This week the Goan Observer team had a thought provoking discussion with Dr Amit Dias of the Department of Preventive Medicine, Goa Medical College, to understand the mysteries and myths surrounding a chronic mental illness, schizophrenia.

World Schizophrenia Day is on May 24. “Let’s cut the stigma and not support it,” says Dr Dias. Let’s understand schizophrenia and increase awareness and acceptance.

QUESTION: LET’S START WITH THE VERY BASIC. WHAT EXACTLY IS SCHIZOPHRENIA?
ANSWER: Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels and behaves. People with schizophrenia may behave like they are not aligned with reality. Schizophrenia is not as common as other mental disorders but the symptoms can be very disturbing and destabilizing.
People with schizophrenia can have trouble distinguishing reality from fantasy, expressing and managing normal emotions, and making decisions. People with schizophrenia attempt suicide more often than people in the general population. Reportedly, up to 10 percent of people with schizophrenia commit suicide in the first 10 years of the illness — particularly young men with schizophrenia.

Q. IS IT THE SAME AS A SPLIT PERSONALITY?
A. This is one of the biggest myths surrounding schizophrenia. Contrary to popular perception, people with schizophrenia do not have a “split” or multiple personalities. It is not the same as dissociative identity disorder. They have false ideas and delusions but do not experience different personality states and most do not pose a danger to others. The community at large needs to be educated about the condition.

Q. ARE PEOPLE WITH SCHIZOPHRENIA VIOLENT?
A. This is yet another myth about schizophrenia. Research indicates that people with schizophrenia are more likely to be victims of violence rather than perpetuate it. Unfortunately, people with schizophrenia are often portrayed as violent individuals in movies and it has led to this misconception. Violence may be seen if there is associated substance abuse as with drugs and alcohol.

Q: IS THERE TREATMENT FOR THIS CONDITION?
A. There is treatment, but as of now, we do not have a cure for schizophrenia. It can be managed with medication and behavioral therapy, especially if diagnosed early and treated regularly.
Besides medication, psychological, vocational and social rehabilitation is very important to ensure a good outcome. If provided appropriate treatment, they can be a significant improvement in the quality of life of the person suffering schizophrenia and their family. The problem we often notice, is that after recovering from the acute episode, people often neglect their treatment and this leads to a relapse. The community at large is not aware and is not sensitive to people with schizophrenia and they are often abandoned and are seen on the streets…some of them teased, ill-treated and abused.
According to a meta-analysis, almost 90% of the people homeless on the street suffer psychosis or schizophrenia. Street Providence is an NGO in Goa which is engaged in rehabilitating such people. People with schizophrenia can be gainfully employed and can do well in a job if they take their treatment regularly and have a supportive environment.

Q: AT WHAT AGE DO THE SYMPTOMS OF SCHIZOPHRENIA APPEAR?
A: Schizophrenia affects men and women equally. It occurs at similar rates in all ethnic groups around the world. Symptoms such as hallucinations and delusions usually start between ages 16 and 30. It is seen that men tend to experience symptoms earlier than women. Schizophrenia rarely occurs in children. Most of the time, people do not get schizophrenia after age 45.

Q: WHAT ARE THE EARLY SYMPTOMS OF SCHIZOPHRENIA?
A: The symptoms and signs of schizophrenia and very diverse and can present with a wide range of symptoms. There could be early signs of problems with personal relationships at school, at home or work. There may be problems with work performance and they may feel like they are hearing voices or get the feeling that they are being controlled. They may be excessively suspicious and live a life like a loner and keep away from others. Remember, these are not characteristic signs restricted to schizophrenia, but need further evaluation to diagnose the condition and prevent a full-blown psychotic episode. The common symptoms of the first episode would include paranoia, which is a wrong belief that others want to harm you, hallucinations, low motivation, reduced experience of pleasure, disorganized thoughts and behaviors, social withdrawal, sleep disturbance, poor emotional control and occasional anger. They are also more likely to have some addictions to either tobacco, alcohol or drugs. One may also present with cognitive symptoms which involve problems with attention and memory, especially in planning and organizing to achieve a goal. Making an early diagnosis may be difficult as the symptoms may be vague.
It is necessary to rule out other causes before the psychiatrist makes the diagnosis of schizophrenia. There are various types of schizophrenia and the signs and symptoms will vary depending on the subtype. Relapse and remission cycles often occur; a person can get better, worse and better again repeatedly over time.

Q: YOU MENTIONED THE TERMS DELUSIONS AND HALLUCINATIONS. CAN YOU SIMPLIFY THESE TERMS FOR OUR READERS?
A: These are both symptoms of psychosis and are part of an altered reality. They are often confused with each other, but they are distinctly different. Delusions are cognitive while hallucinations are sensory symptoms. To simplify, delusions are false beliefs that the person thinks are real. For example, they may believe that others are monitoring or threatening them, poisoning them, or reading their thoughts. Hallucinations cause a patient to hear, see, feel, or smell something that is not there.

Q: WHAT ARE THE WARNING SIGNS THAT A PERSON MAY RELAPSE?
A: Increased anxiety, difficulty sleeping, agitation, increased suspiciousness, increased hostility, increased severity of any of the symptoms. Here rapid recognition of the signs and immediate intervention is necessary.

Q: ARE THERE ANY KNOWN RISK FACTORS?
A: Like most mental illnesses, multiple factors contribute to the development of this condition — genes, environment, brain chemicals, brain structure and brain development. It is not yet possible to use genetic information to predict who will develop schizophrenia. Scientists also think that interactions between genes and aspects of the individual’s environment are necessary for schizophrenia to develop. It is a myth that poor parenting can lead to schizophrenia.

Q: WHAT IS YOUR MESSAGE TO OUR READERS?
A: Everyone needs help in raising awareness about schizophrenia. We should help fight the stigma and encourage people to take treatment. For that we need to educate ourselves, listen and empathize with people affected with this condition and support their family. We need to empower people with schizophrenia to lead fulfilling lives and emphasize the importance of community support. This is also the theme for World Schizophrenia day this year. LET’S CUT STIGMA AND NOT SUPPORT IT.