What is it?

Schizophrenia is a mental disorder that affects approximately one in 100 people in Ireland. It affects men and women equally, although men seem to develop the condition about five to ten years earlier than women. Schizophrenia is rare in people aged less than 15 years of age. Schizophrenia normally presents between the ages of 15 and 35 years of age.

Symptoms of schizophrenia

The symptoms of schizophrenia are often described in two categories: positive (also called active) symptoms and negative (also called passive) symptoms. Positive or active symptoms reflect the experience of new or unusual forms of thought and behaviour. Negative or passive symptoms reflect a loss of previous feeling and abilities.

Positive symptoms

• Hallucinations
• Delusions
• Disordered/muddled thinking
• Feelings of being controlled

Negative Symptoms

• Difficulty concentrating
• Loss of interest in daily activities
• Reduced motivation

Hallucinations are the perception of a nonexistent object or event. They are unusual or explained sensations such as hearing voices, or feeling or seeing something that does not exist. Hearing voices is a common hallucination associated with schizophrenia. The voices may comment on your thoughts, actions, feelings and behaviours or the voices may advise you or issue demands and orders. The voices themselves sound very real and believable. For people experiencing hallucinations, it seems like the voices are from outside of you. The voices may also seem to come from objects, for example a TV or radio. These voices can be familiar or friendly but are often abusive and critical causing the person hearing them to feel like they must obey them, even when you know you shouldn't. The voices can be very distressing and cause additional problems if you follow the orders given. These voices are imaginary but they are created by the mind.

Delusions are experiences or strong beliefs you hold that are not in line with generally-accepted reality. Examples of delusions include the belief that you are being followed by secret agents or that someone is trying to take over the world or hurt someone you love. Delusions can start suddenly or they may start after a while of noticing that something strange has been happening that you can't explain. Delusions can also start as a way of explaining hallucinations. For example, if you hear voices commenting on your thoughts and actions, you may be convinced that you are being monitored or under surveillance. Paranoid delusions are delusional ideas that make you feel harassed or persecuted. They may be unusual, for example, the delusion that you are being influenced by aliens ormore familiar in that you start believing that your family are trying to control you. Another type of delusion is the idea that you see special meaning from ordinary day to day events and feel that they are directly connected with you. For example the belief that TV programmes are about you or the sequence of events relay a special message for you. Delusions can affect someone in a variety of different ways. Delusions may affect the way you think, who you interact with and how you behave.

Thought disorder is when it is difficult to follow a logical sequence of thoughts as your thoughts are muddled. You jump from one idea to the next without any obvious association between the two ideas. It is also common with thought disorder not to be able to seem to remember what you wanted to say. This can affect you in many ways, for example, problems holding a conversation, completing studies in college, keeping down a job and interacting with people.

Feelings of being controlled. This could include the feeling that your body is being taken over by an outside force like aliens or a robot. You may feel that your thoughts are not actually yours but that someone else has put them in your head.

Negative symptoms. These symptoms are less obvious than the positive symptoms. It is sometimes difficult for others to understand that these symptoms are a result of schizophrenia. It is important to note that even though these negative symptoms do not seem as dramatic as the positive ones, they still can cause extreme difficulty to the person experiencing them. Difficulty concentrating, problems with attention and memory are all commonly associated with schizophrenia. There may be loss of interest in daily activities this is when you feel completely disinterested in the activities that you used to really enjoy. These activities did give you a sense of enjoyment, satisfaction, enthusiasm and achievement but now you can not bring yourself to do them.

Loss of motivation - this is when you feel you have no energy, you feel totally drained and find it hard to be excited or motivated to do anything.

Causes of schizophrenia

It is not known for sure what causes schizophrenia to develop. It is thought that schizophrenia usually results from a complex interaction between genetic and environmental factors. As a result, the causes are different for different people.

Genetics

Genetic factors have been shown to have an impact on the development of schizophrenia. Family studies and twin studies have provided valuable information on the influence of genes and environmental factors. Identical twin studies show that if one identical twin has schizophrenia, their twin has approximately a 50:50 chance of developing it also. If one of your parents has schizophrenia you have a one in 10 chance of developing schizophrenia yourself. If both parents have schizophrenia the risk is increased to one in four. The general population risk of developing schizophrenia is one in 100.

Drugs and alcohol abuse

Studies have revealed that some people may develop symptoms of schizophrenia as a result of using street drugs such as ecstasy, LSD, amphetamines and crack. These drugs certainly make you more vulnerable to developing schizophrenia. Street drugs and alcohol make matters worse for you if you already have schizophrenia.

Stressful life events

Studies and personal accounts have suggested that periods of stress or life-changing events can trigger schizophrenia by increasing the body's production of the hormone cortisol. Such stressful life events could include sudden events such as bereavement, or an everyday problem such as difficulty with college or work, or else longer-term stresses such as difficulties with family members.

Brain chemical imbalances

There is some evidence to suggest that chemical imbalances in certain neurotransmitters (the substances that allow communications between nerve cells) play a role in the development of schizophrenia. Studies suggest that an excess of the neurotransmitter dopamine in the brain and a low level of glutamate contributes to the development of schizophrenia.

Environment

Twin and adoptive studies suggest that inherited genes make a person vulnerable to schizophrenia. Environmental factors act on this vulnerability. A lot of research is pointing to stress either during pregnancy or at a later stage. Examples of stress inducing environmental factors that may be involved in schizophrenia include: prenatal exposure to a viral infection, low oxygen levels during birth, exposure to a virus during infancy, early parental loss or separation, or physical or sexual abuse in childhood.

Early warning signs of schizophrenia

For some people schizophrenia appears suddenly and without warning but for others there are some early warning signs and a slow decline in functioning before the first severe episode. During this time people may withdraw from their family and friends, find it difficult to concentrate and notice change in their usual patterns of sleep and appetite. This period is referred to as the prodromal period. Some of the early warning signs include:

• Social withdrawal
• Hostility or suspiciousness
• Insomnia or oversleeping
• Depression
• Deterioration of personal hygiene
• Odd or irrational statements
• Flat expressionless gaze
• Forgetfulness and unable to concentrate
• Extreme reaction to criticism
• Unusual use of words or way of speaking
• Inability to cry or express joy

How is schizophrenia diagnosed?

The process of diagnosis can be lengthy. The condition is diagnosed by a psychiatrist who determines the presence of the symptoms of schizophrenia via interview. All these symptoms do not need to be present at once but they do need to be present for approximately six months. The psychiatrist also needs to rule out other causes of the symptoms experienced before a diagnosis of schizophrenia can be reached.

How is schizophrenia treated?

If you feel you have symptoms of schizophrenia you should firstly consult your GP. He or she will probably refer you to a psychiatrist for initial assessment and treatment. Treatment for schizophrenia includes a combination of medication and psychological therapy, behavioural therapy and social therapy. Treatments are selected on the basis of their ability to reduce symptoms and reduce the chances of recurrence.

What can I do if I am diagnosed with schizophrenia?

It is important to remember that it is estimated that 25% of people diagnosed with schizophrenia will experience a full recovery, 40% will experience recurrent episodes and 35% will experience long-term effects. If you have been diagnosed with schizophrenia the following points are important:

• Keep in contact with your mental health team
• Avoid stressful situations
• Take medication as prescribed by your doctor and have open discussions about possible side effects
• Ask your doctor questions about your condition and learn more about it. Contact Schizophrenia Ireland's helpline for information 1890 621 631 (9am-4pm)
• Try to recognise your early warning signs of relapse
• Develop a close relationship with someone who can help you spot early warning signs of relapse and help you deal with the situation
• Be careful about consuming alcohol
• Join a support group. Contact Schizophrenia Ireland for your nearest local group (1890 621 631 or www.sirl.ie)
• Look after your general health by eating healthily and getting some exercise. Exercise and diet can have a positive impact on weight, sleep, stress and overall outlook on life

What can friends or family do to help?

Families and friends can have a vital role in helping recovery and reducing the likelihood of relapse. The follow suggestions are ways that family and friends can help:

• Be available to listen
• Educate yourself: learn about schizophrenia and its treatments. This will allow you to be more prepared, make informed decisions and be supportive to your friend or family member
• Seek help straight away: early intervention makes a difference so don't wait to get professional help
• Reduce stress: stress can cause schizophrenic symptoms to flare up so it is important to provide a structure or supportive environment for your friend or family member. Avoid putting pressure on your friend or family member or criticising perceived shortcomings
• Encourage independence, e.g. encourage your friend or family member to learn new skills and social outlets. Rather than doing everything for your friend or family member, encourage self-care and self-confidence
• Find out about the reality of schizophrenia including different coping strategies. Find out from the person experiencing schizophrenia how they would like you to help during a time of crisis. Some tips could include the following:
  - Have a list of emergency contact telephone numbers ready
  - Remember that you cannot reason with acute psychosis
  - Be aware that your friend or family member may well be terrified. Try to reassure them.
  - Decrease distractions, e.g. turn off radio orTV
  - Move to a quiet place with fewer people around
  - Devise an emergency plan alongside your friend or family member
• Look after your own general health
• Contact local support groups for family and friends. Schizophrenia Ireland can supply a list of local contact details. Call 1890 621 631.