What You Need To Know About Schizophrenia
- I am glad to be here for it is an opportunity to influence you in how you view people with mental illness. Then you will be able to influence how others think about mental illness and schizophrenia.
- I promise not to be boring, if you will ask questions during the presentation! You may ask questions at any time.
- This is a most important subject because 1 in 5 people will experience some form of mental illness in their lifetime. And all of us will meet someone or know someone who has a mental illness. Conse-quently, all families are affected!
- 1 in 12 hospital beds is occupied by someone with schizophrenia. (Most people think cardiovascular diseases create the number one length of hospital stays.)
- What is mental illness?
(brainstorm for ideas…..)
Mental illness is a general term that refers to a
group of illnesses or disorders of the brain that
interfere with and affect a person’s thinking,
feeling, perceptions and reactions to everyday
circumstances. Thus, a mental illness has a
biological base and interferes with one or more
major activities of life like working, dressing and
relating to others. Mental illnesses are severe in
degree, persistent in duration, and substantially
affect your work, play and relationships within the
family and community. A person finds it difficult to
function independently and maintain a stable,
satisfying life without a wide range of supports
- Mental illness should be seen on a continuum, a line. Starting from the less severe to the worst you have: (Briefly define each.)
- Anxiety Disorders (1 out of 17 people in a given year)
- Severe Phobias
- Depression (clinical, unipolar) (1 out of 12 people in a given year.)
- Bipolar Disorder (manic-depression)
- Schizoeffective Disorder
- Schizophrenia (1 out of 100 people in a given generation.)
-a person can move along the continuum.
-a person can have several disorders.
-a person can be misdiagnosed.
-a person can recover!
- Today I want to talk specifically about schizophrenia.
But let’s do a word association: What comes to mind when I say, “redneck’? (Explain origin of the word: hard working southern sharecropper who got sunburn from hoeing all day.)
(IMPORTANT TO LET PEOPLE SPEAK FROM THE “GUTS,” NO POLITICALLY CORRECT ANSWERS HERE.)
Now, what comes to mind when I say, “schizophren-ia”? (wacko, psycho, crazy, “Freddy Kruger, “Me, Myself and Irene,” nuts).
Where do we get our ideas about schizophrenia, the myths and misconceptions? (movies, the media, sensational newspaper articles, etc.) “Schizo-phrenia”: 2 Greek words meaning “split mind.”
WHAT IS SCHIZOPHRENIA?
- It is a condition that affects the mind. It is a disorder in that there are times the brain does not function “orderly” or “with order.”
- It is a loss of contact with reality. The person has difficulty telling the difference between what is real and what is not real.
- The person experiences psychosis.
- psychosis, a lost of contact with reality can be caused by a brain turmour, medication (heart), endocrine problems, thyroid problems, Alzheimer’s, Bipolar Disorder, and drugs and alcohol use or withdrawal.
- 3% of the population will experience some kind of psychosis.
- 70 percent of all psychosis will be diagnosed as some form of schizophrenia.
- Warning signs: changes in behaviour, confused thinking, changes in speech, personality, emotions, and social activity.
- Schizophrenia affects many mental functions such as: thinking, the five senses, judgement, feelings and behaviour.
- Schizophrenia is NOT a split personality (multiple personality or dissociation disorder).
WHAT ARE THE SYMPTOMS OF SCHIZOPHRENIA?
- First there is no clinical test or blood test. One must have a cluster of symptoms that are “noticed” or notable.
- There are positive symptoms (things there that shouldn’t be there like testing positive for the HIV virus-AIDS).
- Delusions: having fixed false beliefs that are not shared by others (examples: paranoid, grandiosity, religious).
- Hallucinations: sensory perceptions which are due to faulty brain messages. Hearing, smelling, touching, and seeing things that aren’t there. (Common: hearing voices.)
- There are negative symptoms (something removed and replaced by a negative).
- Low energy.
- Lost of interest, inability to enjoy pleasure.
- Withdrawal, isolation. Avoiding friends.
- Flat or blunted affect, no facial expression, poor eye contact.
- Poverty of thought, difficulty in getting thoughts together.
- There are symptoms of disorganization.
- Thoughts and behaviour are disorganized.
- Person communicates less logically.
- Speech is disorganized.
- There are symptoms of depression.
- Depression may be a response to the schizophrenia, dealing with it.
- Suicidal ideation can occur (40% attempt suicide. 10% complete it. Due to great losses and hopelessness.)
- Or the depression may a component of the illness (Schizoeffective Disorder).
- There are cognitive symptoms.
- Person my experience loss of short-term memory.
- Person may have loss of “executive skills” (planning, managing, executing a strategy like catching a bus and going to the store).
- In order for a diagnosis of schizophrenia to be made a person must have a cluster of these symptoms for 6 months and hallucinations or delusion for a period of two weeks.
- All of these symptoms all combined result in a loss of functioning: in thinking, feeling, perceiving, working, relating and socializing.
- A person with schizophrenia is not always “symptomatic.” It comes and goes.
HOW OFTEN DOES SCHIZOPHRENIA OCCUR?
- One in 100 people will have some form of schizophrenia in their lifetime.
- Brother or sister of someone with schizophrenia: 10%
- Child with both parents: 40%
- Identical Twins: 40% (It is NOT completely genetic, which is good news!)
- This is true across all cultures and socio-economic status.
- It usually starts in the late teens (“youth’s greatest disabler”).
- Peak age for men is age 23. Peak age for women is age 27. Starts a bit earlier in men than women (estrogen inhibits?).
WHAT IS THE COURSE OF SCHIZOPHRENIA?
- 25% have one or two psychosis and never experience it again.
- 25% will struggle with several significant psychosis episodes and will need to take medication, but then improve and are able to live independently.
- 25% will experience schizophrenia for years and will need extensive supports and services. They improve but often loose their friends, jobs and don’t finish school.
- 15% will be refractory (medication just doesn’t seem to work). They are often part of the homeless population and in mental institutions for years or decades.
- 10% die by suicide.
WHAT CAUSES SCHIZOPHRENIA?
- We don’t know.
2. The main theories are:
- Genetic vulnerability (hotspots on a number of genes).
- Neurodevelopmental abnormalities in the developing brain (neural pathways damaged).
- Birth trauma (lack of oxygen).
- Viral infections during second trimester of pregnancy.
- It is not completely genetic.
- Identical Twins. 40% chance.
- Stress vulnerability: internally and externally.
WHAT HAPPENS THEN TO THE BRAIN?
- Illness results because the brain changes.
- The brain changes due to “causes” unknown.
- There are changes in the brain chemicals called neurotransmitters: dopamine and serotonin. (too much of it in the area of the brain that controls thinking).
- Brain has more nerve cells (neurons) than there are trees on the planet.
- There are gaps (synapses) between each nerve cell. There are more synapses than there are leaves on all the trees on the plant.
- The brain produces neurotransmitters so that electrical signals that transmit messages from one nerve cell to the next nerve cell can be carried or transmitted (conduit).
- The excess dopamine and serotonin make the person extremely sensitive to stressors (“sensitive brain” or “sandpapered brain”).
- The chemical imbalance produces the symptoms of schizophrenia.
5. NOTE: The same neurotransmitter dopamine involved in schizophrenia is the same one involved with Parkinson’s. Not enough dopamine in the area of the brain that controls motor coordination. Billy Graham, Michael J. Fox, The Pope have Parkinson’s. BUT NO STIGMA is held against them!!
WHAT CAUSES A RELAPSE OF SYMPTOMS (PSYCHOSIS)?
- Person can receive treatment and supports.
- But relapse occurs or is triggered by great stresses. Major life events, daily hassles, emotional over-involvement by others, alcohol and drug use.
- Part of treatment is managing stress, not just medication alone. If life stressors are low and the vulnerability is low the person is more likely to stay well with less relapse.
WHAT IS THE TREATMENT (OR RESPONSE) TO SCHIZOPHRENIA?
- A holistic one: bio-psycho-social-spiritual-recovery-empowerment perspective.
- Medication is one aspect. The use of antipsy-chotic medication to correct the chemical imbalance.
- Psychosocial Rehabilitation: Education about the illness, how to manage it, and improving skills for coping with stress, problem solving, vocational training, etc.
- A healthy spirituality, non-toxic and non-shame based.
- A philosophy of recovery. Restored hope and meaning and purpose and new identity. It is recovering from mental illness and the mental health system and society’s stigma.
- Empowerment: making choices, taking back control.
- Family education is very important in relapse prevention to create a supportive home environ-ment that is les stressful and emotionally involved.
- Relapse rates:
- Occurs 60 to 80 % within 2 years without medication.
- But with medication relapse occurs 15 to 40%.
- BUT with medication, psychosocial interventions and family education, relapse drops to 20% or less.
- It is a myth that people with schizophrenia never recover. With “best practices” up to 90% will recover (live a meaningful quality of life, even if there are relapses).
WHAT ABOUT VIOLENCE?
- It is a myth that people with schizophrenia are violent.
- People with schizophrenia are far more times to be victims of violence than to commit violence.
- Health Canada Study: For the small sub-population of those who are violent, the precursors are three things: not taking medication when they need to due to a hard form of schizophrenia, using alcohol and drugs, and having a volatile personality. (“Schizophrenic pushes woman in front of subway train” should have read “Cocaine addict pushes woman in front of subway train.”)
WHY WOULD A PERSON DENY THEY HAVE SCHIZOPHRENIA?
- The worst of mental illness.
- The great stigma society holds about the illness.
- Denial is a normal part of the process of grief and loss: This can’t be happening to me.
- Lack of insight as a result of a hard form of schizophrenia.
WHY WOULD A PERSON NOT TAKE MEDICATION OR STOP TAKE MEDICATION?
- Part of the denial process. To take medication is to accept that you have the illness.
- Hopefulness. Meds work, then person stops, thinking that they can control it.
- Serious side effects from medications (list).
- Movement disorders, weight gain, sexual dysfunction, drowsiness, loss or increase of appetite, dry mouth, difficulty in sleeping, lactation, amenorrhea, blunted emotions,
- Poor management of medications by doctor.
- Medications don’t work.
- Are better and are weaned off them with doctor’s guidance.
- How should you view a person with schizophrenia?
- The Pat Deegan Flower Illustration. Where do you put the schizophrenia? (Try to get a person to say, “in the centre.” Then correct.)
-Family, friends, work, education, sexuality, politics, spirituality, hopes & dreams, values & beliefs, philosophy of life, other illnesses……schizophrenia.
- “ASK NOT WHAT ILLNESS A PERSON HAS, RATHER, ASK WHAT PERSON THE ILLNESS HAS.”
- See a person with hopes and dreams such as you. Don’t see the person through the myths and misunderstandings and stigma.
- “Our responsibility is never to lose sight of the fundamental sanctity, dignity, and sovereignty of another human being no matter what their diagnosis may be, no matter how ‘regressed’ or ‘poor’ their prognosis may be, and no matter what their disability may be.”
–Pat Deegan, a psychologist recovering from schizophrenia.
-Chris Summerville, CPRP. Executive Director
Manitoba Schizophrenia Society, Inc. May, 2004