What is Schizophrenia?

Many people who have schizophrenia have suffered the symptoms of psychosis for at least six months before seeking help. Sufferers experience deterioration in interpersonal relationships and daily functioning at school or work. Although it can affect anyone at any age, its onset is usually in adolescence or young adulthood. Schizophrenia affects men and women equally.

Symptoms of Schizophrenia

A person who is suffering from schizophrenia may present positive and/or negative symptoms. Positive symptoms reflect a distortion or exaggeration of functions that are normally present, whereas negative symptoms reflect a deficiency of a mental function that is normally present.

Positive symptoms of schizophrenia include:

• Hallucinations (e.g., voices, smells, tastes experienced that do not exist)
• Delusions (i.e., of being persecuted or controlled, or his/her mind being read)
• Bizarre or disorganised behaviour

Negative schizophrenia symptoms include:

• Poverty of speech
• Social withdrawal
• Emotional blunting (i.e., not displaying any emotion, whether positive or negative)
• Apathy
• Attention impairment
• Lack of motivation and drive

Types of Schizophrenia

These are the five recognised types of schizophrenia, and each type has different symptoms:

• Catatonic
• Motor disturbances
• Stupor
• Negativism
• Rigidity
• Excitement
• May be unable to take care of personal needs
• Decreased sensitivity to painful stimulus
• Paranoid
• Delusional thoughts of persecution or grandeur
• Anxiety
• Anger
• Violence
• Argumentativeness
• Disorganised
• Incoherence (not understandable)
• Regressive behaviour
• Flat affect (reduced emotional expression)
• Delusions
• Hallucinations
• Inappropriate laughter
• Odd mannerisms
• Social withdrawal
• Undifferentiated
• May have symptoms of more than one subtype of schizophrenia
• Residual
• The prominent symptoms of the illness have abated, but some features, such as hallucinations and flat affect, may remain

Treatment for Schizophrenia

The goals of conventional treatment include helping patients toward normal interactions with others, enabling patients to live in the community, and controlling the illness through the smallest effective dosage of medication. A combination of medication and psychotherapy is usually required.

Untreated psychosis can cause considerable suffering, distress and bafflement to the person who has the condition and those around him. In addition, people with untreated psychosis are at a higher risk of suicide, aggression and drug abuse. Seeking professional help early is important.

Medication For Schizophrenia

Medication remains the main treatment method. As schizophrenia is often due to abnormal biochemical balances in the brain, medication can help to normalise these imbalances. This type of medication is known as antipsychotics or neuroleptics. They can relieve the hallucinations, delusions and thinking problems associated with schizophrenia. These antipsychotic medicines are also important in reducing or eliminating the chances of relapse.

Clozapine, approved in the US in 1990, has been helping many people unresponsive to other antipsychotic medications without causing a side effect known as tardive dyskinesia (TD), which triggers involuntary facial movements. It does, however, cause a serious decline in white blood cells in one percent of patients, so weekly blood tests are required.

A new drug, risperidone, appears to be able to relieve symptoms without this complication. Other new drugs, olanzapine and quetiapine, have been approved to treat this disabling disorder.

Psychotherapy for Schizophrenia

Besides medication, another effective form of schizophrenia treatment is psychotherapy. Psychotherapy helps the person make sense of his illness, can take various forms and can be conducted on a one-to-one basis or in a group setting. Issues that may need to be dealt with include: the person’s feelings about the illness, his/her experience of medication, denying the illness, the impact that the illness has on the person’s self-esteem, interpersonal relations and other aspects of his/her life.

Rehabilitation and Counselling

Rehabilitation and counselling help the individual to function in society. Social skills training, provided in the group, family or individual sessions, helps build social relationships and independent living skills.

Related: Psychiatric Nursing Homes

Specialised Programme for Early Detection of Schizophrenia

The Early Psychosis Intervention Programme (EPIP) at the Institute of Mental Health emphasises early detection and treatment. This team works closely with private doctors, polyclinics and social agencies to help spot the early signs of mental disorders amongst 18 to 40. EPIP also works with educational institutions and youth workers to identify the onset of psychosis amongst the young.

These partners help to refer patients to IMH or, if applicable, jointly assess them. At EPIP, every outpatient is assigned a case manager, who will manage his overall needs. Psychosis can be treated with medication, medical support and good family care.

For more information on EPIP, please call 6389 2972.

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