Schizophrenia - treatable with early detection

By Carol Aloysius

Schizophrenia is a brain disorder often characterised by abnormal social behaviour and failure to recognise what is real. It usually falls into a group of acute mental illnesses which are called ‘psychosis'. Though more apparent to the public eye these disorders are not the commonest mental illnesses. However, today, mental diseases like schizophrenia are increasingly on the rise worldwide and in Sri Lanka, due to a number of multiple factors arising from the stresses and strains of modern living, birth complications, the consumption of narcotic drugs such as heroin. The most important however is genetic (inherited) reasons.

Although the number who suffer from this condition is comparatively low (one percent of the world's population or 24 million in figures are said to have schizophrenia worldwide), the fact that its victims are mainly young persons in a world still dominated mostly by young people, has prompted the World Health Organisation (WHO) to this year throw its spotlight on schizophrenia when the world observed Mental Health Day last week.

The Sunday Observer asked the Director, Mental Health Unit of the Ministry of Health Dr RASANJALEE HETTIARACHCHI for some insights into the disease, and how our local authorities are dealing with this issue which is now seen in a number of young persons who are either still school going or else employed.

Excerpts...

Q. Why did the WHO choose to focus on Schizophrenia this year?

A. Every year the WHO decides to choose a theme that is in keeping with a mental health issue that requires public attention.

This year it has chosen Schizophrenia because it affects many young people who could be treated and cured if the disease is arrested early.

Unfortunately due to superstitions and cultural taboos, many families with patients suffering from this mental condition are reluctant to seek medical advice until the disease has advanced.

Q. Since many of us are still not very familiar with this condition, tell us what is schizophrenia?

A. It is a condition that is caused by changes in the brain structure and the chemicals of the brain.

Q. How is it caused?

A. The main causes are genetic i.e inherited.

If a close relative of the family like the father or mother has this condition, there is a risk that at least one member of the family will develop it later. But that does not mean that every one in the same family will develop the disease.

Q. Any other risk factors?

A. Genes and environment, ingesting hard drugs like cannabis or heroin, and birth complications such as difficult or obstructed labour.

Q. You mentioned ‘that young people are most at risk of developing it.' What are their age groups?

A. Usually the diseases starts when they are between 16 and 24 years.

Q. What are the symptoms?

A. At the early stages, if they are attending school, they will suddenly and for no reason want to stay at home and refuse to go to school. If they are working, they will prefer to stay home and stop working.

They show a strong desire for privacy and withdraw from social contact, including even their family.

Q. What happens when the symptoms get worse?

A. They may hear voices other people don’t hear. They begin hallucinating and imagining of people mocking them or telling them to do something they don't want to.

They may believe other people are reading their minds, controlling their thoughts. They become suspicious of people, and develop a kind of persecution complex where they think that everyone is trying to harm them.

Q. Can they become violent if not treated?

A. If not treated they can become violent and even kill a person who they think is trying to persecute them.

Q. So how can they be treated?

A. With medication, psychotherapy and counselling. All these interventions are by trained persons especially psychiatrists

Q. What is Psychotherapy?

A. This is done by psychotherapists or psychiatrists. It is a long term treatment where the doctors try to help the patient to understand that the hallucinations he is experiencing are imaginary. For this the patient's as well as the care givers' support is needed.

The patient has to be on medication which will be monitored by the doctor. Some of them may have to be on medication for life. Schizophrenia is like diabetes or some other disease which requires life long medication and regular monitoring. It's nothing to be ashamed of.

Q. Are there side effects of the drugs?

A. There are side effects as some drugs may not always agree with the patient.

That is why I said the patients has to be continually assessed by a psychiatrist who would reduce or change the drugs if necessary.

Q. What is Occupational therapy?

A. It means rehabilitating patients who are recovering to do minor tasks that will help generate income or keep them occupied in a relaxed way such as painting, horticulture, sewing, making soft toys, envelopes, cooking.

The Mental Health Institute and other rehabilitation center in district level are doing this and we help them with the raw material, equipment, resources and monitor their work.

The WHO and government is funding us.

Q. Usually what kind of patients are admitted to the Mental Health Institute?

A. Mostly acute and chronic patients who will need to be warded and treated before they are discharged.

Q. Is the treatment free?

A. Yes. All patients at our state hospitals receive free treatment.

Q. What is the Ministry of Health doing to help them?

A. We have set up Mental Health Clinics in all the districts so as to identify patients who may have mental diseases including schizophrenia.

Unlike in the past, patients thus do not need to travel all the way to Colombo to the Mental Health Institute at Angoda since we have now trained our medical officers to identify and treat these patients under the supervision of the consultant psychiatrists in their respective hospitals.

Q. But there are only a handful of psychiatrists in this country. Can they meet the rising demand for their services islandwide?

A. We have trained and are still training medical offices in mental health and appoint them as Medical Officer Mental Health. We also have psychiatrist wards in all districts manned by at least one qualified psychiatrist. Mannar and Kilinochchi are the only exceptions but the numbers are small so they can be sent to Jaffna and Batticaloa if necessary.

Q. What about patients in remote areas like far flung villages?

A. There is more awareness now so we have patients coming to us for help even in remote areas. But we also have trained family health workers to identify and detect mental diseases among school children and upwards and refer them to the nearest hospital's mental health clinic.

Q. What are your main obstacles?

A. Myths and wrong beliefs still surround the whole subject of mental diseases. It's part of our culture as it is in most Asian cultures. Many people think that it is a ‘devil's disease’ which can be exorcised by a kattadiya. By the time the patient is brought to us, this long delay and pre medical intervention would have often compounded the disease.

Q. You recently received an award from the Consumer Societies network for empowering persons with mental illnesses to live normal lives. What are these Consumer Societies?

A. They are societies manned by people who have overcome various mental diseases and have voluntarily formed themselves into these groups to help others with similar problems, using their personal experience to drive home their message that it is a treatable disease .

Q. Where do you find these consumer societies?

A. They are mostly at grass-root level.

Q. Is schizophrenia found mostly in urban or rural settings?

A. In both.

Q. Your message to the public?

A. Schizophrenia is treatable if identified early. If anyone in your family identifies the symptoms of the disease which I have mentioned earlier, please seek medical advice rather than taking the child to a kattadiya.

If you delay, it will not be easy to cure.

If you act quickly, the patient will be able to recover completely and lead a normal life. I also have a message to the media. We need your help to spread this message. Please support us.

Case study

N was an 18-year-old bright, popular student. However his behaviour changed suddenly and his parents, teachers and friends were distressed to find he had lost interest in his studies, recreational activities and had become withdrawn from social contacts. He had become sloven in dress and personal hygiene. He was also found to be spending most of his time lying in bed staring vacantly into space and seen smiling, muttering and talking to imaginary people. At night he hardly sleeps and paces about restlessly. After being seen by a psychiatrist, he was diagnosed as having schizophrenia and treated. He is now well and leading a normal life.

Facts on schizophrenia

Schizophrenia is popularly called ‘split personality’ and has devastating effects on all aspects of a person's mind. His thinking becomes illogical and muddled, his speech incoherent and disjointed. His emotions become dulled and apathetic or inappropriate. In addition, there may be a very odd experience such as hearing voices, seeing visions and experiencing sensations such as electric currents passing through the body. He may respond to these experiences by shouting at imaginary people or simply mutter and smile to themselves. They have bizarre beliefs that their minds and bodies are being controlled by outside powers or they are being persecuted by others. Sometimes they get agitated and aggressive.

Such patients need to be seen by a psychiatrist as the disease is treatable.

(from Your Child, Your Family by Dr H.A. Aponso)

Chemical contained in broccoli extract could help those with autism

Study demonstrates chemical sulforaphane contained in the vegetable may help those with autism.

Broccoli, cauliflower and cabbage could hold the key to helping those with autism, new research suggests. Doses of sulforaphane, a chemical found in the greens, were given to autistic teenagers and young adults over a period of four weeks - with researchers noting a significant improvement in those receiving the drug.

The chemical, which gives broccoli its distinctive bitter taste and which is also present in foods such as spinach, cauliflower and cabbage, made the autistic individuals studied calmer and more sociable. The findings suggest it may be possible to proscribe a pill to treat - or at least significantly help - those with autism.

Previously drugs have only been able to target specific aspects of autism, controlling symptoms such as aggression, hyperactivity or sleep problems, but this research indicates there may be a targeted chemical response.

Published online in PNAS, the study enrolled 44 young men aged 13 to 27, who had been diagnosed with moderate to severe autism spectrum disorder.

They were randomly assigned to a daily dose of either sulforaphane or a placebo in the study from Massachusetts General Hospital for Children and Johns Hopkins University, Boston.

Of the 40 individuals who reported back, the 26 who took sulforaphane scored significantly better on behavioural assessments than those receiving the placebo.

“When we broke the code that revealed who was receiving sulforaphane and who got the placebo, the results weren't surprising to us, since the improvements were so noticeable,” co-author Andrew Zimmerman, a professor of Paediatric Neurology, said.

He continued: “The results seen on the social responsiveness scale were particularly remarkable.

“I’ve been told this is the first time that any statistical improvement on the social responsiveness scale has been seen for a drug in autism spectrum disorder.”

Sulforaphane’s ability to bolster the body natural defences against oxidative stress, inflammation and DNA damage were first discovered in 1992.

People with autism tend to suffer from various abnormalities in their cells - including inflammation and DNA damage.However, British scientists were hesitant to embrace the research, labelling it “intriguing” but too early to see if broccoli is beneficial in autism.

Dr Rosa Hoekstra, of The Open University, said: “Although the findings of this study are intriguing, it is much too early to draw any firm conclusions about the possible benefits of broccoli for people with autism.”

The study was not wholly positive. Two of those taking the chemical suffered fits - although researchers pointed out these may have been because of their pre-existing condition - and those treated also put on weight.

A third of those tested did not respond to the broccoli supplement, and the study’s effects were not permanent with the respondents behaviour quickly reverting once the treatment had ended.

Nonetheless, researchers are keen to attempt their study on a larger more diverse group of people, including children.

The Independent

First Inclusive Park in Sri Lanka

World Cerebral Palsy Day theme was “Change My World in One Minute”. World Health Organization Country Office for Sri Lanka (WCO) along with the Colombo Municipal Council and Urban Development Authority supported Cerebral Palsy Lanka Foundation to commemorate the World Cerebral Palsy Day on October 1, 2014 to raise awareness on Cerebral Palsy related issues among service providers, policy makers and the general public.

Danush Gopi, a child with cerebral palsy, enjoys his first swing ride at the Vihara Maha Devi Park. He is watched by his father, Dr Gopi Kitnasamy, chairman, Cerebral Palsy Lanka Foundation who initiated the Inclusive Park Project in Sri Lanka, UDA Chairman Nimal Perera, Commissioner Colombo Municipal Council Badrani Jayaratne and WHO Representative, Sri Lanka, Dr F.R.Mehta.

A special Wheelchair Swing was installed at Viharamahadevi Park in Colombo and Lady Ridgeway Teaching Hospital for children. The special swing in Viharamahadevi Park was inaugurated by Nimal Perera, Chairman, Urban Development Authority, Bhadrani Jayaratne, Commissioner, Colombo Municipal Council, Dr. F.R. Mehta, WHO Country Representative for Sri Lanka and Gopi Kitnasamy, Founder, Cerebral Palsy Lanka Foundation. This is the first Inclusive Play Park in Sri Lanka.

This special swing serves three major purposes to the children using wheelchair and children with Developmental Disorders such as Cerebral Palsy, Autism and Down’s Syndrome.

Therapeutic Play - these swings meet children's needs in a variety of ways - not only fun for the child; they offer opportunities for improving arm, leg and trunk strength, increased body awareness, and sensory stimulation and proprioceptive integration.

They also help children who have difficulty maintaining their equilibrium and tolerating stimulus.

In addition, the swinging motion impacts the vestibular system, which can improve a child's balance and in turn their stair navigation and ambulation skills. Improvements in motor coordination, ability to put movements together, and sequencing skills have also been observed as a result of Swing therapy.

And of course, the motion of the swing can be relaxing and calming for children who become over stimulated. Ultimately, swings are just plain fun for children of all ages. Families can now bring their children with special needs to a common play area to mingle with other children and the society.