Schizophrenia: When Reality Feels Unreal? Understanding This Mental Health Condition

Have you or someone you know ever experienced intense confusion (ව්‍යාකූලත්වයක් - confusion) about whether what you think or hear is real or not? Sometimes, it can feel like you're in a different world, with thoughts and feelings that others can't understand. This mental difficulty is what we're going to discuss today: Schizophrenia, or (Schizophrenia). Although it might seem complex, let's talk about it simply.

What is Schizophrenia (Schizophrenia)?

Simply put, Schizophrenia (Schizophrenia) is a somewhat severe mental illness that affects both your mind and body. It impairs your brain's functionality, meaning your thoughts, memory, sensory perceptions (what you feel), and behaviors can become disordered. When this happens, it can be difficult for you to manage many aspects of daily life. If left untreated, this condition can affect your employment, social relationships, romantic relationships, and everything in between. Furthermore, you might struggle to keep your thoughts organized and may unintentionally behave in ways that could lead to accidents or other illnesses.

Are There Different Types of Schizophrenia (Schizophrenia)?

In the past, psychiatrists discussed various types of Schizophrenia. For example, (Paranoid Schizophrenia) (the type where one views everything with suspicion, thinking someone is against them) and (Catatonic Schizophrenia) (the type where one maintains a fixed posture or exhibits excessive movement). However, these classifications were not very useful for accurately diagnosing the illness or choosing appropriate treatments.

Therefore, experts now view it as a condition with various facets and levels within a single illness. Much like a rainbow with many interconnected colors, it is considered a (spectrum). Several conditions that fall under this (Schizophrenia spectrum) are:

• (Schizotypal personality disorder) (this also falls under the category of personality disorders)
• (Delusional disorder) (development of various false beliefs)
• (Brief psychotic disorder) (short-term mental disturbances)
• (Schizophreniform disorder) (symptoms similar to Schizophrenia, but lasting for a shorter period)
• (Schizoaffective disorder) (a condition with symptoms of Schizophrenia combined with mood changes - mood swings)
• Other specified or unspecified Schizophrenia spectrum disorders. These allow doctors to identify unusual variants of Schizophrenia not typically observed.

Who Is Most Affected by This Condition?

Typically, Schizophrenia (Schizophrenia) begins in men between the ages of 15 and 25, and in women between 25 and 35. About 20% of newly reported cases are in individuals over 45 years old. When it develops at this older age, it predominantly affects men.

It is very rare for children to develop Schizophrenia, but it is not impossible. If this condition begins in childhood, it can generally be more severe and challenging to treat.

How Common is Schizophrenia (Schizophrenia)?

This is a somewhat common condition. Globally, approximately 221 people per 100,000 are affected by it.

What are the Five Main Symptoms of Schizophrenia (Schizophrenia)?

Often, individuals with Schizophrenia (Schizophrenia) are unaware they have these symptoms. However, people around you, your family, and friends might notice these changes. These are the five main symptoms of Schizophrenia:

1. Delusions (Delusions): These are false beliefs held in your mind that cannot be disproven, no matter how much evidence exists. For example, you might believe that someone is controlling your thoughts, words, or actions. Or that someone is conspiring against you or trying to harm you. Sometimes, you might think you have special powers or are a very famous person.

2. Hallucinations (Hallucinations): This is a condition where you see, hear, feel, smell, or taste things that aren't actually real. The most common experience is hearing voices that aren't there. These voices might talk to you, criticize your actions, or even give you commands.

3. Disorganized or incoherent speaking (Disorganized or incoherent speaking): When speaking, you might find it difficult to keep your thoughts organized. This means struggling to stay on one topic, or your thoughts might be so jumbled that others cannot understand what you are saying. Sometimes, you might speak in a meaningless way, unable to connect words coherently.

4. Disorganized or unusual movements (Disorganized or unusual movements): Your movements and behaviors might differ from what others expect. For example, you might spin around in one spot without any clear reason, or suddenly become frozen and motionless. Sometimes, you might maintain strange postures.

5. Negative symptoms (Negative symptoms): This refers to a reduction or loss of the ability to do things in an expected manner. For instance, you might show no emotion on your face, or speak in a flat, monotone voice. This also includes a lack of interest in anything, especially in socializing or doing things you normally enjoy. Interest in personal hygiene and appearance might also diminish.

Because of these symptoms, you might also experience the following:

• Being suspicious and fearful about everything.
• Neglecting personal hygiene and appearance.
• Experiencing (Depression), (Anxiety), and suicidal thoughts.
• Being tempted to misuse alcohol, nicotine, prescription medications, or use other illicit drugs, thinking it will provide relief from these symptoms.

What Causes Schizophrenia (Schizophrenia)?

A single, specific cause for Schizophrenia (Schizophrenia) has not yet been identified. Experts believe that a combination of several factors contributes to this condition. The three main identified causes are:

• Imbalances in the chemical signals used by brain cells to communicate.
• Problems occurring during brain development before birth.
• Loss of connections between different parts of the brain.

What are the Risk Factors for Schizophrenia (Schizophrenia)?

Although specific causes for this condition are still not confirmed, there are several factors that increase the risk of developing it:

• Environment: Many environmental factors can increase the risk of developing Schizophrenia. Being born in winter slightly increases the risk. Certain diseases affecting the brain, such as infections and (Autoimmune diseases) (conditions where your immune system attacks parts of your own body), can also increase the risk. Prolonged periods of severe (stress) can also contribute.
• Development and Birth Factors: Your development in the womb also affects Schizophrenia. If your mother had (Gestational Diabetes) (diabetes during pregnancy), (Preeclampsia) (high blood pressure during pregnancy), malnutrition, or Vitamin D deficiency during pregnancy, you have a higher risk of developing Schizophrenia. Similarly, if you had low birth weight or complications during birth (e.g., being born via (Emergency Cesarean Section)), the risk can increase.
• Substance Use: The use of certain substances, especially in large amounts and at a young age, is associated with Schizophrenia. The link between excessive (Cannabis) use during youth, particularly adolescence, and this disease has been well-studied. However, experts are still not entirely sure whether cannabis use is a direct cause of Schizophrenia or merely a contributing factor.

Is Schizophrenia (Schizophrenia) Genetic?

Since experts have not yet found a single specific cause for Schizophrenia, it cannot be definitively stated that it is caused by genes. However, if someone in your family, especially a parent or sibling, has Schizophrenia, your risk of developing the condition is significantly higher.

How is Schizophrenia (Schizophrenia) Diagnosed?

Your (or your loved one's) doctor can diagnose Schizophrenia (Schizophrenia) or related disorders by combining observations of your behavior, the symptoms you describe, and answers to their questions. They will also ask questions to rule out other possible causes for your symptoms. Afterward, these findings are compared with the criteria required for a Schizophrenia diagnosis.

According to the (DSM-5) (Diagnostic and Statistical Manual of Mental Disorders), a diagnosis of Schizophrenia requires the following:

• At least two of the five main symptoms we discussed must be present.
• You must have experienced these symptoms for at least one month.
• Your symptoms must have caused an impact on your work, or your relationships (friendly, romantic, professional, or otherwise).

What Tests Are Done to Diagnose This Condition?

There are no specific diagnostic tests solely for Schizophrenia (Schizophrenia). However, before diagnosing Schizophrenia, doctors may perform certain tests to rule out other medical conditions. The most common types of tests performed are:

• Imaging tests (Imaging tests): Doctors typically use imaging tests such as (Computerized Tomography - CT) scans and (Magnetic Resonance Imaging - MRI) scans to rule out problems like (Stroke), brain injuries, brain tumors, or other structural changes in the brain.
• Blood, urine, and cerebrospinal fluid (Spinal Tap) tests: These tests examine chemical changes in body fluids to identify potential causes for changes in your behavior. They can rule out heavy metal poisoning, other toxic causes, infections, and similar issues.
• Brain activity tests: An (Electroencephalogram - EEG) records and identifies the electrical activity in your brain. This test helps to rule out conditions like (Epilepsy).

Can Schizophrenia (Schizophrenia) Be Cured?

Schizophrenia (Schizophrenia) cannot be completely cured. However, it is often a treatable condition. A very small percentage of individuals can achieve full recovery from Schizophrenia. But it cannot be called a cure, because there's no way to predict who will experience a relapse and who won't. Therefore, experts consider those who recover from this condition to be "(in remission)".

How is Schizophrenia (Schizophrenia) Treated?

Treatment for Schizophrenia typically involves a combination of medications, (Psychotherapy), and self-management strategies. These include:

• First- and second-generation antipsychotics (First- and second-generation antipsychotics): Medications such as (Haloperidol - Haldol®), (Aripiprazole - Abilify®, Aristada®), (Olanzapine - Zyprexa®, Lyablvi®, Symbyax®), and (Quetiapine - Seroquel®) block the action of certain chemical substances (neurotransmitters) used for message exchange between your brain cells. However, these can cause side effects like drowsiness, weight gain, and tremors.
• Next-generation antipsychotics (Next-generation antipsychotics): The FDA recently approved a new type of antipsychotic medication called (Xanomeline and trospium chloride - Cobenfy™). This acts on (Cholinergic receptors) instead of (Dopamine receptors). In clinical trials, this new treatment has reduced symptoms of Schizophrenia and has different side effects. Potential side effects include nausea, upset stomach, difficulty retaining urine, increased heart rate, and constipation.
• Psychotherapy (Psychotherapy): Talk therapies like (Cognitive Behavioral Therapy - CBT) help you cope with and manage the condition. Long-term treatment can also help with secondary problems that may arise with Schizophrenia, such as anxiety, depression, or substance use.
• Electroconvulsive Therapy (Electroconvulsive Therapy - ECT): If other treatments are not successful, your doctor might recommend (ECT). In this treatment, an electric current is directed to your scalp, stimulating certain parts of your brain. This stimulation causes a brief seizure-like state, which helps to improve brain function if you have severe depression, agitation, or similar issues. If you undergo (ECT), you will be given (Anesthesia), so you will be asleep during the procedure and will not feel any pain.

How Soon Will I Feel Better After Treatment?

Your doctor is the best person to tell you how long it will take to feel better from medications and treatments, as different medications take varying amounts of time to show their effects. Additionally, if the initial treatments are not effective, your doctor can discuss other treatment options that might help.

What Can I Expect If I Have This Condition?

Schizophrenia (Schizophrenia) is a condition that varies greatly from person to person. You might experience difficulties with work, relationships, and self-care. However, with treatment, you can gain the ability to work, take care of yourself, and maintain fulfilling relationships.

This condition often has a cyclical effect. This means there might be periods when the disease exacerbates, and your symptoms worsen significantly. After that, there might be a period where your symptoms improve somewhat but do not disappear entirely.

No matter how severe this condition is, remember that with treatment, you can live with it and minimize its impact on your life.

What is the Outlook for This Condition?

Schizophrenia (Schizophrenia) is not a fatal disease. However, its effects can lead to dangerous or harmful behaviors. Approximately one-third of individuals with Schizophrenia experience worsening symptoms over time. This could be due to symptoms not responding to treatment, or difficulty adhering correctly to treatment plans to manage the condition. About 10% of people with Schizophrenia die by suicide.

Others respond well to treatment, but they might also experience periods where symptoms resurface and worsen. Furthermore, lingering issues such as difficulty concentrating and thinking due to the previous impact of the condition can persist.

How Can I Reduce My Risk or Prevent This?

Since experts still don't precisely know why Schizophrenia (Schizophrenia) develops, it cannot be prevented, nor can the risk of developing it be reduced.

How Do I Take Care of Myself?

If you have Schizophrenia (Schizophrenia), you need to do the following to take care of yourself and manage the condition:

• Take medication as prescribed: One of the most important things you can do is to take your medication correctly. If you have Schizophrenia, do not stop taking medication without consulting your doctor. Discuss any problems or side effects you experience with your doctor to find the most suitable medication with the fewest or no side effects for you.
• Attend doctor's appointments as recommended: Your doctor will set up a schedule for your appointments. These appointments are crucial for managing your condition.
• Do not ignore symptoms: Early diagnosis and medical treatment increase your chances of responding well to treatment and achieving good outcomes.
• Avoid alcohol and drug use: The use of alcohol and illicit drugs can worsen symptoms of Schizophrenia and create other problems. This also includes using prescription medications differently than prescribed.
• Consider seeking support: Organizations like the (National Alliance on Mental Illness) can provide helpful resources and information. In Sri Lanka too, there are services that offer similar support; look into them.

When Should I See My Doctor?

You should meet your doctor as prescribed. Also, if you notice a change in your symptoms, for instance, if your symptoms worsen even while taking medication, you should see your doctor. If the side effects of your medication are interfering with your life, you can discuss this with your doctor. Your doctor might be able to treat your condition more effectively and may recommend alternative medications or treatments with fewer or no side effects.

When Should I Go to the Emergency Treatment Unit (ETU)?

If you have thoughts of harming yourself or others, immediately call the National Mental Health Helpline at 1926. If you feel you are close to harming yourself, immediately go to the nearest hospital's Emergency Treatment Unit or call the 1990 Suwasariya Ambulance Service.

What Can I Do If My Loved One Shows Symptoms of Schizophrenia (Schizophrenia)?

If you notice your loved one showing symptoms of Schizophrenia (Schizophrenia) or a related condition, you can try to help them in these ways:

• Ask how you can help: Listening to them, offering your help, and keeping an open line of communication can help them feel connected to others.
• Encourage them to see someone who can help: Treatments for Schizophrenia, especially medications, can improve a person's symptoms and help them understand what is real and what is not.
• Do not judge or argue: Even with evidence, do not judge them or argue with them about what is real and what is not. Individuals experiencing hallucinations or delusions generally do not respond to evidence because they cannot distinguish between reality and imagination.
• Stay calm: If they are agitated or angry, do not raise your voice. Try to make your environment as calm and quiet as possible. Also, ensure they don't feel trapped or threatened in any way.
• Seek help in emergencies: Individuals with Schizophrenia have a higher risk of suicide. If they talk about harming themselves or others, seek immediate help (e.g., call 1926, take them to a hospital).

Finally, What to Remember

Schizophrenia (Schizophrenia) can be a frightening condition for both you and your loved ones. However, contrary to common misconceptions, it is not a condition that prevents you from finding recovery, happiness, or leading a fulfilling life. If you suspect you have symptoms of Schizophrenia, it is crucial to speak with a doctor as soon as possible. Their job is to help you. Doctors, especially those specialized in mental health conditions like Schizophrenia, are trained to assist you without making you feel judged, ashamed, or uncomfortable.

If you notice your loved one suffering from (Psychosis) or symptoms of Schizophrenia, gently and supportively encourage them to seek treatment. Early diagnosis and initiation of treatment can make a significant difference in recovering from and managing this condition.

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