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What Is Schizophrenia ?

Schizophrenia PerceptionSchizophrenia is a mental illness that affects how a person thinks, feels and behaves. The person finds it difficult to tell the difference between real and imagined experiences, to think logically, to express feelings or to behave appropriately. People with schizophrenia may hear internal voices not heard by others or may see things that are not really there. These experiences can seem threatening and can make them fearful and withdrawn. They also may have trouble organizing their thoughts and expressing themselves. Their speech and behavior can be so disorganized that they may seem frightening to others. Schizophrenia is one of the most misunderstood mental illnesses. Contrary to popular belief, it does not involve a "Jekyll-and-Hyde" type of split personality. Instead, it means that all the attributes that go into the makeup of the human personality - logical thinking, feelings and expression, perception and relating to others - become separated from one another.

Important To Know:

1) Schizophrenia literally means "a split mind" and this may be where the misconception of split personality took root. Eugen Bleuler, a Swiss psychiatrist, first used the term in 1911 to describe patients whose thought processes seemed disconnected
2) Schizophrenia affects about one percent of the world's population and is found all over the world, in all ethnic and social groups.
3) People with schizophrenia often have difficulty functioning in society, at work and in school. The illness can be taxing on both the individuals who are affected and on their families.
4) The symptoms of schizophrenia vary widely from one person to another. In some people, the dissociated feelings caused by the illness are a constant part of life. In others, the symptoms will come and go.
5) People with schizophrenia do not always act abnormally. They may appear perfectly responsible and in control, even when experiencing hallucinations or delusions.
6) Schizophrenia cannot be cured completely, but the symptoms can be reduced significantly with treatment.
7) The vast majority of people with schizophrenia are living either full and productive lives or relatively independent lives.
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Facts About Schizophrenia:
» Schizophrenia affects an estimated one percent of the world's population.
» Symptoms usually appear between the ages of 15 and 35.
» Schizophrenia affects males and females equally, although symptoms often appear earlier in males.
» In the U.S., about 2.5 million people have this illness.
» About 80 percent of people with schizophrenia can live either full, productive lives or relatively independent lives with treatment.
» The other 20 percent of sufferers will require long-term, structured care.
» People with schizophrenia have a higher rate of suicide than the general population. Approximately 10 percent of people with schizophrenia (especially younger adult males) commit suicide.
» Schizophrenia accounts for about 40 percent of all long-term hospitalization.
» Schizophrenia can run in families. The risk for inheriting schizophrenia is 10 percent in those who have an immediate family member with the illness, and 40 percent if the illness affect both parents or an identical twin.
» Heredity does not explain all cases, however. About 60 percent of people with schizophrenia have no close relatives with the illness.
» Early treatment and newer treatment options may control the illness in up to 85 percent of individuals.
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Causative Factors of Schizophrenia:

Schizophrenia is usually caused by
» A biochemical disorder in the brain wherein the brain produces too much of the neurotransmitter called ‘Dopamine’. This excess in neurotransmitter results in very high sensory stimulation and nerve impulse firing with consequent multiplicity of thoughts and altered perceptive levels, such persons with a biochemical disorder may develop schizophrenia without any predisposing life stress whatsoever.
» Environmental stress factors of a severe nature eg. death of a family member, severe financial loss, rejection in a love affair, failure in exams, dismissal from a job, pregnancy, marriage, divorce etc.
» A marginal genetic or family predisposition has definitely been noted in schizophrenia, as stated earlier the incidence in normal population is 1–2%, however, if one parent has the illness, then the chances of one of his children having it is 4–5%.
» Distortions in the family dynamics and interactions these result in an unhappy or violent childhood and subsequent poor capacity for mental adjustment in the prospective patient.
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Clinical Features of Schizophrenia:

The common and specific clinic features which should make one suspect schizophrenia are:
» Continuous, often loud, nonsensical unconnected speech, while talking, the patients shift from one topic to another completely unrelated topic without realizing they are making no logical sense.
» Smiling and laughing to oneself without any obvious cause.
» Walking around without clothes and other forms of uninhibited behavior
» Acute violent unprovoked behavior, tearing of one’s clothes etc.
» Sitting in one position for hours, or even days on end.
» The patient stops taking baths and starts looking unkempt, haggard and disheveled.
» When the patient is alone, he feels he can hear voices talking about him.
» Patient starts speaking to himself and making conversations and gestures with imaginary voices and people.
» Visual hallucinations, such as seeing non–existent things.
» The patient becomes suspicious about relatives, neighbors and friends and feels that all have ganged up against him.
» The patient often feels that people are following him and spying upon him.
» TV, radio, video and ordinary gestures of people around him acquire special meaning for him.
» The patient feels that somebody is controlling him (via laser beams, video cameras, magnetic powers etc) or that everybody can read or “Hear” his thoughts.
» The patient may feel that he is related to God, ministers, film stars and is endowed with special status and magical powers.
» Sleep rhythm is completely disrupted with the patient often not sleeping for days on end.
» Work performance, appearance and social relationships begin to deteriorate.
» Even though the patient is mentally ill, he feels he is 100 per cent alright and denies illness altogether.
» The special emphasis on the symptomatology is so that the illness may be picked up early.
» Delayed diagnosis and an advanced stage of illness definitely affect ultimate prognosis of schizophrenia.
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Prognostic Factors in Schizophrenia:

SchizophreniaSchizophrenia can affect anybody, with no class or strata of people being exempt. Doctors, chartered accountants, lawyers, educated and uneducated people, men and women, rich and poor, urban and rural, young and old, can all be afflicted with schizophrenia. Generally, however, schizophrenia begins during adolescence or young adulthood with the age group of 18–30 being highly predisposed. Schizophrenia seems to worsen and become better in cycles with the acute psychotic phase often alternating with residual features such as social withdrawal, blunted emotions and extreme apathy. It is not necessary for family history of schizophrenia to be present in each case, not is it necessary for a stressful event to have preceded the illness.

Prognostic Factors:

Factors which are responsible for a good prognostic outcome of schizophrenia are:
» Age of the patient – Older the patient, the more favorable the prognosis
» The duration of illness – The shorter the duration prior to treatment, the better the outcome.
» The rapidity of development of the symptoms – Surprisingly, it has been found that the more speedily the symptoms develop, the faster do they respond to treatment; a very slow, insidious, and gradual onset of illness suggests a final poor outcome.
» A patient who had close friendships and multiple relationships prior to illness has a brighter chance of recovering than a patient with few or no such relationships.
» Life stress prior to onset – An episode brought on by a major identifiable life stress will respond more quickly than an episode without any obvious cause.
» Marital history – A patient with a stable and helpful marital partner has a favorable prognosis as compared to an unmarried patient.
» Educational history – The higher the level of education, the more are the chance of a patient coming rapidly to terms with the illness and handling the post – illness sequence.
» Occupational history – A patient with a good stable occupation or business prior to onset of illness will respond better than a patient who is jobless and economically unsound.
» Family history – An absence of schizophrenia in the family points to a better prognosis.
» Family's attitude towards the returning patient – hostile behavior by family members, or vice versa, excessive care and attention by them can undermine the patient’s sense of confidence and hamper recovery.
» The patient often feels that people are following him and spying upon him.
» Social support systems – A patient with a joint family and a staunch circle of friends who are ready lend a helping hand, is much better off than a lone man afflicted with the illness, whose relatives are in some far off land, and who has no one to turn to.
» Organic brain damage – Presence of concurrent obvious brain damage (mental retardation, epilepsy, head injury etc.) hinders the final adequate recovery from schizophrenia.
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Treatment of Schizophrenia:

The treatment of schizophrenia may be divided into two stages

The first stage of treatment program is essentially aimed at reducing the acute psychotic symptoms and helping the patient re–establish contact with reality. This phase usually involves admission of the patient into a hospital and administering a biological line of treatment injectable anti–psychotics and very often ECT’s. Short duration psychoses may respond without ECT’s but advanced severe cases do require ECT’s.

The anti–psychotics possibly act on the dopamine levels in the brain and thus help in reducing the hallucinations and delusions and curbing disorganized bizarre behavior. Like all medications, however, anti–psyhotic drugs should be taken only under the careful monitoring of a psychiatrist. Maintenance medication is vital for preventing a relapse. Approximately 40 – 50 per cent of those who stop the medication immediately on discharge from the hospital have a relapse within 1 year. However, if the patients continued taking medication beyond the first year, relapse rates fell to 10 per cent, Maintenance therapy can be given for a long time, even up to 2–3 years, without any major problems, provided it is under the guidance of a psychiatrist.

The second phase of treatment which is equally important is “Aftercare”, which involves helping the partially recovered patient continue recovery while residing in the community. Aftercare programs help the patient to deal with the anxiety.

Depression and confusion that linger after the major symptoms have abated psychotherapy at this stage offers understanding, reassurance, careful insights, and suggestions for developing self–esteem and handling the emotional aspects of the disorder. Often, psychiatrists have to work closely with family members to help them understand the illness and provide an environment which is free from criticism, hostility, and emotional over involvement. A change in the patient’s living and working environment may be suggested to reduce stressful situations.

In aftercare, anti–psychotic maintenance medication serves as a protective cover and buffers the patient from life stresses. Generally, psychiatrists choose a combination of medication, ECT’s and psychotherapy, and modulate them to suit the patient’s individual needs, so that finally the patient may work, live at home and enjoy the activities that he did previous to developing the schizophrenia.

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Our Services for schizophrenia patients:
1) After discussion with family of the patient, a date will be fixed to bring the patient to Mumbai. If he/she is an international patient we will pick the patient and family member(s) at the airport. They will be taken straight to the hospital. After the check-up, he/she will be admitted in the hospital.
2) We arrange Male / female attendant to the patient who can speak English, Marathi, Hindi or Arabic..
3) The family can take information about the patient every day or two from the concerned attendant or from Us
4) The patient will be taken for a walk in the hospital ground after doctor permits.
5) The patient after satisfactory recovery will be sent to rehabilitation centre where the patient is made to do some activities and exercises. They are trained to work and activate their thinking power. Here also, our attendant can visit which will be upto your discretion.
6) At the rehabilitation centre, our attendant will also translate and help psycotherapist to understand the patient and to also explain the pateint what the phycotherapist wants Him/Her to do.
7) We seeks to provide high quality accessible rehabilitation, recovery and skills based learning services based on best practice standards and driven by the needs of our clients.
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At the rehabilitation centre, following servicess will be provided:

After the patient's recovery at hospital He / She will be shifted to a very spacious rehabilitation centre, where the staff is highly trained and well equiped to deal with schizophrenia patients.

Services are focused on: helping people to build on their independence in their chosen communities; strengthening family and friendship networks; creating new ways to enjoy social and recreational activities in the community and supporting people in their educational and other work experiences.

Specific services delivered include: living skills training; disability support and psychosocial rehabilitation; residential services; high level long term support; rehabilitation services and recreational leisure and training program.

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