Schizophrenia

Source: Adapted from Family Medical Adviser, Reader’s Digest

What is schizophrenia?

Many people believe that schizophrenia means a split or multiple personality. This is in fact a very rare condition, called dissociative disorder (which is a personality disorder). In schizophrenia, it is the person’s thoughts and feelings ‘ not their personality ‘ which are split or fragmented.

The experience of schizophrenia is different for each person, but it usually involves a dramatic disturbance in thoughts and feelings, resulting in behaviour that seems odd to other people. Some people hear voices, others see things that are not there, or feel they are under threat or being persecuted in some way. Schizophrenia is the most common of the psychotic illnesses, in which a person cannot tell the difference between what is real and what is imaginary.

Some people have only one psychotic episode in their lifetime and some people recover completely from schizophrenia. Others recover partly, but have occasional episodes or relapses. About one-third of those diagnosed with schizophrenia live with the condition over a period of years and need regular medical care.

Schizophrenia exists in all cultures and countries, but is treated differently. Hearing voices, for example, has a spiritual meaning in some cultures or religions.

Who is at risk for schizophrenia?

Although the cause of schizophrenia is unknown, scientists have identified certain risk factors.

Schizophrenia appears to run in families, but the risk of getting it if a family member is affected is still relatively small. Stressful life events can also be a contributing factor ‘ schizophrenia may be triggered by the death of a loved one, for example, or losing a job, or by ongoing pressures such as poverty, homelessness or discrimination. Family life may also have a role to play in the development of schizophrenia. Early childhood experiences, such as sexual or physical abuse, affect people in different ways, and may be significant in some cases.

A combination of factors is usually responsible. For example, genetic make-up may make a person more vulnerable to schizophrenia, but stressful events or specific life experiences might trigger the start of symptoms.

Symptoms of schizophrenia

The symptoms of schizophrenia vary between individuals, but people with the condition may experience some of the following:

• ‘ Hearing voices or seeing, feeling or even smelling things that are not there.
• ‘ Strange beliefs or thoughts: you may think that you have special powers or that somebody is trying to control you.
• ‘ Thoughts jumping between different topics.
• ‘ Feeling apathetic, depressed and unable to concentrate.
• ‘ No longer enjoying social activities that you used to like; wanting to avoid people or be protected from them.

Treatment for schizophrenia

If you suspect that you have symptoms of schizophrenia, the first step is to contact your doctor. If you are concerned that a relative or friend may have symptoms, encourage the person to go for help and offer to accompany him or her. Getting help early on may prevent schizophrenia from developing.

Your doctor is likely to refer you to a psychiatrist who will assess you and arrange treatment.

Medications for schizophrenia

People with schizophrenia are usually given antipsychotic medication to deal with psychotic symptoms. Older antipsychotics, such as haloperidol, reduce hallucinations and delusions in many people, but cause unpleasant side effects such as muscle spasms. Newer antipsychotics, such as clozapine, have fewer side effects. But like all tranquillizers, antipsychotics have some sedative effect.

These drugs can take between one and three months to work, and you may need to try several before you find one that suits you. Check that you are on the lowest possible dose, to minimize side effects. About one-third of people with schizophrenia do not take their antipsychotics because of unpleasant side effects.

Lifestyle changes

Many people with schizophrenia and their families want to talk about their feelings and experiences and get support in coping with the illness. Talking therapies, such as counselling and psychotherapy, can be used alongside drug treatment. Cognitive behaviour therapy can help with symptoms of schizophrenia, such as delusions and hallucinations. It aims to challenge and test negative thoughts.

New treatments are being researched, and those showing positive results include:

‘ Estrogen supplements (for women);
‘ Fish oils (found in sardines, pilchards and supplements);
‘ Vitamin E and vitamin B6 supplements (for some side effects of antipsychotics).

How to support someone with schizophrenia

A diagnosis of schizophrenia in a family member or friend can be devastating. Thinking carefully about your reactions to them can be helpful.
Do:
‘ Listen to, accept and support the person.
‘ Focus on the person’s feelings ‘ he or she may feel frightened and alone.
‘ Let the person know that you accept that he or she hears voices or interprets things in a particular way.
‘ Encourage the person to get help and support.
‘ Look after and get support for yourself.

Don’t:
‘ Blame the person, or say "pull yourself together."
‘ Blame yourself.
‘ Dismiss the person’s delusions, but don’t agree with them either.
‘ Take over, but consult the person and listen to any views about what sort of help he or she wants.

Living with schizophrenia

If you have schizophrenia, your needs and feelings may change over time. But here is a checklist of things you can do to help yourself:

‘ Learn to recognize early signs that you are becoming unwell and get help early.
‘ Try to reduce stress or worry in your life: identify what makes you feel unwell or particularly stressed and avoid these ‘triggers.’
‘ Contact a self-help or support group for advice on practical issues, such as medication and your rights.
‘ Try talking therapies such as psychotherapy as well as or instead of medication. But never stop taking medication without first discussing this with your doctor.
‘ Take up new activities: art, drama or music can help, as can yoga and relaxation techniques.