An insight into Schizophrenia

Schizophrenia is a debilitating chronic mental disorder in which individuals have an abnormal perception of reality. Although ‘Schizophrenia is a fairly uncommon condition, affecting around 0.25% to 0.64% of people in the United States, according to the National Institute of Mental Health (NIMH)’, (Tim Newman, 2020) it can still surpass other mental health conditions in severity.

Research has been made that males are slightly more susceptible to developing this disorder and with relatively earlier onset than females. Men typically develop symptoms in their late teens or early twenties and women typically show first signs in their early twenties and thirties.

Types of Schizophrenia

Cleveland Clinic divides this condition into four main categories based on their symptomatic manifestation: Paranoid Schizophrenia, Undifferentiated Schizophrenia (characterized by vague symptoms where an individual might be unexpressive and dull), and Catatonic Schizophrenia and Schizoaffective disorder (there may be signs of mood disorder too).

Causes and Risk Factors

It is unclear what exactly induces Schizophrenia. However, experts render genetics and other external stressors such as emotional or traumatic experiences during one’s lifetime as Schizophrenia’s probable causative elements. ‘Schizophrenia tends to run in families, but no single gene is thought to be responsible’, as quoted by NHS.

Neurotransmitters are the messenger molecules of our nervous system. It is suggested that an imbalance in dopamine and serotonin levels, neurotransmitters, accounts as one of the factors to enhance the onset of illness. Abuse of certain drugs such as cocaine or amphetamines can rarely add to the cause of origin but can prove significant in causing a relapse in diagnosed patients. Despite the discussion, the exact origin leading to this disorder still remains unknown.

Signs and Symptoms

Schizophrenic brains are subject to psychosis, i.e. not being able to distinguish between the imaginary and real thoughts. The episodes show the following characteristic symptoms of Schizophrenia but as in any other illness, the symptoms may vary from person to person:

• Hallucination- hearing voices is more common than seeing, smelling or feeling unreal things
• Delusion- the patient can have paranoia (persecutory delusion) and/or hold erroneous beliefs about people or circumstances (referential or somatic delusion), (Goldberg, 2018).
• Catatonic behavior (psycho-motor inertness)
• Distorted thought process (irrational thinking pattern that reinforces negative emotions)
• Confused feelings and nervous expression or lack of speech
• Restlessness and lack of motivation
• Other symptoms include anxiety, depression, cognitive distortion (trouble concentrating, giving attention and/or declining memory)

Diagnosis and Treatment

Schizophrenia has no particular diagnostic test; it is rather diagnosed by a psychiatric evaluation, patient’s demeanor, and details of past episodes over six months at the minimum. The doctor must call for imaging tests including an MRI or CT scan. However, there exist ‘diagnostic criteria’ for this neurological disorder. A mental health practitioner may use guidelines from the Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. Having at least two of the aforementioned symptoms would confirm the diagnosis as positive.

Nonetheless, it is imperative to ensure that the assessment had ruled out all other mental health conditions that could show similar symptoms until this disorder was the final resort, owing to its rarity.

People with Schizophrenia rely upon lifetime treatment as it has no cure.  It is mostly based on symptomatic treatment and psychotherapy sessions which work fine until another relapse or episode occurs. Under constant surveillance, the frequency and intensity of relapses can be controlled and one can still lead a productive life.

The treatment includes:

• Antipsychotics taming psychosis, therapeutics limiting anxiety or depression
• Cognitive Behavioural Therapy sessions to improve thinking pattern and other emotionally supportive resources
• Substance misuse should be highly discouraged for these people
• Most of the times, Schizophrenic patients have co-morbid health conditions (such as diabetes, hypertension, anxiety disorder, etc), diagnosis and treatment for them should run alongside

Apart from the treatment cited above, social interventions are equally imperative. It includes training on social skills to counter the deteriorating interactions and/or family therapy to help the kin keep pace with loved ones. Many people with Schizophrenia need some form of assistance to go about routine lives. Many organizations extend services to support Schizophrenic people with education, employment, accommodation, self-help groups, and crisis management.

The world in response to mental health issues

It has been estimated that 90% of all the global cases reside in developing countries which is why it has particularly drawn attention from the World Health Organisation. According to the fact sheets by WHO, it states, ‘WHO’s Mental Health Gap Action Programme (mhGAP), launched in 2008, uses evidence-based technical guidance, tools, and training packages to expand service in countries, especially in resource-poor settings. It focuses on a prioritized set of conditions, directing capacity building towards non-specialized health-care providers in an integrated approach that promotes mental health at all levels of care. Currently mhGAP is being implemented in more than 100 WHO Member States.’

However, it is still quite a neglected mental health condition in Pakistan owing to the stigma that exists with having a mental illness in our society. It is, therefore, necessary to take measures that would help us not only break the stigma but will also educate the masses of its significance to diagnose and treat. For instance, launching frequent awareness campaigns amongst the youth and making CBTs more common in hospitals and therapy centers will help us address to prevent the root causes.

Although incurable something as simple as compliance of the doctor’s word is the only solution here. It will certainly keep the intrusive characteristics of Schizophrenia from depressing the functional ability of a patient in the long run and ensure a rewarding life ahead.