Schizophrenia is one of the most common mental health disorders affecting individuals in Anguilla. Unfortunately, for those affected, there is much stigma and discrimination which can be avoided if there is much more public health education about this disorder in Anguilla.
What is schizophrenia?
Schizophrenia is a chronic, disabling brain disorder that affects about 1% of Americans. We now know it is not one single disease but might be a combination of many similar conditions. 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. There is no cure, but treatment can usually control the most serious symptoms. Contrary to what many believe, individuals with schizophrenia are not violent people and do not have increase d tendency for violence. It is a shame that we here in Anguilla still house individuals with schizophrenia in prison.
What are some symptoms of schizophrenia?
Symptoms of schizophrenia may include:
• Hallucinations — hearing or seeing imaginary things
• Delusions — wildly false beliefs
• Paranoia — the fear others are plotting against you
Some symptoms, such as lack of enjoyment in everyday life and withdrawal from social activities, may mimic depression.
How schizophrenia affects thoughts
People with schizophrenia often have abnormal ways of thinking. They may have trouble organizing their thoughts or making logical connections. They may feel like the mind is racing from one unrelated thought to another. Sometimes they experience “thought blocking” – a feeling that thoughts are removed from their head. Despite popular belief, schizophrenia is not dissociative identity disorder (multiple personality disorder).
How schizophrenia affects behaviour
Schizophrenia causes a wide range of behaviours. People may speak incoherently or even make up words. They may act agitated or appear stone-faced. Many people have trouble maintaining basic hygiene or orderly homes. Schizophrenia can also cause repetitive behaviours such as pacing. In contrast to common stereotypes, the risk of violence against others is small.
Who gets schizophrenia?
Schizophrenia affects men and women at the same rate, and occurs almost equally in all ethnic groups around the world. Symptoms usually begin between ages 16 and 30. The onset tends to be earlier in men than in women. Schizophrenia rarely begins during childhood or after age 45. People with schizophrenia in their family may have a higher risk for the illness.
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. And brain structures may be abnormal, too. 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.
Making the diagnosis
There are no lab tests to detect schizophrenia, so a diagnosis is usually based on history and symptoms. 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
Prescription drugs can reduce symptoms such as abnormal thinking, hallucinations and delusions. It is thought they work by regulating certain brain chemicals and receptors that influence thinking, perception and behaviour. 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.
Psychosocial therapies
Counseling can help people cope with their problem behaviours and thoughts, and improve how they relate to others. In cognitive behavioural therapy (CBT), people learn to test the reality of their thoughts and better manage symptoms. Other forms of therapy aim to improve self-care, communication, and relationship skills. These strategies are not meant to replace medication, but can help people already stable on medication manage everyday challenges.
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 programmes are particularly effective when combined with psychotherapy. It is sad that there are few rehabilitation programmes in Anguilla, at this time, for individuals with schizophrenia.
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.
Schizophrenia and pregnancy
Most drugs used to treat schizophrenia have no known risk for increasing the risk of birth defects, but decisions about medication treatment for schizophrenia during pregnancy should be discussed with your obstetrician/gynaecologist.
Tips for family members
Schizophrenia can be confused with other mental health disorders so a careful evaluation is important. It can also be difficult to convince someone with schizophrenia to get help, so you as a relative or family member must not be afraid to be proactive and arrange for help. Treatment often begins when a psychotic episode results in a hospital stay. Once the person is stabilized, family members can help prevent a relapse by doing a number of things including the following:
• Encouraging the person to stay on medication
• Accompanying the individual on follow-up appointments
• Being supportive and respectful
Conclusion
Schizophrenia is a chronic, severe and disabling brain disorder that has affected people throughout history. It is a common disorder in Anguilla affecting individuals of all socio-economic groups. There is no cure for this disorder, but many individuals can have their symptoms successfully controlled and go on to live productive lives.
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 MB, BS, DGO, MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
