Schizophrenia Part 1

Schizophrenia is a mental illness associated with symptoms which include hallucinations (can include seeing and hearing things), delusions (false ideas), disordered thoughts, and problems with mood, behaviour and motivation. Like other mental illnesses, there is a general misunderstanding of schizophrenia amongst the public. For example, there is a general misconception that schizophrenia sufferers have a split or “Jekyll and Hyde” type personality which is not true. There is also a misconception that those living with schizophrenia tend to be violent; the truth is that most living with schizophrenia are not violent. Schizophrenia is like many other mental health problems in that it is caused by an imbalance of chemicals in the brain. Like any other long-term illness, it is a major inconvenience and disruption on somebody’s life, however it is not something to be embarrassed about and with proper treatment you can lead a normal life. There are very effective treatment options which allow a person suffering from schizophrenia to lead a normal life. This is the first of four articles on schizophrenia over the next four weeks in the Westmeath Topic.

When does it generally occur?

Schizophrenia occurs in about 1 in 100 people. It occurs equally in men and women. It most often first develops between the ages of 15 to 25 in men and 25 to 35 in women. First diagnosis of schizophrenia is rare after the age of 45. It normally continues throughout life however symptoms can be kept to a minimum with proper treatment. If a person develops schizophrenia in their teens, early diagnosis can be difficult. This is because the first signs can include a change of friends, drop-in grades, sleep problems, and irritability, all of which are behaviours that are common among teenagers. Other factors that may indicate schizophrenia in adolescents include isolating oneself and withdrawing from others, an increase in unusual thoughts and suspicions and a family history of psychosis (loss of touch with reality).

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Initial signs

The onset of schizophrenia can be abrupt. However most people undergo a “prodromal phase” characterised by a slow and gradual development of symptoms, including social withdrawal, loss of interest in school or work, deterioration in hygiene, becoming uncharacteristically unkempt, unusual behaviour, or outbursts of anger. Family members may assume that the person is just “going through a phase”, especially in the case of adolescents who are notorious for going through difficult phases. Often it is only after the appearance of classic symptoms associated with schizophrenia (e.g., psychosis such as delusions and hallucinations) that the diagnosis of schizophrenia is made.

Symptoms

The symptoms are classed as either positive or negative. Positive symptoms are abnormal mental functions while negative symptoms are best described as loss of normal mental functions. Positive and negative symptoms vary in intensity over time; people with schizophrenia display predominantly one type at any particular time.

Negative symptoms

Negative symptoms include loss of motivation (including loss of interest in social activities, mixing with people, loss of concentration and inability to complete activities you previously had no problem completing), loss of a sense of pleasure, slow movements, lack of facial expression and low or flat mood. The person may uncharacteristically neglect their appearance and look unkempt. The negative symptoms of schizophrenia are very similar to the symptoms of depression and can be misdiagnosed as depression.

Positive symptoms

Positive symptoms are psychotic behaviours not seen in healthy people; they cause people to temporarily lose touch with reality.

Delusions

These are false beliefs that are not part of the person’s culture and most people of the same culture would agree are not true. For example, the person may believe that aliens are coming to get them, that television is directing special messages to them or that people are plotting to kill them; the delusions can be anything, there is no set trend for the types of delusions a person may experience.

Hallucinations

This can include hearing, seeing, feeling, smelling, or tasting things that are not real. Hearing voices tends to be the most common type of hallucination. Some people with schizophrenia appear to talk to themselves as they respond to the voices. People with schizophrenia believe that the hallucinations are real.

Disordered thoughts

Thoughts become jumbled or blocked. Thought and speech may not follow a normal logical pattern. The person may make up meaningless words or “neologisms”. Types of thought disorder with schizophrenia include thought echo (person hears their thoughts as if they were being spoken aloud), knight's-move thinking (person moves from one train of thought to another that has no apparent connection to the first) and disorders of thought possession. Disorders of thought possession include thought insertion (when someone believes that their thoughts are being put there by someone else), thought withdrawal (when someone believes that their thoughts are being removed from their mind by an someone or something else), thought broadcasting (when someone believes that their thoughts are being read or heard by others) and thought blocking (when there is a sudden interruption of their train of thought meaning the person stops talking mid-sentence, the person often cannot recall what he or she has been saying).

Movement disorders

Movement disorders may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other extreme, a person may become catatonic. Catatonia is a state in which a person does not move and does not respond to others. Catatonia is rare today due to the availability of modern antipsychotic medication to prevent it.

To be continued …. next week I discuss treatment.

Disclaimer: This article is meant to give a general overview of the topic discussed; for more specific and detailed information, please speak to a health care professional

Whelehans Pharmacy, Pearse Street and Clonmore, Mullingar. Tel 04493 34591. Eamonn’s full comprehensive article on schizophrenia is available in Whelehans on request or check www.whelehans.ie. Simply ask our staff for a free copy. References are also available upon request