Schizophrenia - Blog Post by Hasan Jamal

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Schizophrenia --- From the Acme of Delusion to the Valley of Death

Introduction
Recently I read an article on this dreaded mental disorder. The statistics gave me the real fright and I became deeply concerned about the way this disease is rampaging in our country. I wish to share the knowledge at Pharma Veterans for general awareness, as many like me, may be under the illusion that it is a rare mental ailment.
Even more perturbing is the fact is that in our country there are markedly insufficient facilities to handle this condition with very few psychiatrists/ psychologists, paramedics and social workers available in government hospitals. The cost of private treatment is beyond the reach of majority.
Before I talk about Schizophrenia in Pakistan let me briefly introduce the disease:
Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning and can be disabling.
People with schizophrenia require lifelong treatment. Early treatment may help get the symptoms under control before serious complications develop and may help improve the long-term outlook.
Symptoms
Schizophrenia involves a range of problems with thinking (cognition), behavior or emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations, disorganized speech and reflect an impaired ability to function. Symptoms may include:

• Delusions. These are false beliefs that are not based in reality. For example, patient thinks that he is being harmed or harassed; certain gestures or comments are directed at him; he has exceptional ability or fame; another person is in love with him; or a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.
• Hallucinations. These usually involve seeing or hearing things that do not exist. Yet for the person with schizophrenia, they have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.
• Disorganized thinking and speech. Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated and irrelevant. Rarely, speech may include putting together meaningless words that cannot be understood, sometimes known as word salad.
• Extremely disorganized or abnormal motor behavior. This may show in a number of ways, from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, so it is hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
• Negative symptoms. This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (does not make eye contact, does not change facial expressions and remains blank or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience pleasure.

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present.
In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It is uncommon for children to be diagnosed with schizophrenia and rare for those older than age 45.
Symptoms in teenagers
Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be more difficult to recognize. This may be in part because some of the early symptoms of schizophrenia in teenagers are common for typical development during teen years, such as:

• Withdrawal from friends and family
• Drop in performance at school
• Trouble sleeping
• Irritability or depressed mood
• Lack of motivation

Compared to symptoms in adults, teens may be:

• Less likely to have delusions
• More likely to have visual hallucinations

When to see a doctor
People with schizophrenia often lack awareness that their difficulties stem from a mental disorder that requires medical attention. So, it often falls to family or friends to get them help.
Helping someone who may have schizophrenia
If you think someone you know may have symptoms of schizophrenia, talk to him or her about your concerns. Although you cannot force someone to seek professional help, you can offer encouragement and support and help your loved one find a qualified doctor or mental health professional.
If your loved one poses a danger to self or others or cannot handle his or her food, clothing or shelter, you may need to call emergency responders for help so that your loved one can be evaluated by a mental health professional. In some cases, emergency hospitalization may be needed.
Suicidal tendencies
Suicidal thoughts and behavior are common among people with schizophrenia. If you have a loved one who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with that person. Call your local emergency service immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.
Causes
It is not known what causes schizophrenia, but researchers believe that a combination of genetics, brain chemistry and environment contribute to development of the disorder.
Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neuro-imaging studies show differences in the brain structure and central nervous system of people with schizophrenia
Risk factors
Although the precise cause of schizophrenia is not known, certain factors seem to increase the risk of developing or triggering schizophrenia, including:

• Having a family history of schizophrenia
• Increased immune system activation, such as from inflammation or autoimmune diseases
• Old age
• Some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development
• Taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood

Complications
Left untreated, schizophrenia can result in severe problems that affect every area of life. Complications that schizophrenia may cause or be associated with include:

• Suicide, suicide attempts and thoughts of suicide
• Self-injury
• Anxiety disorders and obsessive-compulsive disorder (OCD)
• Depression
• Abuse of alcohol or other drugs, including tobacco
• Inability to work or attend school
• Legal and financial problems and homelessness
• Social isolation
• Health and medical problems
• Being victimized
• Aggressive behavior

Prevention
There is no sure way to prevent schizophrenia so far but sticking to the available treatment plan can help prevent worsening of symptoms or relapses. Additionally, researchers hope that learning more about risk factors with schizophrenia may lead to early diagnosis and treatment.
Situation in Pakistan
Statics show that in Pakistan there are 2.5 million people suffering from Schizophrenia and if this pace is not checked then by 2050 it will become a major health issue for the countries like Pakistan and the whole world.
It is believed that currently there are 450 million people suffering from different mental ailments in the world, out of which 15 million Pakistanis are suffering from depression. The plight of schizophrenics in Pakistan is even worse and is further compounded by other health complications due to inappropriate and dismally insufficient treatment facilities, resulting into 50% higher mortality then a normal patient. Even more frightful are the alarmingly increased suicidal tendencies among such patients. It is believed that 10 % - 13 % schizophrenics commit suicide and 40% attempt at least once.
Senior doctors from Pakistan Medical Association (PMA) insist that government should take serious and emergent measures to establish larger number of hospitals/clinics and accordingly increase the number of specialized doctors and staff to handle mental health issues in general and schizophrenia in particular. Additionally, they recommend that current curriculum of MBBS needs to be revisited by adding elaborated knowledge on psychiatry/psychology, which hitherto is too brief.
The appalling statistics from WHO reveal that in Pakistan for 100,000 patients with mental issues, the ratio of the availability of psychiatrists and psychologists is 0.31 and 1.0 and Pakistan is placed at number 89 and 50 respectively. For nursing staff and social workers it is 15.43 and 32.20 and the country is placed at number 29 and 17 respectively. The situation of the availability of beds for 100,000 patients is equally distressing.
Conclusion
A vigorous research about the diagnoses and treatment of schizophrenia is being carried out world over. But so far, no definitive results are in sight. Similarly, nothing conclusive on the causes of schizophrenia could be determined till now. Currently the diagnosis is being done on the basis of symptoms and behavioral changes.
However, timely institution of available medication coupled with counseling greatly helps to reduce the intensity of the dreaded disease, preventing the condition to worsen and in rehabilitation.
During the phase of returning to the normal life and even after that for the whole life, such patient has to be handled with great care by the family and friends to enable him to become sociable quickly and make sure that all those attitudes or issues are consciously avoided which may lead the person to sink again in the schizophrenic mire. The relapse is always more intense, complicated and difficult to deal with.
References:

• https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443
• Jang Magazine