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Divine Madness

"Minding Schizophrenia"
By: Risa Caldoza-De Leon MD, FPAPSHPIDivine Madness

The schizophrenic mind is not so much split as shattered. I like to say schizophrenia is like a waking nightmare.” -  Elyn Saks

The World Health Organization (WHO) pegs roughly one in 250 people (51 million people) globally are living with the disorder. Men are usually affected in their late teen to the early 20s while women tend to start exhibiting symptoms when they are in their mid-20 up to early 30’s. It is indiscriminate of race, status or wealth. 

About one million Filipinos have schizophrenia. This tops all brain disorders affecting mentally ill Filipinos, based on records from the Philippine Health Information System on Mental Health (PHIS-MH). Schizophrenia is a chronic, complex, and potentially disabling psychiatric disorder. Most cases develop slowly that it may not be addressed until much later when the signs and symptoms become very obvious.

Disease of Antiquity

Two millennia ago, there have been accounts of schizophrenia-like symptoms written in the ancient Egyptian Ebers papyrus. The 1400 BC Hindu collection, Arthava Veda, described illnesses marked by eccentric behavior and lack of self-control while The Yellow Emperor’s Classic of Internal Medicine of the ancient China, related insanity and seizures with supernatural and demonic forces. Romans and Greeks like Plato thought that madness was divine and was the inspiration for poetry and prophecy.

In the 19th century, Emil Kraeplin, a German psychiatrist, used the umbrella term “dementia praecox” to describe a variety of previously separately recognized mental illnesses, such as adolescent insanity and catatonia syndrome. This led to Eugen Bleuler, a Swiss psychiatrist who in 1908, coined the term schizophrenia, meaning “split mind” to describe the disunity of functioning between personality, perception, thinking and memory and to replace the term dementia praecox. Now, the disease has a name.

Positive and Negative

There are no laboratory tests or other diagnostics that can absolutely establish schizophrenia. Diagnosis is based solely on the patient’s clinical symptoms, history, and mental status examination. Signs and symptoms of schizophrenia vary, but having two or more of the identified symptoms significantly present for a month, a patient is said to have schizophrenia.

According to the National Institute for Mental Health, a person with schizophrenia usually experiences positive symptoms which make him lose touch with reality. These include:

  • Hallucinations - hearing voices or seeing things that may result in withdrawal and anxiety
  • Delusions - believing false ideas
  • Extremely abnormal motor behavior – restlessness, agitation
  • Paranoia – feeling anxious or thinking that someone/something is out to get him
  • Extreme feelings of anger
  • Disorganized speech - frequent derailment or incoherence
  • Being impulsive  - doing things without considering the consequences
  • Experiencing disorganized/confused and unclear thoughts  - wherein the thoughts in the patient’s head are of a confused and unclear variety

There are also negative symptoms of schizophrenia, such as:

  • Anhedonia - the inability to feel pleasure
  • Having a flat expression - loss or lack of emotional expressiveness
  • Being withdrawn from social groups, including family and friends
  • Not being motivated to pursue daily normal activities such as bathing

Gene in a Bottle

Research suggests that schizophrenia runs in the family. If one parent has the disorder, the risk of an offspring to have it is 10%. The “schizophrenia gene” leads to the malfunctioning of two important brain pathways and the eventual development of the disorder. This gene initially remains dormant, but later in life surfaces as a full-blown illness.

Some evidence shows that the brain of the patient could have an imbalance of specific chemicals called dopamine, serotonin and glutamate and abnormal structures within the brain itself. Others believe that trauma about 5 months before and up to one month after birth may contribute to the development of the disorder. Alternatively, viral infections such as influenza and rubella are said to be factors. Patients exposed to toxic environment or stressors may also develop symptoms of schizophrenia.

Drugs and More

Sadly, there is no absolute cure for this scourge. In the olden days, treatments were deplorable, including trepanning or the drilling of holes into the skull to allow evil spirits to exit, and various forms of exorcism. Believing that patients have angered the gods, Cornelius Celsus flogged and starved them. Winston Churchill wanted a mass sterilization for the “feeble-minded” and insane. Humane is not a familiar word back then.

According to the Philippine Psychiatric Association, schizophrenia is a disorder that needs lifelong treatment, which generally involves medications and psychosocial therapies. Conventional antipsychotics have been around since the 1950s and controlled the symptoms by exerting its effects on the brain’s neurotransmitters specifically dopamine and serotonin; examples include haloperidol, chlorpromazine, levomepromazine, and fluphenazine. Antipsychotics allow sufferers to lead functional lives but have side effects of weight gain, involuntary movements, lowered sex drive, low blood pressure and tiredness.

Atypical antipsychotics were drugs produced in the 1990s used against positive and negative symptoms. Clozapine, Olanzapine, Risperidone, Aripiprazole, Quetiapine, and Paliperidone pose lower risks of unwanted side effects.

The long-acting injectable antipsychotics are delivered through syringes, preferably, to patients who find it difficult to take their pills daily. During periods of crises or severe symptoms, patients may need to be hospitalized where they can be safe, adequately nourished and ensured basic hygiene.

Psychosocial interventions are important and aimed at equipping patients with effective coping strategies to manage the condition better such as identifying early warning signs of relapse. Social skills training advocates social and communication interactions. Vocational rehabilitation guides the patient in looking and preparing for a job as well as maintaining it as part of the therapy.

Schizophrenia effects are far-reaching, touching everyone in the patient’s circle. Family therapy will educate and support the household to better deal with this challenging situation.

Rethinking Schizophrenia

If you have been diagnosed with schizophrenia, you can help yourself and those around you by doing these things:

  • Take an active role in managing your illness such as learning the warning signs of a relapse and having a plan of action to deal with the symptoms.
  • Take your medications as prescribed.
  • Learn coping skills to deal with the worst and most persistent symptoms.
  • No to drugs and alcohol. Often drug abuse and schizophrenia go hand in hand. If you have been abusing drugs and alcohol, there are many places that will offer treatment for your drug addiction and the mental illness.
  • Stop smoking. Over half of sufferers are regular cigarette smokers.
  • Keep healthy. Proper diet and exercise are important and getting enough sleep. Learn to manage stress in a variety of ways.
  • Reach out to others for connection and support.
  • Be positive! There is always hope. Most people living schizophrenia get better over time, not worse. For every five people who develop schizophrenia, one will get better within five years of their first symptoms. Three will get better, but will still have times when their symptoms get worse. And only one will continue to have troublesome symptoms.
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