Manish was a 22 years old man who was brought to the doctor’s cabin by his parents. When the doctor greeted him, he did not respond and gave a frowned and suspicious look to the doctor. Upon insistence, he said “I don’t even know why I am bought here as I seem to be completely fine. If people don’t believe me, that’s not my problem”. On further inquiry from his parents, it was found that Manish had been suspended several months ago from college on grounds of violently attacking his classmate, thinking he is conspiring to fail him in the exams. Although Manish was sound academically, his behaviour had become increasingly odd during the past year. He stopped going out of the house, seeing his friends and relatives. He no longer seemed to care about his appearance, his nails grew and hair unkempt and shabby. He wore the same clothes each day and seldom bathed. He spoke less to his family members and seemed to be lost in his own world. His mother reported that she had often seen him muttering to himself as if he is trying to talk to invisible people. Sometimes he would come out of his room and ask who was talking, even though there was no one around talking. Slowly it was seen he started getting suspicious about his family members. He said “I know you all are jealous of my intellect and have joined hands with my classmate to fail me in exams”. He did not want to eat the meal offered by any of his family members and voiced concern that they might be trying to poison him.
The diagnosis by the Psychiatric unit stated that Manish is suffering from SCHIZOPHRENIA. Manish’s story shows how a high functioning adult like him can also go through a major decline in day to day skills when they suffer from schizophrenia.
Breaking down the disorder
Simply put, schizophrenia is a disturbance of the thinking capability wherein the person suffering has no awareness of their thought process. They might feel persecuted as if people are trying to harm them or hear voices talking to them or others, whereas in reality, no one is talking. There is also disturbance in speech, emotions, motor behaviour, perception and relationship to the external world. Often significant cognitive impairment and poor social skills are also seen.
Some facts about this mental health disorder
- According to WHO, more than 21 million people worldwide are suffering from schizophrenia. According to NIMH report (2018), schizophrenia is one of the top 15 leading causes of disability worldwide and the typical age of onset is late teen years to early thirties and tends to emerge earlier in males than in females.
- It’s a treatable disorder, however, some people never fully recover from it and some may need to be on lifelong medications.
- According to WHO, one in two people living with schizophrenia does not receive care for the condition. Care of persons with schizophrenia can be provided at the community level, with an active family and community involvement.
What causes schizophrenia
- Genetic factors: A person with a history of schizophrenia in the family may be at a higher risk of developing this disorder.
- Structural and Chemical deformations in the brain: Cranial scans and post-mortem studies have shown certain structural anomalies in brain-like enlarged ventricles or reduced brain volume in patients suffering from schizophrenia. Chemical anomalies include an imbalance of certain neurotransmitters in the brain like dopamine and serotonin
- Untreated stress and anxiety: Stress and anxiety may contribute to schizophrenia as they can cause a change in behaviour, increased nervousness, rise in temper levels, and poor communication and social skills.
- Family factors: Tensions in the family, history of childhood emotional and/or sexual abuse, lack of interpersonal communication may also be important factors contributing to this mental health disorder.
Suicide rates are higher
An estimated 4.9% of people with schizophrenia die by committing suicide, a rate that is far greater than the general population, with the highest risk in the early stages of this order.
Some people suffering from schizophrenia develop symptoms of depression within 12 months of an acute episode of schizophrenia and these symptoms may be associated with an increased risk of suicide. These depressive features can occur due to the side effect of antipsychotics, regaining insight after recovery, or just be an integral part of schizophrenia.
Schizoid personality disorder
Schizophrenia should not be confused with a schizoid personality disorder. Although a different disorder, a schizoid personality disorder can share some similar symptoms to schizophrenia, such as poor social skills and a lack of emotional expression. Even though the names may sound similar, unlike schizophrenia, people with schizoid personality disorder have touch with reality and they’re unlikely to experience paranoia or hallucinations. Speech is also intact, and it makes sense when they speak. Since it is a consistent pattern of behaviour, the line of treatment for schizoid personality disorder includes majorly psychotherapeutic intervention than medications.
What can you do about it?
The most common line of management for schizophrenia is medication. All persons suffering from schizophrenia need medication for some time and most will do better with continued use of medication so that symptoms are controlled and to prevent relapse. But drugs alone are not effective for holistic treatment of schizophrenia. Psychotherapeutic interventions like CBT and supportive psychotherapy, provided along with medications can improve the quality of life of the person suffering from schizophrenia. The professionals who provide these kinds of treatment are the Psychiatrists and Clinical Psychologists.
Vocational education by occupation therapists increases the chances of successful employment for persons suffering from schizophrenia. Family psycho-education can give patients and family members a better understanding of the disorder and strategies to cope with it. An integrated, comprehensive approach in the management of schizophrenia works best. Nevertheless, the person must be treated with patience and respect and compassion.
Sometimes schizophrenia-like symptoms may also result from conditions such as substance use, a head injury or a medical illness. It is important to understand that treatment for these conditions differs from that of schizophrenia.
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