Schizophrenia is just one of the many mental disorders that affect individuals here in Anguilla. In Anguilla there is much misinformation, stigma and discrimination for this chronic disorder as well as other mental disorders. There is no cure for schizophrenia, but treatment can usually control the most serious symptoms.
What Is schizophrenia?
Schizophrenia is a chronic, disabling brain disorder in which people interpret reality abnormally. It may cause people to hear voices, see imaginary sights, or believe other people are controlling their thoughts. These sensations can be frightening and often lead to erratic behaviour. New research shows that schizophrenia is not a single disease but a group of eight genetically distinct disorders, each with its own set of symptoms. The finding could be a first step toward improved diagnosis and treatment for the debilitating psychiatric illness.
Who gets schizophrenia?
Schizophrenia affects men and women at the same rate, and occurs almost equally in all ethnic groups around the world. It can affect the educated as well as the non-educated individual. It is rare in children but some children can also be affected.
What causes schizophrenia?
The exact cause is not known, but scientists suspect genes and environment both play a role. Inside the brain, levels of the chemical messengers dopamine and glutamate may be out of balance. Brain structures may be abnormal, as well. For example, brain scans of identical twins show that the fluid-filled “ventricles” can be larger in a twin with schizophrenia, compared with a twin who does not have the illness. Activity levels can also be higher or lower than normal in some areas of the schizophrenic brain. About 80 percent of the risk for schizophrenia is known to be inherited.
What are some symptoms of schizophrenia?
In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It is uncommon for children to be diagnosed with schizophrenia and rare for those older than 45.
Schizophrenia involves a range of problems with thinking (cognitive), behaviour or emotions. Signs and symptoms may vary, but they reflect an impaired ability to function. Symptoms may include:
• Delusions. These are false beliefs that are not based in reality. For example, you are being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you; or your body is not functioning properly.
• Hallucinations. These usually involve seeing or hearing things that do not exist. Yet for the person with schizophrenia, they have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.
• Disorganized thinking (speech). Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated.
• Extremely disorganised or abnormal motor behaviour. This may show in a number of ways, ranging from childlike silliness to unpredictable agitation. Abnormal motor behaviour can include resistance to instructions, inappropriate and bizarre posture, a complete lack of response, or useless and excessive movement.
• Negative symptoms. These refer to reduced ability or lack of ability to function normally. For example, the person appears to lack emotion, such as not making eye contact, not changing facial expressions, speaking without inflection or monotone, or not adding hand or head movements that normally provide the emotional emphasis in speech. Also, the person may have a reduced ability to plan or carry out activities such as decreased talking and neglect of personal hygiene, or have a loss of interest in everyday activities, social withdrawal or a lack of ability to experience pleasure.
When to see a doctor?
People with schizophrenia often lack awareness that their difficulties stem from a mental illness that requires medical attention. So it often falls to family or friends to get them help. It can also be difficult to convince someone with schizophrenia to get help but it is important to be persistent.
Suicidal thoughts and behaviour
Suicidal thoughts and behaviour are common among people with schizophrenia. If you have a loved one who is in danger of committing suicide, or has made a suicide attempt, make sure someone stays with that person. Call 911 immediately. Or, if you think you can do so safely, take the person to the hospital emergency room.
Diagnosis
There are no lab tests to detect schizophrenia, so a diagnosis is usually based on history and symptoms. Schizophrenia can be confused with other mental health disorders so a careful evaluation is key.
Tests may be ordered to rule out other medical causes of symptoms. In teenagers, a combination of family history and certain behaviours can help predict the onset of schizophrenia. These behaviours include withdrawing from social groups and expressing unusual suspicions.
Treatment
Schizophrenia requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep and basic hygiene.
A psychiatrist experienced in treating schizophrenia usually guides treatment. The treatment team may also include a psychologist, social worker, psychiatric nurse.
Prescription drugs can reduce symptoms such as abnormal thinking, hallucinations and delusions. It’s thought they work by regulating certain brain chemicals and receptors that influence thinking, perception and behavior. Some people have troubling side effects, including tremors and weight gain. Schizophrenia drugs can also interact with other medications or supplements. In most cases, long-term medication is essential to managing schizophrenia.
Once psychosis recedes, psychological and social (psychosocial) interventions are important — in addition to continuing on medication.
Rehabilitation
Rehabilitation may include job training, money management counseling and guidance in using public transportation or shopping for groceries. The goal is to help people with schizophrenia stay employed and maintain as much independence as possible. Rehab programs are particularly effective when combined with psychotherapy. Sadly, in Anguilla, there are few rehabilitation programmes and many persons, including some public servants, put stumbling blocks which prevent individuals with mental disorders from having jobs. This is a good time for us to ask our aspiring politicians, what are their plans for individuals with mental disorders in Anguilla?
Relapse prevention
People with schizophrenia sometimes quit their medications because of side effects or a poor understanding of their illness. This raises the risk of serious symptoms returning and triggering a full psychotic episode. Regular psychosocial therapy can help people stay on medication and avoid a relapse or the need for hospitalization
Schizophrenia and substance abuse
People with schizophrenia are much more likely than the general population to abuse drugs or alcohol. Some drugs, including marijuana and cocaine, can make symptoms worse. Drug abuse can also interfere with treatments for schizophrenia. Patients with a drug problem may benefit from substance abuse programs specifically designed for people with schizophrenia.
Coping with schizophrenia
Coping with a mental disorder as serious as schizophrenia can be challenging, both for the person with the condition and for friends and family. Education about the condition can help motivate the person with the disease to stick to the treatment plan. Education can help friends and family understand the condition and be more compassionate with the person who has it. Managing schizophrenia is an ongoing process. Keeping treatment goals in mind can help the person with schizophrenia stay motivated. Help your loved one remember to take responsibility for managing the illness and working toward goals. The person with schizophrenia and loved ones may benefit from stress-reduction techniques such as meditation.
Conclusion
Schizophrenia is a severe brain disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions and extremely disordered thinking and behavior. Schizophrenia is a chronic condition requiring lifelong treatment.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
