Schizophrenia
mental; illness; psychosis; schizophrenia; mad; insane; delusions; hallucinations; thoughts;
Contents
Schizophrenia is the name given to a mental illness that affects about one person in every hundred in all cultures. Schizophrenia interferes with the way a person thinks and acts. In the long term it may change a person's personality.
While the term schizophrenia literally means 'split mind' or 'split personality', the mental illness called schizophrenia is not about having a split mind.
Alert!
If someone who has schizophrenia is very distressed, frightened or angry, call the Mental Health Emergency Crisis Number, which is near the front of your local phone book. In South Australia that number is 13 14 65.
What are the symptoms of schizophrenia?
Some people with schizophrenia have major changes in their thinking and behaviour which can last for a long time, while other people may have fewer changes for a shorter time. Between the episodes of disordered thinking the person will have normal times.
The main symptoms of schizophrenia include:
- Thought disorder: Thoughts and speech can be very jumbled, jumping from one topic to another without any obvious link. It can be very difficult to talk with a person who has schizophrenia.
- Delusions: These are false beliefs of being persecuted, or of guilt, or of being very powerful. Some people may think they are being controlled by others, or that they have special powers. Some feel so afraid of others that they withdraw or hide to keep themselves feeling safe.
- Hallucinations: This most commonly involves hearing voices which the person thinks are criticising them or telling them what to do. Some people have hallucinations affecting what they see or feel or smell. To the person having the hallucination, these seem real.
While the person has these changed thought patterns, their illness can be called an 'acute psychosis'. Treatment with medication will usually reduce these psychotic symptoms.
Other symptoms of schizophrenia include:
- Loss of drive: The person doesn't feel able to do the normal tasks of living, including washing, cooking, or changing clothes. This is because of the illness, not because the person is lazy.
- Changes in the way they show emotions: They may not show happiness or sadness when it seems those feelings fit a situation.
- Social withdrawal: This may be due to fear that someone will harm them, or fear that they will not be able to interact well with others because they have lost social skills.
- Lack of insight: Because delusions and hallucinations seem so real, people with schizophrenia can be unaware that they are ill. This, plus the side effects of medication may mean they refuse to take medication.
- Thinking difficulties: Their concentration, memory, ability to plan and organise may be affected, making it harder to work things out, communicate and complete tasks.
What causes schizophrenia?
No single cause of schizophrenia has been found, but several things seem to be involved either to make a person more likely to develop schizophrenia, or to trigger (start off) an episode of the illness.
Genetic factors
Genetic factors (things that run in families) make a person more likely to develop schizophrenia. In the whole population the risk of getting schizophrenia is about one in a hundred (99% of people do not get it). If someone in the family has schizophrenia, the risk of getting it is higher. If a parent has schizophrenia, the children have a risk of about 10% of getting it (about 90% do not).
It seems that many changes within the genes are needed for a person to be at risk of getting schizophrenia. It is not a simple inheritance pattern like colour blindness.
Biochemical factors
There appears to be a change in the balance of some of the chemicals (such as dopamine) used in the brain to pass messages from one cell to another. This change in chemical action is probably due to the genetic differences.
Family relationships
There is no evidence that family relationships cause schizophrenia, but if there is tension in the family, people with schizophrenia seem very sensitive to the tension, and this sensitivity to tension may be the 'trigger' that sets off an episode of illness.
Environment
Stressful experiences often happen before a person first shows signs of schizophrenia. It seems that stressful things can trigger the first signs of the illness in vulnerable people. They may become irritable, anxious and unable to concentrate for a while before they have the first major symptoms. This behaviour can damage relationships, possibly leading to a marriage breakdown or loss of a job. This event may then be blamed for the illness when it was the illness that triggered the crisis. It is difficult to work out whether a stress caused the illness or is the result of the illness.
Drug use
It seems that using some drugs, such as methamphetamine ('speed' or 'ice', ecstasy, cannabis or LSD, might trigger an episode of schizophrenia in vulnerable people. If there is a family history of schizophrenia, it would be best to avoid using these drugs.
When does schizophrenia happen?
- Most people who have schizophrenia have their first episode of illness when they are adolescents or young adults (between 15 and 30 years old). It can start later in life, but this is unusual.
- The illness can come on suddenly, but often, before people have their first episode of illness, changes in their behaviour will have been noticed, such as irritability, depression, isolation (loss of friendships), or not managing study or work well. Many young people have behaviour like this, and do not get ill, but if this behaviour happens much of the time, and gets worse rather than better it should be more of a concern.
- The onset of illness can be triggered by use of drugs such as ice, ecstacy, marijuana or LSD. Sometimes the illness can be hidden because drugs are thought to be the cause of the unusual behaviour.
How long does it last?
- Often when a person is started on treatment (medication), the agitation (irritability, anxiety, fear) can settle down quickly (in a few hours to a few days), however the main symptoms of schizophrenia may take days or weeks to settle. It is important to be patient and wait for the drug to have its effect.
- Some people (about 25%) have one illness with schizophrenia, and then fully recover and do not have it again.
- About 50% of people with schizophrenia have some ongoing problems, often with relationships, lack of drive, or depression. About 20 to 30% do not get better with treatment.
- Relapses can occur even while taking the treatment, especially under stress.
- Most of the changes in behaviour and disability from schizophrenia begin within the first 2 to 5 years.
Treatment for schizophrenia
There is no cure for schizophrenia, but for many people with schizophrenia, their illness responds well to treatment. The most effective treatment for schizophrenia is a combination of medication, psychological counselling and help to manage the impact of the illness on everyday life.
Medication
- The development of medications that treat schizophrenia have meant a major change in the lives of people with schizophrenia. Most people need to go to hospital when they have the first episode of psychosis, but with medication and support they are usually able to go home and continue to live within their community.
- The medications work by correcting the imbalance in chemicals within the brain. The medications that have been used in the past often caused side effects that were unpleasant (like affecting how freely a person could move), but newer medications are more effective than the older ones, and they have fewer side effects.
- For most people who have one episode of schizophrenia, it is recommended that they stay on medication for a long time (usually more than a year or two). Those who have two or more episodes are advised to continue on medication for at least 5 years.
Counselling and support
- This can be helpful for problems with finances, accommodation, work, interaction with others and loneliness. A rehabilitation plan which supports the person to re-establish relationships and to use local resources is important, but will only work if the person is able to be committed to its goals. The illness can affect insight, drive and social skills and make this hard.
Family involvement
Much of the care for people with schizophrenia has to be provided by the person's family, and this can be very stressful for family members.
- They may fear that others in the family might get the illness.
- They may feel shame because of the stigma of a mental illness on the person and the family.
- They may also have to cope with the stress of living with a person who will not take medication even when he or she is clearly unwell.
Myths about schizophrenia
People with schizophrenia do not have a split personality
- There is actually no such thing as a split personality. Schizophrenia means that the person's thoughts become disordered and this can be confusing, but this is not a split personality!
People with schizophrenia do not have an intellectual disability
- Schizophrenia is not an intellectual disability, it is a mental illness.
People with schizophrenia are not dangerous
- When people with schizophrenia are receiving appropriate medication they are mostly not dangerous.
- Some people become aggressive when they experience an acute episode, usually as a response to their extreme fear and confusion about what is happening to them.
- Some people will not take their medication because it affects how they feel, and they may be angry if they feel that someone is forcing them to take medication.
People with schizophrenia are not addicted to their medication
- Medication helps people with schizophrenia by reducing the number and intensity of the symptoms, as well as decreasing the likelihood of having a relapse. Therefore it is necessary to stay on the medication to stay well – not because it is addictive but because it is needed.
Problems caused by schizophrenia
- More than 70% of people with schizophrenia become depressed during their illness (this is not surprising as it causes major changes in their life and their plans).
- About 10 to 15% of people with schizophrenia commit suicide.
- Use of legal substances (such as alcohol and cigarettes) and of illegal substances (such as ice, marijuana and ecstasy) is high, and often people with schizophrenia do not take good care of their health and nutrition.
- During an acute illness with schizophrenia, which might be as a result of not taking the needed medication, some people become terrified of others (including their family) and may become angry and violent in their attempt to keep themselves 'safe'.
Seeking help
- When a person has his first psychotic episode, there can be a long time between starting to show changes in behaviour and being diagnosed with the illness, possibly up to a year.
- Friends and family may need to seek help for him, as someone with schizophrenia does not understand that his feelings are caused by an illness. He may blame the people who are trying to support him for making him feel confused.
- Early diagnosis seems to reduce the length of time that a person is unwell from schizophrenia and the severity of the illness, so if family or friends can encourage a person to seek help early, this can be useful. Do not delay seeking help in the hope that in time the problem will just go away naturally.
- If someone seems to be at high risk of harming themself or someone else, it may be necessary to get help without that person's permission.
Resources
South Australia
- Child Adolescent Mental Health Service (CAMHS)
Northern Region 8161 7389
http://www.wch.sa.gov.au/services/az/...
Southern Region 8326 1234
http://www.flinders.sa.gov.au/mental_health
- The Second Story Youth Health Service (TSS)
- Central: 57 Hyde St, Adelaide
- South: 50a Beach Rd, Christies Beach
- North: 6 Gillingham Rd, Elizabeth
Contact TSS via the Youth Health line on 1300 13 17 19,
or for mobile phone callers (08) 8303 1691, normal rates apply.
- Mental Health Assessment Crisis Intervention Service (ACIS)
Emergency Crisis Service 13 14 65
- Mental Illness Fellowship of SA Incorporated
Consumers Line Ph: 8221 5160
http://www.mifsa.org.au/
- Women's Information Service (has up to date contacts in SA)
Ph: 8303 0590 Country Callers Freecall 1800 188 158
http://www.wis.sa.gov.au/
Australia
References
Auseinet: Australian Network for pomotion, prevention and early intervention for mental health
http://auseinet.flinders.edu.au/index.php
Medical Journal of Australia, Supplement - Early Intervention in Youth Mental Health Vol 187, 2007
Click here
For more information, see the Fact Sheet. 'Psychosis and Young People'. http://www.eppic.org.au/mhp/resources/downloads/fact_psychosis.pdf
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Youth Healthline on 1300 13 17 19 (local call cost from anywhere in South Australia).