Living with Schizophrenia

• Introduction to schizophrenia
• Living with schizophrenia
• The importance of medication compliance

 

• When should I consult my doctor?
• Tips for improving quality of life for patients and carers

Introduction to schizophrenia

The term schizophreniawas first coined by Swiss psychiatrist Eugen Bleuler to describe the presence of schisms between thought, emotion and behaviour. Clinically, schizophrenia is a disturbance lasting for at least 6 months and including at least one month of at least two of the following:

• Delusions
• Hallucinations
• Disorganised speech
• Grossly disorganised or catatonic behaviour
• Negative symptoms

Living with schizophrenia

Schizophrenia remains one of the top causes of disability in the world, despite more than five decades of pharmacological and psychosocial interventions. The impairments faced by people with schizophrenia are widespread, affecting social, occupational and independent living activities. People with schizophrenia commonly have disabilities in partner relationships, work roles, social withdrawal, household participation, general interests, self care and social friction. These disabilities are especially common among young and middle aged adults, and occur even in people responding to treatment for psychosis.

A long term study looked at the change in social disability of people who had a first episode psychosis. It found that the level of social disability for a particular individual fluctuated with time, and many individuals experienced different levels of disability. About one third of the people involved in the study improved considerably over 15 years, and 40% had little or no disability at the end. However, one out of seven did not improve.

The importance of medication compliance

Several scientific studies have shown that most patients with schizophrenia are noncompliant with their medications. This means that they either do not take the correct dose of their medications, or do not take their medication regularly. Several studies have shown that 90% or more of schizophrenic patients do not take their medication as directed. There are various reasons why patients do not take their medication, including forgetting to pick up a refill, cost, or an intentional decision to not take medication.

Patients who do not take their medication as directed often experience poorer outcomes, including increased hospitalisation rates. A large study used information from pharmacists to identify patients who did not take their medication as directed. They found that patients with good compliance had the lowest rates of hospital admission. As compliance decreased, the rates of hospital admissions increased. Once admitted to hospital, those who were less compliant stayed longer in hospital.

 

When should I consult my doctor?

You should consult your doctor if you or someone close to you notices unusual behaviours that might indicate signs of early psychosis. There are programs, such as the Early Intervention in Psychosis (EIP), which use a range of approaches to intervene at the earliest opportunity. Early intervention helps to improve symptoms, functional capacity and quality of life. A recent review found this method effective in delaying transition to psychosis, reducing duration of untreated psychosis, preventing relapse, reducing hospital admissions and rates of suicide, and reducing treatment costs.

You should also consult your doctor if you are experiencing side effects from your medication, or are having difficulty taking your medication in a regular fashion. Some common side effects are:

• Sleepiness during the day, or feeling drugged or like a zombie
• Dizziness and/or fainting
• Irregular or unusually fast heartbeat
• Tense or jerky muscles and/or shaky hands or arms
• Restlessness
• Drooling or a dry mouth
• Blurry vision
• Difficulty passing urine
• Thirst
• Passing urine frequently or bed wetting
• Nausea
• Sore and swollen areas around your nipples, or fluid from your nipples
• Weight gain
• Problems enjoying sex
• Men: erectile difficulties
• Women: a change in periods over the past 3 months

Consult your doctor if you have any concerns related to schizophrenia, or any other health or mental conditions.

Tips for improving quality of life for patients and carers

There are several things that can be done to help reduce the impact of schizophrenia on your lifestyle. These include:

• Early diagnosis and comprehensive treatment of the first episode
• Comprehensive care, especially in the first 3–5 years following diagnosis. The course of illness is strongly influenced by what happens in this critical period.
• Antipsychotic medication
• Careful monitoring of side effects
• Psychosocial interventions should be routinely available to all patients and their families. These include:
  • Family interventions
  • Cognitive-behavioural therapy
  • Vocational rehabilitation
  • Therapy for comorbid conditions (e.g. substance abuse, depression, anxiety)
  • Other forms of therapy
• A positive social and cultural environment, including:
  • Adequate shelter
  • Financial security
  • Access to meaningful social roles
  • Availability of social support
• Tailoring of interventions to phase and stage of illness, and to gender and cultural background
• Maintenance of good physical health
• Quality medical care involving general practitioners and psychiatrists.

More information

For more information about schizophrenia and its treatments, videos and useful tools, see schizophrenia.

References

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