schizophrenia

Let’s talk about schizophrenia

Your Health
DR GITA MATHAI

People sometimes change inexplicably in their late teens – they behave bizarrely, argue unnecessarily with everyone, imagine events, become suspicious or withdraw into a shell. This is actually a disease called schizophrenia and these forms are classic, delusional, paranoid and catanonic. The word itself means "split mind " in Greek as it was confused with a multiple personality disorder by earlier physicians. Today, these two illnesses are classified separately.

Schizophrenia is a serious mental illness that is likely to affect one in 100 men and women (0.5-0.7 per cent respectively). It strikes people usually in their late teens and twenties. It is rare for schizophrenia to set in after the age of 40 and children are rarely diagnosed with it. They can, however, go on to develop it as adults if they have some other mental illness such as autism.

The onset of schizophrenia is so gradual that it mostly goes unrecognised and untreated, especially in developing countries with inadequate healthcare. In addition, people baulk at the idea of admitting they or a loved one is suffering from schizophrenia though no one has a problem saying they have an incurable chronic illness like diabetes or hypertension.

Schizophrenic patients may be delusional or hallucinate — that is see and hear things that are not real. Their speech may be disconnected, dressing and behaviour may be socially inappropriate and they may cry and laugh for no reason at all. Sometimes the person may be “catatonic” or unresponsive to any external stimulus.

Unreasonable behaviour and a quarrelsome nature may affect relations with friends, family and colleagues. The person may be unable to keep a job. Insomnia and morning drowsiness affect efficiency. The appetite may be poor.

The diagnosis of schizophrenia is difficult as the symptoms evolve gradually over a period of months or years. It is often difficult to pinpoint the exact date at which the changes were noticeable. The symptoms should be present for a month for schizophrenia to be suspected and remain for six months for the diagnosis to be established. The patient or a caretaker can report the symptoms. They should be substantiated by evaluation by a qualified medical professional.

PET scans also do not strictly conform to normal parameters. The brains in schizophrenics have smaller temporal and frontal lobes. The levels and ratios of certain brain chemicals like serotonin, dopamine and glutamine are altered.

The exact reason for these behaviour altering brain changes is not known. However, seven per cent of persons with schizophrenia have a family member who suffers from a similar disease. Many have been born to mothers who suffered several viral illnesses during pregnancy. Environmental factors also play a role — the incidence of the disease increases in persons who are financially insecure or from dysfunctional families with a history of childhood abuse.

Schizophrenics tend to gain weight because their lifestyle is sedentary. Patients also have a predilection for addiction — to tobacco products, alcohol and drugs like cannabis. They are often unwilling to check the addictions to control lifestyle diseases like diabetes or hypertension. Also, they do not adhere to diet modifications or medications needed to keep their disease in check; so this shortens lifespan. They eventually die 10-15 years earlier than their peers. They are also 15 per cent more likely to commit suicide.

Gone are the days when schizophrenics were locked up, immersed in cold baths or given electrical shock therapy. Today there are a plethora of drugs that can be used singly or in combination to control the symptoms of schizophrenia and help the person function fairly normally. These drugs act by correcting the enzyme and chemical imbalances in the brain. Response to medication may be slow and this may be frustrating for the patient as well as caregivers but medication can be increased only gradually to optimal levels. Drugs, combinations and dosages have to be individualised and vary from person to person.

The side effects of medication are weight gain, menstrual irregularities and drowsiness. Some people become very stiff and have abnormal smacking movements or grimaces but doctors are able to tackle this with other medications.

Rehabilitation is important. Once the symptoms are controlled, patients can function in society and even hold down jobs. They need to be trained to handle money and in personal care and hygiene. Medication needs to be continued even when the symptoms have disappeared. The involvement of the whole family helps as the person is then more likely to follow medical treatment and less likely to relapse.

People often ask for a “miracle drug” — a single tablet to treat all diseases. The only universal ingredient to improve health in all diseases (even mental problems) is physical exercise. So go take a walk.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in