Schizophrenia is a common disease. It is known to affect 1 % of the population of the US or close to two million individuals and we all know some individuals who suffer from schizophrenia.
Main definition: Loss of contact with reality. Note the difference between a neurotic and psychotic disorder. The important distinction is that a neurotic person knows that he is ill whereas a psychotic person does not believe he/she is ill. He/she believe that his voices / perceptions are real. The individual can lose much of his / her ability to rationally evaluate his surroundings and interactions with others.
Schizophrenic patients display a range of unusual behaviours which cause profound disruption in the lives of the patients suffering from the condition and in the lives of the people around then. Affects both males and females equally, all races and all social classes in all cultures.
Schizophrenia often first appears in men in their late teens or early twenties. In contrast, women are generally affected in their twenties or early thirties. Hallucinations and delusions are common; these distort the perceptions of reality for the schizophrenic patient. The visible behaviours may seem bizarre to the casual observer but are real to the patient. Nearly one-third of those diagnosed with schizophrenia will attempt suicide. About 10 percent of those with the diagnosis will commit suicide within 20 years of the beginning of the disorder. New interventions with medications and frequent observations by family and support groups have reduced the numbers of successful suicides. However, more is needed to be done to help this group of patients.
Patients with schizophrenia are not likely to share their suicidal intentions with others, making life-saving interventions more difficult. The risk of depression needs special mention due to the high rate of suicide in these patients. Relatives caring for the sick will often not be aware of the patient’s suicidal intentions.
In the Western World, the most significant risk of suicide in schizophrenia is among males under 30 who have some symptoms of depression and a relatively recent hospital discharge. Other risks include imagined voices directing the patient toward self-harm (auditory command hallucinations) and intense false beliefs (delusions).
The relationship of schizophrenia to substance abuse is significant. Due to impairments in insight and judgment, people with schizophrenia may be less able to judge and control the temptations and resulting difficulties associated with drug or alcohol abuse. In addition, it is not uncommon for people suffering from this disorder to try to "self-medicate" their otherwise debilitating symptoms with mind-altering drugs. The first onset may occur during a drug induced mental state. This makes the condition difficult to diagnose and treat.
The abuse of such substances, most commonly nicotine, alcohol, cocaine and marijuana, impedes treatment and recovery. The chronic abuse of cigarettes among schizophrenic patients is well-documented and probably related to the mind-altering effects of nicotine.
A small number of patients will be able to lead a normal life by abstaining from the use of illicit drugs. It will also be helpful for this group of patients to lead a low stress life. Stress and substance will bring the symptoms of schizophrenia.
It is important for the patient to be given his/her regular antipsychotic medications. In the hospital setting the nurse will always do this. One need to make sure that the patient swallows the medication. It is not uncommon for patients to “cheek” the medications and to spit them out when no one is looking.
Some researchers believe that nicotine affects brain chemical systems that are disrupted in schizophrenia; others speculate that nicotine counters some of the unwanted reactions to medications used to treat the disease. It is not uncommon for people diagnosed with schizophrenia to die prematurely from other medical conditions, such as coronary artery disease and lung disease.
It is unclear whether schizophrenic patients are genetically predisposed to these physical illnesses or whether such illnesses result from unhealthy lifestyles associated with schizophrenia. Some researchers believe that schizophrenia is a learned behaviour and can be unlearned.
My experience, working with psychiatric patients suggests that both components (genetic and environmental) are present. Most have a family history of schizophrenia combined with substance abuse and high stress.
