What is Schizophrenia?

Schizophrenia is a severe mental illness of profoundly disruptive clinical manifestations that involves one’s behaviour, thoughts, emotions and perception of the environment and people around them. The disorder usually begins before the age of 30 and is equally prevalent in men and women.  About one in 100 people will experience at least one episode during their lifetime. During the symptomatic phase patients often lose touch with reality and thus fail to recognise one’s behaviour as abnormal. Patient may also lose his/her ability to take rationale decisions. As a result refuse to seek treatment and may actively resist it if recommended. If treated early the disorder shows better outcome. However if remains untreated for long time it is likely to run a chronic course with gradual deterioration in social and occupational functioning.

What is the clinical presentation of Schizophrenia?

The clinical symptoms of schizophrenia are often classified by clinicians into positive symptoms and negative symptoms. Positive symptoms represent a change in behaviour or thoughts like hallucinations, delusions, violent or disorganized behaviour. While Negative symptoms, as name suggests, represent reduction or total lack of thoughts or functions that are usually expected to be seen in healthy person.

Positive symptoms  

1.      Imagining objects, sounds which are actually not there as real eg. Hearing voices of people talking about or talking to patient, seeing objects that do not exist (hallucinations)

2.      False fixed beliefs like people are trying to harm or conspiring against patients (Persecution), talking about patient (Referential), controlling  patient’s thoughts,  behaviour  (delusion of control)or patient having acquired extraordinary power or authority (grandiose delusions)

3.      Not able to think clearly. Thinking may become confused, muddled. Sometimes patient may complain of his/her thoughts being known to people or read by others, unwanted thoughts inserted in mind, his/her own thoughts are removed or blocked

4.      Patient may speak irrelevantly. Many occasions it is difficult to understand the context.

5.      Patient may behave in a abnormal/odd manner eg. May appear excessively scared, start collecting rubbish, Not taking self care, getting disinhibited in front of others or getting abusive, violent without reason.

Negative symptoms

1.   Patient show no motivation to follow daily routine, not maintain personal hygiene.

2.   Often neglects duties, responsibilities

3.   May appear blank, show no emotional reactions, emotions are dulled

4.   Patient remains withdrawn and detached. Does not take interest in activities or people around him/her

5.    Patient speaks scarcely and often reluctant to initiate or participate in conversation.

Why one develops schizophrenia?

There is no one cause for schizophrenia. It is considered that every individual has certain risk of developing schizophrenia but whether the person will develop the disorder is determined by a combination of biological, psychological and environmental factors. The most common understandings suggest role of genetic factors with increased risk among individuals with family history of schizophrenia in either the immediate family or close relatives. A significant stressful or traumatic event can sometimes trigger the illness. The most common pathway of developing schizophrenia includes changes in brain neurotransmitters like Dopamine which are chemicals used by brain for transmitting information from one brain cell to another. The other risk factors associated with schizophrenia include use of addictive substances like cannabis, alcohol.

When to seek treatment?

It often takes time to recognise the symptoms of schizophrenia as the onset may be gradual. But significant change from previous behaviour associated with any of the symptoms mentioned above should be viewed with caution. Patient should be immediately taken to the nearest doctor or psychiatrist. In many instances families don’t seek psychiatric treatment either because of the misconceptions or stigma of being discriminated in society.  While in some other cases the family may attribute these symptoms to black magic and seek faith healing. In both instances the valuable time may be lost and the illness may continue longer. Remember, early detection of schizophrenia and treatment is associated with better outcome whereas the longer the duration of untreated illness the poorer is the outcome. Hence it is essential for the family to be aware of the illness and in case of any doubt to seek medical opinion immediately.

What are the treatment options?

Schizophrenia is treated using combination of medical treatment such as antipsychotic medicines and psychosocial interventions. Antipsychotic medicines are the mainstay of treatment. Different types of antipsychotic medicines are available and a particular drug is chosen by the doctor based on the type of symptoms, earlier response to treatment if any, side effects of the medications, age of patient, associated medical illnesses etc.  

The antipsychotic medicines are of two types. The older first generation medicines and the newer, second generation medicines. The side effects such as drowsiness, trembling, increased salivation, tightness of joints, rigidity, sudden upward deviation of eyes (occulogyric crisis), neck are more common with the first generation antipsychotic medicines like Haloperidol, Trifluoperazine. To prevent these side effects these medicines may be combined with anticholinergic medicines such as Trihexyphenedyl. These side effects are minimal with second generation antipsychotics like Risperidone, Olanzapine, Quetiapine. Sometimes patient may also experience weight gain, lack of sex drive with medicines and will need to consult the doctors time to time for same.

Psychosocial treatments are primarily focussing on daily living activities, social interactions and skills and occupational functioning of the patient and play important role in reintegrating the patient with family and community. 

Can patients recover completely?

The response to treatment in individual patient with Schizophrenia may vary. Majority of the patients with short illness span respond very well to treatment. Those patients with chronic illness, those who have discontinued medications on multiple occasions in past   may show challenging course requiring more than one medicine trials or need for combination of medicines. The recurrence of symptoms after successful treatment can be seen in nearly half the patients. Hence drug treatment usually needs to be continued for at least 5 years. Lifelong maintenance therapy may be required in some patients to prevent recurrence.

As per the current scientific evidence, nearly two third patients show good response to treatment with about 20% patients becoming completely asymptomatic at the end of the treatment and not have another episode. About half the patients may experience relapse of the symptoms. About one third may show partial response and continue to remain symptomatic. It is estimated that 10-20% patients with schizophrenia may not show response to treatment and are likely to require constant support and supervision.   

How can you help as family?

As mentioned earlier during the symptomatic phase of illness patient may lose touch with reality and not recognise his behaviour as abnormal. They not only not seek treatment but resist actively if taken to treatment facility. Thus the patients mainly rely on family or friends for their care and support. The understanding and attitude of family towards illness also influence the outcome. The family thus need to understand the illness, understand the ways of coping with the illness, need for supervised medications and continuation of treatment.

The family also need to be alert for possible complications or crisis situations that may arise during the course of illness such as severe aggression, violence, thoughts of harming others, any self harming or suicidal ideas or behaviour. In case of any of such crisis the family should immediately report it to the doctor as this requires emergency intervention and/or hospitalization. 

The family education and therapy sessions are available to help family understand schizophrenia as an illness, explore the ways of supporting their patient and decide to solve practical problems that can be caused by the symptoms of schizophrenia.   

Can we prevent schizophrenia?

There are no known ways to prevent development of the disorder. However research has now identified a early (prodromal) stage of illness where early intervention can be greatly beneficial.

What do we do for patients with chronic schizophrenia?

Chronic Schizophrenia patients require Psychosocial Rehabilitation in addition to medications. It involves the use of psychosocial therapies to increase social abilities, self-sufficiency, practical skills, and interpersonal communication in schizophrenia patients. The goal is to enable persons who are severely ill to develop social and vocational skills for independent or assisted living. These include Social Skills Training for correcting anomalies in  behavioural skills; Psycho-education of family members about the illness and ways to deal with the patient and minimising expressed emotions; Individual & Group Therapy: generally focusing on real-life plans, problems, and relationships; Cognitive Behavioural Therapy to improve cognitive distortions, reduce distractibility, and correct errors in judgment and Vocational training programs to help regain old skills or develop new ones in order to be gainfully employed

Twelve steps of Living with Schizophrenia
  • Recognize the illness in its early stage
  • Consult the doctor immediately
  • Discuss the treatment options with your doctor.
  • Avoid self medication
  • Take medications as prescribed. Continuing medications will help prevent relapse.
  • Follow up with your doctor regularly. Regular contact with doctor and timely review help preventing recurrence.
  • Avoid excess tea, coffee
  • Stop or cut down on nicotine use if any
  • Avoid drugs like cannabis, Alcohol.
  • Eat and sleep well. Adequate sleep and healthy diet is necessary for good physical and mental health.
  • Exercise regularly. Physical activity helps reducing stress, anxiety.
  • Plan recreational activities.

  ( This document is compilation of information from Web and Print Media for purpose of making the scientific educative material easily available for patients and families)