Mental Health 101: Schizophrenia

July 12, 2016

As we continue our efforts to shed some light on some common mental health disorders, we wanted to take a moment to shine a bright light of truth on a commonly misunderstood mental health condition: schizophrenia. Used commonly as a plot device in the media (particularly television and movies,) the word is used quite often but is horribly misrepresented and widely misunderstood. We thought we’d change all that with some real facts and education around the subject.

Back again to help us with our efforts is Dr. Elizabeth Fitelson, Assistant Professor of Psychiatry at Columbia University and director of their Women’s Mental Health Program, who was happy to help us dispel the myths around this mental health diagnosis:

Philosophy: So, for those who might not be familiar, what is schizophrenia?
Dr. Fitelson: Schizophrenia is a psychotic disorder. It’s one of the core, more severe mental illnesses.

Almost everyone is aware of the word, ‘Schizophrenia,’ but most mistake it for Multiple Personality Disorder and/or Dissociative Identity Disorder. The terms gets misused a lot in the press and on TV shows where there’s a lot of mischaracterization of what it really is, which is a mental illness characterized by psychotic symptoms.

The essence of psychosis/psychotic symptoms is a loss of touch with reality, so this can include delusions which manifest as false beliefs that are not part of a culturally-acceptable understanding of the world. The delusions can be paranoia that a particularly person is out to get you, or they can be bizarre like aliens are coming down and speaking to you at night. There can also be hallucinations, which can be auditory, visual, olfactory (which means smell or scent-oriented,) or even tactile alterations in perception. Auditory hallucinations can be hearing things that aren’t real, typically voices speaking to them and often in very derogatory ways. Some people can have visual hallucinations, experience weird smells, or even experience tactile hallucinations.

Disorganized speech is another hallmark criteria of Schizophrenia, where sometimes people can seem to be making sense and then they get disorganized in their speech where you can’t really follow what’s going on. Another symptom of Schizophrenia is grossly disorganized or catatonic behavior, which results in people behaving inappropriately in public in bizarre ways, or experiencing catatonia, which is being stuck in a state of ultra-consciousness; and in severe cases becoming completely non-responsive to outside stimuli.

Finally, there can be so-called ‘negative symptoms,’ which are particularly classic to Schizophrenia diagnoses, which appear before the actual psychotic symptoms occur. They’re typically described as diminished emotional expression, a lack of motivation, and it’s typically characterized by progressive isolation: letting things go, not really seeming to care about things that they used to care for.

In order to be diagnosed with Schizophrenia, you have to have two or more of those initial symptoms present pretty consistently for at least six months of active phase symptoms. There’s often what’s called a ‘prodrome,’ where there’s a real personality shift. For example a high school kid who’s popular and successful slowly becomes more withdrawn over a couple of years, not really functioning in school, and becomes very withdrawn and not interested in things they were interested in before, and it’s not necessarily because they’re depressed.

Schizophrenia can be an episodic illness where symptoms can come and go, so patients can experience an episode of real psychotic symptoms and then recover. For many people, they just have one episode and may not experience a recurrence, but for the majority of patients there will be multiple recurrences of symptoms, with some having chronic, ongoing symptoms.

I should point out here that the symptoms leading to diagnosis can be present in other mental health conditions, so it’s important to be thorough when examining the symptoms as a whole. For example, psychosis is a symptom, not a diagnosis. Also, someone with severe major depression can actually have psychotic symptoms where they become delusional and may have hallucinations, but they don’t have Schizophrenia. Similarly, someone who has had major surgery and then has a delirious reaction to anaesthesia might have ‘IC Psychosis’ or ‘Post-Operative Psychosis’ where they are disoriented and may be seeing or hearing things or paranoid. But, again, that’s not Schizophrenia. So, psychosis or psychotic symptoms are expressed under certain types of stressors, and for a Schizophrenia diagnosis, the psychotic symptoms have to occur in the context of a prodrome, must be recurrent, and they must impair functioning over a long period of time.

 

Philosophy: What’s the best treatment for schizophrenia?
Dr. Fitelson: The best treatment protocols are anti-psychotic medications which can be very helpful in treating particularly positive symptoms, like active psychotic symptoms, the delusions, and the hallucinations. Those medications, however are somewhat less helpful in treating the negative symptoms. In most cases, people with Schizophrenia will need medications as part of the treatment, but there are many other types of therapy that can be quite helpful.

One of the things that we know, based on recent research, is that mobilizing family support and helping families understand the illness so they can support the patient are both incredibly helpful. There are different types of family therapy, like Multi-Family Systems Therapy.

Some people really benefit from certain types of cognitive behavioural therapy for psychosis. That type of supportive therapy is also very helpful. So, really, a general combination of medications along with individual and family therapy are considered the most helpful.

 

Philosophy: If you’re diagnosed, what are some things you can do to care for yourself?
Dr: Fitelson: I think self-care is crucial to all mental health diagnoses, so learning how to care for yourself as best you can is key. Also, finding a good support team: find a great therapist with whom you can build a good treatment relationship, and develop a strong relationship with your medical support team; the medications unfortunately do have significant and sometimes severe side-effects, so being able to work with them to find treatment that actually works and with which you can live with is very important. You also need to feel comfortable communicating your symptoms.

It’s of special note that paying attention to the types of food you eat will really help. The empty calories in junk food are not nutritious, and the brain really needs a lot of nutrients to function at its best. Focusing on a healthy diet and getting a good amount of exercise can be quite helpful, particularly since a lot of the side-effects of particularly newer anti-psychotic medications can affect weight gain, especially for women.

 

Philosophy: How can your family members help support you?
Dr: Fitelson:  Family support and the support of loved ones is incredibly important. Unfortunately, sometimes people with Schizophrenia lose insight about their illness when they’re most ill ,which is very hard for the people who care for them. Someone who doesn’t think she’s sick isn’t necessarily going to take medications that make her feel badly, and that’s very hard and frustrating for family members and loved ones. It’s why family support and good treatment relationships are really key, making sure that everyone’s working together to ensure you get adequate sleep and good nutrition, both of which I think are really under-emphasized in mental health.

Schizophrenia is incredibly isolating, so trying to maintain those relationships, even though it’s difficult, is important. Again, paying attention to diet, sleep, exercise, and the other things that are generally grounding and helpful in life can help tremendously. The people who tend to do better are the people who have more relationships and better social supports, and those are the really critical ingredients to recovery.