Are you hearing voices in your head?

The word schizophrenia may elicit fear. There is a lot of misunderstanding among the public with this disorder. The term actually means split (schizo) mind (phrenia). But it is a misnomer as the illness does not split the mind.
The features of this illness include positive symptoms. These are not good symptoms but they refer to distressing symptoms.They appear as hearing of imaginary voices (auditory hallucinations), and abnormal beliefs (delusions) such as becoming paranoid to people around them. There can be a variety of positive symptoms.

Then there are negative symptoms such as social withdrawal and inability to concentrate or express emotions. There are also cognitive and mood symptoms.

How common is it?

Schizophrenia occurs throughout the world, in all cultures and their presentations have been recorded throughout history although they were misunderstood. The incidence is markedly about the same through all geographical regions and the lifetime incidence is about 1%.

The onset is often late adolescence and early adulthood although it can occur at all ages. The sex ratio is equal among males and females although the onset in males tend to be earlier.

In the olden times when the illness was not understood, they have been blamed on the devil, on being charmed and on being witches. As such the people affected by schizophrenia had to suffer all forms of supernatural treatments and torture without any relief.

Till the present times, many schizophrenic patients have been wrongly managed! I recall a middle class teenaged girl who was suffering from auditory hallucinations and other behavioural changes which the family did not recognise as illness for a few years. The delay in the treatment resulted in the illness becoming chronic despite improvement in her condition with treatment.

In the recent decades, the illness was blamed on parents and the child’s environment and upbringing. We now know that there is a neuro-biochemical basis to this illness. There is a disorder of the neurochemistry in the brain in certain areas.

Understanding schizophrenia

What is difficult is to understand how and why it develops. There is a lot of progress in the understanding of this disorder. There are complex causes which include the interplay of multiple genes, brain structure and the environment, such as problems at childbirth and the use of illicit drugs, such as cannabis and amphetamines.

A common case that I encountered is a young male who had abused amphetamines who developed symptoms of schizophrenia. Even after stopping the use of these drugs, the symptoms persist. It is like the drugs have precipitated the illness which might not have developed if the person had not abused these psycho-active drugs.
Early diagnosis and initiation of treatment will result in a much better outcome. This has to be emphasized, as often the delay in treatment will result in the person not being able to recover.

Parents and families have difficulty persuading the person to seek treatment and may wait, hoping that the person will recover spontaneously. This will not happen. So do not delay.

In recent years and being in private practice, I have noticed that some patients present very early, within a couple of weeks of positive symptoms even though there may have been a period of prodromal changes in the person. It is very satisfying to treat such patients as the person responds quickly to treatment.

Treatment and management

Nowadays, there is a range of medications that are very effective. The drugs have progressed from first generation drugs in the 1950’s to newer second generation drugs. There are even third generations medicines today.

An important point is to maintain on treatment when there is improvement or recovery as it is well known that the recurrences of this illness becomes less responsive to medicines and higher doses will be required.

Apart from medical treatment, there is a need for psychosocial intervention. This includes psycho-education and counselling of the patients and their families, providing rehabilitation and occupational therapy to improve recovery and reduction of impairment.

There are community self-help organizations that assist families and provide training for the individuals. Such an organization in our community is the Malaysian Mental Health Association. There are similar organizations in other states.

Nowadays, patients with schizophrenia can be quite well, leading fairly normal lives. Many continue to work and are self-supporting. They may continue their studies and even start their own families. Their prognosis have improved a great deal.