From Warning Signs to Wellness: Understanding Schizophrenia, Symptoms, Causes and Treatment

Schizophrenia is derived from two Greek words, ‘Schizen’ which means split and ‘Phren’ meaning mind. The term was first coined by Eugene Bleuler in 1908. It has often been incorrectly understood as Split or multiple personality, whereas in truth it is not a personality related disorder. Instead, it is a severe, chronic mental disorder that affects how a person thinks, acts, expresses emotions, perceives reality and relates to others. It falls in the category of disorders labelled as Psychosis.

It affects about 1% of the population and causes impairments in all aspects of life. The condition develops slowly and the first signs can be hard to identify, often developing during teenage years. The condition first shows up in males in teenage or early 20s, whereas in females it usually begins in 20s or 30s.

Symptoms

The symptoms of schizophrenia are grouped under positive, negative, disorganized and cognitive symptoms. The main symptoms include-

Delusions: These are false, fixed and sometimes strange beliefs that aren’t based in reality and the person refuses to give them up even when provided evidence against them. A person with delusions may believe that people are plotting against him, talking about him or that he is being followed. Other examples of delusions include false belief that a person has exceptional ability or fame; another person is in love with him; or a major catastrophe is about to occur.

Hallucinations: this includes perceptions that are not real. Hearing voices is the most common type of hallucinations. The voices may command the person, comment on him or talk to him. Other hallucinations can be seen in the modalities of touch, smell, vision or taste.

People with schizophrenia may also display symptoms such as self muttering, smiling to self, irrelevant talk, making gestures, agitation, maintaining inappropriate or bizarre postures and having problems in thinking and speech.

The negative symptoms include lacking emotions or limited emotions, often an expressionless face, social withdrawal, poor motivation, low in energy and interest and problems in self-care. They may not take a bath for days. Social interactions diminish or stop completely.

Patients also have problems in understanding information and using it to make decisions, problems in focussing or attention and memory.

Another feature of schizophrenia is that people themselves are not aware that they have a problem. They usually do not recognize that delusions and hallucinations are abnormal, or understand their behavioural abnormalities. This is referred to as lack of awareness or insight.

This makes the process of treatment difficult as individuals do not seek treatment.

CAUSES OF SCHIZOPHRENIA

The exact cause of schizophrenia is not known. Multiple causes are responsible for its causation. These include-

Genetics- Schizophrenia often runs in families which means there is a likelihood that it may be passed from one generation to another.

Brain chemistry- There are abnormalities in brain chemicals, called Neurotransmitters. One such chemical is called Dopamine which is found to be increased in schizophrenia patients. These chemicals are involved in certain pathways or circuits in the brain responsible for thinking, perception, mood and behaviour.

Environment- Things like viral infections, drugs of abuse such as cannabis, stressful environment or situations may trigger the onset of the disorder.

DIAGNOSIS

The diagnosis of schizophrenia is made based on a set of criteria developed by the World health organization, listed in the international classification of diseases (ICD-11). A psychiatrist will make a diagnosis based on these criteria and conduct some tests as deemed necessary. However, there are no blood tests or imaging studies which help in diagnosis.

TREATMENT

The goal of treatment is to control the symptoms, reduce the chances of relapse, improve the quality of life of the individual and help integrate the person back in the society. A number of medications are available to treat the disorder. It must be noted that early diagnosis and treatment leads to the best outcome. The medications used to treat schizophrenia are called antipsychotics. A broad array of antipsychotics is now available for treatment. They help control the symptoms effectively.

While medications help relieve symptoms of schizophrenia, psychosocial treatments help with behavioural, psychological, social and emotional problems that go with the illness. Therapy also helps patients build insight, recognize signs of relapse and develop a relapse prevention plan. The therapies include individual therapy, family therapy, cognitive remediation and rehabilitation programmes.

With proper treatment, most people with schizophrenia can lead a productive and fulfilling life. Early diagnosis and treatment are the key.

ROLE OF FAMILY IN SCHOPHRENIA

The family has an important role to play in prevention of relapse in schizophrenia. The important factors include family acceptance, assistance and communication. Family acceptance is characterized by no shame towards the illness, readiness to seek treatment and no negative emotions towards the patient. Family assistance is important for managing medication, psychosocial rehabilitation and helping patients socialize and integrate in the society. Communication within the family should be gentle, and clear, conveying support and reassurance to the patient.

The family needs to take care of themselves as the burden of care of people with schizophrenia is high.

MYTHS/MISCONCEPTIONS RELATED TO SCHIZOPHRENIA

The following are some of the common myths about schizophrenia, which are not true

• Schizophrenia is split personality/ multiple personality
• Most people with schizophrenia are violent or dangerous
• Bad parenting is the cause
• It is caused by black magic
• If a parent has schizophrenia, then the child will get it too
• You can’t hold a job if you develop schizophrenia
• There is no treatment

About the author:

Dr. Sonali Bali is a well known psychiatrist with over 20 years of experience. She is a recipient of All India Sarada Menon Gold Medal in Psychiatry. Dr Bali currently works in Vimhans hospital Delhi, CK Birla Hospital Gurgaon and Paras Hospital Gurgaon. She is a specialist for all psychiatric problems in adults like Schizophrenia, Bipolar disorder, Depression, OCD, Anxiety Disorders, Personality disorders, Alcohol and other drug dependence disorders.

She also has a special interest in Consultation Liaison psychiatry, Emergency psychiatry, Rehabilitation of chronic Mentally ill patients, and complex difficult to manage cases. She is soft spoken, fluent in English and Hindi and gives personal attention and time to all her patients.