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SchizophreniaLea Nagy For the
Times-Standard 12/05/2006
Recently the Times-Standard headline read “seasonal schizophrenia” on the front page of the paper and I wondered what the weather had to do with this major mental illness. As it turns out the article did not discuss the diagnosis of the mental illness called schizophrenia but was focused more with weather patterns and changing temperatures. Comparing opposite poles in temperature from highs in the day to lows at night really did not relate to this disorder. I decided that it was time to help folks gain a better understanding of this mental illness. One seasonal aspect to the illness of schizophrenia is an article published in the New Scientist magazine where research suggests that people in Europe and North America who are more likely to be born in the winter and early spring (February and March in the northern hemisphere) could be more prone to developing the illness. In other words, the subjects who were born during these months had a slightly higher than average rate of schizophrenia, while subjects born in August and September had a slightly lower than average rate. There seems to be slightly more risk of schizophrenia between the high (winter and spring) and low risk months of birth. Research suggests that the birth months that have the lowest risk are July through October. Understanding schizophrenia is crucial for our community so they can be better prepared to offer support, gain empathy and understanding, and have compassion for those afflicted with this mental illness. According to NAMI (the National Alliance on Mental Illness) about 1 percent of the world's population today is diagnosed with this highly treatable brain disorder. However with medications, community services, and self care people with schizophrenia need less hospitalization and do recover to lead independent and productive lives. Left untreated, schizophrenia can be devastating, destroy lives, and lead to homelessness and poverty. Persons with schizophrenia can experience intense stigma, suffer loss of family and be trapped in their illusions. In the film “Out of the Shadow” which was previewed a couple of years ago at the NAMI Annual Conference in San Diego, the true story of Susan Smiley's mother Millie is told. The toil on the family was evident and the ongoing struggles of Millie involved everyone in the family and community. Schizophrenia is not caused by bad parenting or personal weakness, it doesn't mean a person has a split personality; rather it is a biological brain disorder. In fact the cause of this illness is not known, there seems to be a combination of problems, some factors could be due to heredity and other factors seem to occur during a person's development or even during prenatal development in the womb. Brain research shows changes in brain structure and chemistry and some of these changes may be present early in life. This mental illness interferes with a person's ability to think clearly, manage emotions, make decisions, and relate to others. People may see and hear things that are not there or believe things that are not true or real. There is no lab test or single symptom or one indicator of this illness, but rather a collection of symptoms over time (6 months or more) and can be diagnosed by a psychiatrist. There are three categories of symptoms which are: * Positive symptoms are symptoms which are added to a person, i.e. psychotic symptoms such as hallucinations or delusions of thought. The word positive here means symptoms that are added, not especially good to have. * Disorganized symptoms: symptoms of confused thinking confuse speech called word salad, unusual behavior such as people walking in slow ritualistic ways (walking in circles) or have trouble talking. They can be extra sensitive to color, shapes, and noise. * Negative symptoms: symptoms that are taken away or lacking such as emotional flatness, inability to start and follow directions, withdrawal, and isolation. This illness is tragic because it usually appears in early teens and twenties when young people are starting to succeed, attend college and build their lives. People also remember how they were before they became ill and they can grieve for what was. More men than women are diagnosed with this disease. Schizophrenia rarely occurs after the age of 40. So after all is said and done, what helps someone with this serious mental illness? Getting a correct diagnosis, early treatment, understanding, compassion, respect, and support is important. Encourage family and friends to call NAMI at 444-1600 and attend support groups. Encourage your loved one to seek treatment, stay on medications, get counseling, and seek an activity that helps them engage with others. Loved ones can learn all they can about the disorder by attending the NAMI Family to Family education classes that are free in our county. They can help their loved ones learn as much as they can about their own mental health issues and stay well. Stay calm, do not criticize, and know where to ask for help when you or your family member needs it. Be knowledgeable about the supports and services in the community and help your loved one get what they need. Remember it is not about you. It is about the illness, folks do not contract schizophrenia on purpose, nor do they choose to have hallucinations or delusions. We all need to understand this illness, offer support, and continue to improve the lives of those individuals who are on the path to recovery. NAMI meets the first Thursday of the month at 7 p.m. and the third Thursday of the month at 5:30 p.m. at 507 F St. in Eureka, Ca. Lea Nagy is mental health
liaison for Humboldt County.
Written with consultation by Dr. Kate Bell, medical director for Humboldt County Mental Health. Nov 30, 2006 PakTribune
A link between paternal age and schizophrenia has been reported before but scientists were not sure whether this was due to increasing mutations with advancing age or the result of inherited personality traits. To find out, researchers at the University of Wales College of Medicine in Cardiff and Gothenburg University in Sweden examined the medical records of 50,087 Swedish army conscripts recruited between 1969 and 1970. Their findings, reported in the British Journal of Psychiatry, show that 362 of the former soldiers had been diagnosed with schizophrenia by 1996. Their fathers` ages varied between 19 and 65. In a control group of men without schizophrenia, the fathers` ages ranged from 15 to 75. The study found that the odds of developing schizophrenia increased by 30 percent for each 10-year increase in paternal age. Adjusting for poor social integration had only a minimal effect on the findings, suggesting personality traits were not a major factor. "This supports the hypothesis that accumulating germ cell mutations may lead to an increase in genetic liability to schizophrenia in the offspring," Dr Stanley Zammit, from the University of Wales, said. Schizophrenia can be a devastating mental illness but with the right care and treatment there is now a real chance of recovery for most people. The first signs of schizophrenia typically emerge in adolescence or young adulthood. The effects of the illness are confusing and often distressing to families and friends. People with schizophrenia suffer from difficulties in their thought processes, which lead to hallucinations, delusions, disordered thinking, and unusual speech or behaviour. All these symptoms mean that people affected with the illness find it difficult to interact with other people, and may withdraw from the outside world. People with schizophrenia clearly suffer great disruption to their lives. However, families and friends may also be deeply affected, due not only to the distress of seeing the effects of the condition, but also to the difficulties associated with supporting the patient. Coping with the symptoms of schizophrenia can be especially difficult for family members who remember how active or lively a person was before they became ill. A complex illness Schizophrenia is a complex illness, which is thought to be due to a number of different factors acting together. These factors seem to include genetic influences, trauma (injury) to the brain occurring at or around the time of birth, together with the effects of social isolation and/or stress. Other effects may also be important, but no one factor can be said to be the cause of schizophrenia. Rather, each of these factors is thought to increase the risk that a person may develop symptoms. Schizophrenia affects between 1% and 2% of people during their lifetime. Schizophrenia is found all over the world, and rates of illness are very similar from country to country. Schizophrenia is the single most destructive disease to young people. Men and women are at equal risk of developing the illness. Whereas most males become ill between 16 and 25 years old, most females develop symptoms between ages 25 and 30. Medications and other treatments for schizophrenia, when used regularly and as prescribed, can help reduce and control the distressing symptoms of the illness. However, some people are not greatly helped by available treatments, or may discontinue treatment because of unpleasant side effects or other reasons. Even when treatment is effective, some people find difficulty in regaining the life they had and require other forms of help. However, some people only have one or two episodes and are left with little or no residual illness. When a person develops symptoms of schizophrenia, they are likely to experience distortions of reality, such as hallucinations and delusions. They may also experience less dramatic symptoms which are related to a ‘loss of experience’. Hallucinations Hallucinations are things that are heard, seen, felt or even smelled or tasted that don’t seem to come from anything ‘real’. Although hallucinations can occur in any sensory form, hearing voices that other people do not hear is the most common type of hallucination in schizophrenia. Voices are usually thoughts that are in the mind of the person and they can take different forms, perhaps loud and frightening or a commentary at normal volume. The thoughts can appear to be so loud that the person may believe that people nearby will also be able to hear them. In order to make sense of hearing these things, the mind will often make the person believe the voices are in fact coming from somewhere outside. Delusions Delusions are strange beliefs that are not based on reality, and are not explained by a person's usual cultural beliefs, such as religious. Delusions may take on different themes. For example, people suffering from paranoid-type symptoms (roughly 1/3 of people with schizophrenia) often have delusions that they are persecuted or plotted against, or false and irrational beliefs that they are being cheated, harassed, poisoned or conspired against. These people often believe that a member of their family or someone close to them is making them happen. Delusions of grandeur, in which a person believes he or she is a famous or important person, may also occur in schizophrenia. Sometimes the delusions experienced by people with schizophrenia are quite bizarre; for instance, believing that a neighbour is controlling their behaviour with magnetic waves; that people on television are directing special messages to them; or that their thoughts are being broadcast aloud to others. A person experiencing delusions may try to keep them secret, knowing that others would not understand. Other individuals are gradually overwhelmed and begin to act strangely according to the content of the delusional explanations. Behaviour change In some cases, especially with hindsight, families may realise that their relative's behaviour has been changing over a period of time in subtle ways. They may for instance have become slower to think, talk and move, and may have become indifferent to social contact, their sleeping patterns may have changed so that they are happy to remain up all night and sleep all day. Body language may also be affected. These are the so-called 'negative symptoms' and they will affect the person in a different way from positive symptoms. The overall result is a reduction of motivation, and the extent of this can vary from minor to severe. Negative symptoms are much less dramatic than positive, but they tend to be more persistent. Recognising these changes can be particularly difficult if the illness develops during teenage years when it is quite acceptable for changes in behaviour to occur, particularly where the young person is experimenting with new freedoms and lifestyles These are often described in two groups - positive and negative. "Positive" symptoms These unusual experiences are most common in schizophrenia, but can occur in other mental disorders. Hallucinations A hallucination happens when you hear, smell, feel or see something - but there isn't anything (or anybody) actually there to account for it. In schizophrenia, the commonest hallucination is that of hearing voices. What's it like to hear voices? They sound utterly real. They seem to be coming from outside you, although other people can't hear them. You may hear them in different places or you may hear them coming from a particular object, such as a television. The voices may talk to you directly, or they may talk to each other about you. It can sound as if you are over-hearing a conversation. Voices can be pleasant but are often rude, critical, abusive or just plain irritating. How do people react to them? Sometimes you may feel that you have to do what they say, even if they are telling you to harm yourself or to do something you know is wrong. Much of the time you can ignore them. Sometimes they will get you down. Where do they come from? Voices are not imaginary, but they are created by the mind. Brain scans have shown that the part of the brain that is active when someone hears voices is the part that is active when they are talking, or forming words in their mind. It is as though the brain mistakes your own thoughts for real voices coming from our surroundings. Do other people hear voices? People with other mental disorders, such as severe depression, may also hear voices that talk directly to them. In depression, these voices are critical and repeat the same word or phrase over and over again. Some people hear voices which do not interfere with their daily life. They may be pleasant, or not very loud, or only happen from time to time. These do not usually need any kind of treatment. Other kinds of hallucination Visions and hallucinations of smell, taste or being touched can also happen, but these are less common. Delusions A delusion is a belief that you hold with complete conviction, although it seems to be based on a misinterpretation or misunderstanding of situations or events. While you have no doubts, other people see your belief as mistaken, strange or unrealistic. They find that they can't really discuss this belief with you. If they ask you why you believe it, your reasons don't make sense to them, or you can't explain it - you "just know". How does it start? You may suddenly start to believe it. This may follow a few weeks or months when you have felt that there has been something strange going on, but that you couldn't explain what it was. You develop a delusional idea as a way of explaining hallucinations that you are having. For example, if you have been hearing voices commenting on your actions, you may decide that you are being monitored by some government agency. Paranoid delusions These are delusional ideas that make you feel persecuted or harassed. They may be: - unusual - you may feel that MI5 or the government is spying on you. You may believe that you are being influenced by neighbours who are using special powers or technology. - everyday - you may start to believe your partner is unfaithful. You do so because of odd details that seem to have nothing to do with sex or infidelity. Other people can see nothing to suggest that this is true. Delusions of persecution are obviously distressing for you. They can also be upsetting for the people you see as your persecutors, especially if they are close to you, like your family. Ideas of reference You start to see special meanings in ordinary, day-to-day events and believe that they are specially connected to you. For example, that radio or TV programmes are about you, or that people are communicating with you in odd ways, such as through the colours of cars passing in the street. Coping with delusions
When your ideas are disconnected in this way, it can be hard for other people to understand you. Feelings of being controlled You may feel that:
Some people have technological explanations, such as the radio, television or laser beams, or believe that a device has been implanted in them. Other people may blame witchcraft, angry spirits, God or the Devil. "Negative" symptoms These are less obvious than positive symptoms.
Negative symptoms are much less dramatic than positive symptoms, but they can be just as troublesome. Does everyone with schizophrenia have all these symptoms? No. Someone can hear voices without negative symptoms, but may not have thought disorder. Some people with delusional ideas seem to have very few negative symptoms. If someone only has thought disorder and negative symptoms, the problem may not be recognised for years. Loss of insight After a while, the symptoms can be so intense that they take over your life. It can feel as though everyone else is wrong, that they just can't understand what you can. Depression Before help or treatment, around half of those having schizophrenia for the first time will feel depressed. Around 1 in 7 people with continuing symptoms will have depression. This may not be recognised because the signs can be mistaken for negative symptoms. Although antipsychotic medication has been blamed for this in the past, it seems that treatment with medication actually reduces depression in schizophrenia. If you have schizophrenia and feel depressed, make sure that you tell someone and that they take you seriously. What causes schizophrenia? We don't yet know for sure. It is likely to be a combination of several different factors which will be different for different people. Genes 1 in 10 people with schizophrenia have a parent with the illness. Studies of twins can help to show how much is due to genes and how much to upbringing. Identical twins have exactly the same genetic make-up as each other, down to the last molecule of DNA. If one identical twin has schizophrenia, their twin has about a 50:50 chance of having it too. Non-identical twins don't have the same genetic make-up as each other. If one of them has schizophrenia, the risk to the other twin is just slightly more than for any other brother or sister. These findings hold true even if twins are adopted and brought up in different families. This suggests that the difference is truly due to genes rather than upbringing.
Research suggests that genes account for about half of the risk of developing schizophrenia. We don't yet know the combination of genes responsible for this. Brain damage Modern brain scans show that, compared with people who don't suffer from the illness, there are differences in the brains of some people with schizophrenia. For some people with schizophrenia, parts of their brain may not have developed normally, because of:
Cannabis (hash, marijuana, pot, ganja, skunk, dope, spliffs, joints)
Difficulties often seem to happen shortly before symptoms get worse. This may be a sudden event like a car accident, bereavement or moving home. It can be an everyday problem, such as difficulty with work or studies. Long-term stress, such as family tensions, can also make it worse. Family problems At one time, it was thought that schizophrenia was caused by communication problems within the family. There is no evidence to support this idea. However, , family tensions can worsen schizophrenia. Childhood deprivation There is some evidence that, as with other mental disorders, early experiences of deprivation and abuse can make it more likely that you will develop schizophrenia. Medical treatments Most people with schizophrenia are prescribed drugs, which seek to reduce the positive symptoms. The drugs used for schizophrenia are antipsychotics or neuroleptics (major tranquillizers). The two major groups of antipsychotics are typical and atypical antipsychotics. Antipsychotic drugs can take between one and three months to take effect. The typical antipsychotics are taken as tablets or syrup. Some are available as longer-lasting depo injections. Antipsychotics can have a range of side effects. These can be unpleasant. The most severe include muscle spasms, unusual body movements and acute movement disorders. The side effects of atypical antipsychotics are milder than typical antipsychotics, but they are more expensive. Non-drug treatments Talking therapies such as counselling and psychotherapy may be helpful for both people with schizophrenia and their families. These talking treatments are mostly used alongside drug treatment for people with schizophrenia. Support and self-help groups can also help.Cognitive behavioural therapy (CBT) has been used successfully for the symptoms of schizophrenia such as delusions or hallucinations. There is some evidence that alternative therapies including exercise, art/music therapy changing diet/nutrition, homeopathy and herbal remedies have been found helpful in people with schizophrenia. Sometimes, people in an acute phase of the illness may need to be admitted to hospital under the Mental Health Act for assessment and/or treatment without consent. This is called sectioning. In many cases the person with schizophrenia will admit themselves to hospital if necessary, however most people with schizophrenia live in the community and many only see their doctor when they need a prescription. Many people with schizophrenia now carry Crisis Cards or set up Advance Directives, which make their treatment wishes known if they have to be admitted to hospital. Cognitive Behavioural Therapy (CBT) This may be done by clinical psychologists, psychiatrists or nurse therapists. The therapist helps you to:
Counselling and supportive psychotherapy These don't directly affect the symptoms of schizophrenia, but may be helpful if:
This is not to do with trying to find reasons for the schizophrenia. Family meetings are designed to help you and your family cope better with the situation. They can be used to discuss information about schizophrenia, ways to support someone with schizophrenia, and how to solve practical problems that may be caused by the symptoms of the illness. Around ten meetings are needed over a period of about 6 months. Cognitive remediation This is being researched and is not yet widely available. It is a kind of "mental gym" that has shown some promise in helping to improve memory, and concentration in people with schizophrenia. Why take medication? The aim is to reduce the effects of the symptoms on your life. Medication should:
Medication for schizophrenia comes as tablets, capsules, or syrup. It's hard for anybody to remember to take tablets several times a day, so there are now some that you only need to take once a day. If you find it hard to take tablets every day, you may find it easier to take antipsychotic medication as an injection. This is called a 'depot injection' and is given at weekly or every 2,3 or 4 weeks. Most of the depot injections are older, "typical" antipsychotics, but one of the atypicals, Risperidone, is now available in this form. "Typical" antipsychotics In the mid-1950s, several medications appeared that could reduce the symptoms of schizophrenia. They became known as "antipsychotic" medications. These older drugs are called "typical"or "first-generation" antipsychotics. They work by reducing the action of a particular chemical messenger in the brain called dopamine. Side-effects Stiffness and shakiness, like Parkinson's disease, along with feeling sluggish and slow in your thinking. In most cases, this will mean that you are taking too much of the medication. It should be reduced to a level at which these symptoms disappear. If you need higher doses, these side-effects can be controlled with anti-Parkinsonian medication.
Over the last 10 years, several newer medications have appeared. They work on a different range of chemical messengers in the brain (such as serotonin) and are called "atypical" or "second-generation" antipsychotics. They are less likely to cause Parkinsonian side-effects, although they may cause weight gain and problems with sexual function. They may also help the negative symptoms, on which the older drugs have very little effect. They also seem much less likely to produce tardive dyskinesia. Many people who use these newer medications have found the side-effects less troublesome than those of the older medications. Side Effects
These medications work well for many people - about 4 in 5 people get help from them. They control the disorder, but do not cure it. You have to go on taking the medication to prevent the symptoms returning. Even if the medication helps, the symptoms may come back. This is much less likely to happen if you carry on taking medication, even when you feel well. How long will I have to take medication for? Most psychiatrists will suggest that you take medication for a long time. If you want to reduce or stop your medication, discuss this with your doctor. You should usually reduce your medication gradually so you can notice any symptoms returning, before you become unwell again. What happens if you stop your medication? If you stop taking the tablets, the symptoms of schizophrenia will usually come back - not immediately, but often within 6 months. Getting back to normal What happens after your positive symptoms have been controlled? Schizophrenia can make it difficult to deal with the demands of everyday life. Sometimes, this is because of the symptoms. Sometimes, the illness may have gone on for so long that you may just have got out of the habit of doing things for yourself. It can be difficult to get back to doing ordinary things, like washing, answering the door, shopping, making a phone call or chatting with a friend. Is medication enough? Medication is very useful. However, even if you are taking medication, you will usually need to use other types of help to give yourself the best chance of a good recovery. Outlook Many people with schizophrenia now never have to go into hospital and are able to settle down, work and have lasting relationships. In the long term: For every 5 people who develop schizophrenia: 1 in 5 will get better within five years of their first episode of schizophrenia. 3 in 5 will get better, but will still have some symptoms. They will have times when their symptoms get worse. 1 in 5 will continue to have troublesome symptoms Myths Isn't schizophrenia a split personality? No. Too many people have the idea that someone with schizophrenia can appear perfectly normal at one moment, and change into a different person the next. This is nonsense. We misuse the word schizophrenia in two different ways. By it, we may mean 'having mixed or contradictory feelings about something'. This is just part of human nature - a much better word is "ambivalent". Just as commonly, we may mean that someone behaves in very different ways at different times. Again, this is part of human nature. Doesn't schizophrenia make people dangerous? People who have schizophrenia are rarely dangerous. Any violent behaviour is usually sparked off by street drugs or alcohol, which is similar to people who don't suffer from schizophrenia. Although there is a higher risk of violent behaviour if you have schizophrenia, it is almost insignificant compared to the effects of drugs and alcohol in our society. If we stopped all the violence caused by schizophrenia, we would only succeed in preventing 1% of all the violence in society. People with schizophrenia are far more likely to be harmed by other people, than other people are to be harmed by them. Schizophrenia never gets better 1 in 5 people with schizophrenia recover completely. Contacts Rethink National Advice Service Rethink severe mental illness (formerly National Schizophrenia Fellowship) is the leading charity with information on schizophrenia. We run day services, support services, respite care, advice and help lines, and courses for both people with mental illness and their carers. We are also involved in campaigning and challenging stigma. Tel: 0208 974 6814 Email: advice@rethink.org Address: 28 Castle Street, Kingston-upon-Thames, Surrey, KT1 1SS Schizophrenia Association of Great Britain The Schizophrenia Association of Great Britain provides information primarily on schizophrenia and nutritional treatments of symptoms. Tel: 01248 354048 Email: info@sagb.co.uk Address: "Bryn Hyfryd", The Crescent, Bangor, Gwynedd, LL57 2AG SANE 1st Floor Cityside House 40 Adler Street London, E1 1EE National helpline: 0845 767 8000 (noon to 2am - seven days a week) See also Biological clocks Neuro-linguistic programming Mental Health day the news The wakey wakey pill Cannabis - a victim of politics Autism To be or not to be |
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