Schizophrenia (from the Greek word schizophrenia means ‘split mind’) is a psychiatric diagnosis that describes a mental disorder characterised by impairments in the perception or expression of reality and significant social or occupational dysfunction. A person experiencing schizophrenia is typically characterized as demonstrating disorganized thinking, and as experiencing delusions or hallucinations, in particular auditory hallucinations.
Although schizophrenia is a rare condition, if you consider the worldwide scenario, it is quite disturbing. According to the World Health Organisation (WHO) statistics, there are 20 million people in the world suffering from schizophrenia. Its incidence is comparatively low but the prevalence is high because it is a chronic mental illness (the number of cases per year are low, but a lot people are currently suffering from the condition).
There are various misconceptions about schizophrenia; it does not mean having a split personality or multiple personality disorder. People who have schizophrenia are not dangerous or violent and may display the same behaviour as the general population. Many times such people do become victims of societal attitudes. Lack of proper treatment or care may lead to the progression of the disease. Schizophrenia is a severe mental illness with a continuous as well as episodic course. Various bio-psycho-social strategies could be used for the betterment of people suffering from schizophrenia. With the right support, therapy and treatment people may show a lot of improvement and could live healthy lives.
There are various types of schizophrenia:
In this type, the person experiences extremes of paranoia, such as suspicion, obsession or confusion, and they may act upon it; a person experiencing this behaves oddly and shows inappropriate emotional responses and very little engagement with normal life.
in this type, there is a complete shutdown of the person emotionally mentally and physically; they have very little or no facial expressions.For example, they may not move for long periods. There is no self-drive to eat, drink, or urinate. Sometimes it becomes a medical emergency in cases where the catatonia lasts for several hours.
in this type, the person has a variety of symptoms which fall into more than one type of schizophrenia.
It is form of schizophrenia in which emotional changes are seen in the patient, delusions and hallucinations, fleeting and scattered behaviour, irresponsible and unpredictable mannerisms common. The mood is sad and doesn’t always match the situation and often accompanied by giggling or self-satisfied, self-absorbed smiling. The patient may display a proud manner, grimaces, mannerisms, pranks, hypochondriacal complaints, and may reiterate phrases.
People diagnosed with schizophrenia may have variety of symptoms. This may happen on and off, or only two or three times in a lifetime. At the beginning of the illness, the symptoms are sudden and severe.
During the psychotic phase, the patient may understand many parts of reality. They may show everyday living, conduct necessary activities such as working, eating, or getting around. Some severe cases show limitations in functioning.
The symptoms in the psychotic phase are:
- Hallucinations, where they see, hear, feel or smell things that are not real.
- Delusions, where there are strange beliefs that are false.
- Confused thinking, where the person has a quick shift of thoughts from one to another.
- Feeling emotions, thoughts and moods that are not appropriate with events.
People experiencing schizophrenia may also:
- Show a lot of energy or become catatonic (a state in which the body is rigid).
- Speak about things that don’t make sense.
- Not wash or groom themselves.
- Keep isolated.
- Lose the ability to function at workplaces or do other activities.
- Show less interest in life.
- Show signs of depression or have mood swings.
- Be very inactive.
CAUSES AND RISK FACTORS
There is no single cause of schizophrenia. It is believed that several factors including environmental and genetic factors contribute to the condition. There is some genetic contribution to schizophrenia and such related mental conditions are more commonly seen in biological relatives of patients suffering from the illness. However, there are other neurobiological factors that may also contribute. Psychosocial and family dynamics can also play a role in the onset and recovery of schizophrenia.
The lifetime chance of developing schizophrenia is estimated to be about 1%. So, one in a hundred individuals may develop schizophrenia in their lifetime. And, it is equally prevalent among both men and women. In men, the illness is usually found between the ages of 10 to 25 years whereas in women it is more common between 25 to 35 years of age.
Substance abuse also has a significant association with schizophrenia. Individuals reporting high levels of cannabis use are reported to be six times more likely to suffer from schizophrenia as compared to non-users.
We cannot prevent schizophrenia; however, measures can be taken to reduce the risk. Since risk factors such as substance abuse and stress can contribute to vulnerability towards schizophrenia, avoiding these can help maintain a normal state and avoid occurrence. Early detection and care is the key to prevent the further progression of the disease.
There are no definitive medical tests that can confirm the condition. The diagnosis of schizophrenia is done on the basis of a clinical case history and along with a mental status examination of the patient. The diagnosis includes full psychiatric evaluation, medical history assessment and physical exams. The lab tests are used to check that there are no underlying causes for these symptoms.
Criteria in diagnosing schizophrenia
One criterion is if two or more of the following symptoms are present for at least 30 days:
- Disorganised speech
- Catatonic behaviour
- Negative symptoms like lack of vocabulary or apathy
Other criteria for diagnosis are:
- Significant problems at work or school related to other people, or issues in taking care of oneself.
- Showing signs of schizophrenia for six months with active symptoms that last for at least a month.
- Having no other medical issue, mental health disorder or substance abuse problem that causes the symptoms.
Schizophrenia is treatable if there is early detection and control. Social and community support and treatment with medicines are proven to be effective. Efforts taken to transfer patients to hospitals or mental health institutions that provide appropriate care make the progression slow. Support from family members and the community is proven to be very useful.
Medication for schizophrenia is usually prescribed to reduce symptoms of psychosis such as hallucinations, delusions, paranoia and confused thinking. Pharmacotherapy for schizophrenia has evolved over the years and thus various effective medications are available for treatment of schizophrenia. It is also proven helpful along with psychotherapy to treat symptoms like lack of motivation, lack of expressiveness and social withdrawal.
Therapy is also proven helpful to improve life skills to manage stress and to improve communication. Sometimes group therapy can also help connect with other people who are experiencing the same type of symptoms.
A patient’s lifestyle can be managed in the following ways:
Find social support
Get patients to connect with friends and family in a meaningful way to calm them down and release stress. Staying involved with others by continuing their daily work is also proven beneficial. Joining a class or a club to spend time with people having common interests is also helpful. Staying connected can help them feel good about themselves.
Increase in stress acts as a trigger factor for schizophrenic episodes by raising the body’s cortisol hormone production. Relaxation practices are proven to be helpful to reduce stress.
Exercise helps to increase focus and energy and helps to make patients feel calm. A 30-minute workout on most days including walking, running, swimming, or dancing has proven effective in reducing the symptoms of schizophrenia.
Get proper sleep
Regular sleep cycle helps to maintain the mood. Sleep of more than eight hours is recommended.
Avoid substance abuse
Drugs, nicotine and alcohol worsen symptoms of schizophrenia add may also interfere with some drug treatments.
Inculcate healthy eating habits
Omega-3 fatty acids obtained from fish oil, walnuts, and flaxseeds can help improve focus, avoid fatigue and balance mood. Eating at proper intervals and including nutritious food items can help to maintain adequate nutrition.
PROGNOSIS AND COMPLICATIONS
Schizophrenia is a lifelong condition, and, currently, there is no cure for it. However, many of the medical conditions and traits associated with the disorder can be treated and managed with suitable treatment, therapy, education and support. People with schizophrenia can have meaningful relationships, go to school or work, and lead productive and healthy lives like any other person.
Untreated and with lack of help, the disease can result in:
- Significant decrease in thinking, reasoning and remembering
- Suicidal thoughts
- Financial problems due to the inability to work
- Losing connections
- Aggressive behaviour
- Schizophrenia[Updated Oct 04, 2019].WHO. Available at: https://www.who.int/news-room/fact-sheets/detail/schizophrenia. Accessed on: March 04, 2021.
- What is Schizophrenia? [Updated Aug, 2020]. Psychiatry. Available at: https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia. Accessed on: March 04, 2021.
- Schizophrenia [Updated Aug, 2020]. Helpguide. Available at: https://www.helpguide.org/articles/mental-disorders/schizophrenia-signs-and-symptoms.htm. Accessed on:March04, 2021.
- What are the 4 types of Schizophrenia and how they can affect you? [Updated Nov 07, 2018]. Cleveland Clinic. Available at: https://health.clevelandclinic.org/what-are-the-4-types-of-schizophrenia-and-how-can-they-affect-you/. Accessed on: March 04, 2021.
- Schizophrenia [Updated Feb 02, 2018]. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/4568-schizophrenia. Accessed on:March 04, 2021.
- NCHMD. Available at: https://www.nchmd.org/education/mayo-health-library/details/CON-20199572. Accessed on:March 04, 2021.