schizophrenia

by Sally Burningham

At some time in our lives, about one in every hundred of us will be affected by the symptoms of schizophrenia, the most common form of severe mental illness.

blurred image of a person sitting down holding head in hands
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In schizophrenia, there is a breakdown in communication between different parts of the brain. This means that thoughts, sensations, memories and emotions no longer function together harmoniously but, instead, become confused and disordered. As a result, a person may feel unable to trust their own reactions or the behaviour of those around them. They are also likely to be bewildered, frightened and, often, increasingly uncertain of what is going on in their own heads and what is happening in reality.

When someone has schizophrenia, they may be aware that something is wrong but not have enough understanding of their condition to know that they need treatment and support. Friends or relatives may need to persuade them to see their GP, who may then refer them on to a psychiatrist for more specialist help.

Schizophrenia can be very distressing for both the person with the illness and their family and friends. But information and support can make it easier to cope.

facts about schizophrenia

Schizophrenia can start at any age but usually not before puberty, and is most commonly diagnosed for the first time in people in their late teens and 20s.
It occurs equally in men and women, though it quite often starts at an earlier age in men.
It is found in people of all races and backgrounds all over the world.
An individual has a l0% risk of developing schizophrenia if one parent or a brother or sister has it (or once had it). However, if both parents are or have been affected, the risk increases to 45%.
About 25% of those diagnosed with schizophrenia have only one episode and make a full recovery. Approximately 50% will continue to experience symptoms from time to time, often with long symptomless periods in between. The remaining 25% will have disabling symptoms and need considerable support throughout their lives.
One in ten people with schizophrenia dies an unnatural death, usually through suicide.

misconceptions

'people with schizophrenia are always violent'

Violence is often – wrongly – associated with schizophrenia. The truth is that people with the illness are far more likely to harm themselves than be violent towards others. Someone with schizophrenia is up to 100 times more likely to kill themselves than to kill someone else.

Violence is far more common among people who abuse alcohol or drugs. Over 60% of violent crime is committed under the influence of alcohol, and those who are dependent on street drugs are three times more likely to be violent than people with schizophrenia. Except in times of acute crisis, the latter are no more violent to others than are ordinary members of the public. The problem is that these acute episodes tend to draw media coverage, thus reinforcing the public's erroneous linking of schizophrenia with violence.

'people with schizophrenia have "split personalities"'

'Schizophrenia' is one of the most widely misunderstood terms in mental health. It is the name of a distressing condition in which the mind has difficulty in functioning as a whole and in retaining its grasp on reality. However, 'schizophrenia' is often wrongly used in everyday speech to describe a 'split personality', an extremely rare condition in which someone's personality switches rapidly from one type to another. It is even used to describe a person who holds two conflicting views at the same time. But, neither of these is right.

'cultural difference has no effect on diagnosing or treating schizophrenia'

All people – including doctors – are deeply affected by their cultures, and it is not uncommon for some to view the cultures of others with incomprehension or even suspicion. As a result, problems can arise if those with mental health problems and the medical professionals treating them come from very different backgrounds. The symptoms of the ill person may be misunderstood, they may be given inappropriate treatment or they may receive no treatment even though it is needed.

In cases like this, it is important that, when a person with a severe mental health problem first sees a doctor or other professionals from a very different cultural background, someone from their family or community should accompany them. These individuals can then explain the ill person's background and any ways of thinking, behaving or expressing emotion that may seem strange to the professional but which may be perfectly normal within that person's community. (See the feature focus on Asian women for more information.)

recognising schizophrenia

The onset of schizophrenia can be sudden and dramatic or may build up very gradually over time. There is a wide range of symptoms, which will vary from person to person and can often vary in the same person at different times. Symptoms may appear only once and then disappear for ever; they may persist for a long time; or they may come and go.

common symptoms

hallucinations These are disturbances in perception where a person hears, sees, smells, tastes or feels things that are not apparent to others but which are quite real to the affected person. One form of hallucination is to hear imaginary voices from an external source such as a TV set. These voices may be friendly, but they are usually critical or hostile. The person may hold conversations with them either silently or out loud. Sometimes it seems as if the voices are trying to take control, which can be very distressing.

delusions These are false beliefs about what is actually happening. For example, the person may believe that someone is inserting thoughts into their mind or plotting against them, or that they are really a different person altogether, such as a present-day celebrity or a famous person from the past. No amount of reassurance or rational argument can change these beliefs while the person is in this particular state.

disturbances in thinking The person may be unable to think clearly because their mind is overwhelmed with a jumble of ideas or because it suddenly goes blank for no apparent reason. As a result, the way they talk may seem strange to other people and difficult to understand.

emotional changes The person may find that their emotions are intensified so that they feel very sad or highly excited. However, more often their emotions become blunted and they may be less affectionate and responsive and more withdrawn and difficult to make contact with. Sometimes they may react in quite inappropriate ways such as laughing at a sad event or crying at a joke.

changes in behaviour The person may find they lack energy and motivation. It may be hard to concentrate, and they may lose interest in other people or activities because they are so bound up in struggling with their own problems. They may even lose interest in their own appearance and forget to bother about personal hygiene. They may withdraw from social contact and spend long periods on their own, either sleeping or seeming to do very little.

The imaginary voices – which are very real to a person with schizophrenia – may tell them to do things that they normally wouldn't do. The person may also isolate themselves – for example, in their bedroom – to try to reduce the stimulation of the outside world, which can seem to overwhelm them.

what causes schizophrenia?

We do not yet know the causes of schizophrenia. However, it is likely that there are a number of contributory factors, which may vary from person to person.

In some cases, schizophrenia appears to run in families. People who have a parent with schizophrenia have an increased risk of developing the illness, whether or not they have been raised by that parent. However, up to 60% of people with schizophrenia have no family history of the illness.

It is possible that a stressful event such as bereavement or other form of crisis may contribute to the development of schizophrenia. In some cases, the onset of the illness is preceded by a highly stressful event, but in others, there may be no obvious stress. However, once people have developed schizophrenia, they become highly susceptible to any form of stress and it can often trigger a further episode.

Other possible contributory causes have been put forward, but more research is needed.

treatment

There is no test for schizophrenia and many of the symptoms are similar to those found in other conditions. For example, delusions and hallucinations are also experienced in mania and severe depression, and certain street drugs can produce symptoms very like those of schizophrenia.

When a person experiences such symptoms for the first time, the GP is likely to refer them to a psychiatrist, who may admit them to hospital to observe their condition before deciding on treatment.

Treatment should involve a combination of measures:

It should always include regular supportive discussions with a professional who can provide information and explanations about the illness and help the person to try to re-establish some sort of structure in their life.
It may involve medication. Antipsychotic drugs (also known as major tranquillisers or neuroleptics) help to relieve symptoms such as hallucinations, delusions and disturbances in thinking and can prevent relapses. They are not very effective in dealing with such symptoms as a lack of energy and motivation.
It should provide some form of organised social support. People with schizophrenia need to be in an environment that makes just the right demands on them without exerting too much pressure so that they can regain their confidence. Attendance at a day centre, drop-in centre or training project can be very helpful.
It may include attending a social skills or practical skills group, which can help the person to become more independent, or a group where problems or feelings are discussed with others who have undergone similar experiences.
It may include family meetings if the person lives with relatives or is in close contact with them.

A person with schizophrenia will probably need treatment and support for a considerable time. Arrangements vary in different areas, but those diagnosed with schizophrenia should be allotted a professional – sometimes called a 'key worker' – who will help to make sure that they receive the necessary services and that their needs are assessed on a regular basis. The key worker – the link between the ill person and their family and the other professionals involved in the person's care – can be contacted for advice and support.

tips on taking antipsychotic medication

It may take some days or weeks before any improvement is noticed.
To avoid the risk of a relapse, the drug may have to be taken for some time (perhaps up to two years) after the person feels better. Then they must come off it gradually.
The person taking the drug should not come off the drug without consulting their doctor.
Side-effects such as drowsiness, dry mouth or blurred vision may be noticed. These usually diminish after a few weeks. If they don't, they should be discussed with the doctor who may be able to alter the medication. The newer antipsychotic drugs have far fewer side-effects than the old ones.
If long-term drug treatment is advised to prevent a relapse, the pros and cons of this should be discussed carefully with the doctor and those close to the person being treated.

self-help

Accept that you may have good and bad days. Do things one step at a time and don't take on too much or you will feel overwhelmed.
Try to avoid stresses that upset you. If there are some that you can't avoid, look for ways to help you deal with them – for example, a relaxation exercise.
Set yourself realistic short-term goals that will help you regain your confidence, such as cooking a meal or going for a swim.
If you think a complementary therapy might help, check with your GP. For more information see the therapies section of the complementary medicine site.

how friends and family can help

Support from family and friends is very important, but it has to be the right kind of support. Someone with schizophrenia is often unable to cope with very close relationships or with stress. You will need to distance yourself emotionally while remaining supportive.

Try to remain outwardly calm and unflustered, however irritated or upset you feel. Showing that you are angry or anxious or critical of the person will make things worse.
Give any explanations clearly and simply. The person will be unable to cope with long and complicated reasons.
Do not laugh or make fun of the person's strange beliefs or allow others to do so, but do not collude with them either. You might say you understand that this is what they feel, but it is not the way you see it.
Try to avoid involving them in situations that are too stressful – large family gatherings, for example – while encouraging them to participate in less demanding social activities.

help and info

You will find lots of useful advice and information in two other articles in this section: self-help strategies and family and friends.

If you or a friend or relative is experiencing schizophrenia, the following organisations may be helpful in providing information and support or in pointing you in the right direction.

organisations

Hearing Voices Network
79 Lever Street.
Manchester M1 1FL
Tel: 0845 122 8641
E-mail: info@hearing-voices.org
Website: www.hearing-voices.org
Offers information, support and understanding to people who hear voices and those who support them.

National Schizophrenia Fellowship (Scotland)
Claremont House
130 East Claremont Street
Edinburgh EH7 4LB
Tel: 0131 557 8969
E-mail: info@nsfscot.org.uk
Website: www.nsfscot.org.uk
NSF (Scotland) is a member led charity that works to improve the well-being and quality of life of those affected by schizophrenia and other mental illnesses, including families and carers. Provides community-based services, information, advice, support and promotes greater understanding of schizophrenia.

Rethink
5th Floor
Royal London House
22-25 Finsbury Square
London EC2A 1DX
General Enquiries Tel: 0845 456 0455 (Mon-Fri 9am-5pm)
National Advice Line: 020 8974 6814 (Mon, Wed, Fri 10am-3pm; Tues, Thurs 10-1pm)
E-mail: advice@rethink.org
Websites: www.rethink.org
Dedicated to improving the lives of anyone affected by severe mental illness, by providing information, advice and advocacy services, raising awareness of mental health issues, and challenging the attitudes that create stigma. Website has sections on employment, money, benefits and legal rights.

Samaritans
c/o Chris
PO Box 90 90
Stirling FK8 2SA
Helpline: 08457 90 90 90 (24 hours)
E-mail: jo@samaritans.org
Website: www.samaritans.org
The Samaritans exists to provide confidential emotional support to any person, irrespective of race, creed, age or status who is in emotional distress or at risk of suicide; 24 hours a day. Can be contacted by e-mail, telephone, writing, or by visiting one of over 200 local branches (details are on the website).

SANE
1st Floor
Cityside House
40 Adler Street
London E1 1EE
SANELINE: 0845 767 8000 (every day 6pm-11pm)
E-mail: sanemail@sane.org.uk (admin queries only)
Website: www.sane.org.uk
SANELINE is a National mental health helpline providing information and support for people with mental health problems, and those who support them. They can provide information on the illness and symptoms, local and national mental health services, medication, treatments and therapies.

Zito Trust
16 Castle Street
Hay on Wye
Hereford HR3 5DF
Tel: 01497 82 00 11
E-mail: zitotrust@btinternet.com
Website: www.zitotrust.co.uk
Offers information, advice and support to family and friends of people with severe mental health problems, particularly where treatment seems inadequate.

websites

Coming Off Psychiatric Medication
www.comingoff.com
Website that aims to give up to date information about psychiatric medication, how it functions and the withdrawal process.

DAISIES
http://groups.myspace.com/daisiesgroup
New online group on Myspace providing support, advocacy, and awareness for people with schizophrenia.

HealthyGenius.com
www.healthygenius.com
An extensive new website about mental illness.

National Institute for Mental Health in England (NIMHE)
www.nimhe.csip.org.uk
NIMHE is responsible for supporting the implementation of positive change in mental health and mental health services.

PsychCentral
http://psychcentral.com
The Internet's largest and oldest independent mental health social network created and run by mental health professionals. The site has lots of useful resources, recommended books and even quizzes.

World Fellowship for Schizophrenia and Allied Disorders
www.world-schizophrenia.org
The only global organization dedicated to lightening the burden of schizophrenia and allied disorders for sufferers and their families.

reading

	Accepting Voices by Marius Romme and Sandra Escher (MIND, 2003) This book illustrates that many people hear voices and that not everyone has recourse to psychiatry, but that there are ways of coping which enable people to come to terms with their experience. It focuses on techniques to deal with voices, emphasizing that personal growth should be stimulated rather than inhibited. Get this book

	Coping With Voices and Visions by The Hearing Voices Network Written by people who have these experiences outlining different ways to cope with voices. Get this book

	Hearing Voices: Working Out a Positive Approach by Sharon File (MIND, 2004) This workbook presents a cognitive behavioural approach to coping with hearing voices. It explores theories about how and why voices can happen, and explains what CBT is and why it might help. It takes the reader through simple exercises to help them learn about their voices, and explores a range of techniques to help them. Get this book

	I Am Not Sick I Don't Need Help! by Xavier Amador and Anna-Lica Johanson (Vida Press, 2006) This is a book addressed to carers of people with serious mental illness such as schizophrenia, with the purpose of helping them to understand why their loved ones refuse to acknowledge their illness and therefore refuse the medications they need, often as a matter of life and death. It is written in a simple and highly accessible style. Get this book

	Living with Schizophrenia: An Holistic Approach to Understanding, Preventing and Recovering from Negative Symptoms by John Watkins (Michelle Anderson Publishing, 1997) A sophisticated and critical account of theory regarding the "negative" symptoms of schizophrenia. A goldmine of practical information and strategies for dealing creatively with these problems. Get this book

	Making Sense of Voices: A Guide for Mental Health Professionals Working with Voice-Hearers by Marius Romme Sandra Escher (MIND, 2000) Just under 10 years ago, the authors triggered a seismic shift in the understanding of voice-hearing. They put the powerful case for accepting and validating people's own interpretations of their voices, and showed how such interpretations often enabled people to live with them far more effectively than bio-medical approaches. This handbook for practitioners builds on this work. It combines examples with guidance on the various processes involved in enabling voice-hearers to deal with their voices and lead an active and fulfilling life. Get this book

	Recovery an Alien Concept? by Ron Coleman (P & P Press, 2004) Personal story of hearing voices and recovery. Get this book

	Schizophrenia: A Very Short Introduction by Chris Frith and Eve Johnstone (Oxford University Press, 2003) Describes what schizophrenia is really like, how the illness progresses and the treatments that have been applied. It also summarizes the most up-to-date knowledge available about the biological bases of this disorder. Get this book

	Surviving Schizophrenia: A Family Manual by E Fuller Torrey (Pgw Publishing, 2006) Describes the nature, causes, symptoms, treatment and course of schizophrenia. It also explores living with the disease from both the patient's and the family's point of view. Get this book

	Schizophrenia: Your questions answered by Trevor Turner (Churchill Livingstone, 2003) Schizophrenia is the most common of the psychotic illnesses, affecting approximately 1% of the UK population at some point in their lives. This book will help care providers to understand and identify the symptoms of schizophrenia. Written in a Q and A format, answers are presented in an accessible style, and include case studies. There are also some frequently asked patient questions in non-medical language. Get this book