Schizophrenia

Think of a severe mental illness, and schizophrenia would quite likely be the first to pop into your mind. Its characteristic symptoms, such as delusions, hallucinations, disjointed thought processes and emotional and social withdrawal, are easily recognizable, and if left untreated, can result in extreme debilitation.


Statistics
Schizophrenia affects people regardless of race, and it is more than twice as common as HIV/AIDS. It is estimated that 1 out of 100 people born today will develop the disorder. The prevalence is equal among males and females. However, schizophrenia tends to begin earlier in men than in women, and these men also tend to develop a more severe form of the disorder. Even though it is a lifelong disorder with no known cure, schizophrenia can be managed effectively with the right combination of treatment and medications.


Signs and symptoms
There are 3 classifications of schizophrenic symptoms: positive, negative, and disorganized.

 

POSITIVE SYMPTOMS

More active manifestations of abnormal behaviour, or an excess or distortion of normal behaviour

  • Delusions
  • Hallucinations

NEGATIVE SYMPTOMS

Deficits in normal behaviour

  • Apathy
  • Relative absence of speech
  • Inability to experience pleasure
  • Lack of emotions when normally expected

DISORGANISED SYMPTOMS

Variety of erratic behaviours that affect speech, motor behaviour and emotional reactions

  • Disorganised speech
  • Inappropriate emotions
  • Bizarre behaviour
  • Motor dysfunctions that range from wild agitation to immobility

 

Although delusions and hallucinations are characteristic symptoms, only 50-70% of patients with schizophrenia experience them. Symptoms of schizophrenia develop slowly and at the initial stages, are easily mistaken for other mental illnesses.  Children who eventually develop schizophrenia may show early signs, such as poor motor coordination and mild social and/or cognitive problems.


Causes


Genetic influences
Schizophrenia has a strong hereditary component. This means that some people would be born with a genetic predisposition towards developing schizophrenia. Individuals who have an immediate family member with the disorder have a 10% or higher risk of developing the illness, compared to 1% of the general population. Environmental factors also play a part.


Environmental influences
Environmental influences do not cause schizophrenia, but may play a role in its development if the person is already vulnerable to it. Exposure to varying degrees of biological and environmental stress may activate the underlying predisposition. Some potential environmental contributors are pregnancy or birth complications, abnormalities in the brain or chemical imbalances, serious early childhood infections or a history of seizures.


Psychological and social influences
Stressful life events do not cause schizophrenia but may contribute to the development. Stress can also exacerbate symptoms of pre-existing schizophrenia. High levels of animosity, criticism, and emotional over involvement within family interactions have been strong predictors of relapse among people with chronic schizophrenia, which is why a supportive family is crucial to relieving the symptoms.


Treatment
The mainstay of treatment for schizophrenia is the use of antipsychotic medications.  Medications help schizophrenics think more clearly by reducing the delusions and hallucinations, but they affect mostly positive symptoms.


Community-care programmes, social and living skills training, and behavioural family therapy count among the treatments on the psychosocial spectrum. These interventions place more attention on social support, helping the schizophrenics become more self-reliant by taking charge of their own care by identifying warning signs of a relapse and coping strategies. Role-playing during social skills training re-teaches the essential skills of basic conversation and relationship building.


An integrative treatment approach works best combining collaborative psychopharmacology, assertive community treatment (ACT), family psychoeducation,and illness management and recovery helps to address the various aspects of schizophrenia.


Prevention
Currently, while there is no ways of preventing schizophrenia, there are other ways to counter the severity of the disorder. Early identification and treatment of children and adolescents who may be at risk of getting schizophrenia later in life improves the prognosis of the disorder. Vaccinations against viruses in women who plan to conceive protect the child during the prenatal stage of development. Improving prenatal nutrition and care also helps to reduce the environmental risk.


Conclusion
Research suggests that the earlier schizophrenia is treated, the better the outcome is for the person and the lower the costs incurred. In 2001, the Early Psychosis Intervention Programme (EPIP) was initiated at IMH, emphasizing early detection and treatment. Part of its strategy involves working with educational institutes to identify and assess adolescents and young adults who exhibit signs of psychosis or indicators of other mental health problems. A combination of proper treatment and medications, together with support from the community, will enable people suffering from schizophrenia to eventually lead comfortable and productive lives.


Khoo Teck Puat Hospital Department of Psychological Medicine provides comprehensive treatment and management for schizophrenia. We have a dedicated multidisciplinary team of psychiatrists and psychologists that work closely with patients and their family to provide treatment and care.


It is never too late to seek help. If you would like to obtain an assessment, please obtain a referral from your doctor or call 65558828 for an appointment.