What is Schizophrenia?

Schizophrenia is a mental disorder in which the patient finds it difficult to tell the difference between real and unreal experiences, to think logically, to have normal emotional responses, and to behave normally in social situations. There are various symptoms, the combination of which establishes the type of Schizophrenia the person may be suffering from. Despite many researches and studies, there is still no concrete evidence as to what exactly causes Schizophrenia. 

CAUSES:  

(Courtesy: Internet)

1. Genetic factors play a major role. People with family history of schizophrenia may be more likely to get the illness themselves.

2. Environmental events may trigger schizophrenia in people with genetic background. For example, infection during intranatall development or stressful psychological experiences may increase the risk for developing schizophrenia later in life. Social and family support  plays a vital role in the improvement of the illness.

PREVALENCE:

Schizophrenia affects about approximately 1% of the people worldwide. However, it occurs equally among men and women. In women it is seen to begin later and is milder in intensity. Although schizophrenia usually begins in young adulthood, there are cases in which the disorder begins later (over age 45). Childhood-onset schizophrenia is the one which starts after age 5. 

SYMPTOMS:
Schizophrenia develops slowly over months or years. Like other chronic illnesses, it cycles between periods of fewer symptoms and periods of more symptoms. At first, you may feel tense, or have trouble sleeping or concentrating. You can become isolated and withdrawn, and have trouble making or keeping friends. As the illness continues, psychotic symptoms develop:

• Appearance or mood that shows no emotion (flat affect)
• Bizarre movements that show less of a reaction to the environment (catatonic behavior)
• False beliefs or thoughts that are not based in reality (delusions)
• Hearing, seeing, or feeling things that are not there (hallucinations)

Problems with thinking often occur:

• Problems paying attention
• Thoughts "jump" between unrelated topics (disordered thinking)

Symptoms can be different depending on the type of schizophrenia:

• Paranoid types often feel anxious, are more often angry or argumentative, and falsely believe that others are trying to harm them or their loved ones.
• Disorganized types have problems thinking and expressing their ideas clearly, often exhibit childlike behavior, and frequently show little emotion.
• Catatonic types may be in a constant state of unrest, or they may not move or be underactive. Their muscles and posture may be rigid. They may grimace or have other odd facial expressions, and they may be less responsive to others.
• Undifferentiated types may have symptoms of more than one other type of schizophrenia.
• Residual types experience some symptoms, but not as many as those who are in a full-blown episode of schizophrenia.

People with any type of schizophrenia may have difficulty keeping friends and working. They may also have problems with anxiety, depression, and suicidal thoughts or behaviors.

SIGNS AND TESTS:

A psychiatrist should perform an evaluation to make the diagnosis. The diagnosis is made based on a thorough interview of the person and family members. No medical tests for schizophrenia exist. The following factors may suggest a schizophrenia diagnosis, but do not confirm it:

• Course of illness and how long symptoms have lasted
• Changes from level of function before illness
• Developmental background
• Genetic and family history
• Response to medication

CT scans of the head and other imaging techniques may find some changes that occur with schizophrenia and may rule out other disorders.

TREATMENT:

During an episode of schizophrenia, you may need to stay in the hospital for safety reasons, and to receive basic needs such as food, rest, and hygiene.

MEDICATIONS:

Antipsychotic medications are the most effective treatment for schizophrenia. They change the balance of chemicals in the brain and can help control the symptoms of the illness.

These medications are helpful, but they can have side effects. However, many of these side effects can be addressed, and should not prevent people from seeking treatment for this serious condition.

Common side effects from antipsychotics may include:

• Sleepiness (sedation) or dizziness
• Weight gain and increased chance of diabetes and high cholesterol

Less common side effects include:

• Feelings of restlessness or "jitters"
• Problems of movement and gait
• Muscle contractions or spasms
• Tremor

Long-term risks of antipsychotic medications include a movement disorder called tardive dyskinesia. In this condition, people develop movements that they cannot control, especially around the mouth. Anyone who believes they are having this problem should check with their doctor right away.

For people who try and do not improve with several antipsychotics, the medication clozapine can be helpful. Clozapine is the most effective medication for reducing schizophrenia symptoms, but it also tends to cause more side effects than other antipsychotics.

Because schizophrenia is a chronic illness, most people with this condition need to stay on antipsychotic medication for life.

SUPPORT PROGRAMS AND THERAPIES:

Supportive and problem-focused forms of therapy may be helpful for many people. Behavioral techniques, such as social skills training, can be used during therapy or at home to improve function socially and at work.

Family treatments that combine support and education about schizophrenia (psychoeducation) appear to help families cope and reduce the odds of symptoms returning. Programs that emphasize outreach and community support services can help people who lack family and social support.

Important skills for a person with schizophrenia include:

• Learning to take medications correctly and how to manage side effects
• Learning to watch for early signs of a relapse and knowing how to react when they occur
• Coping with symptoms that are present even while taking medications. A therapist can help persons with schizophrenia test the reality of thoughts and perceptions.
• Learning life skills, such as job training, money management, use of public transportation, relationship building, and practical communication

Family members and caregivers are often encouraged to help people with schizophrenia stick to their treatment.

PROGNOSIS:

The outlook for a person with schizophrenia is difficult to predict. Most people with schizophrenia find that their symptoms improve with medication, and some can get good control of their symptoms over time. However, others have functional disability and are at risk for repeated episodes, especially during the early stages of the illness.

To live in the community, people with schizophrenia may need supported housing, work rehabilitation, and other community support programs. People with the most severe forms of this disorder may be too disabled to live alone, and may need group homes or other long-term, structured places to live. Some people with milder forms of schizophrenia are able to have satisfying relationships and work experiences.

COMPLICATIONS:

• People with schizophrenia have a high risk of developing a substance abuse problem. Use of alcohol or other drugs increases the risk of relapse, and should be treated by a professional.
• Physical illness is common among people with schizophrenia due to an inactive lifestyle and side effects from medication. Physical illness may not be detected because of poor access to medical care and difficulties talking to health care providers.
• Not taking medication will often cause symptoms to return.

CALLING FOR HELP:

Call your health care provider if:

• Voices are telling you to hurt yourself or others.
• You feel the urge to hurt yourself or others.
• You are feeling hopeless and overwhelmed.
• You are seeing things that aren't really there.
• You feel like you cannot leave the house.
• You are unable to care for yourself.

PREVENTION:

There is no known way to prevent schizophrenia. If you do have the condition, the best ways to prevent symptoms from coming back are to take the medication your doctor prescribed, and see your doctor or therapist regularly. Always talk to your doctor if you are thinking about changing or stopping your medications

(Disclaimer: The above post has inputs from the PUBMED Health articles. It is written only from an informative point of view. It should not be taken as a consultation. Kindly discuss with your physician regarding the details about Schizophrenia.) 

Mental Health in India

I know what you will be thinking by the time you reach mid way of this post - "Why am I reading this? I've got no problems! I am perfectly Normal". Yes even I know that you are 'normal'. But there are others whom you may be directly or indirectly related who are affected with mental illness, for whom you care... so read on...

We live in a country where our fear of mental illness is so deep rooted that we tend to become irrational when we think of those mentally affected. Our society has been stained with so many misconceptions and wrong theories about mental illness. I want to ask all of you who consider yourself to be a part of this 'NEXT" generation, how many time have you giggled at a roadside beggar wearing some filthy clothes, muttering and laughing to himself. I am sure most of you have. Honestly, even I was no exception to this...

But have you ever wondered why did you laugh at that guy? You would say, because he is Mad! So? Would you have reacted similarly at a person with high fever or say having Diabetes or any other damn illness? I am sure you would not!

Today we still hear news that Women are branded as "witches" (chudail) and then burned or stoned to death in many pockets of our country. Elders still see mental illness as some 'Devil's possession'! And what is the solution they teach us? Beat such 'deserving' victims with broomsticks and lathis and 'drive away' the spirit out of their bodies! It was not long ago in our soceity that patients with psychosis were taken to an asylum, usually very far away from the 'normal' civilization and chained so that others could live safely. But in between these hard truths there's also something to smile about. Atleast certain portion of our society has come a long way in giving the mentally ill, a treatment that is far more humane...

I did a short post in Psychiatry few months back in a public hospital. People including even my relatives raised an eyebrow on my decision! They looked suspiciously at me. "Kirti tu bhi paagal ho jaayega kuch dinon me, chod de ye sab!" (Kirti, even you will go crazy in few days, leave this post)

'Paagal'... Now that is something i sure giggle at! I wonder often, who must have 'invented' this word! The nearest english analogue of paagal would be 'Crazy' or 'Mad', right? So aren't you crazy about so many things in your life? So should i call even you as 'paagal'? Baseless theory right? So are many theories about mental illness in our society.

Ask people around and most of them (70%) will say a person becomes mentally ill because 'uska dimaag kamjor hai' (his brain is weak). But the fact is that mental illness cant be "cured" only by 'strengthening' your mind or your will power. What happens next? The ill person becomes more and more aloof. A blanket of guilt and secrecy covers him thereby blocking every possible intervention which could have pulled him/her out of that loneliness till the situation gets out of hand.

But here i want to ask each one of you have you ever ignored that nasty cough or that 100+ fever? So my question remains, 'If your physical body is so special to you, your brain in fact is the most integral part of it! Then why ignore mental illness? Why laugh at some one whose brain has fallen ill.' Everyone who has a heart can get a heart attack, similarly everyone who has a brain can have mental illness! And so if you still think you are immune to mental illness, well... you know what I mean.

Indians always cry over racism they face on the basis of their colour. But aren't we Indians racist when it comes down to stigmatizing people with mental illness and branding them as 'abnormal'?

The need of the hour is to wake up and embrace a new ideology towards mental health. Its time to break away those shackles of old ideas and myths and misconceptions and think responsibly and rationally when it comes to meeting a mentally ill person. Such a person is not 'dangerous' or 'funny'... deep inside he/she expects a small gesture of love and understanding from you...

So tap your brain a bit if you really think you are 'Normal' and think about this... Rather than pointing your finger at them, let your helping hand be a reason for light in that lonely darkness...

Take care