Schizophrenia: what is it, who is at risk and how is it treated?

SCHIZOPHRENIA  patients and their families carry a heavy emotional burden because of the myths and stigmas attached to the condition.

Not only are they incorrectly described as persons with a ‘split personality’, often people with schizophrenia are considered dangerous.

This is not the case, stresses Dr Kerryn Armstrong, a psychiatrist at the Akeso Clinic Milnerton, who goes on to outline some of the common misconceptions:

* One of the biggest myths is that all people with schizophrenia are dangerous. While their behaviour may be influenced by delusions or hallucinations, most people with schizophrenia are not violent and do not display dangerous behaviour.

* It is also a myth that all schizophrenic people are the same. In fact, people with schizophrenia experience a wide range of symptoms with diverse presentations.

* Another myth is that people with schizophrenia cannot be treated and belong in institutions when in fact schizophrenia can be successfully managed with medication and psychosocial rehabilitation therapies.

What is schizophrenia?

According to Dr Armstrong it is,“A psychiatric disorder characterised by chronic or recurrent psychosis that occurs in about one percent of the general population and is almost equally prevalent in men and women.

 It is commonly associated with impairments in social and occupational function and is among the most disabling and economically costly medical disorders. The World Health Organization ranks schizophrenia as one of the top 10 illnesses contributing to the global burden of disease, – Dr  Kerryn Armstrong

The disorder results from a complex interaction between genetic and environmental factors.

“Risk factors include a family history, pregnancy and birth complications, greater paternal age, late winter/early spring birth and growing up in an urban environment,” adds Dr Armstrong. “There is sufficient evidence to indicate that cannabis use is also a risk factor for the development of psychosis.”

Is it hereditary?

According to the doctor there is strong evidence for genetic risk involved in schizophrenia. “Family studies have shown that siblings and children of those with schizophrenia are at 10 times greater risk of developing the disorder.

Symptoms

Symptoms usually become evident in the late teens or early 20s, ranging from late childhood right through to the seventies.  “Patients may present with  personality change, becoming withdrawn or suspicious and perplexity or depressive symptoms.”

Characteristic features include:

*  Hallucinations

* Delusions

*  Disorganised speech

*  Bizarre or catatonic behaviour

*  Mood and anxiety symptoms can also occur.

How is it diagnosed?

The standard classification of mental disorders used by mental health professionals provides diagnostic criteria, including:

* The patient must have two or more symptoms including delusions, hallucinations, disorganised speech or catatonic behaviour for a significant portion of time during a one month period.

* There must be impairment of function and signs of the disturbance must persist for at least six months. Other disorders and possible medical causes of symptoms must be excluded.

How is the sufferer affected?

Hallucinations are commonly auditory but may be visual, gustatory, olfactory or tactile in nature.

Delusional content is extremely diverse, however delusions of persecution are particularly common.

Negative symptoms such as flattening of affect, poverty of thought or speech and avolition (lack of motivation or initiative) may be prominent and may remain despite the resolution of psychosis, causing functional impairment.

In addition to characteristic symptoms, individuals with schizophrenia also demonstrate impairment in a range of cognitive abilities, Armstrong points out.

These include deficits in attention and concentration, processing speed, learning and memory, reasoning/executive function, verbal skills and social cognition.

“They are also at increased risk of physical ill health, with schizophrenia being associated with medical disorders including diabetes, hyperlipidaemia and hypertension. The life expectancy of people with schizophrenia is decreased by more than a decade compared to the general population, with excess medical mortality largely related to heart disease,” says Dr Armstrong.

Prevention

Regarding the possible prevention of schizophrenia, Armstrong says various approaches aimed at preventing the emergence of psychotic disorders in those at high risk are being investigated. “Cognitive behaviour therapy has shown favourable outcomes concerning rates of transition to psychosis, and omega-3 fatty acids lower but promising evidence.  Low-dose antipsychotic medication may be beneficial, but uncertainty remains regarding long term effects and duration of treatment needed.”

Treatment

A biopsychosocial approach should be employed in managing patients with schizophrenia, Armstrong suggests. “Antipsychotic medication should be prescribed to treat psychotic episodes and prevent future relapses. A choice of agent and route of administration should be made in conjunction with the patient and their family, taking into account considerations such as the side-effects of different agents, co-morbid medical conditions, drug interactions, insight into condition and compliance.

“Psychoeducation for the patient and family is crucial, with ongoing psychosocial support and psychological interventions such cognitive behavioural therapy tailored to individual patients’ needs.”

In the event of a psychological crisis, please call 0861 4357 87 for assistance.

Article regards of South Coast Herald.