About one in a hundred people suffers from schizophrenia at some time in his or her life. iVillage has linked with the mental health charity SANE to increase our awareness
Many illnesses affect the way we think and experience things. Influenza and other illnesses involving high fevers may cause delirium, but nobody would describe these fevers as mental illnesses. Such illnesses also have physical symptoms and can often be diagnosed from abnormal functioning of some part of the body.
Mental or psychiatric illnesses do not have specific physical symptoms and the abnormal state of mind and bizarre behaviour are usually prolonged. This makes it difficult for the doctor, who can only diagnose his patients from the unusual experiences and behaviour they describe.
Schizophrenia is the most common serious mental illness. A quarter of a million people in Britain have schizophrenia today, although many of these have the illness under control.
What are the symptoms?
People often misuse the word schizophrenia and there are many common misconceptions about the illness. However schizophrenia is not a 'split personality' or 'Jekyll and Hyde' condition, nor is it a label to be pinned on anyone who commits violent crimes.
Schizophrenia has many different symptoms and these are divided into positive symptoms, which are abnormal experiences, and negative symptoms, which are more an absence of normal behaviour.
Positive symptoms can make people feel that they are not in control of their thoughts and actions and include hallucinations and delusions. Someone with these symptoms may hear voices that demand they take certain actions or feel that their body has been taken over, like a puppet or a robot under outside control. Modern medicines will usually control positive symptoms, however alarming they appear.
Negative symptoms come on much more slowly and don't respond to treatment so well. These affect interest, energy, emotional life and enthusiasm. Someone with these symptoms will withdraw, give up their friends and be unable to communicate effectively with others. Relatives often blame negative symptoms on laziness and lack of effort instead of recognising that they are due to an illness.
How is it diagnosed?
Diagnosis is difficult because the course of the illness is lengthy and some of the classic indications of schizophrenia may appear so slowly that only a family member would notice the change. The psychiatrist faced with making a diagnosis will base it on 'scoring' a whole range of symptoms: hearing voices, thoughts not being one's own, outside forces acting on body actions, delusional perception.
How it starts
Slowly: schizophrenia often starts gradually in the middle and late teens. It is hard to tell whether a gradual change in behaviour is a sign of mental illness or normal teenage rebellion. If the trend continues and other symptoms start to appear, get advice at once.
Suddenly: some cases of schizophrenic illness start suddenly, sometimes after a shock or other stress such as childbirth, infection or exams. A person starts to hear voices, has delusions and a gamut of positive symptoms. Yet there is often a complete and rapid recovery with treatment.
In later life: Some people get schizophrenia in their sixties or seventies. It is then more common in women, particularly those with poor hearing and living on their own. The illness usually responds well to medical treatment.
What are the causes?
Heredity is known to play a part. The great advances made during the past 20 years in genetics and understanding how heredity works make this an exciting area in the search for the causes of schizophrenia.
Abnormalities in the chemistry of the brain are also important. Individual brain cells communicate with one another by chemical messengers called neurotransmitters. Scientists have suggested that people with schizophrenia may produce too much of one of these transmitters, dopamine, and that this may explain the positive symptoms of the condition. Although dopamine transmission may be involved in some of the symptoms of schizophrenia, a dopamine abnormality is not a sufficient explanation for the disease. For many years, it has been suspected that there might be structural changes in the brains of patients with schizophrenia.
There is no convincing evidence that other psychological factors, such as distorted relationships within a family, are capable of bringing about schizophrenic illness, but it does appear that families can play an important part in preventing relapse by avoiding too much criticism, hostility or overprotection of the patient.
The role of drug abuse
We do not yet know enough about the causes to say how the illness can be prevented. However, one specific factor is important: drug abuse. Illicit drugs such as amphetamines, LSD, cocaine and cannabis can cause hallucinations and paranoid delusions similar to those found in schizophrenia. The psychotic effects of these drugs do not always clear up readily and there is some evidence that they may trigger a prolonged schizophrenic illness. In addition, such drugs can cause a relapse of an established illness.
What are the treatments?
There is, as yet, no cure for schizophrenia but most sufferers improve with treatment, especially if it is combined with psychosocial help. Medication in the form of antipsychotic drugs is necessary to alleviate some of the disturbing symptoms. Unfortunately, in addition to their therapeutic action, these drugs all have unwanted side effects, in particular involuntary muscle movements and tics, facial grimaces and restlessness.
Early diagnosis
When someone you know is preoccupied with bizarre thoughts, becomes emotionally withdrawn, has difficulty in thinking or shows signs of depression and a decline in performance, you should get professional help, because these signs may herald a schizophrenic breakdown. The family should seek urgent help from the GP because there is now evidence that the earlier the symptoms of schizophrenia are treated, the better the outcome.
Most GPs know relatively little about mental illness and will refer their patient to a consultant psychiatrist for diagnosis. In the early stages of schizophrenia, the diagnosis may be uncertain because the full-blooded symptoms have not yet developed. Often the psychiatrist will want to give his patient the benefit of the doubt, although this may rebound on the sufferer and his family as the illness, if untreated, will often become much worse. The sufferer may, as a result, lose insight, be unaware that he is sick and be unwilling to be treated.
Hospital treatment
The psychiatrist, after talking to you, may suggest that you go into hospital for assessment or treatment. As a voluntary patient, you are entirely free to come and go as you please and can discharge yourself at any time.
If you are not willing to go to hospital voluntarily, you may be admitted to hospital against your will. In order to safeguard your liberty, there are quite elaborate procedures for compulsory admission, which are laid down in the Mental Health Act (1983). The fact that someone has been sectioned does not mean that his illness is worse or less likely to be controlled than that of other people. In fact, the reverse seems to be true, and those with the most florid symptoms often respond best to treatment.
Trying to make life normal
Although many individuals may be left with residual difficulties after an acute attack of schizophrenia, life should be as normal as possible. Advice should be sought about employment, marriage, going abroad, childbirth and other areas of life so that appropriate plans can be made. It is also sensible to preserve the expectation that someone with a schizophrenic illness should try to co-operate with others and to behave in a socially acceptable way.
Watching for a relapse
Patients with schizophrenia are almost invariably required to continue to take a maintenance amount of medication even when they appear to have recovered and feel well. If friends or relatives discover that the patient is no longer taking medication in the prescribed way, they should alert the psychiatrist or key worker, since failure to take antipsychotics may lead to a further schizophrenic breakdown.
Although most relapses occur when the patient fails to take medication, there are other contributory causes: general health, drug abuse and lifestyle. There is some evidence that relapse is more frequent in families (or other carers) showing a high level of intrusive emotion and lessened where they are more tolerant and accepting.
For further information about schizophrenia visit www.sane.org.uk
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