A B C D E F G H I J K L M N O P R S T U V W

SCHIZOPHRENIA

What is Schizophrenia ?

Schizophrenia is a common condition affecting 1 in 100 people in Britain. It comprises a number of severe mental disorders, each with a variety of symptoms, and may occur suddenly or gradually. It typically affects young adults. Patients' thinking, feeling and perception is affected. They lose touch with reality and live in a world of their own. They are often described as having a flat personality and have a depressed mood. These are called the "negative" symptoms. They may show extremes of emotion, which are often inappropriate. Sudden interruptions in their train of thought or speech may occur. This makes it very difficult for other people to understand them. Consequently they tend to become isolated from society. They have difficulty in holding down a job. Hallucinations are common. These involve hearing voices that other people cannot hear. Sometimes the hallucinations are visual or may involve touch, taste or smell. They may believe that they are being watched, followed, or persecuted by people, groups or organizations (paranoia). These are the so-called "positive" symptoms of schizophrenia.

How does it Schizophrenia ?

The cause of schizophrenia is not known. There is some evidence to suggest that it may run in families. It may be partially caused by the family environment, e.g. giving a child confusing contradictory messages. There is however, little evidence for this. One in three sufferers are described as being previously shy or withdrawn. Many doctors feel that schizophrenia represents a chemical disturbance in the brain. In support of this theory is the fact that some drugs, such as LSD (acid) or amphetamines (speed), can cause symptoms similar to schizophrenia. In addition, it would explain how some of the new drugs help to reverse some of the symptoms.

Why does Schizophrenia occur ?

As the cause of schizophrenia is not known, it is impossible to say why the disorder happened. Schizophrenia is characterized by ups and downs. These downs may be brought on by stressful life events, insomnia or by stopping medication.

Treatment involved for Schizophrenia

The management of this condition involves the family, the GP and his team, as well as the psychiatrist and community psychiatric nurse. In the acute episode, hospital admission may be necessary. Drugs are the mainstay of treatment. However, this should not detract from the importance of support, patience and understanding that health workers and family must give. This is important if a trusting and caring relationship is to be established with the sufferer. The main group of drugs used are the phenothiazines. These are thought to work by blocking the release of a chemical substance from nerve cells. The commonly used oral drugs from this group are chlorpromazine and trifluperazine. These drugs often have to be taken three times a day. Newer drugs have become available and are being increasingly used, as they have fewer side-effects, e.g. pimozide and sulpiride. For very severe cases, not responding to drugs, electroconvulsive therapy (ECT) may be used. Sufferers from schizophrenia often fail to take their medication regularly and consequently may relapse. Therefore long-acting drugs, such as fluphenazine and flupenthixol, have been developed to overcome this problem. They are given by injection which is slowly released from the site of the injection over a period of 2 to 3 weeks. The injection then has to be repeated. Treatment is kept going until the patient is better and then may continue for some months after. This treatment is usually supervised by a community psychiatric nurse (CPN) attached to a hospital or health centre. After such an improvement, attempts will be made to prevent further recurrence by encouraging the sufferer to attend a day hospital or centre. Here they will receive help from a variety of health workers designed to rehabilitate the sufferer.

During treatment for Schizophrenia

Side-effects from the treatment with phenothiazine drugs are unfortunately quite common. Trembling, restlessness and uncontrollable movements can occur. These resemble the symptoms of Parkinson's disease. Sometimes severe muscle spasms or cramps can occur. These are controlled and prevented by a different class of drug called anticholinergic drugs, because they reduce the action of a substance in the brain called acetylcholine. The commonest drug used in this group is procyclidine, which may be taken by mouth or by injection. It is usually given with the phenothiazine drugs. (These anticholinergic drugs can also cause side-effects such as dryness of the mouth and blurring of vision.) Other side-effects of phenothiazine drugs are drowsiness and sedation. Alcohol may aggravate this and therefore it is better avoided with these drugs. People who have been taking the phenothiazine drugs over a long period of time are prone to a condition called tardive dyskinesia. This is a disorder of movement which may appear after years of treatment. The symptoms include champing of the jaw and unintentional movements of the tongue and face.

If Schizophrenia is left untreated

Untreated, the sufferer will find himself distanced from his family and carers. He will find it increasingly difficult either to cope with reality or to manage in society. Following a first episode, almost half will recover completely and have no further attacks in the next 5 years. Because of the unwanted side-effects, drug treatment is kept to a minimum and the benefits balanced against the side-effects. Recent research has shown that an earlier diagnosis and earlier treatment results in a better long term outlook.

Effects on the family of Schizophrenia

Schizophrenia is a distressing condition for the family and friends of sufferers. A great deal of patience, understanding and encouragement needs to be shown to the sufferer, who may be unpredictable and have difficulty communicating. At times, the stress may become too much for the family carers who will themselves need support.