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Schizophrenia

  • How is it Caused?
       
  • The Biological aspect

  •    
  • The Psycho-social aspect

  • How can you identify Schizophrenia?

  •    
  • Loss of interest and social withdrawal

  •    
  • Delusions

  •    
  • Hallucinations

  •    
  • Disinterest in personal hygiene

  •    
  • Inability to express emotion

  • What is the First Step?

  • How is Schizophrenia treated?

  •    
  • Medical Treatment

  • How important is Medication?

  • Is the treatment safe?

  •    
  • Psycho-therapy

  •    
  • Social Rehabilitation

  • What is the extent of Recovery possible?


    Schizophrenia (skit-zo-free-nia) is a term coined by the famous Swiss Psychiatrist, Eugene Bleuler [1857 – 1939] in the year 1911 which was accepted later worldwide. It denotes a severe and complex mental illness wherein the patient loses the ability to think, feel or behave in a normal way. The patient perceives a distorted reality but is usually unaware that he is ill. Patients also suffer from delusions ie. firmly held but false beliefs and begin to act on them. As a result of their faulty thinking and perception, their behavior becomes abnormal. Nearly 6 – 7 million Indians suffer from this disorder variously described as the “Cancer of the mind” and the “Greatest disabler of youth”.. It starts in the most productive period of life 15 - 45 years and is cosmopolitan in its occurrence. It cuts across barriers of gender, educational and social classes. It is now widely recognized that Schizophrenia is a brain disorder.

    How is it Caused?

    The exact cause of the illness is not known as yet. Research into the illness continues; what has emerged in recent years is a bio psychosocial model of the illness.

    The Biological aspect

    Research indicates that schizophrenia is a disorder of the brain with a tendency to run in families.. A certain vulnerability to the illness is transmitted genetically; a person whose family records other cases of schizophrenia is more likely to be afflicted than one without such a history. The children of a schizophrenic parent. for example, each have about a 10% chance of developing schizophrenia as compared with 1% chance in the general population. Most scientists agree that a vulnerability to the illness is inherited, a potential that, given a certain set of factors, can lead it schizophrenia.

    The Psycho-social aspect

    It is generally seen that among genetically vulnerable individuals, those who are exposed to a highly critical or stressful environment are more likely to succumb to schizophrenia than those who are not. The onset of the illness itself is often triggered by a traumatic event in the person's life. The death of a loved one, some deeply-felt failure, rejection or disappointment can lead to schizophrenia in a susceptible individual.

    It can be seen therefore that while schizophrenia is related to biochemical irregularities in the brain, external stress, family and social pressures, if intense, can work on a vulnerable individual and lead to schizophrenia. Families carrying a genetic record of past illness are especially susceptible.

    How can you identify Schizophrenia?

    The onset of schizophrenia is gradual and not dramatic. However there are a few common symptoms which mark the illness.

    Loss of interest and social withdrawal

    The person starts losing interest in his work, studies, family and friends. He is unable to concentrate, is irritable or looks vacant when questioned, stops going to work, often spends time wandering aimlessly or doing nothing, looking preoccupied or lost in thought. This is usually accompanied by a sharp fall in academic or work performance, disturbed sleep patterns and loss of appetite. The individual also begins to withdraw into himself, to shun company and social interaction of any sort.

    Delusions

    Sometimes schizophrenia is identified by the patient's fixed belief in something that is obviously untrue. He may believe that he is being persecuted, that people are conspiring against him at work; he may suspect his spouse's fidelity and many take to watching her constantly; he may believe his thoughts are being controlled by some external force for instance, that a radio receiver is planted in his head. These beliefs will not be shaken by attempts to reason with him.

    Hallucinations

    During the 'acute' phase of the illness the patient often hears voices in his head and begins responding to them. He is seen apparently talking to himself but in a disjointed way, often laughing, gesturing ,smiling.

    Sometime the patient sees frightening figures, in his fear he may become uncontrollable and be driven to violence, even attempting suicide.

    Disinterest in personal hygiene

    In the later stages, the patient refuses to bathe or keep himself clean, loses interest in his physical appearance and that of his surroundings.

    Inability to express emotion

    The patient becomes emotionally 'blunted' - he is unable to express appropriate emotion and does not appear to be in touch with outer reality. It is not often that all the symptoms listed appear in any one individual. But if any of these symptoms can be identified, then it is imperative that the First Step be taken.

    What is the First Step?

    Take the patient to a psychiatrist. The importance of this step cannot be over-emphasized. The sooner the illness is identified and treated for, the greater are the chances of recovery. If schizophrenia is left untreated, it can become chronic- and then it will be too late to effect anything bur the most minimal improvement. Simply labeling the patient as 'slow-minded', 'lazy' or 'pretending ' does not solve the problem. It must be accepted that there is a problem and the sooner it is treated for, the better.

    How is Schizophrenia treated?

    It has been found that the best approach to treating schizophrenia is a broad-based one -comprising Medical Treatment, Psychotherapy and Social Rehabilitation.

    Medical Treatment

    Medical Treatment is the most important part of the program and must be adhered to strictly if the patient is to show consistent improvement. The antipsychotic drugs prescribed aim at controlling the acute symptoms of the illness and suppressing distortions in perception. Sometime ECT-Electro convulsive therapy or shock treatment - is advised during a schizophrenic episode but usually in conjunction with the drugs.

    How important is Medication?

    Medication is vital because it aims at restoring the normal functioning of the brain. Once the illness has been identified and the patient is started on a program of drug treatment, it as vital that he keeps to it. These drugs are the product of years of research and are found to have a definite beneficial effect on the patient. If they are stopped for any length of time, the disease will inevitably proceed on its course, causing a relapse. Until recovery has been effected, the drugs should not be stopped, Some times treatment with drugs will have to be continued for years.

    Is the treatment safe?

    Yes.
    Administration of drugs and giving ECT or shock treatment is completely safe in expert hands and does not cause damage to the patient's mind or body. These drugs do not causes additction and there are no bad effects after they are stopped ,as for instance, in the case of alcohol. In some patients however, the drugs produce certain side effects-like excessive lethargy, stiffness of limbs, drooling of saliva or fixing of eyeballs in one position. These effects can be removed by counter-active drugs. So patients showing such reactions will have to take a combination of antipsychotic drugs and the counter-active drugs.

    Psycho-therapy

    Very often the sever loss of self-esteem and depression suffered by the patient can be countered only by effective psychotherapy - sessions of counseling, encouragement and extension of positive support to the patient by friends and family. Supportive individual talks on a regular basis with mental health professional such as a psychiatrist or psychologist helps the patient to talk freely about his perceptions, problems and experiences. Sympathetic counseling enables him to learn to distinguish the real from the unreal and distorted, and gradually to understand more about his illness and himself. Very often he learns to live with symptoms which cannot be completely eradicated.

    Social Rehabilitation

    In order that the patient may function normally and become a productive member of society social rehabilitation becomes essential. One aspect of rehabilitation is Occupational therapy which aims at the acquisition of simple social and trade skill in keeping with the patient's capabilities so that he may be gainfully employed and resettled in life. A second aspect is Group Therapy by which means a patient is enabled to interact freely with others and thus to regain and strengthen his inter personal skills and his self-confidence. An important feature of this efforts to rehabilitate the patient is Family Counseling where the family can discuss the patient, his problems and theirs with a professional psychiatrist and be given guidance on how to treat the patient and how best to aid the recovery process. All aspects of this program are important although it must be emphasized that medication, as prescribed, should never be neglected, even in case of substantial improvement, since that may lead to a relapse . The overall result of such a comprehensive approach to the treatment of schizophrenia is that the patient not only improves as a result of medication, but as he becomes proficient at some trade and continues his counseling sessions, also recovers his self-esteem and become more confident of his place in society.

    In India, we now have Clozapine and Risperidone and Olanzapine is expected to be introduced shortly.

    What is the extent of Recovery possible?

    The extent of recovery possible is dependent to a great extent on the stage at which treatment is begun. This underlines the necessity for early identification and early treatment.
    It is possible in may cases to fully rehabilitate the patient with medication and psycho-social therapy- if the illness had been identified in the early stage. However, even if the patient has returned to normal functioning, a periodic check-up with a psychiatrist is advised.
    Current figures show that:
    About 30-40% register complete recovery
    About 30-40% are seen to be partially recovered' (This means they will improve but need continuous medication) and about 20-30% become chronic.(They may improve but never be fully recovered.)

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