The importance of schizophrenia awareness

Schizophrenia is complex, and many people are only aware of a few of its characteristics. In the media, schizophrenia has been confused with completely different mental health conditions, which has led to a public perception of schizophrenia that does not match reality. This confusion isn’t helped by a lack of public education on the condition, leading to unfair stigmatisation. This article seeks to address that.

 

What is schizophrenia?

Schizophrenia is a mental illness that can affect how a person thinks, feels and behaves. While these symptoms can interfere with people’s ability to lead a normal life, effective treatments can make this easier.

 

Schizophrenia is associated with a young age of onset, generally around the mid to late twenties – although it can occur in a person’s thirties or under the age of 18, this is much rarer. Emil Kraeplin, the German psychiatrist who was one of the first to study schizophrenia, named it ‘dementia praecox’ – praecox means early. There are multiple theories as to why schizophrenia is so specific in its age of onset, but we aren’t yet sure of the exact reason.

 

Schizophrenia is highly heritable, with a larger genetic component than other mental illnesses. For instance, depression is thought to be 50% heritable – roughly 50% genetic and 50% environmental – but schizophrenia is thought to be up to 80% genetic. Schizophrenia may be triggered by stressful life events or drug or alcohol misuse, but these are thought to be stressors that set off latent processes and are not causes of schizophrenia.

 

The DSM 5 lists schizophrenia under a class called ‘Schizophrenia spectrum and other psychotic disorders’. This class is for disorders primarily characterised by psychosis, with schizophrenia being the most well-known. It also includes substance-induced psychotic disorder. The DSM used to classify schizophrenia into 5 subtypes, but it no longer does this – these subtypes describe what symptoms the person is experiencing most strongly, such as paranoia or disorganisation.

 

Substance use disorder is much higher in people experiencing schizophrenia, around 47%. This means dual diagnosis is common in people with schizophrenia. It’s not entirely clear why this is – but many antipsychotic drugs work on dopamine. As dopamine dysfunction is a core component of schizophrenia, it’s possible this also has ramifications for susceptibility to addiction. Substance misuse can also be a result of stress, maladaptive coping mechanisms and attempting to medicate the negative symptoms of schizophrenia, such as anhedonia.

Schizophrenia and psychosis

Psychosis is the symptom most commonly associated with schizophrenia in people’s minds. Psychosis means perceiving or interpreting reality differently from people around you and can involve seeing and hearing things that aren’t real. This is sometimes described as losing touch with reality.

 

Hallucinations

Hallucinations are seeing, smelling, hearing or tasting things that aren’t there. Hearing voices is frequently associated with schizophrenia, but this is not the only sense that people with schizophrenia can experience hallucinations.

 

Delusions

This involves thinking and believing things that aren’t true. People experiencing schizophrenic delusions may believe they are receiving secret messages meant only for them that they can interpret, that they are in danger, or they are a danger to others.

 

Disordered thought

This means thinking becomes disorganised. It leads to speech and writing that is hard to understand, disjointed thoughts, and linking topics together that are not related.

 

Positive and negative symptoms

 

Psychotic symptoms are known as positive symptoms because they are experienced in addition to reality. But while positive symptoms are more well-known, schizophrenia also has many negative or subtractive symptoms – which are more associated with slowing down and withdrawing. These can be just as debilitating as positive symptoms.

 

Negative symptoms are the most common first symptoms of schizophrenia, and because this can look like other disorders such as depression, they can make accurate diagnosis difficult. It is common to experience both positive and negative symptoms simultaneously.

 

Someone experiencing negative schizophrenic symptoms can exhibit avolition (absence of motivation), lack of interest in daily activities and socialising, difficulty displaying emotions and with day-to-day functioning, and a reduction in speech.

 

Treatment for mental health conditions involving psychosis, like schizophrenia, often involves the use of antipsychotic medications. However, these medications have little effect on negative symptoms, and some can even worsen them. This means people with schizophrenia will often be offered adjunctive medications for their negative symptoms, like antidepressants, along with psychosocial interventions.

Stigma and misconceptions

In the recent past, schizophrenia was frequently misconstrued as a ‘split personality disorder.’ The word ‘schizophrenia’ is rooted in the Greek words for ‘split’ or ‘fragmented’ and ‘mind.’ Split and fragmented mean very different things, and reading the word as ‘split’ may lead people to believe schizophrenia is a different condition entirely, such as Dissociative Identity Disorder. This misidentification has not been helped by inaccurate and belittling portrayals in media and film that often conflate these two conditions.

 

As well as being misunderstood and inaccurately portrayed, schizophrenia is the subject of profound stigma. This is not unique to schizophrenia – mental health conditions, in general, are highly stigmatised. However, schizophrenia is a condition that is often perceived as uniquely frightening and dangerous.

 

One study showed that 64.5% of people with schizophrenia have experienced stigmatisation. This stigma was often rooted in an inflated fear of violence and a lack of understanding of the condition. 

 

Stigmatisation leads to impaired recovery, reduced quality of life and social isolation. This is particularly unfortunate in the case of schizophrenia as these factors can interact with negative symptoms like withdrawal and lack of desire to socialise, worsening them.

 

Stigma, lack of awareness, and lack of understanding also put undue pressure on families and caregivers and delay treatment. Family members frequently do not recognise what their loved one is experiencing as schizophrenia, and this can mean they aren’t able to get the right help. The perceived stigma of having a family member with schizophrenia can also mean family members and caregivers delay in getting their loved one the help that they need.

 

Early intervention tends to lead to much better outcomes for schizophrenia, which is why education and destigmatisation are so important – removing as many barriers as possible to getting early help is critical. This window of time for early intervention is quite large – treatment within the first two to three years of onset has been shown to prevent the relapse of psychosis and much of the disability caused by psychotic illnesses by around 50%.

What do people with schizophrenia need?

 

If you want to help someone you love who has schizophrenia, there are several things you can do.

 

Help them to get professional support

Specialist intervention is crucial for giving your loved one the best possible outcome, so do all you can to support them in getting it.

Focus on feelings, not thoughts

Many people struggle when a loved one is experiencing paranoia or delusions. Focusing on their feelings instead can help to avoid the trap of arguing about what is or isn’t true – this won’t help your loved one.

Educate yourself

Schizophrenia is not well understood. Gaining a realistic understanding of the condition will benefit both you and your loved one.