P.S. There's hope for Schizophrenia

This week has been National Schizophrenia Awareness Week. And as always, we’re all about bringing better awareness to the conditions that a lot of us know very little about.

Schizophrenia, and the psychosis symptoms that characterise this disorder, is probably the most misunderstood and stigmatised of the mental disorders. People with schizophrenia are often thought of as having a ‘split personality’ or ‘multiple personalities’, both of which are completely different, and very rare, disorders that are totally unrelated to schizophrenia. Some of the other myths about schizophrenia - that people who have it have an intellectual disability, that they are violent and dangerous, that it is caused by bad parenting - are just that: myths. So thanks for that, Hollywood.

Schizophrenia is an illness that disrupts the functioning of the mind. It can cause intense episodes of psychosis which can involve delusions (false beliefs that can’t be changed by evidence) and hallucinations (hearing voices or otherwise sensing things that aren’t real). In general, a person who is experiencing psychosis finds it hard to determine what is real from what isn’t. Their view of the world is distorted. What they are experiencing is of course very real to them. And to us, that might look a little bit disordered or chaotic or different.

People can experience one episode of psychosis and recover and never experience it again. Or the psychosis can be a symptom of one of a group of mental illnesses that disrupt the functioning of the brain, one of which is schizophrenia.

Schizophrenia is a comparatively rare mental illness. It is estimated that between 4 and 7 in 1000 Australians have a schizophrenia. The experience of psychosis is more common: around 1 in 100 Australians will experience a psychosis at some stage of their lives. The worldwide incidence of chronic psychotic conditions is about 1%. About half the people who develop a psychotic disorder will have experienced it by their early 20's and about 80% of people with a psychotic disorder will experience their first episode between the ages of 15 and 30 years.

In addition to the symptoms of psychosis, for a person to be diagnosed with schizophrenia a range of non-psychotic symptoms usually exist as well. These deficits tend to last much longer and can include: diminished emotional expression (e.g., showing much less emotion than usual: making less eye contact, using less hand gestures and showing less emotion in facial expressions and speech. This doesn’t necessarily mean the person feels less emotion, just that they can’t express it); poor motivation; reduced speech (e.g., a person might talk a lot less or not at all, repeat themselves or have trouble being specific); and, loss of pleasure in activities.

Although it's true that schizophrenia cannot be cured, there’s plenty of reasons to hold hope for this illness these days. Here's my top 3 reasons why there’s heaps of hope for Schizophrenia today.

  1. Many people can recover from schizophrenia.
Thirty-one years ago, Elyn R. Saks was diagnosed with schizophrenia. Her prognosis was grave: she wouldn’t be able to live independently, hold a job or find love.
After her hospitalisation at 28 years old, a doctor suggested she work as a cashier. If she could do that, they’d reassess her abilities and possibly consider a full-time job.
Today, Saks is the Associate Dean and Orrin B. Evans Professor of Law, Psychology and the Behavioral Sciences at the University of Southern California Gould Law School. She’s a mental health advocate and the author of a powerful memoir, The Center Cannot Hold. And she is happily married to her husband. Take that world!
As Saks writes in this New York Times piece, “Although I fought my diagnosis for many years, I came to accept that I have schizophrenia and will be in treatment the rest of my life. Indeed, excellent psychoanalytic treatment and medication have been critical to my success. What I refused to accept was my prognosis.”
While estimates of recovery vary, research cited by RANZCP suggests that over half of those diagnosed with schizophrenia achieve good or partial recovery between episodes. While one in seven achieve almost complete recovery. This tells us that recovery is possible. There are also certain things that increase the likelihood of recovery - achievements in work or being socially competent before becoming unwell, avoiding drugs and alcohol and having better insight into one's illness. Getting treatment early and consistently taking prescribed medication also greatly improve the chances of recovery.
  1. Early intervention can reduce the impact of psychosis.
Schizophrenia rarely occurs unexpectedly. Instead, it produces a gradual decline in functioning. There are usually early warning signs, referred to as the “prodrome,” which last one to three years and which provide the perfect place to intervene.
Providing someone with support and treatment before and during their first episode of psychosis can reduce the likelihood of future episodes. Early intervention can also limit the impact in other areas of their life. Identifying symptoms early – things like suspiciousness, unusual thoughts, changes in sensory experience (hearing, seeing, feeling, tasting or smelling things that others don’t experience), disorganized communication (difficulty getting to the point, rambling, illogical reasoning) and grandiosity (unrealistic ideas of abilities or talents) - and connecting people at risk with appropriate support services – whether or not they go on to experience psychosis – is critical. And, if they do have a psychotic episode, it means they’re connected to professional supports. This connection contributes to shorter periods of untreated psychosis, better outcomes and a reduced likelihood of future episodes.
Early intervention programs treat patients during their first psychotic episode and the critical five years following. Treatment options include psychosocial treatments – including family interventions – vocational services and individual case management. These measures provide support in all aspects of life and have been found to be a predictor of long-term recovery. There are now over 200 (!) specialised early psychosis treatment centres around the world, including 17 headspace Youth Early Psychosis Program centres and the Orygen Youth Health in Melbourne.
  1. Medications are getting better and are not the only treatment
Hooray for this news!
Whilst medication is seen as an essential part of managing a psychotic illness like schizophrenia, these medications have come a long way. Anti-psychotics were first used for patients with schizophrenia in the 1950’s and whilst they worked well on the symptoms of psychosis, they had some pretty horrendous side-effects. For people who had been taking these medications for some time, side effects could include Parkinson-type symptoms and tardive dyskinesia which is characterised by muscle spasms that cause your body to twist uncontrollably. These days the side effects aren’t as severe, except in high doses, and even then they are not nearly as bad as they were. Or so I am told.
While antipsychotic medication remains central to treatment for most people with schizophrenia, there are a number evidence-based psychological treatments available as well. These treatments usually work alongside medication, targeting wellbeing, social functioning and life skills that may have suffered as a consequence of the illness. Treatments such as family psychoeducation and Cognitive Behavioural Therapy (CBT) are increasingly recognised as successful ways to manage symptoms and prevent future episodes.

None of this banging on aims or helps to reduce the challenges that people who live with schizophrenia and their families face. There is still a lot we don’t know about this disorder and a lot we are trying to learn. But we do know that most of the myths about this condition are just that. We know that if we can recognise the symptoms early, connect people with appropriate services and ensure valuable support is provided when and where it is needed most then we can continue to have some hope.

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