SCHIZOPHRENIA AFFECTS one per cent of the population and is the most debilitating of the mental disorders. Thirty-three per cent of the patients diagnosed as schizophrenic runs a chronic course with deterioration in function.
Schizophrenia usually starts in adolescent and early 20s and have an impact on the youth's development. It is during those years that young people learn a technical skill, form a marriage alliance, start working and start a family. Many adolescents have failed in their development because of the severity of the illness.
What are the aetiological factors that contribute to the manifestation of the illness? According to the stress-vulnerability theory, individuals have a genetic predisposition and psychosocial stressors unmask the disorder. The neuro-developmental theory looks at factors that occur during pregnancy and the perinatal insult that occurs at birth. The bio-psychosocial theory looks at biological factors, psychological factors and social factors.
The biological factors look at genetics and chromosome abnormality, neurotransmitters and hormones as well as other medical illness. The psychological factors look at personality development and family and cultural issues. The social factors look at poverty and the lack of resources on the manifestation of the illness. What is proposed is that the stressors of life act together on a susceptible individual and the disorder is manifested.
The features of the disorder are poor or deteriorating school or work performance, strange irrational behaviour, undue aggressive behaviour, undue talking and laughing to self, bizarre thinking and speech pattern and lack of self-care. Individuals have some or all the features which must be present for at least six months to produce a diagnosis of schizophrenia. If the features are present for less than six months individuals are given another diagnosis.
Early intervention and a multimodal approach to management will improve the functioning of the individual. Schizophrenia is a chronic medical illness and should be treated as such. The role of the family in the aetiology and treatment cannot be over-emphasised. It also requires communities to be involved in the treatment of the sick among them.
Medication, behaviour therapy, supportive psychotherapy, stress management, psychoeducation and social intervention are the approaches to management.
The medications are varied and quite effective in treating the symptoms and preventing relapse. Modification of abnormal or aggressive behaviour can be done with behaviour therapy. Patients need to ventilate their feelings about having a mental illness and its impact on their lives. One must always remember that people discriminate against the mentally ill for many reasons and the patients have to deal with this. The patients have the same basic need for food, clothing, shelter, education and health as every other individual. Schizophrenics are at a higher risk of suicide and homicide; suicide and homicide prevention is important.
With the increasing stress of life, schizophrenia can occur in the young or the old and can affect any individual. The condition is treatable and people can function optimally. The medication era has made tremendous progress in the management of individuals with schizophrenia, but community involvement is lacking. The naked, hungry, rain-soaked, sunburnt humans on our streets are an example of this.
You can help the mental health movement by getting involved in the preventative, curative and rehabilitative approaches towards mental health.
- Dr. Yvonnie Bailey-Davidson,
consultant psychiatrist.
