, if you already have schizophrenia, family tensions
can make it worse.
is the outlook? Schizophrenia can make it hard for someone to work,
to study, and to get on with other people. It can make it hard to live
an independent life, and it can cause a lot of distress in families,
and help for schizophrenia are much better today. Before 1950, many
people with schizophrenia spent most of their lives in mental hospitals.
Now, many people with schizophrenia never have to go into hospital.
who suffer from it are eventually able to settle down, work and make
lasting relationships. New treatments and ways of helping schizophrenia
mean that the outlook is now much brighter.
1 in 4 people will get better within five years of their first episode
2 out of 3 will get better, but will still have some symptoms. They
will have times when their symptoms get worse.
Around 1 in 5 will have troublesome symptoms that will continue to interfere
with their lives.
schizophrenia is left untreated, the greater its impact on your life.
The sooner it is noticed and you get help for it, the better.
treatments are available?
If you have the symptoms of schizophrenia for the first time, you may
need to stay in hospital for a while for thorough assessment and treatment.
However, if the illness is caught early enough, this may not be necessary.
You would need to see a psychiatrist because schizophrenia needs expert
help. Even if you do have to come into hospital, it will usually be
for only a few weeks. Afterwards, any help or treatment you need can
be given at home.
help the most disturbing symptoms of the illness. However, they do not
provide a complete answer. Medication is an important first step, which
makes it possible for other kinds of help to work.
from families and friends, other forms of treatment and services such
as supported housing, day care and employment schemes also play a vital
part in getting better.
- "Typical" Antipsychotics
In the mid - 1950s, several drugs appeared that could reduce the symptoms
of schizophrenia. They became known as "antipsychotic" medications.
These older drugs are called "typical" antipsychotics. They
work by reducing the action of a particular chemical messenger in the
brain called dopamine.
weaken delusions and hallucinations gradually over a period of a few
weeks. If you have had thought disorder, you may find that you are able
to think more clearly.
The most common are stiffness and shakiness, like Parkinson's disease.
Giving anti-Parkinsonian drugs can reduce these. These "typical"
anti-schizophrenia medications may make people slow and sleepy, and
overweight. An uncomfortable restlessness can be caused by these medications,
and they can interfere with your sex life. Perhaps the worst side effect
is permanent movements of the mouth and tongue . This affects about
1 in 20 people every year who are taking these medications.
Over the last 10 years, several newer medications have appeared. They
work on a wider range of chemical messengers in the brain and are called
"atypical" anti-psychotics. They are less likely to cause
Parkinsonian side effects, although they may cause weight gain and some
cause problems with sexual function. They may also help the negative
symptoms, on which the older drugs have very little effect. Many people
who use these newer medications have found the side effects much less
troublesome than those of the older medications.
well does mediation work?
These medications, although they work well for many people, are NOT
a cure. The symptoms of schizophrenia often come back. This is much
less likely to happen if you carry on taking medication even when you
feel well. This is why a psychiatrist will usually suggest that you
take medication for a long time. If you want to stop your medication,
you need to discuss this with your doctor, family or friends.
is it Taken?
Medication for schizophrenia comes as tablets, capsules, and syrup.
We can all find it hard to remember to take tablets several times a
day, so there are now some that you only need to take once a day.
find it hard to take tablets every day, you may find it easier to take
anti-psychotic medication as an injection. These are called depot injections
and are given weekly or every 2,3 or 4 weeks. On the other hand, taking
tablets gives you more control over your medication and its effects.
happens if you stop medications?
The symptoms of schizophrenia will usually come back - not immediately,
but usually within 6 months.
back to normal
What happens after your positive symptoms have been controlled? Schizophrenia
can make it difficult to deal with the demands of everyday life. Sometimes
this is because of the symptoms. Sometimes, the illness may have gone
on for so long that you may just have got out of the habit of doing
things for yourself. Ordinary things - washing, answering the door,
shopping, making a phone call or chatting with a friend - can seem very
can help up to a point but you need to be able to get other types of
help to have the best chance of getting better. Your local mental health
team, social services and voluntary organisations in your area should
You may find it hard to understand what is happening if your son or
daughter, husband or wife, brother or sister develops schizophrenia.
They may have become odd, distant or just different from how they used
to be. They may be avoiding contact with people and may seem to be less
active. If they have delusional ideas, they may well keep quiet about
them. If they are hearing voices, they may suddenly look away from you
as if they are listening to something else. When you speak to them,
they may say little, or be difficult to understand. Their sleep pattern
may change so that they stay up all night and sleep during the day.
no one realises what is happening. You may wonder if this behaviour
is just rebellious or perverse. It can happen so slowly that, only when
you look back, can you see when it started. It can be particularly difficult
to recognise these changes if the illness develops during teenage years.
This is a time when young people are changing anyway, and often experimenting
with new freedoms and lifestyles.
do realise that schizophrenia is the problem, you may start to blame
yourself and wonder 'Was it my fault?' You may wonder if anyone else
in the family is going to be affected, what the future holds or how
they can get the best help.
need as much help and information as possible from the psychiatric team.
They also need advice. What do they need to do? Someone with schizophrenia
will be more sensitive to stress, so it is helpful to avoid arguments
and keep calm - perhaps easier said than done! The psychiatric team
needs to listen to the worries and concerns of families. It can advise
on drugs and their side effects, as well as suggesting small manageable
tasks that may help recovery.
Someone with schizophrenia may not always realise they are ill. They
may refuse treatment when they badly need it. the Mental Health Act(in
England and Wales) and similar legal arrangements in other countries,
allow a person to be admitted to hospital against their will. This is
only used if someone needs assessment or treatment, and they cannot
or will not accept it, and:
their health is at risk or
· they are a danger to themselves or
· they are a danger to other people
the information provided is useful. For more material please download
from the website - www.rcpsych.ac.uk