What is Schizophrenia?

About 24 million people worldwide suffer from schizophrenia and 90% of people with untreated schizophrenia are in the developing countries- WHO.

The above mentioned are just a few symptoms of a person who is diagnosed with Schizophrenia which is a serious disorder that damages the normal brain functioning.

About 1% of the population is diagnosed with this disorder, which shows that it is not a very common disorder but it is a serious and a chronic disorder. This can affect people throughout their life span and most likely in the early adulthood between the ages of 16 and 30 years, but is rare in children and the older population.

The brain is a central system which controls our thinking, feeling, and our understanding of the world. A disorder such as Schizophrenia alters thinking, feeling and understanding to the extent that the person becomes out of touch with reality.

A person affected with the disorder will exhibit odd, irrational and disorganized behaviour. The person may not be able to think logically or express appropriate emotions; interaction with people would be affected and he/she may not be able to carry out simple every day tasks. As a result there is an impact on every aspect of the person's life, family, and work. This disorder also distresses the families, who in India are the primary and often only care-givers.

Major symptoms of a person with schizophrenia are as follows:

Hallucinations: the person may hear voices, see things that are not there or experience unusual sensations in the body. For example, hear aliens talking to him/her, or even the voices of people not actually present, or smell an imaginary chemical that is pumped in the air to kill him/her etc.

Delusions: these are strange beliefs and thoughts that are held only by the person which are not based on reality. For example, they may believe that the water is poisoned to kill them, or that they are spied upon, or that aliens control their thoughts and are forcing information on them, or that they are a reincarnation of a famous person or God etc. It would be pointless to convince them that what they are saying is not reality.

Altered thoughts: the person would not be able to process or organize his thoughts and as a result there is racing of thoughts, which become incoherent. As a consequence of racing thoughts, the person's speech too becomes incoherent, irrelevant and will not make sense to the listener, words may be jumbled and sentences may be absurd.

Altered Sense of self: the person is confused about his own self and cannot identify the difference between the self and outside world.

Lack of motivation: the person experiences loss of interest and motivation in life and low energy levels.

Blunt feelings/ exaggerated emotions or inappropriate emotional expression: the person will be unable to express any emotions, and or show exaggerated emotions, usually laughter / weeping / anger. There may be emotional expressions that are situation inappropriate.

Facial expressions and hand gestures are limited, non-existent or can be excessive.

Social withdrawal: the person prefers staying alone and does not like to be in the company of others. This is partly because of depression and partly because of the fear of not being able to handle themselves in company.

Depression: feelings of helplessness and hopelessness and intense sadness may occur partly because of the realization of the disorder in them.

What causes this brain disorder?
While schizophrenia is a mental disorder, it is not because of the person's choice as a result of his weak personality, neither due to poor upbringing or bad parenting; neither due to brain damage.

Research has shown differences in the brain structure and chemicals of a person who is normal and the one who is diagnosed with Schizophrenia. The risk is higher when there is a history of mental disorder in the family. It is therefore not anybody's fault. It is purely a disorder of the brain that certain people develop.

For some the disorder sets in gradually while for others it is sudden. Taking medical help by identifying the early warning signs of the disorder can control the severe effects of the disorder on the behaviour of the person, and prepare the individual to cope with the disorder to some extent.

Some early warning signs that families of people with schizophrenia may observe:

• Social withdrawal, isolation and indifference, deterioration in social interaction.
• Inability to concentrate, evident difficulty in making decisions, deteriorating personal hygiene.
• Declining academic or work performance.
• Hyperactivity or inactivity, or alterations between them.
• Inappropriate emotional reactions or emotionally blunt/expressionless.
• Unusual sensitivity to noise/light or other things.
• Peculiar use of words.
• Not blinking, staring or ceaselessly blinking.
• Inability to sleep and unusual waking hours, mixed up with day and night.
• Unusual preoccupation with religion and occult.
• Strange/bizarre behaviour such as wearing gloves continuously, self-harm etc.
• Suspicion and or fear of others including close family members.

Note: None of these signs by themselves indicate the presence of mental illness. Do seek medical advice if several of these signs are present or there is a marked difference in the behaviour that persists for more than few weeks.

Treatment
With treatment one can make the disorder manageable by controlling the symptoms so that the person can manage every day functioning. Chances of recovery are high when the treatment begins at the initial stage of the disease. The outcome of treatment depends on several factors including the severity of the disorder, age of onset, efficacy of treatment process etc.

Medication and supportive therapy are two major forms of treatment.
Depending on the severity of the disease, medications can help in controlling the symptoms in matter of days or weeks, while it may take longer for a person to reach a stabilized condition.

Supportive therapy involves teaching of life skills such as managing medication, learning to socialize, self-care, handling finances, getting a job and other skills that would help the person to lead life more independently.

An important part of treatment would be in working with the families of people with schizophrenia who would be going through a lot of distress and also helping them help the affected member.

With treatment, people have been able to cope with this disorder and carry out their every day functioning better. They are even able to work and support themselves.

Remember that not all of them are violent and not everybody needs to be institutionalized. What they need is help - let us not shun them, but offer help by first understanding them and then supporting and rehabilitating them.

If you know of anybody who has been showing such strange behaviour, consult a psychiatrist at the earliest.