What is Schizophrenia and how is it treated?

What is Schizophrenia and how is it treated? May 5, 2013

Schizophrenia is a serious, often highly disabling mental illness. Many get confused and think schizophrenia is a split personality disorder. This is not the case at all. Instead it is characterized by the presence of psychotic symptoms, and the absence of significant mood symptoms.

People can get some psychotic symptoms with the Mood Disorders (Depression and Bipolar Disorder). These should only be present during the mood episodes, and are supposed to be consistent with the mood state rather than bizarre. So, for example, a person who believes he is an alien from another planet sent here on a mission to root out evil is unlikely to have a mood disorder. A person who believes strongly that they are going to die and that their organs are already dead on the inside, may however be suffering from depression.

The distinction between mood disorders and Schizophrenia is not as clear-cut as we might think. As a result, there is also a condition called Schizoaffective disorder, which is diagnosed when patients have episodes which exhibit symptoms normally associated with both Mood Disorders and Schizophrenia.

When people think of Schizophrenia, they tend to think of delusions and hallucinations, which can be bizarre and distressing to relatives. Paranoid delusions, for example that the CIA are bugging your phone, can be disabling. Surprisingly most patients with schizophrenia show what can seem to outsiders like a curious acceptance of their delusions, and minimal to no apparent emotional response. This should not be taken to mean that the illness is not causing suffering. Instead, it is a symptom of the illness itself, which psychiatrists call “affective flattening.” What this means is that patients do not show any of the normal outward signs of emotions, and may indeed be unable to describe how they are feeling even if asked.

Patients who are acutely unwell with schizophrenia will often also exhibit disorganized speech which is hard to follow. In some cases, sentences will disappear altogether , and a highly confusing “word salad” is the result.

Schizophrenia is largely a social condition, and very disorganized behavior is also a prominent sign in many people with an acute episode.

As distressing as all these acute symptoms are, they will usually respond very well to antipsychotics (dopamine receptor blockers). The major issue with schizophrenia is what happens in between episodes. A combination of cognitive, emotional, and motivational symptoms will usually combine to form significant disability. As the DSMIV definition states, in order to get the diagnosis the patient will exhibit such disability that,

“For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset.”

Not everyone who presents with a psychotic episode will turn out to have Schizophrenia. In fact, the diagnosis should not even be made until symptoms of some form have persisted for six months.

Biological Treatment

Medication can be very helpful, especially in treating and preventing the acute episodes. It is important that an expert is involved in working out which treatment regime is best. It can sometimes be hard to determine which symptoms are those from the disease itself and, which may be caused by, for example sedation, which some medications can cause.

Psychological Treatment
Due to the difficulty many patients with Schizophrenia feel in expressing their emotions, traditional psychotherapy has a limited role in this illness, especially in the acute phase. There is some evidence for a role for CBT in residual symptoms and for Family Treatment, which may reduce the risk of relapse

Social Treatment
Helping patients with Schizophrenia cope better at home, feel like they are contributing to society, and have better relationships is very important. To demonstrate the love of God to people with Schizophrenia is surely part of the Church’s task.

Spiritual Treatment
Schizophrenia should be considered in the case of anyone who suddenly seems to develop very strange religious beliefs or experiences. This post is getting too long, so I don’t have time here to explain sufficiently (perhaps this should be a subject for a later post). In my clinical practice, when assessing Christians who had told me about unusual religious experiences for possible schizophrenia, I would sometimes ask them “what do people at your church feel about those experiences you describe?” The answer was almost invariably that church members, or in some cases the pastor had expressed that they were concerned about the experiences to the patient.

In addition, social withdrawal, or an apparent diminishment in the ability to function should lead to a mental health assessment. Sometimes people with schizophrenia may not readily volunteer their symptoms, and so an expert interviewer may uncover the reasons for the person’s change.

In essence with all the mental illnesses I have explored so far, a change in thinking, emotions, or behavior is the trigger to ask for help. I encourage you to refer to two posts in particular to help you detect what may be cases of mental illness in the future:

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