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Mental Health-Schizophrenia

Thursday, 22 January 2009

Schizophrenia is a mental disorder that affects around 1 in every 100 people. The illness is characterised by disturbances in a person's thoughts, perceptions, emotions and behaviour. There are many misconceptions about schizophrenia-that the very definition of the illness means having a split personality and that people with schizophrenia are violent and dangerous. Today Professor Paul Fearon is in studio to talk about the cause, symptoms, and treatment of schizophrenia and dispel any myths or common misconceptions about the illness. We will also be speaking to Brian Hartnett, who was diagnosed with schizophrenia in 1996 and has been on medication ever since.

This week is the third week of our 'Good Mental Health' strand which is running every Thursday this month. So far we have covered Depression, and postnatal depression. Next week we will be looking at panic and anxiety

Professor Paul Fearon

Prof. Paul Fearon graduated in Medicine from University College Dublin, and after 5 years postgraduate training in general medicine, he specialised in psychiatry. He completed his training at the Maudsley Hospital, London and was a consultant general adult psychiatrist there for 7 years. As a senior lecturer at the Institute of Psychiatry in London, he headed the Section of Social Psychiatry and Epidemiology where his research interests included the epidemiology and role of social factors in schizophrenia and bipolar disorder. He returned to Dublin to take up his post in St. Patricks Hospital and Trinity College Dublin in 2008.

Today Prof Fearon will take us through the causes of schizophrenia, common symptoms which can lead to diagnosis, and treatments available. As there is a real stigma attached to this mental disorder, he will talk about some common myths, and give us the real information behind these.

What is schizophrenia?
Schizophrenia is a mental disorder that affects around 1 in every 100 people. It affects men and women equally and seems to be more common in city areas and in some minority ethnic groups. It is rare before the age of 15, but can start at any time after this, most often between the ages of 15 and 35.

Symptoms of Schizophrenia


These are often described in two groups - positive and negative.

1. "Positive" symptoms:

These unusual experiences are most common in schizophrenia, but can occur in other mental disorders.

-Hallucinations
A hallucination happens when you hear, smell, feel or see something - but there isn't anything (or anybody) actually there to account for it. In schizophrenia, the commonest hallucination is that of hearing voices.

-Delusions
A delusion is a belief that you hold with complete conviction, although it seems to be based on a misinterpretation or misunderstanding of situations or events. While you have no doubts, other people see your belief as mistaken, strange or unrealistic. They find that they can't really discuss this belief with you. If they ask you why you believe it, your reasons don't make sense to them, or you can't explain it - you "just know".

-Muddled thinking (or "Thought Disorder")
It becomes harder to concentrate - for example, it may be difficult to:
- finish an article in the newspaper or watch a TV programme to the end
- keep up with your studies at college
- keep your mind on the job at work.

2. "Negative" symptoms:

These are less obvious than positive symptoms.

- Your interest in life, energy, emotions and 'get-up-and-go' just drain away. It's hard to feel excited or enthusiastic about anything.
- You can't concentrate. You may not bother to get up or go out of the house.
- It can be difficult to wash or tidy up, or to keep your clothes clean.
- You may feel uncomfortable with people - that you have nothing to say.


Does everyone with schizophrenia have all these symptoms?

No. Someone can hear voices without negative symptoms, but may not have thought disorder. Some people with delusional ideas seem to have very few negative symptoms. If someone only has thought disorder and negative symptoms, the problem may not be recognised for years.



What causes Schizophrenia?
We don't yet know for sure. It is likely to be a combination of several different factors which will be different for different people.

-Genes
-Brain damage
-Street drugs and alcohol
-Stress
-Childhood deprivation


In the long term:
For every 5 people who develop schizophrenia:
-1 in 5 will get better within five years of their first episode of schizophrenia.
- 3 in 5 will get better, but will still have some symptoms. They will have times when their symptoms get worse.
- 1 in 5 will continue to have troublesome symptoms.


Treatment

1. Medication

The aim of medication is to reduce the effects of the symptoms on your life. Medication should:
- weaken delusions and hallucinations gradually, over a period of a few weeks
- help you to think more clearly
- increase your motivation and ability to look after yourself.
Medication can help the most disturbing symptoms of the illness. However, it does not provide a complete answer. It is usually an important first step which makes it possible for other kinds of help to work.

Support from families and friends, psychological treatment and services such as supported housing, day care and employment schemes are vitally important.



2. Psychological Treatments
Cognitive Behavioural Therapy (CBT)

This may be done by clinical psychologists, psychiatrists or nurse therapists. The therapist helps you to identify problems that are most troublesome for you. These could be thoughts, experiences or ways of behaving, look at how you tend to think about them - your "thinking habits".

This kind of therapy can help you to feel better about yourself, and to learn new ways of solving problems. We now know that cognitive therapy can also help you to cope with troublesome hallucinations or delusional ideas. Most people have between 8 and 20 sessions lasting about 1 hour. For CBT to be effective, you should have at least ten meetings over a period of about 6 months.

3. Counselling and supportive psychotherapy

These don't directly affect the symptoms of schizophrenia, but may be helpful if:
- you need to get things off your chest
- you need to talk things over in greater depth
- you need some support with the daily problems of life.



Myths


Does Schizophrenia mean 'split personality'?

No. Too many people have the idea that someone with schizophrenia can appear perfectly normal at one moment, and change into a different person the next. This is nonsense.

We misuse the word schizophrenia in two different ways. By it, we may mean 'having mixed or contradictory feelings about something'. This is just part of human nature - a much better word is "ambivalent". Just as commonly, we may mean that someone behaves in very different ways at different times. Again, this is part of human nature.

Does schizophrenia make people dangerous?

People who have schizophrenia are rarely dangerous. Any violent behaviour is usually sparked off by street drugs or alcohol, which is similar to people who don't suffer from schizophrenia.

Although there is a higher risk of violent behaviour if you have schizophrenia, it is almost insignificant compared to the effects of drugs and alcohol in our society. If we stopped all the violence caused by schizophrenia, we would only succeed in preventing 1% of all the violence in society. People with schizophrenia are far more likely to be harmed by other people, than other people are to be harmed by them.

Does schizophrenia ever get better?
1 in 5 people with schizophrenia recover completely.
Source of much of this info is Royal College of Psychiatrists, www.sirl.ie, www.schizophrenia.com, and www.irishhealth.com
For more information contact:
Schizophrenia Ireland
Helpline: 1890 621 631(Mon-Fri, 9am- 4pm); email: info@sirl.ie

Today's guest; Brian Hartnett started hearing voices in 1988 when he was in London. In 1996 he was diagnosed with Schizophrenia.

He works fulltime as a Peer Advocate with the Irish Advocacy Network (IAN) who work in partnership with the Health Service Executive (HSE) to provide support to people who use the mental health services and also people in the wider community who suffer from mental health difficulties. You can go to their website by clicking on this link http://www.irishadvocacynetwork.com/index.html


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