Living with Schizophrenia

Not my image

I was reading this book I found lying on a table at the library the other day. It's called Living with Schizophrenia by Dr. Neel Burton and Dr. Phil Davison. Since I've been visiting a boarding home where many of the residents are coping with the illness I thought it would be good to brush up on what it's all about. Here's a recap (some of it copied straight out) of what the book said.

The term schizophrenia was coined by Swiss psychiatrist Paul Eugen Bleuler in 1910. It is derived from the Greek words "schizo" (split) and "phren" (mind).

The chance of developing schizophrenia is 1 in 100 (1%). The chance of any given person suffering from schizophrenia at any one time is 0.4% or one in 250.

Most cases of schizophrenia are diagnosed in late adolescence or early adulthood.

Schizophrenia more or less affect men and women in equal numbers. It exists in all cultures, climates and ethnic groups.

Stress can be a contributor to developing schizophrenia. Genes (family history) play a roll in developing schizophrenia, but they are "not the whole story".

People who smoke cannabis are up to six times more likely to develop schizophrenia. Other drugs that have been associated with schizophrenia include stimulant drugs such as amphetamines, ecstasy and cocaine.

Symptoms of schizophrenia -

Positive symptoms:

Hallucinations

Delusions

Cognitive symptoms:

Difficulties with attention, concentration and memory

Negative symptoms:

Impaired attention

Restricted amount and/or range of thought and speech

Restricted range of emotions, or inappropriate emotions

Loss or drive and motivation

Social withdrawal

Hallucination is defined as a "sense of perception that arises in the absence of stimulus." Hallucinations involve hearing, seeing, smelling, tasting or feeling things that are not actually there. The most common hallucinations in schizophrenia are auditory hallucinations - hallucinations of sounds and voices. Voices can either speak directly to the schizophrenia sufferer (second-person - "you" voices) or about the sufferer (third-person - "he or she" - voices). Voices can be highly distressing, especially if they involve threats or abuse or if they are loud and incessant.

Delusions are defined as being "strongly held beliefs that are not amenable to logic or persuasion and that are out of keeping with their holder's background". Although delusions are not necessarily false, the process by which they are arrived at is usually bizarre and illogical. In schizophrenia the delusions are most often of being persecuted or controlled, although they can also follow a number or other themes.

What causes the symptoms of schizophrenia?

According to the "dopamine hypothesis" of schizophrenia, positive symptoms result from an increased level of a chemical messenger, dopamine, in a part of the rain referred to as the mesolimbic tract. Antipsychotic medications that are effective in the treatment of the positive symptoms of schizophrenia block the effects of increased dopamine in the mesolimbic tract.

Negative symptoms result from a decreased level of dopamine in another part of the brain referred to as the mesocortical tract.

More recent research has found that a number of other chemical messengers in the brain, such as glutamate and serotonin, are also involved in schizophrenia, although their precise roles are as yet unclear.

Antipsychotic medication

Although there is no miracle cure for schizophrenia, the illness can be treated, and three out of four schizophrenia sufferers can expect either to recover completely or to improve significantly. Antipsychotic medication is the mainstay of treatment, but psychological treatments such as patient and family education, self-help groups, illness self-management, social and vocational skills training, and cognitive-behaviorural therapy can also play an important role in reducing symptoms, preventing relapse and re-hospitalization, and helping one take control over their illness.

How antipsychotic medication works

Positive symptoms of schizophrenia result from an increased level of the chemical messenger dopamine in a part of the brain called the mesolimbic tract. Antipsychotics are effective in the treatment of positive symptoms principally because they block the effects of dopamine in the mesolimbic tract.

How effective is antipsychotic medication?

Antipsychotic medication is effective in controlling positive symptoms in about 70-80% of schizophrenia sufferers, although it often takes several days before any effects are evident. Until then the schizophrenia sufferer may benefit from taking a sedative such as lorazepam if he or she is distressed or agitated. In some cases, several antipsychotics may need to be tried before the one that is best for them can be found. Unfortunately, antipsychotic medicine has relatively little effect on the cognitive and, especially, the negative symptoms of schizophrenia.

Is antipsychotic medication always needed?

Yes, it is always needed. Although non-pharmacological, psychological treatments have an important role to play in the management of schizophrenia as well.

Which antipsychotic medication?

Current treatment guidelines for the treatment of schizophrenia recommend start on one of the more recent "atypical" antipsychotics. The most commonly prescribed ones are risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), amisupiride (Solian) and clozapine (Clozaril/Denzapine). Each has a slightly different side effect profile such as a disturbance in voluntary muscle function (for example).

Starting antipsychotic medication

The starting does of antipsychotic medication is usually small as to minimize any potential side effects.

What if the antipsychotic medication is ineffective?

If a person does not respond to the chosen atypical antipsychotic after a trial period of 6-8 weeks, the antipsychotic can be stopped and a different one started.

For how long should antipsychotic medication be taken?

Antipsychotics not only combat the symptoms of schizophrenia, but also prevent the symptoms from recurring. If one has improved on a particular antipsychotic, they should continue taking it at the same does for at least he next 6 months, preferably for the next 12-24 months and possibly much longer.

Psychosocial treatments

Managing stress and anxiety

Stress and anxiety can make you more vulnerable to a relapse in your illness. People with positive coping and thinking styles and good social skills are better able to diffuse stressful situations; for example, by doing something about them, putting them in their correct context, or by simply talking about them and "sharing the pain".

One common and effective strategy is called "deep breathing". Breath in through your nose and hold the air for a several seconds. Then purse your lips and gradually let the air out making sure you let out as much as you can. Continue doing this until you are feeling more relaxed.

LIfestyle changes also help. You can simplify your life, even if this means doing less or doing only one thing at a time. Have a schedule and stick to it. Get enough sleep. Exercise regularly; for example, walk, swim or do yoga. Eat a balanced diet based on starchy foods such as wholegrain bread, potatoes, pasta and rice. Eat five portions of fruits and vegetables a day. Eat some protein-rich foods such as fish, poultry, meat, eggs and pulses. Avoid fat, sugar and salt. Avoid excessive caffeine and alcohol. Take the time to do things you enjoy. Connect with others and share your problems with them. Change your thinking style: have realistic expectations, reframe problems, express your feelings, maintain a sense of humour.

Coping with voices

Sometimes voices can in themselves be a significant source of stress and distress. Simple strategies to reduce or eliminate voices include: Keep a diary of the voices to help you to identify and avoid situations in which they arise. Find a trusted person to talk to about the voices. Focus your attention on an activity such as reading, gardening, singing or listening to your favourite music. Talk back to the voices: challenge them and ask them to go away. Manage your anxiety and stress using the techniques discussed. Take your antipsychotic medication as prescribed. Avoid drugs and alcohol.