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Schizophrenia is a long-term mental disorder that affects about 1% of the population. It involves a breakdown in the relationship between thought, emotion, and behaviour. It typically involves faulty perception and beliefs, known as hallucinations and delusions. These faulty perceptions and beliefs result in a withdrawal from reality, known as “psychosis”. Schizophrenia can also include a range of other symptoms such as a sense of mental fragmentation, flattened affect (a difficulty reading and expressing emotional cues) and cognitive deficit, which can mean a difficulty processing information from the exterior world.
Schizophrenia does not mean the individual has “multiple personalities”. Multiple personalities exist in another condition called “dissociative identity disorder”.
Experiencing schizophrenia can be very frightening and disturbing; particularly where the person with schizophrenia is experiencing a break with reality.
Typical hallucinations can involve hearing a voice or voices that are not present in reality. These voices may provide a running commentary on the actions of the afflicted person, but can also become highly critical, persecutory, and suggest self-harm or suicide.
Typical delusions can be the belief that one’s thoughts are being broadcast, that messages are being sent to the person through television and radio, or paranoid beliefs that the world is conspiring to harm the person.
People suffering schizophrenia can often behave in bizarre or unpredictable ways.
Typical behaviours include a breakdown in the communication, where the affected individual jumps from topic to topic with disconnected relationships between topics. In severe cases, this may be called “word salad”. Typical behaviours may also include an accentuated paranoia and distrust. The individual may engage in strange actions to “ward off” intrusive thoughts and may have trouble concentrating due to the disruption from internal symptoms.
In a very small number of cases people living with schizophrenia may exhibit violent behaviour. These people are typically experiencing psychosis and may be out of touch with reality. They may be experiencing intense paranoia about the world, or hold beliefs that members of the outer world are persecuting or targeting them through words or actions. Unfortunately, although violent psychotic behaviour only emerges in very rare cases, these instances are very often grossly over-represented in the media contributing to the stigma around the condition.
Treatment is generally over-seen by a GP or psychiatrist.
Treatment for schizophrenia involves in most cases the provision of “anti-psychotic” medication which is generally, but not universally, effective at reducing delusions and hallucinations associated with schizophrenia. Common anti-psychotic medications include Zyprexa, Risperidone, Seroquel and Clopine.
Anti-psychotic medication can have significant side-effects. These can most frequently include lethargy, sedation and excessive sleeping. Other side-effects include excessive saliva production, dizziness and weight gain.
Anti-psychotic medication can be classified as “typical” or “a-typical”; a-typical anti-psychotics are generally newer and may have fewer side effects.
Anti-psychotic medications are not always completely effective in reducing symptoms in all cases.
Psycho-social therapies can be very worthwhile and can assist individuals to build strength and manage symptoms, such as learning to live with internal voices or re-learning to read communicational cues. Individuals also learn about the nature of their illness over time and how to best manage the changes in symptoms.
In general the best first step if you think a loved one has schizophrenia should be to contact your local GP. If possible, bring your loved one to meet the GP.
However, in some cases, a person experiencing delusions or hallucinations may be quite convinced of the reality of what they are experiencing. To them, the delusion or hallucination may seem very real. This is commonly called “lack of insight”. In such situations it may be very difficult to convince the individual that the delusion or hallucination is unreal. In such circumstances it is best to find a mental health worker or social worker who has experience dealing with people with schizophrenia and a lack of insight.
If you think your loved one is in danger of hurting themselves or someone else, please contact your local community mental health centre as a first step. In NSW, there is a 24 hour Mental Health Access Line available on 1800 011 511. In extreme cases of concern, contact the NSW Ambulance Service or NSW Police.
If your loved one is hesitant about entering hospital, trusting a psychiatrist or taking medication it is important to let them know that hospitalisation may be very brief and may give them a safe space to deal with what they are going through. You can also let them know that psychiatrists are there to help. Finally, let them know that medication can very often be very helpful in reducing disturbing phenomena that they are experiencing.