MIND MATTERS
On the occasion of World Schizophrenia Day (observed on May 24), experts discuss the myths, challenges, latest research and lesser-known facts about this serious psychiatric ailment, which affects around 0.32 % of population (one in 300) worldwide, as per
“Imagine if you suddenly learned that the people, the places, the moments most important to you were not gone, not dead, but worse, had never been. What kind of hell would that be…” These lines were spoken by actor Russell Crowe in the character of Nobel laureate Mathematician John Nash in the 2001 film A Beautiful Mind, which dealt with the genius’ struggle with schizophrenia.
Mental illnesses like schizophrenia have been depicted in celluloid a number of times in India and abroad. The Soloist
(the true story of cellist Nathaniel Ayers), Karthik Calling Karthik, and 15 Park Avenue are some other films that turn the spotlight on this sensitive subject with nearclinical accuracy despite artistic liberties.
WHEN REALITY AND FANTASY CLASH
Schizophrenia (meaning fragmented mind) is a serious, complex disorder of the thought process, entailing confusion between reality and fantasy, causing hallucinations and delusions. Though genetic make-up plays a key role in manifestation of the disease, apart from other triggers, the exact causes are still not clear. The disease affects the entire brain, thereby adversely impacting the thought, emotion, memory, cognitive behaviour, vocabulary, movement and actions of the patient.
Psychiatrists observe that the onset (initial episodes) of schizophrenia happens usually in the late teens/adolescence or in early adulthood — between 25 and 30 years of age. Senior citizens can get schizophrenia, but the disorder is called organic psychosis in such cases. Though it can be prevalent in any gender or race or ethnic groups, it is found to affect males more than females and the incidence is a bit higher among the low socio-economic groups. As per WHO, one out of 300 (0.32 %) people are affected by schizophrenia worldwide, though only about one third of this number gets proper treatment and care.
Anyone with a family history of such serious mental illness is genetically vulnerable to the disease. The genes can be present in a dominant or dormant state. If such people are exposed to environmental triggers like stress, trauma, hormonal changes or certain drugs, there are chances of schizophrenia manifesting
—Dr Sheikh Abdul Basir
The various types of schizophrenia are Paranoid (most common type — almost 80% of patients fall in this category), Catatonic, Hebephrenic or Disorganised, Simple, Unspecified, Undifferentiated, Residual Schizophrenia and so on.
SYMPTOMS
Symptoms of schizophrenia can be positive or negative. Positive symptoms include paranoia, hallucinations (visual images, voices, smells and touch) and delusions (strong beliefs and notions), illogical changes in thought and behaviour, persecution syndrome, suspicion, self-talk or a belief that someone is talking to them, commanding them, running a negative commentary about them etc.
Negative symptoms include low motivation, lack of focus and attention, lack of social interactions, self-isolation, disconnection and detachment towards daily routines, lethargy and apathy.
GENETIC & ENVIRONMENT TRIGGERS
Explaining the ailment, Dr Sheikh Abdul Basir, senior consultant psychiatrist and founderdirector of Mind Piper, says, “Both nature (genetic make-up) and nurture (environmental triggers) have a role in the development of schizophrenia. Anyone with a family history of such serious mental illness is genetically vulnerable to the disease.
The genes can be present in a dominant or dormant state. If such people are exposed to environmental triggers like stress, trauma, hormonal changes or certain drugs, there are chances of schizophrenia manifesting. However, though it’s a genetic disease, not every member of the family will get it.”
TREATMENT AND RELAPSE
Unfortunately, there is no biochemical or radiological test to determine if one has schizophrenia. Therefore, identifying initial symptoms and seeking treatment is the only remedy, say doctors.
“If family members can identify the symptoms early, after the initial schizophrenia attack, and bring the patient for immediate treatment, the prognosis would be good. The patient’s acceptance level, cooperation with treatment and the family’s support are also important factors for consideration. Anti-psychotic medication, including second-generation drugs, psychotherapy and counselling can help most patients lead a normal, functional life. The dosage, duration and mode of treatment will vary from case to case depending on the stage of diagnosis. If the patient is erratic in taking medicines or discontinues treatment after feeling better, without the psychiatrist’s advice, there is every chance of a relapse because traces of the disease can still be present in the brain. Follow-ups are also a must,” adds Dr Basir.
SCHIZOPHRENIA & NARCOTICS
Studies are being conducted to determine the co-relation between substance abuse and schizophrenia. Cannabis (marijuana or ganja) has been found to cause genetic mutation, which can later develop into schizophrenia. Cumulative medical studies have shown that those with genetic vulnerability who smoke cannabis are five times more at risk of developing schizophrenia compared to non-users of cannabis.
Elaborating, Dr Koganti Charan Teja, consultant neuro-psychiatrist at KIMS and associate professor, VRK Medical College, says, “Medical research points out that cannabis causes mutations in AKT 1 and COMT genes in vulnerable people, which manifests as schizophrenia. Ongoing research also indicates that other hard drugs like crystal meth may also increase the risk of schizophrenia, though the studies are inconclusive yet.” Another interesting point is that fingerprint and finger-length anomalies — asymmetrical ratio of the right and left hand — have been noticed in schizophrenia patients, says the neuropsychiatrist.
It should be kept in mind that in schizophrenia patients, the secretion of the brain chemical dopamine is excessive, and intake of cannabis also raises dopamine secretion, thereby causing an imbalance of neurochemicals or neuroanatomy (function and structure of the brain). Narcotic substances are a strict No-No
—Dr Koganti Charan Teja
THE VARIOUS TYPES OF SCHIZOPHRENIA ARE PARANOID (MOST COMMON TYPE — ALMOST 80% OF PATIENTS FALL IN THIS CATEGORY), CATATONIC, HEBEPHRENIC OR DISORGANISED, SIMPLE, UNSPECIFIED, UNDIFFERENTIATED, RESIDUAL SCHIZOPHRENIA AND SO ON