Living with
Schizophrenia

What is schizophrenia?

Schizophrenia is a severe and disabling illness that affects the brain. In spite of the relatively low prevalence, the illness has an enormous impact on the individual and on society in terms of the emotional suffering and financial burden.

Schizophrenia typically appears in late adolescence or early adulthood and usually follows a life-long course.

 

In schizophrenia there is a tendency towards disintegration of the personality. Intermittent episodes of acute psychosis and remission are typical.
Research in this field is on-going and we now have a much better understanding of the causes and other factors involved in schizophrenia.

How might schizophrenia be recognised?

To be diagnosed with schizophrenia, a person must display two or more of the following, each present for a significant portion of time during a one-month period (or less, if successfully treated):

  • Delusions (these are false personal beliefs resulting from an inability to separate real from unreal experiences).
  • Hallucinations (auditory hallucinations – for, example, hearing voices that other people do not hear – is the most common type).
  • Disorganised speech (vague thoughts, loose association of ideas, thought-blocking and creation of new words [neologisms] are common).
  • Grossly disorganised behaviour (for example, dressing inappropriately, neglecting personal hygiene and social isolation) or catatonic behaviour.
  • Negative symptoms (lack of or decline in emotional response, speech, motivation, and concentration, amongst others).

What causes schizophrenia?

It is estimated that approximately 1 % of the population will develop schizophrenia during their lifetime.

 

The exact cause of schizophrenia is unknown. It is likely to be the end result of a complex interaction between genetic, biochemical, developmental and environmental factors.
Certain brain abnormalities may be present early in the course of the illness, even perhaps before the onset of clinical symptoms.

 

Although the exact cause of schizophrenia is unknown, these factors seem to increase the risk of developing or triggering schizophrenia:

  • Genetics/having a family history of schizophrenia, especially in a parent or sibling.
  • Congenital or pregnancy and birth complications, like malnutrition or exposure to toxins or viruses that may impact a baby’s brain development.
  • Taking some mind-altering (psychoactive or psychotropic) recreational drugs as a teenager or young adulthood.

What influences the course and prognosis of schizophrenia?

Without treatment the course of schizophrenia is chronic, frequently with deterioration in social and occupational functioning, which cause a high degree of disability.

 

Variables that are associated with better outcome include:

  • Acute onset of illness
  • Presence of a precipitating event
  • Later age of onset
  • Good pre-illness functioning
  • Presence of mood symptoms (depression or euphoria)
  • Acceptance and support by family and community
  • Positive attitude towards treatment program.

How is schizophrenia diagnosed?

A psychiatrist should examine the patient to make the diagnosis and tests are carried out to exclude other medical illnesses.
Tests that may be used in diagnosis include:

  • Physical examination, blood tests and screening: This is done to rule out other mental health disorders and to determine that symptoms are not due to substance abuse, medication or a medical condition. Screening may include MRI (magnetic resonance imaging) or CT (computerised tomography) scans of the brain.
  • Psychiatric exam: A psychiatrist or psychologist will talk with you about your thoughts, feelings and mood. They may use a questionnaire to help them.
    They will also determine whether you have any other mental health condition or substance abuse. They may also want to talk to your family or people you live with to determine your everyday functioning.
  • DSM-5: Your doctor or mental health professional may use the criteria for schizophrenia listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association (these are the symptoms listed earlier).

Living and managing

Living with schizophrenia can be very challenging. Here are some suggestions that may help:

  • Consider partaking in psychosocial interventions: These can be important for maintaining daily functioning, and include:
    • Individual therapy: This may help to normalise thought patterns and can also help those affected to cope with stress and to identify early warning signs of relapse.
    • Social skills training: This focuses on improving communication and social interactions so that the affected person can participate in daily activities.
    • Family therapy: This provides support and education to families dealing with schizophrenia, including how to recognise warning signs in loved ones and what to do during a relapse or psychotic event.
    • Vocational rehabilitation: This will help people with schizophrenia prepare for, find and keep supported forms of work.
  • Stick to your treatment plan: Antipsychotic medication should always be taken as directed. Do NOT skip your medications because symptoms are likely to return or worsen. Also check with your doctor first before taking other medications, including any over-the-counter medications, vitamins, herbal remedies or other supplements, as these may cause unwanted interactions with antipsychotic medications.
    Do not stop going to therapy sessions either, no matter how difficult they are.
  • Avoid alcohol and drug use: Using alcohol or stimulant substances like nicotine or recreational drugs can make it difficult to treat schizophrenia. If the affected person is addicted, get help from your healthcare provider about the best ways to quit and manage withdrawal symptoms.
  • Maintain healthy relationships: Friends and family members can provide support and help you watch out for warning signs of mood shifts.
  • Pay attention to warning signs: Addressing early symptoms can prevent episodes from worsening.
    You may be able to identify a pattern to what may be triggering relapses. Family members and friends can also help you identify if you are displaying symptoms and what may have triggered them. Have a plan if you experience an episode, including contacting your doctor or mental health professional.
  • Stay generally healthy: It is important that you exercise regularly, eat a healthy diet and get adequate sleep to help manage your mental health condition successfully.
  • Learn about schizophrenia and join a support group to empower and motivate yourself to stick to your treatment plan: Get more resources to help you cope and to reduce any negative feelings or stigma you may feel about having schizophrenia.
    Find out more about schizophrenia on Let’s Talk. You can find resources that you may find useful in helping to manage stress and stay positive. You can also find out about where to get help if you are struggling to cope and need someone to talk to.
  • Ask about social services assistance: Assistance with affordable housing, transportation and job training may be provided.
  • Practise relaxation and stress management techniques: Explore healthy ways to channel your energy, such as hobbies. Additionally, try out stress management techniques such as meditation, visualisation, muscle relaxation, massage, deep breathing, yoga or tai chi that may help ease stress and anxiety.

What is the treatment of schizophrenia?

Antipsychotic medications, such as chlorpromazine or risperidone, are the most effective treatment for schizophrenia. They help to control symptoms by changing the balance of chemicals in the brain.
Common side-effects may include dizziness, sleepiness, weight gain, tremor, feelings of restlessness, slowed movements, increased chance of diabetes and high cholesterol.

 

It is usually necessary to admit the patient to a psychiatric unit during an acute episode of psychosis or relapse. There is considerable evidence to show that the longer psychosis remains untreated, the poorer the long-term outcome. A minimum of two years of treatment is recommended for first episode schizophrenia before gradual reduction and discontinuation of medication can be considered.

Most psychotic relapses occur as a result of the patient discontinuing medication.

 

Schizophrenia is mostly described as a life-long illness, which means that most people with this condition need to stay on antipsychotic medication for life.

Long-term hospitalisation is no longer the treatment of choice. The aim is to place the patient back in the community at the highest possible level of functioning.
To achieve the highest level of functioning, a combined treatment approach, involving a multi-disciplinary team, usually a primary physician, community workers and the family.

What are the outcomes like for schizophrenia?

The outcome for a person with schizophrenia is difficult to predict. Symptoms mostly improve with medication.
Supported job training, housing and other community support will be needed.

 

The person with schizophrenia must learn how to take medications correctly and how to manage side-effects. They need to see their doctor often and must learn how to notice early signs of a relapse. Family members should be educated about the disease and offered support.

 

If left untreated, schizophrenia can result in severe problems that can include:

  • Suicide or suicide attempts
  • Anxiety disorders and obsessive-compulsive disorder (OCD)
  • Depression
  • Substance abuse (alcohol and recreational drugs)
  • Inability to work or attend school
  • Legal and financial problems
  • Social isolation
  • Health and medical problems
  • Being victimised
  • Sometimes, aggressive behaviour that can pose a threat to others.

What to do in a crisis?

Crisis intervention implies providing immediate aid to the patient in crisis; for example, in the case of acute psychosis.
Hospitalisation or admission to an appropriate facility is recommended if the patient is psychotic or suicidal. The least restrictive and preferred situation is one in which the patient has the ability to agree to admission.

 

If the patient is considered to be incapable of making an informed decision, the Mental Health Care Act 17 of 2002 provides the state with the power to commit the patient if he/she is deemed to present a danger to himself/herself or to others. Provisions are made for a 72-hour assessment period which may enable a person to recover from an illness before being committed to a psychiatric hospital.

Sources

Let’s Talk. (n.d.) Conditions: Schizophrenia. Available from: http://letstalkmh.co.za/condition/schizophrenia/

 

Mayo Clinic staff. (n.d.) Diseases and Conditions: Schizophrenia. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443

 

Mayo Clinic staff. (n.d.) Diagnosis and Treatment: Schizophrenia. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/schizophrenia/diagnosis-treatment/drc-20354449

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Sources

Let’s Talk. (n.d.) Conditions: Schizophrenia. Available from: http://letstalkmh.co.za/condition/schizophrenia/

 

Mayo Clinic staff. (n.d.) Diseases and Conditions: Schizophrenia. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443

 

Mayo Clinic staff. (n.d.) Diagnosis and Treatment: Schizophrenia. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/schizophrenia/diagnosis-treatment/drc-20354449