Schizophrenia & Psychosis

The extent of the problem
Schizophrenia is a severe mental illness. It affects approximately one person in every hundred in all countries around the world. More hospital beds are filled by people suffering from schizophrenia than from any other single illness. Schizophrenia frequently has a debilitating affect on all aspects of the sufferer’s life and can extract an enormous emotional toll on their family and relations, who will often be responsible for their care.

What is Schizophrenia?

Positive symptoms
A diagnosis of schizophrenia is made when a person experiences certain key symptoms. These include specific types of hallucinations, delusions and disturbances of thinking. Hallucinations are false perceptions. The sufferer hears things, sees things or smells things that are not heard, seen or smelt by other people. Hearing voices, often talking about the person in a hostile manner, is a very common symptom of schizophrenia. Delusions are false beliefs, that are frequently bizarre and held with often unshakable conviction but are not shared by other people. Delusions vary in content but some common ones include: a belief that an external force has taken control of the person’s mind or body; a belief that a group of people or an organisation is trying to harm or persecute the person for no good reason; a belief that things the person reads or sees have special meaning or influence; an extreme and specific belief in the influence and action of magic, telepathy, laser beams or other alien forces. Disturbances of thinking or thought disorder refer to a disorganisation of thought that can result in strange and jumbled language. These types of key symptoms are often referred to as positive symptoms, and they can be extremely distressing and frightening to people who experience them. They can frequently be associated with very high levels of anxiety and disturbed behaviour, especially when severe or in the acute phase.

Negative symptoms
Unlike positive symptoms, which are dramatic changes in the person’s experiences, negative symptoms are usually apparent as changes in the person’s behaviour. They are termed negative because they are indicated by a decrease or absence of behaviour. These include: a decrease in motivation; a decrease in activity; a decrease in conversation and talking; social withdrawal; an apparent lack of emotion; poverty of thought and a difficulty in getting on with people.

Negative symptoms can vary in their extent from being quite mild to severely impairing a person’s ability to function and take care of themselves.

Course
Schizophrenia often has its onset in late adolescence or early childhood. The course or development of the disorder can vary widely between individuals.

Although some people will make a good recovery after their initial episode, the disorder is frequently episodic. Some people experience frequent relapses with persistent symptoms and disability throughout most of their lives.

Causes
The cause of schizophrenia continues to remain an enigma. It is probable that there is a genetic component and that there is a disruption of the brain’s neurotransmitters (chemicals which carry messages within the brain). There is also strong evidence that emotional and social stresses are important in precipitating episodes of illness.

Treatment and care
At present there is no cure for schizophrenia. Powerful tranquillising drugs called neuroleptics are the mainstay of treatment. These are used for two purposes: to reduce positive symptoms during acute exacerbations or relapses and prophylactically to prevent further relapse. Because the medication protects against further episodes it is probable that the schizophrenia sufferer will be prescribed it for long periods of time, and to increase compliance with medication, it is often given through injection. Medication can cause unpleasant side effects which may need to be treated in their own right. New drugs are becoming available which it is claimed have fewer side effects and also improve negative symptoms.

Acute symptoms of schizophrenia often involve inpatient hospital treatment. When the illness has caused pervasive deficits in aspects of the person’s social and personal functioning, lengthy rehabilitation will be as important as physical treatment. This can involve varying levels of community support and outreach such as sheltered accommodation or day hospital provision. Many approaches are designed to help people improve their ability to live independently in the community.

Over recent years psychosocial and psychological treatments have been developed. These include helping the family to manage the illness which can have a marked effect on decreasing relapse rates, and cognitive behavioural methods to reduce persistent positive symptoms. These methods are new but have enormous promise in improving the sufferer’s quality of life when used in combination with medication. Because of the severity of schizophrenia and the disabilities which are often associated with it, sufferers should have all access to all the resources of a comprehensive mental health system.

What are Behavioural and Cognitive Psychotherapies?

Behaviour Therapy, Cognitive Therapy and Cognitive Behaviour Therapy have some common features. They are based firmly on research findings and derive from specific theories. The focus is mainly on the here-and-now, rather than the past, and the main goal of therapy is to help bring about changes in the person’s life which are measured and evaluated. Goals for change may involve:

• A way of acting eg. being more outgoing
• A way of feeling eg. being less scared or less depressed
• A way a thinking eg. learning to problem solve or get rid of self defeating thoughts
• A way of dealing with physical or medical problems eg. lessening the difficulties associated with back pain.
• A way of coping eg. training developmentally disabled people to care for themselves

Cognitive or Behaviour Therapists may work with individuals, groups or families, and therapy is time limited. The approaches can be used to help any person – irrespective of intelligence, insight or other abilities.