Co-author: Saanika Zanwar
Schizophrenia is a mental health disorder that affects thought, feelings and actions of an individual. Diagnosing this disorder requires understanding how one is affected through their daily life activities, social interactions and occupation (if present). While there are chances of relapse, with proper diagnosis and treatment, it is possible to recover from schizophrenia in an adaptive manner. Typically, the onset of schizophrenic behaviour is during one’s mid to late twenties, although it can also be noticed earlier or later usually up to mid-30s. In this article, we hope to shed some light on what schizophrenia looks like and its interventions.
What are the signs and symptoms to look out for?
There are 5 major signs of schizophrenia. Out of these at least two must be present in the individual:
Delusions. Beliefs an individual has that are resistant to change despite evidence disproving the belief. Some common examples include:
Delusions of persecution. Belief that someone or something is out to harm the individual
Delusions of reference. Belief that certain cues, environment, situations, gestures and more are directed to oneself, having personal meaning
Delusions of grandeur. Belief of being an important or famous figure or to having exceptional abilities or superpowers
Delusions of control. Belief that own thoughts and actions are controlled by someone alien
Nihilistic delusion. Belief of a catastrophe to occur
Hallucinations. Perceptive experiences that an individual has without any external instigation of events. They are vivid but involuntary. These can occur through all senses present but most common through visual and auditory in schizophrenia. For children, visual hallucinations are more common and essential to be identified away from fantasy play.
Disorganised speech. Trouble in concentrating and maintaining train of thought. Common signs include loose associations (shifting from topic to topic rapidly), perseveration (repetition of same phrases), neologisms (made-up words and phrases), clang (meaningless rhyming).
Disorganised or catatonic behaviour. Difficulty in performing daily activities with unpredictable emotional responses and lack of impulse control. Catatonic behaviour includes minimal to no reaction to surroundings.
Negative symptoms. Refers to the absence of certain behaviours noticed in a healthy individual. Quite significant and evident in schizophrenia. Two predominant ones include diminished emotional response and avolition. Diminished emotional response includes inexpressiveness, flat face, lack of eye contact. Avolition includes decrease in conducting self-motivated activities. Other negative symptoms include lack of social interactions, diminished speech and decreased ability to experience pleasure.
Significant impairments in work, lifestyle, self care and relationships. When looking at someone in their adolescence, this can also include academic functioning. The symptoms tend to stay active for one month continuously and these signs of disturbances last for at least 6 months in the different stages.
One thing to note is that these can vary from person to person in pattern and severity with potential to change over time.
Typically there are three stages to keep an eye out for:
Acute episode. Time period where the symptoms are fully present in an individual
Partial remission. Time period with an improvement after an episode where symptoms are only partially present in an individual
Full remission. Time period with an improvement after an episode where no disorder specific symptoms are present in an individual
Around 20% have suicidal ideation and even attempt suicide, typically with higher chances after a psychotic episode or hospital discharge.
It is important to recognise these stages in an individual as it helps understand what treatment would be helpful at that time period to manage the condition.
Causes of schizophrenia
Specific causes are unknown but a combination of genetic and environmental factors are to be present. Genetic factors play an important role as a contributor to determine risk of schizophrenia in an individual. At the same time, it is important to note that not all individuals with a genetic risk develop the disorder. Environmental factors act upon this and have the potential to enhance the risk of developing the disorder. One major factor is stress, at pregnancy and/or at a later stage of the development. Examples include exposure to a virus at prenatal stage or infancy, early parental loss or separation, abuse in childhood.
Treatment options to consider for schizophrenia
Medications: These help lower the symptoms by affecting neurotransmitters in the brain at the lowest possible dosage. However, it can take several weeks to notice improvements. Usually, individuals in the acute episodes stage are recommended to take medications to manage the symptoms.
Antipsychotics. There are first generation and second generation antipsychotics that alter brain chemistry to reduce the symptoms of schizophrenia like delusions, hallucinations and prevent them from recurring. Some are prescribed first generation antipsychotics as individuals react to them better. At the same time, it is important to note that antipsychotics have major neurological side effects that may or may not be reversible. Some examples of antipsychotics include Aripiprazole (Abilify), Asenapine (Saphris), Chlorpromazine, Fluphenazine, Haloperidol and more.
Long-acting injectable antipsychotics. usually given to the individual every two to four weeks in case the individual is not keen on medication. Helps with adherence to treatment.
Psychosocial interventions: Can be helpful for individuals in the full remission stage.
Individual therapy. Helps normalise thought patterns and cope with the stress of managing the disorder
Social skills training. Helps improve social communications and interactions and improves ability to participate in daily activities
Family therapy. Helps provide support to families dealing with schizophrenia
Vocational rehabilitation and supported employment. Helps with occupational training, to manage and keep jobs
Cognitive Behavioural Therapy: A therapy intervention that helps modify beliefs and behaviour that lead to negative emotions. A short-term problem focused treatment that provides coping skills, typically given once a week for 12-14 weeks. Based on research, it can be efficient for individuals in full remission or partial remission with a combination of medications.
Electroconvulsive Therapy: An intervention used when all other therapies and medications fail to help manage symptoms. It requires sending an electrical current to the brain to alter nervous system activity. The treatment involves weekly sessions for 4-6 weeks. With follow-up treatments, can reduce chances of relapses
Hospitalisation: In severe cases where no treatments or medications help, hospitalisation helps with safety, nutrition, sleep and hygiene.
Recovery from schizophrenia is possible. Recognising these symptoms in yourself or your loved ones can be frightening. But becoming aware of the symptoms and signs help for early interventions and diagnosis of the disorder to gain a better understanding of how to cope with it. This in turn can help manage symptoms, have a healthy lifestyle and work.