Sep 23, 2001 08:53 PM
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Having recently watched several films, where characters are portrayed as having Schizophrenia, I realise how real sufferers must feel at these misrepresentations. Having been a Clinical Nurse Manager in the Psychiatric field, working with this illness in both a hospital and community setting, I thought it may be helpful to dispel some of the myths.
Schizophrenia is a brain disease with concrete and specific symptoms, which are due to physical and biochemical changes in the brain. It is an illness which usually strikes young people in their prime(16-26), and is almost always controllable with medication. It is a Psychotic disorder characterised by disturbances in thought, perception, affect(mood), behaviour and communication, which lasts longer than six months.
Schizophrenia is NOT a split personality, nor a result of childhood trauma, bad parents or poverty. Nor is it the result of any actions or personal failure by the individual.
There are 5 different types of Schizophrenia:-
Simple; This is a very basic form of the illness which lack the symptoms of the the other forms. Many may go through life with this illness and are never diagnosed. They tend to be those who go through life with no ambitions or motivation, and many spend their lives on the streets drifting from place to place.
Hebephrenic(disorganised); This is the form of the illness that is mainly depicted in films. It is characterised by fragmented, delusional thoughts, disorganised behaviour and unusual mannerisms and facial expressions. The speech is often incoherant, peppered with made-up words which only have meaning to the individual. They often show regressive behaviour whereby they become a child again. Delusions and hallucinations are common, as is bizarre moods, lack of interest in pleasurable things and social withdrawal. There also appears to be a higher rate of drug abuse.
Catatonic; Symptoms here include motor disturbances(involuntary movements), stupor, negativism, rigidity, overexcitement and decreased sensitivity to painful stimulus. They are often unable to take care of personal needs.
Paranoid; Here delusional thoughts of persecution are frequent, as are grandiose delusions. This is where the Napoleons and Queen Victorias turn up. There is also a lot of anxiety and anger, which if mishandled can lead to violence and severe arguments.
Undifferentiated; This is where the individual may have symptoms of more than one of the above subtype.
Residual; This is when the prominent symptoms of schizophrenia have abated, but some features, such as hallucinations and flat mood may remain.
Even in this modern age with all the hi-tec medical advances, the actual cause of schizophrenia is still unknown, although some aspects are becoming clearer.
BIOCHEMISTRY.
People with schizophrenia appear to have a neurochemical imbalance in the neurotransmitters that allow communication between brain cells. Treatment via antipsychotic and the new(atypical) antipsychotic drugs are used to target 3 neurotransmitter systems in the brain. These are dopamine, serotonin and norepinephrine.
CEREBRAL BLOOD FLOW.
With the aid of modern brain scans, it has been found that people with schizophrenia have difficulties in coordinating activities in different areas of the brain. eg. Most people transfer activity to a specific area of the brain to perform certain functions causing other areas to become less active. In schizophrenia it has been found that the reaction of the brain is the same as the normal brain, but the other areas which should become less active, do not.
Oh dear, this is sounding very complicated now! Still I'm sure you know what I am saying. I hope.
Researchers have also been able to identify specific areas of unusual activity in the brain during hallucinations.
MOLECULAR BIOLOGY.
It has also been found that people with schizophrenia have an irregular pattern of certain brain cells. Now since these cells are formed long before a baby is born, there is speculation that this irregularity may point to a possible'cause' of the illness in the prenatal period.
QUANTUM PHYSICS.
Only joking!
Stress, alcohol and certain drugs do not cause schizophrenia, but can trigger the onset, or make symptoms worse in those who have the illness.
When someone is initially diagnosed as having schizophrenia, they usually find it very hard to believe. We are all programmed from an early age to accept that if someone is deemed crazy or insane, they are outcasts to be laughed at and are worthless to society. But even here, the concept of the diagnosed schizophrenic not wishing to be seen as crazy, is not as simple as it seems. Schizophrenia comes under the heading of a Psychotic illness, and this is where the problem lies.
There are two basic forms of mental illness; neurosis and psychosis.
Neurosis is a less severe form of mental illness, where although the sufferer has some'mental' symptoms, they know there is something wrong with them, and are more likely to seek out medical help, with resulting treatment.( anxiety, depression}
Psychosis is a more severe form of mental illness, where although you know something is happening to you, you believe it is due to a real or mystical experience which no-one can understand but you. They will not accept there is anything mentally wrong with them, and so will not seek, or readily accept medical help.
Therefore most schizophrenics will initially deny they have the condition, and in fact some deny it their whole lives. Others, when going through a good phase, will admit to having the illness, but here again, many just say this without really believing it. It is very difficult to admit to yourself that your mind does not function properly, especially when you perceive the things that are happening to you as real. So therefore, if you do not accept you have a disorder, how can it be helped? How can you be cured of something you don't believe you have?
This is where early diagnosis is vital, so that support and education, especially for the sufferers family and friends who will hopefully help them through it, can begin.
A quick mention of treatment.
In the past, the main treatment for the illness was antipsychotic drugs, with courses of ECT for the more severe cases.(Actually some of the treatments in the past were even more severe than ECT, but I won't go there).
These drugs included Thioridazine, Flupenthixol, Fluphenazine, Chlormpromazine, Pimozide and Haloperidol. The main side-effects being extrapyramidal(movement disorders), shaking, stiff limbs and loss of control of muscles. Like all side-effects, some are more prone to these than others, and many of these drugs are still in use with good results.
There is now a new family of drugs on the market known as New(Atypical)Antipsychotics. These include Risperidone, Quetiapine, Amisulpride, Sertindole, Olanzapine, Ziprasidone and Zotepine. The side-effect here may be weight gain, excess salivation, increased temperature and sedation.
There is also the Depot Injection of course. A depot injection is a slow release version of whichever drug you have been prescribed, which only need be administered every one or two months. These are suitable for those who are not likely to continue or remember to take their medication when in the community.
On the whole, treatment is not something I feel I should or can deal with here. This is best left to the professionals who know the individual case, diagnosis and person. What is the best treatment for one person may not be so for another. Schizophrenia, like any other illness, does not fit neatly into a single box, and many factors should be taken into consideration when treating the individual.
