What you need to know about schizophrenia

**Schizophrenia can affect anyone from all races and cultures**. [iStockphoto]

Schizophrenia is a chronic, severe mental disorder that affects the way a person thinks, acts, perceives reality and relates to others. Schizophrenia involves psychosis, a type of mental illness in which a person cannot tell what is real from what is imagined. At times, people with psychotic disorders lose touch with reality.

Dr Sarah Kanana Kiburi, Consultant Psychiatrist at Aga Khan University Hospital Nairobi gives insights about this condition, presentation, causes and management.

What are the symptoms?

This condition is characterized by delusions, which are false, and sometimes strange beliefs that are not based on reality and that the person refuses to give up, even when shown the facts.

They also suffer from hallucinations, that is things that are not real such as hearing voices. The voices may comment on the person's behaviour, give commands, or even insult them.

Other symptoms include disorganized speech and behaviour, lack of emotional expression, loss of interest and drive in daily activities (such as neglect of hygiene) and cognitive impairments which include problems with memory, attention and reasoning.

What causes Schizophrenia?

Schizophrenia is an illness, but the causes are largely unknown. Researchers have uncovered several things that appear to make someone more likely to get schizophrenia. These include genetics, brain chemistry and environment:

Genetics (heredity): Schizophrenia can run in families, which means a greater likelihood that it may be passed on from parents to their children.
Brain chemistry and circuits: People with schizophrenia may not be able to regulate brain chemicals called neurotransmitters that control certain pathways, or "circuits," of nerve cells that affect thinking and behaviour.
Environment: Viral infections, exposure to toxins like marijuana, or highly stressful situations may trigger schizophrenia in people whose genes make them more likely to get the disorder.

Who gets Schizophrenia?

Schizophrenia can affect anyone from all races and cultures. While it can happen at any age, It more often surfaces when the body is having hormonal and physical changes, like those that happen during the teen and young adult years.

The disorder affects men and women equally, although symptoms generally appear earlier in men.

The earlier the symptoms start, the more severe the illness tends to be. It rarely occurs in children below 12 years.

How is the condition diagnosed?

If symptoms such as delusions and hallucinations are present, the doctor will take the patient's medical history and then use various tests such as blood tests, or brain imaging studies, to rule out another physical illness, or intoxication (substance-induced psychosis) as the cause of the symptoms.

The patient may be referred to a psychiatrist or psychologist if no physical reasons are found. These are mental health professionals trained to diagnose and treat mental illnesses using specially designed interviews and assessment tools to evaluate a person for a psychotic disorder.

What is the treatment for Schizophrenia?

Treatment might include a combination of drugs and therapies with the goal of easing the symptoms and cutting the chances of a relapse, or return of symptoms:

The primary medications used to treat schizophrenia are called antipsychotics. These drugs do not cure schizophrenia, but help relieve the most troubling symptoms, including delusions, hallucinations, and thinking problems.

While medication may help relieve symptoms of schizophrenia, various psychosocial treatments can help with the behavioural, psychological, social, and occupational problems that go with the illness.

These psychosocial therapies include cognitive remediation, rehabilitation, and individual, family and group therapies. Using these therapies help patients to manage their symptoms, identify early warning signs of relapse, and come up with a relapse prevention plan.

Hospitalisation may be recommended for people with severe symptoms, those who might harm themselves and those without anyone to take care of them at home.

Are people with schizophrenia dangerous?

Typically, most people with schizophrenia are not violent. They are withdrawn and prefer to be left alone. When they act dangerous or have violent behaviours, it is generally a result of their psychosis, hallucinations and the fear that they are being threatened in some way by their surroundings. But they can be a danger to themselves and are at a higher risk of suicide.

Can people with schizophrenia lead normal lives?

With the right medicine and therapy, about 25 per cent of people with this disease will recover completely. Another 50 per cent will see some improvement in their symptoms. Many people with this mental illness can live full, productive lives.

Depending on how severe the condition is and how well they get and stick with treatment, they should be able to live with their families or in community settings rather than in long-term psychiatric hospitals.