Understanding Schizophrenia

the ridge explores Schizophrenia as a cultural and clinical disorder in our January issue. Find out more about the clinical disorder from Dr. Ann-Marie Lew, Head of the Counselling Centre at the UHWC in NUS.

Ann-Marie Lew, Ph.D.
Head, Counselling Centre
UHWC, NUS

Introduction

Schizophrenia is a chronic and severe mental illness with a worldwide prevalence of about 1 percent. Individuals with schizophrenia lose touch with reality, have difficulties engaging in normal patterns of communication, thinking, behaviour, and are less able to experience and express normal feelings.

Schizophrenia usually emerges in men in their early 20s and in women in their late 20s to early 30s. It afflicts males and females equally.

Factors that contribute to the development of schizophrenia include genetic factors and biochemical factors; research has found that individuals who have a parent with schizophrenia are more likely to develop schizophrenia, and that individuals with schizophrenia may have faulty brain chemistry.

Stress also plays a role in the onset of schizophrenia; it acts as a trigger for people who are already at risk for developing this illness.

Symptoms

Individuals are diagnosed with schizophrenia when they experience a combination of the following symptoms over a period of time:

• Delusions – false beliefs that are not culturally relevant (e.g., individuals believe that others can control them, are out to get them, are reading their minds; individuals believe that they are famous persons)
• Hallucinations – unusual perceptions (e.g., individuals hear voices that others do not hear and that may be abusive or ominous; individuals see, feel, taste, or smell things that others do not sense)
• Disorganized/Unusual Speech – incoherent, incomprehensible speech; speech is littered with made-up words
• Disorganized/Unusual Behaviors – individuals may sit for hours without moving or talking much
• Lack of Drive and Appropriate Emotions - lack of motivation and self-care; immobile facial expressions and monotonous voice

Given the severity of the symptoms associated with schizophrenia, individuals’ daily functioning can be greatly impaired. They may have difficulties taking care of themselves and maintaining jobs, and their family members and friends have to take on the role as caregivers.

Prognosis

Effective treatments for schizophrenia have been developed in recent years, and the prognosis for individuals who are receptive to treatment is much better now. While a third of individuals suffer a life-long illness, a third have only one episode and fully recover, while another third may have multiple episodes but are able to function well in between episodes.

Treatments

Medications are the most important form of treatment in managing schizophrenia. There are various kinds of antipsychotic medications, and they can be taken orally or intravenously.

Although it is common for hallucinations to improve within days and delusions to improve within weeks, individuals respond differently to antipsychotic medications and several medications must sometimes be tried before an effective treatment is found.

Individuals may also experience side effects from taking antipsychotic medications; common side effects include drowsiness, dizziness, blurred vision, hand tremors, and stiffness. It is important that individuals consult with their psychiatrist when they experience side effects; individuals who stop taking medications on their own to avoid side effects risk a relapse.

Given that schizophrenia is a chronic disorder that needs constant management, most people with schizophrenia will have to be on medication for the rest of their lives.

Psychotherapy and counselling can help individuals learn skills to cope better with their symptoms and be better able to communicate, work, and maintain relationships with others.

Such treatment can also educate individuals about their illness, develop their self-confidence and motivation, and provide support and encouragement.

Individuals can also participate in social and vocational training programmes and learn how to function more effectively and independently in their communities.

How you can help?

If you know of individuals who may be suffering from schizophrenia, do not endorse or argue about their delusions and hallucinations.

Accept that these unusual thoughts and perceptions are true for them and point them to health professionals who can help them overcome their distress and confusion.

If these individuals are NUS students, you can accompany them to the Health Service at Yusof Ishak House (6516-2390) and the Counselling Centre (6515-2523) at Alumni House.

Community resources include general practitioners who can assess and refer the individual to specialist services, the Institute of Mental Health with its Early Psychosis Intervention Program (6389-2972), and psychiatry departments in the government restructured hospitals (e.g., National University Hospital: 6772-4514; Singapore General Hospital: 6321-4344).

Should you assess that an individual is at risk of hurting himself or others, call the police immediately and tell them that this individual is violent and has a mental illness that needs medical help.

Nevertheless, it would be a mistake to assume that individuals with schizophrenia are all violent; the media propagates this myth when it chooses to publicize the few people with severe mental illnesses who become violent.

Most individuals with schizophrenia are in fact non-violent and prefer to be by themselves. We should not be afraid, and rather seek to help.

Primary References:

• Mental Health First Aid (Singapore)
• National Institute of Mental Health (USA)
• Diagnostic and Statistical Manual of Mental Disorders

the ridge would like to thank Dr. Ann-Marie Lew and the UHWC Counselling team for their support and professional guidance.