Is schizophrenia a rare disorder?

by Harshani A. Pinnawala

Though many have heard the word ‘schizophrenia”, they may hardly have any idea about this disorder. Yet, this does not mean that it is a rare mental disorder. This mental disorder affects approximately one percent of the population of the world. In America itself it has been already affected two million people. Men are at high risk while comparing to women.

Schizophrenia is also known as ‘split personality disorder’ where a diagnosed person may suffer from hallucinations, delusions, distorted thought or reduced ability to function in society. A schizophrenic person is unable to keep a good communication with the human environment.

According to Diagnostic and Statistical Manual of Mental Disorders (DSM), schizophrenia can be categorised into five subtypes. “Undifferentiated type” is one of the most common mental disorders among humans. An undifferentiated type patient will have a combination of all the symptoms such as delusions, hallucinations, confusion, emotional turmoil, excitement, dream-like autism, fear, disorder thoughts and bizarre behaviour. Most often these symptoms can be seen in the patients who are in the process of breaking down and becoming schizophrenic. But at the same time he does not fit into any other type because of the mixed symptoms.

A “catatonic type” patient may show a sudden loss of all animation and a tendency to remain motionless for hours or even days in single position. The patient may talk or shout incoherently, pace rapidly, openly indulge in sexual activities, attempt self-mutilation or even suicide, or impulsive attack and try to kill others. The suddenness and extreme frenzy of these attacks make such patients dangerous to both themselves and to others. Some of these patients are highly suggestible and will automatically obey commands or imitate the actions of others or mimic them. They pay no attention to outer world or the surroundings. Their facial expressions are vacant and their skin appears waxy. If a patient's arm is raised to an awkward and uncomfortable position he may keep it for minutes or even hours.

Disorder

“Disorganised type” is also known as ‘hebephrenic’ schizophrenia which is another type of schizophrenia. Though this type occurs at an early age, this is not very common among people. A patient can have a history of oddness, over scrupulousness about trivial things and preoccupation with obscure religious and philosophical issues. As the mental disorder progress, the patient becomes emotionally indifferent and childish. The common symptoms can be a silly or weird smile and inappropriate, shallow laughter after little or no provocation. the speech becomes incoherent and may include baby talks, childish giggling, and repetitious use of similar-sounding words. Their speech becomes incomprehensible. Hallucinations are common among this type of patients.

The voices heard by these patients may accuse them in immoral practices. Delusions might be of a sexual, religious or persecutory nature and they might become unchangeable and fantastic. For example, a woman might complain that she was being followed by enemies and she had been killed a number of times. In addition, the patients might become hostile and aggressive. The patients might exhibit bizarre behaviour in the form of odd facial grimaces, talking and gesturing to themselves, inexplicable laughter and weeping.

Paranoid Type is the most common type of schizophrenia. However, in recent years the prevalence of this type has shown a substantial decrease though the reasons are still unknown. Habitually, paranoid-type schizophrenic patients show histories of increasing suspiciousness and of severe difficulties in interpersonal relationships dominated by absurd, illogical, and often changing delusions.

A patient may become highly suspicious of relatives or associates and may complain of being watched followed, poisoned, talk about, or influenced by various tormenting devices rigged up by ‘enemies'. The patients are also exposed to themes of grandeur which are common in paranoid-type delusions. For example, they may claim to be the world's greatest philosopher or some well-known persons such as God. They may hear singing, god speaking, the voices of their enemies and may see angels or feel damaging rays piercing their bodies at various points.

In response to a command from a ‘voice’ a patient may commit violent acts. These patients can sometime become hazardous, as when they attack other people they are convinced have been persecuting them.

Episode

Residual type is the fifth officially recognised type schizophrenia. These patients have experienced an episode of schizophrenia from which they have recovered sufficiently, so as not to show well-known psychotic symptoms. However, these patients manifest some mild signs of their past disorder namely odd beliefs, flat affect, or eccentric behaviour.

Casual factors

There are several factors associated with the different types of schizophrenia. A frequently asked question about the casual factors of schizophrenia is, “is it hereditary?” it is necessary to mention that schizophrenia is not directly passed from one generation to another generation genetically. There is no single cause for this illness. Despite various research in the medical field the underlying causal factors of schizophrenias remain uncertain. However, researchers have identified three key factors; biological, psychosocial and socio-cultural factors.

Disorders of the schizophrenic type tend to ‘run in families’ increasing the notion of ‘tainted’ genes as an important casual factor. The evidence for higher-than-expected rates of schizophrenia among biological relatives of index cases is overwhelming. Those who have close blood relatives with a history of schizophrenia have a high risk of getting this disorder. Nevertheless, twin studies have shown a different story which explains that if one identical twin has schizophrenia, the risk of having the disorder for the other twin is 50 percent .

A few researchers have suggested that ‘shy gene’ leads to develop social anxiety which has a connection with the schizophrenia.

Psychosocial and socio-cultural factors include everything such as social, nutritional, hormonal and chemical environment, social dynamics and stress a person experiences, use of drugs, education, virus exposure, and usage of vitamin which facilitate to develop schizophrenia.

Treatment

Schizophrenia is a life-long condition which can be treated but not cured. Because of the complexity of this disease, treatment for schizophrenic patients have changed noticeably in the mid 1950s.

However, schizophrenic patients highly depend on medications and on psychosocial interventions. These can reduce the ‘positive’ symptoms of schizophrenia. Unfortunately, there is no single approach for the effectiveness of the patients.

These medications are highly expensive and have shown to induce weight gain, rare but serious neurological disorders.

Psychotherapy is widely suggested, but due to lack of trained therapists, this method is not being widely used. Psychotherapy is basically used to establish the self-esteem, confidence and self-dignity.

Electro convulsive therapy is the last line of treatment. This may be prescribed in cases where other treatments have failed. With severe episodes of schizophrenia, hospitalisation might arise. This can be voluntary or involuntary depending on the condition of the patient.

However, recent research suggests that schizophrenia might be prevented by taking care of certain precautions, especially, during pregnancy period and as well as by early childhood, adolescent and adult environments.

In addition, a person should reduce the consumption of alcohol and other drugs to be away from this disorder.

Lessons for a lifetime

by Dr. W.B. Wijekoon

What a foreigner taught me
I was a young up-and-coming doctor in the nineteen sixties, driving a brand new flashy Volkswagen Beetle car. I used to horn unnecessarily, as those days I thought one has to run through this short life, until my father advised me that this life is short, never run through it, always walk.

A foreigner was in the front car and behind I was tooting the horn to overtake.

He blocked me, got down, walked up to my car door and when I lowered the shutter this is what he told me so very politely. “Young Man, do you know that sound pollutes? And that you are polluting the environment every time you toot that horn. Aren't you ashamed to pollute your beautiful country?”

He walked back to his car and drove off.

From then up to date, I use the horn of my vehicle only in dire emergencies. Most of the time never, so much so that last month I drove to Kataragama and Yala with my nephew seated by me, having taken a bet about non use of the horn and believe me I covered 750 kilometres up and down without horning even once and I won the bet.

People in Singapore and UK hardly horn, they use the headlights to overtake. Their ‘patience’ is unbelievable.

What the patient taught

I was a young consultant physician in 1965. My first appointment as Consultant was in Matara General Hospital. One day I was doing the ward round with all the Assistant Doctors, Interns, SHO, Registrars, Nurses and Attendants. The whole lot following me. When I approached an 80-year-old patient, I asked him ‘Seeya, Diva daanda’ (‘Put the tongue out’) He retorted, Sir, Pihiyak hari Katurak hari tiyenawada? (Do you have a pair of scissors or a knife). Ay seeya, I asked in consternation (why) Divak daanne kohomada Sir, kapanne natuwa? Sir min pasu kiyanna Diva Dik karanna natnam Diva Pennanna. (Sir, hereafter tell “Show the tongue or protrude it”). That was a wonderful lesson he taught me about the proper use of the Sinhala language, especially by a southern man.

What the virus taught

This lesson was taught very recently. I am in my late seventies now (The last chapter of life, 1-25 being the first chapter). I have always been advising my patients in this last chapter, that even with minimum feeling of ill-health and unfitness, never exert, but rest until you feel perfectly fit, because invariably it is a virus that has entered your system and producing this state of ‘ill health’ and we have no known weapon (antibiotic) to destroy a virus up to date. On the other hand, a bacterial infection can be easily tackled with antibiotics. In the fourth and final chapter of Life the resistance drops drastically and the only way to combat the virus invasion is to take adequate rest, nutrition and pain killers in moderation.

I was feeling unwell with backache and feverishness, I swam 16 lengths at the SSC pool on Friday and on Saturday I washed my car and mopped my bedroom. and on Sunday I did my usual five mile walk from 4.30 a.m. to 6 a.m. In my youthful days this was my therapy to “Chase the virus away” and indeed it worked well! Those days. This time the virus over-powered me and taught me a bitter lesson for the rest of my life.

My paper delivery man met me at 4.30 a.m. That Sunday and uttered “Sir, ada bebali, bebali, purudu walk yanawa wage” (You are today walking bubbling with life”). “Kata waha” - “Evil mouth” I pondered and came back home and had the usual cold water bath, had breakfast and was dressing up to proceed for work at the Central Hospital.

Lo and behold, I started shivering with high fever my tongue was getting sucked in and I was virtually dying.

I got into the car and was driven by my son to the ICU there – on the way I had to get down and vomit several times. As I entered the ICU, I walked up to the bed there and the staff were smiling at me and I felt much better and on my own I ordered an ECG to exclude a heart attack. The ECG was absolutely normal. My temperature had risen to over 104 degrees C and blood count had dropped far below normal.Typical acute viral invasion effects. I made my own diagnosis, asked for a glass of water and in half an hour got myself driven back home.That was it – I rested for about seven days and now I am back to normal.This is a lesson to all people who read this - when you enter the last and penultimate chapters of life, never exert when you feel unwell.

Rest adequately till you feel very well.

In rat model, ex-smokers remain quitters

A new inhibitor helps previously nicotine-addicted rats stay on the wagon, according to a study published in the Journal of Experimental Medicine. Kicking the cigarette habit is difficult enough, but resisting the urge to light up in situations previously associated with smoking can be a quitter's downfall.

But help may be at hand. A new inhibitor developed by Fang Liu and colleagues at the Centre for Addiction and Mental Health in Toronto helped ex-smoker rats resist that urge.

Liu and colleagues found that long-term nicotine exposure caused two neurotransmitter receptors to interact in the brain, and their inhibitor prevented this interaction. In rats trained to self-administer nicotine, the inhibitor had no effect on their propensity to indulge.

But in “ex-smoker” rats (those weaned off nicotine), the inhibitor decreased the number of relapses after exposure to environmental cues previously associated with a nicotine fix.

If the inhibitor works the same way in humans, it may provide a powerful new way to reduce relapses in people who have quit smoking or chewing tobacco.

- MNT

Bullying in childhood caused by children with mental health disorders

Children diagnosed with mental health disorders were three times more likely to be identified as bullies, according to new research.

Bullying is a form of youth violence defined as repetitive, intentional aggression that involves a disparity of power between the victim and perpetrator. A 2011 nationwide survey found 20 percent of U.S. high school students were bullied during the preceding 12 months.

And while it is well-established that victims of bullying are at increased risk for mental health illness and suicide, few studies have investigated the mental health status of those who do the bullying.

In the study, Association Between Mental Health Disorders and Bullying in the United States Among Children Aged 6 to 17 Years, researchers reviewed data provided by parents and guardians on mental health and bullying in the 2007 National Survey of Children's Health, which included nearly 64,000 children.

In 2007, 15.2 percent of U.S. children were identified as bullies by a parent or guardian. Overall, children with mental health disorders were three times more likely to bully other children. A sub-analysis by type of mental health disorder found that children with a diagnosis of depression were three times more likely to bully, while a diagnosis of Oppositional Defiant Disorder (ODD)was associated with a six-fold increase in the odds of being identified as a bully.

“These findings highlight the importance of providing psychological support not only to victims of bullying, but to bullies as well,” said study author Frances G. Turcotte-Benedict, a fellow at Hasbro Children's Hospital in Providence, RI.”

“In order to create successful anti-bullying prevention and intervention programs, there certainly is a need for more research to understand the relationship more thoroughly, and especially, the risk profile of childhood bullies.

- NYT

Chest band may relieve chronic cough

A soft, extendible band fitted around the chest may help to relieve cough in patients with persistent dry cough.

Over the course of one year, Japanese researchers evaluated the antitussive effect of the chest band worn for eight hours a day in 56 patients with chronic cough due to a variety of conditions.

Results showed that 88 percent (n=49) of patients improved their cough scores, and 59 percent (n=33) were able to reduce the cough.

Researchers conclude that soft chest band therapy for intractable, prolonged, and chronic cough is a safe and effective therapy.

- MNT