Schizophrenia magazine by Redaction

Schizophrenia the magazine ! !

Schizophrenia the magazine was written by Ilja Geelen, Suzanne Nielen, Lonneke Buist and Sanne Barzilay

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SCHIZOPHRENIA THE MAGAZINE

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Some myths and facts about schizophrenia

MYTH

Schizophrenia is a rare disease

FACT  It is estimated that 1 out of 100 people develops schizophrenia.

FACT Three out of every 100 people will experience a psychotic episode at some time in their lives

AN INTRODUCTION TO SCHIZOPHRENIA You’ve probably already heard about schizophrenia at some point in your life. But although it is a relatively well-known disease, a lot of people still don’t know what’s it about. Partly because of all the myths going around, but also because it is a mysterious disease, which hasn’t been completely figured out yet. Reading this article, will hopefully result in a better understanding of the disease. Let’s begin with the definition. Schizophrenia is a serious mental illness that is characterized by having problems with distinguishing what is real and what is not. It becomes hard to think clearly, to manage your emotions and to associate with others. The illness is best known for the psychoses that it causes, which is a period full of confusion in which you can’t tell the difference between fantasy and reality. Schizophrenia usually shows between the ages of 16 and 35 and around 1 out of 100 people suffer from the disease. A few symptoms of schizophrenia include hallucinations, delusions and confused thinking. The causes of schizophrenia are still relatively unknown. No clear universal cause has yet been found. It is however known that the outset of the disease is influenced by a lot of different factors. Abnormalities in the brain are considered to be a reason and hereditary factors also play an important role. Nevertheless, it is important to realise that even if none of your relatives have schizophrenia, you can still get the disease. When you’re at risk of getting the disease it may be wise to watch out for alcohol and drugs, because they are known to provoke schizophrenia or worsen it. Stress is also an important factor to take into account, since it has a great influence on giving rise to psychoses. A common misunderstanding about schizophrenia is that people suffering from it have multiple personalities. This is not the case. This misunderstanding originates from the fact that the name schizophrenia comes from the Greek language and means a ‘split mind’. In retrospect, this wasn’t a smart name to choose, because it is the biggest cause of confusion about the diagnosis of schizophrenia. There are various types and levels of the disease and therefore every person suffering from it has different symptoms. With schizophrenia you speak in terms of positive and negative symptoms. Positive symptoms are the ones that are typical for schizophrenia, like hallucinations. While negative symptoms are the symptoms that were already present and !1

SCHIZOPHRENIA THE MAGAZINE

don’t necessarily belong to schizophrenia. Like a lack of energy, depression and blunted emotions. But there are more differences in symptoms to be seen. Therefore, schizophrenia is separated in three types. The first type is paranoid schizophrenia. This mostly involves having absurd or suspicious ideas and believes. A common example is the idea that you are being followed by someone, but hearing voices in your head is also a symptom that belongs to this type. Secondly, you have the disorganized type. This type is characterised by having problems with thoughts and emotions. Like chaotic behaviour and inconsistent speech (sometimes even using words which don’t exist), which makes it hard for people to understand you. Having blunted or inappropriate emotions is the last symptom linked to disorganized schizophrenia. Patients with this type don’t normally show a lot of emotions and seem indifferent in life. They can also start laughing without a clear cause. And the last type is catatonic schizophrenia. This particular type is characterised by having problems with locomotion. These problems differ per patient. One can stand motionless in a possibly bizarre pose while the other suffers from uncontrollable and aimless movements. On top of that, these symptoms can also alternate each other. Furthermore, the ability to speak can be harmed and a tendency to imitate someone else’s behaviour may be developed. However, not all of these symptoms have to be present to be diagnosed as the catatonic type. Unfortunately, schizophrenia can’t be cured. At least not with the means that are available today. It however can be controlled. For this to be achieved, two important factors are needed: the right medication and a suitable environment. The medication reduces hallucinations and delusions, makes a patient less anxious and helps the patient to think clearly. These medicines that treat schizophrenia are called antipsychotics. They can come in the shape of tablets or injections. It is however very important that the medicines are taken regularly, not just when the patient is actively experiencing symptoms of the disease. Otherwise the medication won’t work properly. This is the hard part. Even if you feel perfectly well, you need to take your medication to prevent any psychoses from happening, which requires a lot self-control. It is also important to find the medication that suits the patient best, because there can be a lot of unwanted side-effects. But medication is not the only significant factor. The surroundings of the patient are just as important.

SCHIZOPHRENIA THE MAGAZINE

Schizophrenic patients are very sensitive for the things that happen around of them. Changes in daily life can therefore have a big influence and become the cause for a psychotic period. When these changes canâ&#x20AC;&#x2122;t be avoided, it is important that they donâ&#x20AC;&#x2122;t happen suddenly, so the patient can prepare for them. Psychotherapy has also proved to be very helpful in dealing with the disease. So with the right medication and a stable life without stress, it is possible to live with the disease. There will of course always be limitations, but those will just have to be accepted. Isaac Newton also had characteristics of schizophrenia and just look at all the things he achieved.

Schizophrenia the magazine

RENAMING SCHIZOPHRENIA

some myths and facts about schizophrenia

MYTH People with Schizophrenia are really violent

FACT Although hallucinations and delusions can lead to violent behaviour, this is doesn’t automatically mean that every schizophrenia patient is always violent. Especially when medication is used.

MYTH Schizophrenia means that you have multiple personalities.

“One of the biggest prejudices about schizophrenia is in the name itself.” This was a schizophrenia patient’s response when I asked him for any prejudices and misunderstandings he encountered when informing strangers about his syndrome. ”It’s the thought that having schizophrenia means having a split or double personality, which isn’t the case at all. But it is what the name suggests,” I just looked at him quizically then, ashamed to admit to myself that ever before starting my research for this month’s issue, I had thought the exact same thing. Fortunately, he didn’t notice my sudden blush and continued explaining instead. “The name schizophrenia is composed out of two Greek words: ‘Schizo’ meaning split and ‘phrene’ meaning mind. However it shouldn’t be taken this literally. The term was meant to refer to ‘splitting of mental functions’ because the syndrome is basically the malfunctioning of the mind in certain ways.” I must admit, after my shame was mostly gone, I didn’t really think about this striking prejudice anymore. But when I continued my research about schizofrenia online, my attention was captured by certain articles that reminded me of the patient’s words and stirred an interest in me. It’s then that I decided to specify my research to the names of schizofrenia throughout the years. It turns out that schizofrenia wasn’t the first name to be given to the psychological syndrome. When Dr. Emile Kraepelin discovered it in 1887, he gave it the name ‘dementia praecox’, which is Latin for early dementia. He chose this term due to one of the symptoms of schizophrenia being memory loss, which he recognised in the adolescents his research was focused on. Needless to say, this term was a too quickly drawn conclusion. It isn’t for no reason that it was replaced by the term schizophrenia later on: by then it had been discovered that memory loss does not always occur in schizophrenia patients and that there are many more symptoms to it. 1

Schizophrenia the magazine

Biography of Eugen Bleuler Paul Eugen Bleuler was born on April 30, 1857, in a big town called Zollikon in Switzerland. He’s best known for his contributions to the understanding of mental illness and he came up with terms like „schizophrenia”, „schizoid”, „autism” and „ambivalence”. Bleuler was really interested by Sigmund Freud’s work. Like Freud, he believed that our mental processes could be unconscious and influenced the way we behaved on the outside. However he found Freud’s movement that he’d starter „over-dogmatic” and wrote to Freud saying that „this ‚ all or nothing’ is in my opinion necessary for religious communities (…) but for science I consider it harmful. In a lecture in Berlin on 24 April 1908 he introduced the term „schizophrenia”, hereby replacing the term „dementia praecox”.   Paul Eugen Bleuler died on July 15, 1939.

It was Swiss psychiatrist Eugen Bleuler who in 1911 changed the name to schizophrenia because by then it was clear the previous name given was obviously misleading. He was also the first to separate its symptoms into positive and negative ones. He meant for the name to describe the fragmented thinking of patients rather than the idea of having a split personality, which is the way the public understood this term. As the definition of the syndrome changed over the years, the name and with that the public’s misunderstanding, remained an accepted term not just by the people who didn’t know any better but also by the experts, who you’d expect to be aware of the misleading character of the term. However, a couple of years ago something changed in the general attitude towards the term schizophrenia. A growing amount of complaints rose, mainly from patients and people working in or related to the psychiatric field, about the negative stigma the name holds. For the first time, the idea to give a new, less stigmatising name to the syndrome was put forward. One of the main leading forces behind this issue was Anoiksis, a Dutch foundation for and by people with a sensitivity for psychoses, amongst whom many schizophrenia patients. As stated on their website, people were done with having to explain every single time that they did not have a split personality, and that having a susceptibility for pychoses was not the same as being the illness. After all, it is often said someone is schizophrenic rather than they have schizophrenia, which bothers many patients. In response to these negative ideas triggered by the term and wanting for the media to present a more realistic image of the syndrome, Anoiksis set up a contest. A few hundred people from the Netherlands but also from abroad sent in their ideas for new names, confirming this way that the want for schizophrenia to be renamed was big. The big winner of the competition was Dysfunctional Perception Syndrome or DPS, in which “dysfunctional perception” refers to the selecting and integrating of the many stimuli from inside and outside by the brain, being disordered during the psychosis. The word “syndrome” means that it is a collection of various symptoms. This name was picked by the jury but wasn’t considered the ideal name by them because it does not cover the syndrome entirely. Things such as difficulties in making fluent social contact and thinking clearly aren’t considered in this term. The name they did ultimately approve was “Psychoses Susceptibilty Syndrome” or PSS, which they think does describe schizophrenia really well. This name hasn’t been officially accepted yet, because the question remains whether changing the name would be enough to remove the stigma. After all, wouldn’t the same stigma just be connected to the new name, now? For the name change to be a success, it would need to be accompanied by sufficient information. But despite the new name not having been the success they had hoped it to become just yet, it has certainly stirred discussion and raised some awareness. Since the internet is now full of opinion columns and articles about whether or not a name change would make sense, I figure we can say that the issue of the wrong stigma has at least been brought under attention.

Interview special part I

Menno (49 years old) has schizophrenia. We interviewed him about his diagnosis and its effects on his life. Note: The interview was held in Dutch and later translated into English. We therefore do not claim that the entire interview was literally quoted. However, we tried our best in our translation to stay as close to the words spoken as possible.

Schizophrenia in general We started the interview by asking Menno some questions about schizophrenia in general. Who, after all, could explain this better to us than someone who has experienced it himself?

Can you give us a brief description on schizophrenia? “Schizofrenia is a chronic condition in which the patient finds it hard to separate reality from things that aren’t actually there. The main symptom of schizophrenia is getting psychoses. A psychosis is when you’re very confused and are stuck between fantasy and reality. There are three main types of schizophrenia: paranoid schizophrenia, disorganised schizophrenia, in which the thought process is disorganised, and catatonic schizophrenia, “I was walking through in which the patient gets into a kind of stiff state with very robot-like or the halls screaming ‘I sometimes barely any movements.”

know exactly what’s going on!’ when really, I didn’t, of course”

Which of these three types do you have yourself, if we may ask?

“That’s actually a weird story, because my diagnosis was different at my first admission into the mental hospital than at the second. At the first admission I was catatonic. I was walking around very robot-like and totally confused. At my second admission, I was diagnosed with

paranoid schizophrenia. I couldn’t sleep and was walking through the halls shouting things like “I know exactly what’s going on here! I know exactly what you’re doing!” when really, I didn’t, of course.”

So you can have more than one type of schizophrenia? “Well, yes, apparently it can change over the years. I didn’t know that either before my second admission, but apparently it’s possible.”

What are the main symptoms of schizophrenia? “The symptoms of schizophrenia are divided into positive and negative symptoms. Positive and negative in this case don’t mean that there are nice and not nice or good and bad symptoms. Positive symptoms means the things that you gain because of schizophrenia; like delusions and hallucinations. Delusions are when for example you see a cat, but think it’s a lion. A hallucination would be when you see a cat and you know that it is a cat, but you still believe it’s a lion. So you’re aware of reality, still you believe the non-existent “The drugs were fun at image. Negative symptoms are abilities that you lose because of the time, but the price I schizophrenia, for example the ability tell fantasy from reality.”

Is schizophrenia hereditary?

paid for it was very high”

“Yes, it is, my mother also has schizophrenia. From the Dutch population about 0,8% has it. And if you have one parent with schizophrenia the chance of getting it increases to 10%. If both of your parents have it the chance doubles. That is also the reason why I never wanted to have children, because I find the risk too big. But although genetics do have an influence, it is not the only factor. There was a research with identical twins in which one of the them had the disease, but that didn’t mean that the other halve of the twin suffered from it, too. Also, I used drugs when I was young, which doubles your chance of getting schizophrenia. Even if you don’t smoke every week. I admit it was fun at the time, but the price I paid for it was and still is very high.”

Living with schizophrenia, part I: diagnosis We questioned Menno about his diagnose and what happened afterwards. He told us his story – but in his own way: open, but without sob stories and carefully guarding the borders of his privacy. A respectable attitude, and a very interesting story.

When did you find out you had Schizophrenia? “That was after my first commitment into the mental hospital, when I was a student.”

What was this like for you? “It was really weird. They just gave me this booklet about schizophrenia and its symptoms and told me that was what I had. At first I didn’t want to believe it. I thought they had just assumed I had schizophrenia, because my mother also suffers from it. I didn’t want to accept it, either, I wanted

nothing to do with this label. But when I started reading the booklet, I slowly started realising that I did recognise these symptoms and that maybe they were right.”

You said that you were diagnosed after your first commitment. What were you committed for, if I may ask? “I was committed because I was psychotic. Some weeks it went well and I could just do my study but other weeks were horrible. Because I didn’t have any medication it was very unpredictable and it kept getting worse. I thought committal wasn’t necessary and I had all kinds of theories about it. Because I refused, my parents started a lawsuit. I got compulsory admission for at least three weeks, and after that the doctor would decide whether I was healthy enough to leave. When I was finally committed I was relieved, because I had done everything I could, and I hadn’t succeeded. But now I was finally getting what I needed. So in the end it was positive.”

“When I was finally committed I was relieved.”

What happened after you were committed and had received your diagnose? “I had many kinds of therapy: art groups, talk groups, music groups, etc. I also got medication, which worked okay but had quite some side effects that I really needed to get used to. The medication I have now doesn’t have these.”

Living with schizophrenia, part II: daily life Because we were interested in the impact schizophrenia has on Menno’s daily life, a big part of our interview evolved around this subject. We certainly got the answers we were looking for – and more.

Do you use a lot of medication nowadays? “I use only one type of medication now. There are people who use a combination of different medicines, but the medication I use now works just fine. I switched types after my second psychosis, when it turned out that I had switched types. Medicines don’t cure schizophrenia but they help to limit its effects. You can’t be cured from schizophrenia, but you can learn to cope with it, which is what they try to do with these therapies and medicines.”

What do you suffer from most in your daily life? “I have a bad memory, but I’m almost fifty so I guess that’s normal. In the past I sometimes suffered from dizziness, because of my medication. But I got rid of that when I switched medication. I sometimes am insecure or afraid. Mostly when I am out of my normal routines. But even that is human. I don’t feel like I suffer from schizophrenia a lot.”

Are you restricted by the disease? “I probably am, but I don’t really notice it a lot. I did take a psychological test once which didn’t have a very good outcome. But I try to work a lot on my photography, to focus on things I like.”

How do you cope with it? “Mostly by just taking my medication, and also I do a lot of sports. It is important to have a healthy lifestyle and to stay busy.”

Is it hard for you to get a job? “Yes, you can forget about that. I did have a job for a short time. I did the administration at an activity centre, which was actually below my level, because I had studied Economics at the university. It was fun while it lasted, but I didn’t get a good job out of it. On top of that I am “There are a few big already fifty years old, so I don’t really feel the need to start a new job now. I am able to entertain myself.” life events around

What is the reason you can’t get a job? Is it hard to keep once you have it, or won’t the employers give you a chance?

which psychoses often occur.”

“Mostly the first. I wasn’t able to keep the job, because the pressure became too high. That was also the reason I became psychotic for the second time. It wasn’t the only factor, though. I had just come back from a trip to a day activity centre in Poland, where I caught a virus which resulted in me not being able to ‘hold in’ my medication. My dad had also just had a heart attack, so I visited him in the hospital every day. All these factors contributed to me having my second psychosis. You can say that stress has a big influence on it.”

So you’re stating quite some influential factors here. Can we conclude that psychoses always have a clear immediate cause or causes, like these? “They often do. There are a few big life events around which psychoses often occur, events like going to college, getting married, getting a child… This is actually the same for depression, you also see that occur often around these big events.”

Have you ever been depressed because of the disease? I DIAGNOSE MY PSYCHIATRIST AS A CHRONIC LABEL STICKER

“No, fortunately not. You can also have psychoses because of a (manic-) depression, but that is still different than schizophrenia. A manic depression, which is nowadays called bipolarity, is also a lot easier to diagnose. If you’re manically depressed, you are happy for a few weeks and then you feel totally awful. I would hate that. The difference is that with schizophrenia you also have delusions and hallucinations.

Now that I’m reminded of it, I know this nice saying from Loesje, which says: “I diagnose my psychiatrist as a chronic label sticker” which is actually exactly what psychiatrists do: all the time they have to look at patients and try to puzzle out what diagnosis fits them.”

Do the people around you treat you differently? “Only in the beginning. Nowadays, they don’t really treat me differently. Most of the people in my life know about my disease, for example my mother, father, sister and my friends, but they know that there are no real problems. When I was committed they supported me, which was really nice. It works way better, too, to just keep on seeing your friends and all. If you’re just sitting around with an attitude like ‘why is the world doing this to me?’ that doesn’t help much in your coping with the disease.”

Do you also get negative reactions? “No, not really. Many of my acquaintances are somehow connected to psychiatry, so you won’t really get any negative reactions from them. There are, however, a lot of prejudices about psychiatry. A friend once came to my housewarming party where I had invited a lot of ex-psychiatric patients and he said to me that they were actually surprisingly normal. I think that is also a bit to compensate for their disease. Most people just want to be normal, to fit in and not stand out.”

“The main prejudice is that people think schizophrenia means having a split personality.”

Despite of this normal behaviour, is there perhaps a way to recognise people with schizophrenia? “Well, if people are psychotic and they are talking to themselves on the streets, you’ll know. *jokingly* But nowadays you can of course take your mobile phone with you, so you won’t stand out.”

You also give some kind of lectures on schizophrenia, how does that go?

“I sometimes used to go to the ‘Boei’, which is a café in Eindhoven, where people who have been in contact with psychiatry meet. The director of that café gives education to schools about psychiatry and I have joined him in that for about 20 times. I also used to teach a course which was about what you can do yourself to recover from schizophrenia. Because you cannot be cured from schizophrenia, but with medication and sensible living you can cope with it. In psychiatry they call this the coping mechanism.”

This may sound weird, but are they also positive effects of the disease? Maybe in the way it has changed your life, or things it may have taught you? “I don’t really know. If I hadn’t had the disease I would have been a different person. But there’s nothing positive about being diagnosed with schizophrenia. What is positive, is that I can live a good life with the disease, while there are lot of people for whom this is not possible and who are always suffering from the disease.”

Are there a lot of prejudices on Schizophrenia? “Yes, there are quite some. The main one is that people tend to think that schizophrenia is about having a split personality. That’s because Schizophrenia means split midriff in Greek, and the Greek believed that the spirit was located in the midriff. So the name to them actually meant a split spirit.

Nowadays we know that this isn’t really correct, but many people still think it is. Nowadays there is a discussion going on about whether and how to rename the disease. My preference goes to Dysfunctional Perception Syndrome (DPS), because I think it best describes the disease. But the most popular one is Psychosis Susceptibility Syndrome (PSS), which means you are sensitive for having psychoses.”

A final note When interviewing Menno, we tried to leave it up to him how personal he wanted to get. He preferred keeping it about the disease itself and less about the way he experienced it. When later, in a conversation after the interview, we spoke about this, he explained: Schizophrenia is different for everyone. Everyone experiences it differently, every psychosis is personal. In psychiatry, not much attention is paid to the way you are experiencing you psychoses. They focus more on the disease itself. They won’t stop you if you start talking about your personal experiences and feelings behind the disease, but they’ll just listen, nod and go on to the next part of the therapy. It’s very hard to explain to other people what schizophrenia is like for you. A friend of mine once got asked the same question. He replied with a simple rhetorical question: “try telling me what a

strawberry tastes like.” I think this very well describes how hard it is to explain things like schizophrenia.

Note: Menno preferred not to have a picture of him included in the article. The pictures we used instead are not our property. Their sources can be found in the credits in the back of the magazine.

Interview special part II

Annick (16 y/o) had an uncle with schizophrenia. Interested in this perspective, we asked her what it was like for her as a child to have a relative suffering from the disease. How would you describe your uncle, according to your memory? “Well, he had more problems than just schizophrenia, like his drug and smoking addiction. So add those all up, and you can imagine it’s not an everyday person. I would describe him as chaotic, unorganised, not really down to earth. He looked kind of shabby, especially when he’d forgotten to shave again, but he had a friendly face. And he was friendly and caring.”

“I’d describe him as chaotic, unorganised, not really down to earth.”

Do you know when your uncle was diagnosed? “I know he only suffered from schizophrenia the last couple of years, so I’d say about 5 to 8 years ago.”

When did you, yourself, get to know your uncle had schizophrenia? “I didn’t until after he passed away. I always knew something was up, but couldn’t quite figure out what. Keep in mind that I was about 12 years old when he passed.”

There are 3 main types of schizophrenia, do you know what type your uncle had? *We explain her the main types*” Uhm, he had hallucinations and ideas in his head that just weren’t right. For example he thought he was married to his psychologist and he was convinced he was Jesus for a while. So I think that’d be paranoid schizophrenia.”

How much and what did you notice in his behaviour? “He was always a bit strange, but I don’t have a clear memory of his behaviour.”

Did you or other relatives (have to) treat him differently because of his schizophrenia? “My grandparents did, who were his parents so it isn’t that strange. He wasn’t really capable of taking care for himself, so my grandma helped him. And when he acted odd, no-one really reacted.”

“When he acted odd, no-one really reacted.”

Did he treat you differently? “No, as far as I remember he was a nice and kind man, who was trying to be good for his family.”

Was his relation to you and/or others affected by it? “Yes of course, it especially affected my grandparents. I know it was hard on them. And my mother and my aunt also had trouble with it, but they never really spoke about it.”

Did he ever speak about his syndrome to you or other relatives? Did others ever talk about it? “I don’t think so, I don’t know if he really realised what was going on. As far as I remember no-one really talked about it, or at least not in my presence.”

Was he using medicines? And/or did he get treatments/therapy?

“As a kid I was a bit scared. He was my crazy uncle.”

“I know he was in therapy at a place called ‘de Grote Beek’ in Eindhoven. But I think it was not only for his schizophrenia, but also for his drug addiction. As far as medicine goes, I don’t know.”

Did he have a job? Was his life affected by schizophrenia in other ways that you know of? “He did have a paper-round at one point, but he couldn’t really keep on doing it, because of the chaos in his head. His life was a mess; it was unorganised, no structure whatsoever. But I can’t say whether this was because of his addiction or his schizophrenia. It was probably the combination of both.”

To what extend did you understand why he behaved the way he did? And other relatives? “I did not understand it at all, but I guess the rest of my family did.”

Did it affect the way you felt/thought about him? Perhaps it scared you off a bit? “As a kid, yes, I was a bit scared. He was my crazy uncle. But I got used to it and I didn’t mind it so much after a while. He was just unpredictable so I was never really at ease with him, but that is mostly because I didn’t understand what was going on. When I think back, I wish I had known, because then I wouldn’t have been scared and I could’ve enjoyed his company more.”

Did you and/or others find his syndrome hard to deal with? “I think everybody thought it was hard to deal with, because you never quite understand what is going through his head and why he does certain things. In the end, he was probably the one who suffered the most from it, and I know my family realised that. Because we only spent a little time with him, but he had to deal with it every single day. And I think that is important for everyone to realise, because it’s much harder for the one who suffers from it than the relatives.”

“We only spent a little time with him, but he had to deal with it every single day.”

Note: Annick preferred not to have a picture of her included in the article. The pictures we used instead are not our property. Their sources can be found in the credits in the back of the magazine.

----------------------------------------------------------------------------------------------------------------Schizophrenia is a serious mental disease. It is nearly impossible to live a functional life with it if you don’t get proper treatment. But in order to get treatment you will first have to be diagnosed as schizophrenic. So how to find out if you have schizophrenia? It’s not as easy as it seems. First you need to understand, there is not just one form of schizophrenia. There are many different forms and excluding one of them doesn’t mean you don’t have any of the other forms. Secondly, schizophrenia is highly difficult to diagnose, seeing as it’s symptoms have many similarities with those of other mental illnesses. However don’t let this get your hopes down, there are still signs to look for, ways to find out whether you or someone you know might possibly have schizophrenia.

First things first: we’ll start with the early sings of schizophrenia. Schizophrenia usually starts developing between the age of 16 and 30, which is when these warning signs might occur. If you show any of these warning signs, and especially if you show many of them, that might indicate that you could be developing schizophrenia, and we advise you see a doctor for further testing.: - Inability to cry or express joy. - Withdrawal of social activities. - Hostile or suspicious behavior. - Deterioration of personal hygiene. - Forgetfulness and an inability to concentrate. - Seemingly odd or irrational statements. - Strange use of words or way of speaking. - Flat, expressionless gaze. - Laughing or crying at inappropriate times. - Depression. - Oversleeping or insomnia. - Extreme reaction to criticism.

Keep in mind that these were only the early warning signs; more developed schizophrenia involves more extreme symptoms. Furthermore these warning signs might also indicate that you have a mental disease other than schizophrenia or have recently suffered severe trauma.

In general the symptoms for schizophrenia can be divided into three types: The first type is positive symptoms. Positive symptoms are psychotic behaviors not seen in healthy people. People with positive symptoms often "lose touch" with reality. These symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether the individual is receiving treatment. They include the following:

1. Hallucinations. Hallucinations are sounds or other sensations experienced as real by a certain individual, that nobody else experiences. Hallucinations can involve any of the five senses, however auditory hallucinations are most common in schizophrenia (e.g. hearing voices). Visual hallucinations are also relatively common.

2. Delusions. A delusion is a firmly-held idea that someone has despite clear and obvious evidence that it isnâ&#x20AC;&#x2122;t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder. These delusions often involve illogical or bizarre ideas or fantasies. Common schizophrenic delusions include: - Delusions of persecution. The belief that others (government, their family, etc.) are out to get them, often involving bizarre ideas and plots. - Delusions of reference. The belief that a neutral event in the environment has a special and personal meaning. (e.g. thinking an add or program on TV is sending a message meant specifically for you). - Delusions of control. The belief that oneâ&#x20AC;&#x2122;s actions or thoughts are being controlled by something other than themselves. Common delusions involve thought broadcasting (belief that others can read your private thoughts), thought insertion (belief that someone else is planting thoughts in your head), and thought withdrawal (belief that you thoughts are being stolen). - Delusions of grandeur. The belief that one is a famous or important figure (e.g. Jesus Christ or Napoleon). Delusions of grandeur might also involve the belief that one has unusual powers that no one else has (e.g. the ability to fly).

3. Disorganized speech. People with schizophrenia often think fragmented, a lot of loose thoughts that don’t seem to connect. This can often be seen in the way they speak. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. They may respond to questions with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things. Signs of disorganized speech include: - Loose associations. Shifting from one topic to another rapidly, without connection between one thought and the next. - Neologisms. Words or phrases that are made up and only have meaning to the patient. - Perseveration. The repeating of words and statements. - Clang. Meaningless use of rhyming words.

4. Disorganized behavior. Patients with schizophrenia often have problems working goaldirected. This makes taking care of themselves, working and interacting with others difficult. Signs for disorganized behavior include: - Behaviours that appear bizarre and don’t have purpose. - Lack of inhibition and impulse control. - Unpredictable or inappropriate emotional responses. - Decline in overall daily functioning.

Then there’s the negative symptoms. Negative symptoms are not, like positive symptoms, behaviors that differ from the norm, but rather the absence of normal behaviors. Common negative symptoms of schizophrenia include: 1. Lack of emotional expression. This involves showing blank or restricted facial expressions, speaking with a flat voice, not making eye contact etc. 2. Lack of interest or enthusiasm. This involves problems with motivation; lack of self-care. 3. Seeming lack of interest in the world. This involves social withdrawal and seeming to be unaware of the environment.

4. Speech difficulties and abnormalities. This involves not being able to carry a conversation, short and sometimes disconnected replies to questions, speaking in monotone etc.

The third type is cognitive symptoms. Cognitive symptoms are subtle and therefor often difficult to recognize as part of the disorder. They are often only detected when other tests are performed. Cognitive symptoms include the following: 1. Poor "executive functioning" (the ability to understand information and use it to make decisions). 2. Having trouble focusing or paying attention. 3. Problems with "working memory" (the ability to use information immediately after learning it). Cognitive symptoms often make it hard to lead a normal life and earn a living. They can cause great emotional distress.

If you have some of these symptoms very strongly yet completely lack others, that is not enough to exclude the chance that you might have schizophrenia. You see, it can be divided into three different types: paranoid schizophrenia, disorganized schizophrenia and catatonic schizophrenia. They are classified by their most prominent symptom.

Paranoid schizophrenia. Paranoid schizophrenia involves the patient have absurd or suspicious ideas and beliefs, often revolving around a coherent, organized theme or â&#x20AC;&#x153;storyâ&#x20AC;?. Delusions of persecution are most common, however delusions of grandeur are also quite frequent.

Disorganized schizophrenia. Disorganized schizophrenia can be diagnosed when the patient portrays symptoms such as: - Impaired communication skills - Incomprehensible or illogical speech - Inappropriate reactions (e.g. laughing at a funeral) - Emotional indifference - Infantile behavior (baby talk, giggling) - Peculiar facial expressions and mannerisms

Catonic schizophrenia. Catonic schizophreniaâ&#x20AC;&#x2122;s most prominent feature is a disturbance in movement: either a decrease in motor activity, reflecting a stuporous state, or an increase in motor activity, reflecting an excited state. - Stuporous motor signs. Someone in stuporous state will show a dramatic decrease in activity. The person often ceases all voluntary movement and speech, and may be extremely resistant to any change in his or her position, even to the point of holding an awkward, uncomfortable position for hours. - Excited motor signs. Sometimes, people with catatonic schizophrenia pass suddenly from a state of stupor to a state of extreme excitement. During this frenzied episode, they may shout, talk rapidly, pace back and forth, or act out in violenceâ&#x20AC;&#x201D;either toward themselves or others.

* Please remember that only a qualified psychologist or psychiatrist can properly diagnose schizophrenia, or any other brain disorder. The following symptoms overlap with many other diseases such as bipolar disorder, major depression, the various kinds of personality disorders (specifically paranoid and schizotypal personality disorders), and other problems such as brain tumors and temporal lobe epilepsy. There is no "typical" case of schizophrenia. Everyone has different symptoms. Seek the opinion of your doctor always. Moreover, it is always important to keep the big picture in mind. Having just a few of these symptoms does not necessarily mean that a person has schizophrenia, or any other sort of psychiatric disorder. Almost all of the signs below can be present to a "normal" degree in people; it is when someone displays them to a significant degree that they can become psychiatric symptoms. Think if all of these behaviors as being on a continuum, in which the middle 99% of people displaying varying degrees of the behavior, but are still within the "normal" range. The 1% of people on the outer edges have the behaviors in extreme proportion, and/or a significant proportion of the time, and that is when they can become debilitating. A diagnosis of schizophrenia requires that continuous disturbance (i.e. debilitating symptoms) be present for at least six months, including at least one month of certain key symptoms (active symptoms: delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative symptoms such as severe emotional flatness or apathy) Sources: http://www.helpguide.org/mental/schizophrenia_symptom.htm, http://www.schizophrenia.com/earlysigns.htm, http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml?utm_source=publish2&utm_medium=refe rral&utm_campaign=www.kpbs.org, http://en.wikipedia.org/wiki/Schizophrenia

A mother’s story A mother talks about her experiences with her son diagnosed with schizophrenia.   She prefers staying anonymous.

Whenever I have to describe my experiences with my little boy to others I often say that life is like a horrifying sci-fi movie living with him. It’s the kind of movie where everything starts of all peaceful and happy but then goes downhill and eventually becomes a horror movie. It’s the kind where you’ve absolutely no clue what’s happening and you look around at others but they can’t help you because they’ve no clue either. It’s the kind where they speak a totally different language and you’re watching it without subtitles. It isn’t a fun movie, but it’s still our story that’s told; so we have to continue watching.   If our lives would actually be filmed, it would start when my boy was 15 years old. That was when everything still was wonderful and perfect. My boy did absolutely great in school, had so many friends, even had a girlfriend (which I wasn’t really happy about) and was every teacher’s favourite. He would go to parties on fridays, sleep in on saturdays and

hang out with friends to „do homework” on sundays. He was happy.

„It’s our story that’s told; so we have to continue watching” ! But suddenly, his grades dropped. He stopped going to those parties. Stopped hanging out with his friends. When I asked him about another missed homework note he said that he forgot to bring it with him that day. He was disorganised and forgot appointments for doctors and hairdressers. In the first week I noticed this change of behaviour I just thought it was him growing up. You always hear about those kids rebelling against their parents when they’re that age. But this was different. Wasn’t rebelling supposed to be going to more parties and drinking more than you’re supposed to to free yourself from the system? 17

That’s how rebelling was in my time. But my boy stayed at home and avoided all things.   At a certain point he had a lot of trouble doing the simplest chores I gave him and started showing more and more agression. My friends just told me he was in puberty; „oh my girl does the same! Although her grades are still perfect!” and „Yes, that sounds familiar. Don’t overreact to something so natural!”. But I had such a weird feeling that something wasn’t quite right.

„One day he told me: ‚I’m sorry mum, for not being how you want me to be’” The movie would then cut to my boy having his first hallucination. I still remember him waking me up in the middle of the night, being so afraid because he heard voices all around the house and smelled a really bitter smell. You could see the fear flicker in his eyes and it looked like he wasn’t really down to earth. „Are you sure you’re not having a bad dream, sweetie?” I asked him, unsure of what to do. „Mum! Aren’t you hearing them? They’re screaming now! Aren’t you hearing them? Aren’t you smelling it?” he yelled at me at this point. I tried to calm him down but was unable to. So I called 999.

I won’t ever forget that first night.   The story follows that my boy was diagnosed with schizophrenia after a lot of talks with psychologists. He got medication and was hospitalized for a little while more. He needed a lot of time to get back to reality again. The recovery from his hallucination was horrible and very painful. The pain was all psychological, but that didn’t mean it didn’t hurt. My boy felt ashamed and embarrassed to not being able to distinguish imagination from reality. He felt malfunctioned, like he wasn’t an actual human being. One day he told me „I’m sorry mum, for not being how you want me to be”. I never really accepted his illness, but when he said that I knew I should have. I had been a terrible mother just thinking it was all in his head. I mean, it’s all in his head, but in a different way than I thought. I just wanted him to be like the other boys, to just be normal so he would have an easy and fun life. My little boy couldn’t say for sure what was reality and what not and I just sat there ignoring reality. A bit ironic, huh?   The movie would end with all the family around his grave, my little boy committed suicide at 17 because he couldn’t live with his illness.

„I just sat there ignoring reality”

So you know someone who might have or who has schizophrenia. Now what? While caregivers might do a lot to help and treat a schizophrenic patient, it is also very important that their family and friends help them. “I think someone I know might have schizophrenia” An important thing to do if you think someone you know has schizophrenia is to talk to them about your concerns. You cannot force this person into treatment but you can offer support and encourage them to find a qualified doctor or mental health provider. “A schizophrenic person is refusing treatment” People with schizophrenia are likely to resist treatment, because they think their delusions are real. When this is the case, it’s important for a family member or loved one to make sure that this person is safe. In extreme cases they might even need to call the police to take the schizophrenic patient to the hospital and be admitted involuntarily. When they return from the hospital you should encourage them to take their medicine and attend follow-up appointments. If they stop their medication and treatment, their symptoms are likely to become severe and they will become unable to care for themselves. They might end up on the street or in jail. “My schizophrenic friend/family seems to want to move forward with their life but doesn’t know how. How can I help them?” You can help patients by setting realistic goals for them and helping them learn to function in the world. Each step toward these goals should be small and taken one at a time. It’s important to support the patient during this time. It can be harmful to pressure and/or criticize a person suffering from a mental illness. Telling them they are doing something right is the best way to help them move forward.

This is the chemical formula for love: C8H11NO2+C10H12N 2O+C43H66N12O12S2 dopamine, seratonin, oxytocin. It can be easily manufactured in a lab, but overdosing on any of them can cause schizophrenia, extreme paranoia, and insanity.

“How do I react when a schizophrenic person is having delusions?” You need to understand that to this person, these beliefs or

hallucinations seem very real. It is not helpful to say they are wrong or imaginary. However going along with the delusions isn’t helpful either. It is better to calmly tell them you see things differently. Acknowledge that everyone has the right to see things in their own way. Being respectful, supportive, and kind without tolerating dangerous or inappropriate behavior is the best way to approach people with schizophrenia.

“Is it dangerous to be around someone with schizophrenia?” People with schizophrenia aren’t usually violent. Nonetheless, some of the symptoms (e.g. delusions of persecution) are associated with violence. People with the disorder are also more prone to substance abuse, which might also increase the chance that a person will become violent. If a person with schizophrenia becomes violent, the violence is usually directed at family members and tends to take place at home. However the risk of violence among people with schizophrenia is still very small and you will not be putting yourself in danger by being near them.

SOURCES www.thrivehealth.ca