Times of India
25 May 2008
Pune, India
By Seema Hingorrany

PT sheds some light on schizophrenia, an often misunderstood affliction
The 2002 Academy Award winner for Best Picture, A Beautiful Mind brought schizophrenia into the public eye, depicting the true story of the progression of the illness in a brilliant Nobel Prize winner John Nash. As the film illustrated, schizophrenia makes it difficult for a person to distinguish between what is real and unreal and to comprehend situations clearly. These thoughts disorder can hamper one’s occupational functioning, relationships, and day–to–day activities. It’s important to shed light on this dark subject.

For the sake of discussion, let’s take the hypothetical case of one Raghav, a 23–year–old. He could be a brilliant student who at some point of time, starts to change drastically. Raghav starts showing propensity of being increasingly paranoid about people and is seen muttering to himself most of the time. He becomes convinced that his friends are ‘Out to get him’ since they are jealous of him. He then tells his mother that his room has cameras fitted to tap his every moment and his enemies are in on the conspiracy. From there, things just get worse. Raghav stops bathing and shaving. He starts hearing voices telling him to find the bugs and deactivate them. Realising that most of Raghav’s thoughts are getting bizarre, his parents take him to a mental health professional where he is diagnosed with schizophrenia. This could be any person’s story, but it is most tragic when its onset is early.

Onset
Schizophrenia usually starts between the late teens and the mid–30s, whereas onset prior to adolescence is rare (although cases with age at onset of 5 or 6 years have been reported). Schizophrenia can also begin later in life (e.g., after age 45 years), but this is uncommon. Usually, the onset of schizophrenia occurs a few years earlier in men than women. The onset may be abrupt or insidious.

Causes
Just as the risks for diabetes and heart disease are thought to run in families. The research in this area investigates the possibility that individuals result from interplay of genes. Many environmental factors have been suggested as risk factors, such as exposure to viruses or malnutrition in the womb, problems during birth, and psychosocial factors, like stressful environmental conditions. Many researchers believe that people with schizophrenia are either very sensitive to a brain chemical called dopamine, or produce too much of it

Symptoms
Delusions are unusual beliefs that are not based in reality. Paranoid delusions, or delusions of persecution, for example believing that people are “out to get” you.

Delusions of reference: It may seem as if people are talking about you or special personal messages are being communicated to you through the TV, radio, or other media. Somatic Delusions are false beliefs about your body, for example that a terrible physical illness exists. Delusions of grandeur, or when you believe that you are very special or have special powers or abilities. An example of a grandiose delusion is thinking you are a famous celebrity. For example, Marc David Chapman who shot John Lennon in 1980 thought he was Lennon and the real Lennon was an impostor.

Hallucinations
Auditory hallucinations cause people to hear sounds that are not there. Visual hallucinations cause people to see things that do not exist.

Disordered thinking interferes with planning, motivation and communication. A person with schizophrenia may, for example, aimlessly wander, display childlike silliness or become unpredictable and agitated. Or they may display behaviour that is considered inappropriate according to usual social norms.

It is a chronic mental disorder in which people hear voices, become convinced that others are plotting to harm them or believe that others are broadcasting their thoughts to the world. These experiences could make them fearful and withdrawn and affect their relationships with others

Social withdrawal causes the schizophrenic to seek isolation. This may include an intolerance of being in crowds, small gatherings or even with just one other person. People suffering from schizophrenia may fail to experience or express pleasure in things that they once found enjoyable.

Flat presentation (affective flattening)
This can be indicated by unchanging facial expressions, poor or no eye contact, reduced body language and decreased spontaneous movements. A person experiencing affective flattening may stare vacantly into space and speak in a flat, toneless voice.

Remember
Few people experience all these symptoms at once. Some may occur during the remission phase and may worsen in the most active phase of the disorder. No one symptom gives diagnosis. One has to visit a psychologist or a mental health professional to get the clear diagnosis.

Treatment
Antipsychotic medications change the balance of chemicals in the brain and can help control the symptoms of the illness. Psychotherapy of some type is highly recommended for people suffering from schizophrenia. By adding behavioral treatments for schizophrenia to a medical treatment regimen, the rate of relapse is reduced. A variety of types of psychotherapy are available to schizophrenics. Cognitive therapy, psycho education, and family therapy can all help schizophrenics deal with their symptoms and learn to operate in society. Social skills training are of great importance, in order to teach the patient specific ways to manage themselves in social situations. With adequate and proper treatment, symptoms of schizophrenia do come under control.

(The writer is a clinical psychologist and psychotherapist)