Schizophrenia is a severe chronic mental condition where patients experience progressive personality changes and interpret reality abnormally. It may result in a combination of hallucinations, delusions and disordered judgment that impairs daily functioning. Schizophrenia is very disruptive and disabling. About 1% of the population, or 300,000 Malaysians have schizophrenia.
Watching Out for the Symptoms
Symptoms of schizophrenia may be positive or negative. What does that mean?
These are psychotic symptoms not usually seen in otherwise healthy people. It is where patients "lose touch" with some aspects of reality. Examples of "positive" symptoms:
These usually involve seeing or hearing things that don't exist. While hallucinations can be in any of the five senses, it is most common to hear voices.
These are false beliefs out of touch with reality. For example, you believe that you're being harmed or harassed; you have exceptional ability or fame; another person is in love with you; or a major catastrophe is about to occur. This happens to most people with schizophrenia.
Incoherence or frequent derailment of thought; causes impairment of effective communication and replies in conversations may be partially or completely unrelated. Occasionally, speech may include putting together meaningless words that can't be understood.
Extremely disorganised or abnormal motor behaviour
This may show in a number of ways, from childlike silliness to unpredictable agitation. Behaviour isn't focused on a goal, so it's hard to do tasks. It can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
Refers to a reduced ability to function normally due to disruptions to normal emotions and behaviours. Includes:
“Flat affect” (reduced expression of emotions via facial expression or voice tone)
Reduced feelings of pleasure in everyday life
Difficulty beginning and sustaining activities
Types of Treatment
Schizophrenia requires lifelong treatment, even after symptoms have long subsided. An experienced psychiatrist usually leads a team of psychologists, social workers, psychiatric nurses and case managers to coordinate the care of the patient.
As with any mental illness, medication like antipsychotics, anti-depressants and anti-anxiety drugs are the cornerstone of treatment. As these drugs come with their own side effects, administration of the drugs highly depends on the individual's willingness to cooperate with treatment.
Antipsychotics may be categorised into 3 types: first-generation antipsychotics, second-generation antipsychotics and long-acting antipsychotics.
Second-generation antipsychotics are largely preferred as there is minimal risk of serious side effects such as a movement disorder caused by first-generation psychotics. Long-acting antipsychotics are administered every 2 to 4 weeks as an intramuscular or subcutaneous injection. If someone has a preference for fewer pills, this option will be helpful for adherence.
Once psychosis recedes, it is important to keep up with psychosocial interventions such as:
Individual therapy - Helps normalize thought patterns. Patients also learn to cope with stress and identify early warning signs of relapse to manage their illness.
Social skills training - Focuses on improving communication, social interactions and the ability to partake in daily activities.
Family therapy - Provides support and education to families dealing with schizophrenia.
Vocational rehabilitation and supported employment - Helps people with schizophrenia prepare for, find and keep jobs.
This is to ensure the safety, proper nutrition, adequate sleep and basic hygiene of patients who are experiencing severe symptoms.
This is an alternative for patients who remain unresponsive towards drug therapy.