A Dummy’s Guide to Schizophrenia in Pakistan

With the growing need for acceptance, we must first educate ourselves to fully understand things. Discussing schizophrenia is extremely sensitive and necessary in today’s world, even though it is not as common, schizophrenic patients probably suffer the worst of all. In countries like Pakistan, where the term itself is foreign, the need to educate has never been more imminent.

Schizophrenia is a chronic, severe mental disorder that affects the way a person thinks, acts, expresses emotions, and registers reality. Since schizophrenia isn’t as common a disorder as the others, it receives considerably less attention in our society, even though it can be the most chronic and disabling.

Schizophrenic patients often suffer from performing well in society, doing daily tasks, in education, and in relationships as well. It is normal for them to feel frightened or withdrawn all the time, and it could feel like they’ve lost connection with reality. Unfortunately, like dyslexia and ADHD, schizophrenia cannot be cured, however, it can be controlled with proper treatments and medications.

People often confuse schizophrenia with a multiple personality disorder, however, that is not the case. Schizophrenia involves a psychosis, a type of mental illness in which an individual cannot distinguish between what’s real and what’s imaginative. To such patients, the world may be extremely confusing since they cannot register changes accurately which is why their behavior comes off as strange.

Schizophrenic patients often go through psychotic episodes, these are known as sudden changes in their personalities or behaviors because of their lack of connection with reality. The severity of schizophrenia varies from person to person like any other disorder, some people tend to have only one psychotic episode, while others go through several episodes during their lifetime. Psychotic episodes only hinder the person’s abilities during the episode, once over, a schizophrenic patient can lead a normal life until the next one.

Schizophrenia symptoms change over time, some may improve, and some may worsen. These are known as relapses and remissions.

Detecting Schizophrenia as Early as Possible

The earliest you can detect schizophrenia is your late teenage years or early 20s. It is known to affect women in their 20s and 30s, the period where it just beginning symptoms and not a full-blown psychosis is known as a prodromal period.

This prodromal period can last up to weeks, months, or even years. Find out which is the prodromal period in schizophrenia is rather difficult since it is hard to specify a trigger and there are only subtle behavioral changes. Such changes in teens include:

• Falling grades
• Social withdrawal
• Difficulties in concentrating
• Sudden changes in temperament
• Trouble sleeping.

Psychotic or Positive Symptoms

In this particular case, positively does not mean ‘good’. It is referring to the additional thoughts or actions witnessed by a patient that isn’t based in reality. Such schizophrenia symptoms include:

• Delusions: these are usually false-, mixed-, or made-up beliefs that have little to no reality but a person suffering from schizophrenia refuses to give up these beliefs even when shown facts. For example, they may believe such that other people can hear their thoughts, or that someone is out to get them, people are plotting against them, etc.
• Hallucinations: hallucinations involve sensations that are not real, being able to hear voices in the common for people with schizophrenia. Such ‘voices’ may bother the patient by insulting them, ordering them, or planting strange ideas in their heads. Other forms of hallucinations include seeing imaginary people, smelling bad odor, getting a strange taste in their mouths, and sensations on their skin even though nothing is touching it.
• Catatonia: this symptom can be related to paralysis in a way, in this condition, a person with schizophrenia may stop speaking completely, and their body may be fixed in a single position for a very long time.

Disorganized Symptoms

Such symptoms are also called positive symptoms however they reflect that a schizophrenic patient cannot think clearly:

• Talking in sentences that don’t make sense or using strange words, making it difficult for the person to communicate or hold a conversation,
• Shifting quickly from one thought to the next without obvious or logical connections between them,
• Moving at a slower pace,
• Indecisiveness,
• Writing excessively but without meaning,
• Forgetting or losing things,
• Repeating movements or gestures, like pacing or walking in circles,
• Having problems making sense of everyday sights, sounds, and feelings.

These also include a few cognitive symptoms which state that the person will have trouble doing the following things:

• Poor Executive Functioning: understanding information and using it to make decisions,
• Focusing or paying attention,
• Working Memory: using their information immediately after learning it,
• Recognizing that they have any of these problems.

Negative Symptoms of Schizophrenia

Similarly, to positive symptoms, negative does not refer to ‘bad’ symptoms. It simply denotes the symptoms which represent the absence of normal behaviors in people with schizophrenia. These include:

• Lack of emotion or a limited range of emotions,
• Withdrawal from family, friends, and social activities,
• Low energy,
• Speaking less,
• Lack of motivation,
• Loss of pleasure or interest in life,
• Poor hygiene and grooming habits.

Causes of Schizophrenia

There are no exact causes of schizophrenia, however, it is an illness with a biological basis. Researchers and doctors have narrowed down a few things that could make someone more likely to develop schizophrenia such as:

Genetics: schizophrenia does run in families, so a likely reason for anyone to develop the disorder is that it was passed on from their parents.

Brain Chemistry: people who suffer from schizophrenia may not be able to efficiently manage brain cells known as neurotransmitters that control certain circuits within your brain that affect a person’s thinking and behavior.

Brain Abnormalities: people with abnormal brain structures are also more susceptible to schizophrenia, however, the disorder is not only limited to people with brain abnormalities- but it can also affect others too.

Toxic Environment: when a person is constantly exposed to highly stressful environments or to damaging toxins, they are more likely to develop schizophrenia. Your body is most susceptible to the disorder when it is going through hormonal and physical changes, which is why schizophrenia is most common during teenage and young adult years.

Diagnosis

To diagnose schizophrenia a doctor may conduct several tests, also sometimes a physical exam. The more common types of tests are blood tests, brain imaging studies, to rule out any other physical illnesses or intoxication as the cause of the symptoms.

If no other reasons are pointing towards schizophrenic symptoms, a psychologist or a psychiatrist is consulted. These psychiatrists and psychologists then use specially designed interviews or tools to assess a person for a psychotic disorder.

The therapist then bases their report on the person’s and family’s symptoms as well their personal assessment of the patient’s attitude and behavior. A person is said to be eligible to be diagnosed with schizophrenia if any of the following symptoms last more than 6 months:

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized or catatonic behavior
5. Negative symptoms

During this period, the patient must have active symptoms for all 6 months or more. The symptoms should negatively affect them socially or at work and can’t be caused by any other condition. However, DO NOT self-diagnose, always consult a professional.

Treatment of Schizophrenia

As mentioned before, there is no cure for schizophrenia, however, it can be controlled in several ways:

• Medications: the primary medications used to treat schizophrenia are called antipsychotics. These drugs don’t cure schizophrenia but help relieve the most troubling symptoms, including delusions, hallucinations, and thinking problems.
• Coordinated Specialty Care (CSC): this is known as more of a team effort to treat schizophrenia, it combines medicine and therapy with social services, employment, and educational interventions. By involving such sectors and the family as early as possible, it will help give the patient a normal life.
• Psychosocial therapy: even though medication can help limit or control a few symptoms, various psychosocial treatments can help with the behavioral, psychological, social, and occupational problems that go with the disorder. Through therapy, patients also can learn to manage their symptoms, identify early warning signs of relapse, and come up with a relapse prevention plan. This may include- rehabilitation, cognitive remediation, individual psychotherapy, family therapy, and support groups.
• Hospitalization: people who usually display severe symptoms of schizophrenia have to be hospitalized just to prevent them from harming themselves or others. When admitted they may undergo electro-conclusive therapy which helps improve a patient’s mood and personality over time.

Can Schizophrenic Patients Be Dangerous?

While several books and research present schizophrenia as a horrifying illness, and patients as violent and dangerous, this usually isn’t true. Most people with schizophrenia are not violent, most patients prefer to be left alone.

When patients take part in violent and unstable behavior that is usually due to a psychotic episode and they have little to no control over their actions during that time. More importantly, people with schizophrenia are probably more dangerous for themselves; the highest number of suicides reported within schizophrenic patients.

The Outcome for Schizophrenia

Like any other illness or disorder, schizophrenia is just that. With proper attention and treatment, it can be controlled to a great deal and can lead to productive and fulfilling lives. If a patient gets along well with treatment, they are likely to spend their lives normally in community settings rather than psychiatric care.

Remember, your mental illnesses are not your weakness. There’s nothing that cannot be controlled. Chin up, keep thriving!

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