Mental health can be a difficult subject to discuss. Often, mental health issues run in families and often are not addressed unless something serious or harmful occurs which makes it impossible to ignore the issue. However, help is available. The medical community has made significant developments in understanding the way that the brain works, thus making strides in the successful treatment of mental health issues. If you or a loved one is uncertain about how to broach psychological concerns, there are people who can help.
Who Does Schizophrenia Affect?
One of the most misunderstood mental health disorders is schizophrenia. In the past, many people suffering from schizophrenia were dismissed as beyond aid. This is no longer true. According to the National Institute of Mental Health, approximately 1.1% of the worldwide population over age 18 suffers from schizophrenia. This equates to roughly 2.2 million people in the United States alone. Schizophrenia affects people who come from all walks of life, whether they are homeless or live with loving families, and many also have co-occurring health issues, including substance use disorder.
People with schizophrenia may feel different and not know why. The onset of schizophrenia can occur at any age. It most commonly manifests during the late teens to early 20s in men, while in women, symptoms often don’t occur until their late 20s to early 30s. Schizophrenia is rarely seen in children younger than 12, and it’s rare for symptoms to first begin in adults older than 40. The first symptoms are often difficult to distinguish from more common conditions, such as attention-deficit/hyperactivity disorder or even normal adolescent behaviors. In situations where there is a familial history of mental health issues, it is imperative to seek medical advice anytime a loved one’s thoughts seem scattered or they seem to be withdrawing or acting out.
Symptoms and Causes of Schizophrenia
If certain signs appear to present themselves for longer than six months, seeking a psychological consultation is highly recommended. The symptoms include:
• Lack of emotion or motivation
• Inability to remember things on a regular basis
These symptoms will progressively worsen without treatment and should be taken seriously. There is too often a stigma associated with people who battle schizophrenia, yet it is crucial to note that there is hope, and effective treatment is available. Many people who live with schizophrenia have full, rich, and productive lives these days.
Research is ongoing, but with advances in science, much more is known regarding the origination of schizophrenia. It is highly suggested that schizophrenia may be hereditary. The genetic component does not involve one gene but is a combination of total genetic makeup along with environmental factors in a person’s life. However, the likelihood of a person developing schizophrenia is six times higher if there is a parent or sibling with the condition.
Delusions and hallucinations are often striking indicators that schizophrenia may be involved as there are not many other legitimate conditions that contribute to these symptoms. It is important to rule out drug use as the cause of these symptoms due to the fact that some drugs, such as LSD or methamphetamines, can be the catalyst for hallucinogenic symptoms. Evaluating the history, progression, and duration of symptoms can give health care providers more detailed information that can lead to a proper diagnosis and appropriate treatment decisions. There are very few conditions that result in hallucinogenic episodes, so if there are no drugs involved, schizophrenia should be considered as a possible reason for such events.
Schizophrenia patients are often wrongly thought of as a danger to others. However, most violence perpetrated by those with schizophrenia occurs directly to themselves. Violence to others is not a sign of schizophrenia, and most of those affected actually prefer solitude and are seen as withdrawn as a whole. It’s important to note, as well, that as a group, schizophrenics have a risk of suicide 50 times higher than the general population. It is the number one cause of early death in those with this diagnosis, with an estimated suicide rate of 10-13% overall. As many as 60% of males with this diagnosis attempt suicide at least once. These are terrifying statistics and a sad reality check that we still have much more work to do in identifying and treating people who suffer from the devastation of schizophrenia.
Diagnosis and Treatment
A recent study in America concluded that nearly 50% of people with severe mental illness received no treatment in the past year. A majority of those patients were unaware of their diagnosis, yet those who were aware had several reasons for not getting appropriate treatment. The excuses included things like they wanted to fix things on their own, they thought it would go away, it was too expensive to get treatment, they didn’t know where to go to get help, and that medication would not help them anyway.
These are the obstacles that providers face in attempting to reach out to people in need of services. Making information available to everyone is a vital step in recognizing and reaching people who can benefit from mental health services, as well as reaching families and friends who might know people who should receive the help that is available. Clearly identifying patients in need and educating the public about the kind of treatment that is possible is a hurdle that can realistically be overcome.
Fortunately, there are effective treatment options for schizophrenia. After ruling out other possible causes of symptoms with physical examinations, drug screening, and blood panels, along with a full mental health screening, schizophrenia can be diagnosed through a more thorough checklist of items. In addition to evaluating the answers given, mental health professionals also evaluate a person’s mental status by observing their overall appearance, how cognizant they are during the screening, their level of personal hygiene, overall demeanor, and how in-tune they are to the questioning going on.
The patient will be asked about suicidal thoughts and any hallucinogenic episodes, as well as how they are feeling about life in general. During this screening, a full medical history is taken, which also helps rule out other causes of the symptoms being displayed. Once an official diagnosis is made, a full treatment plan will be created addressing the biggest issues of concern within the scope of symptoms. The goal is to ease distress and overcome the feeling of helplessness someone with schizophrenia may be feeling about their life. Keeping in mind what kind of outcome each patient expects, a provider can decide which treatment protocol to prescribe for each person.
Antipsychotic medications are the most commonly prescribed drugs to treat schizophrenia. They are thought to work by affecting the brain’s production of dopamine. The goal is always to find the lowest dose that provides symptom relief, thereby minimizing the risk of disruptive side effects. There may be a combination of drugs prescribed, and doses will most likely be changed off and on as the patient adjusts to each medication.
Schizophrenia and Substance Abuse
Up to 70% of people with schizophrenia may also suffer from substance use disorder. A person with untreated or under-treated schizophrenia may turn to the use of drugs to deal with issues such as anxiety and social phobias as well as trouble with sleep. The problem is, using drugs or alcohol can often aggravate symptoms. Issues like auditory hallucinations are typically worsened by alcohol, and nicotine can actually reverse the effects of certain medications used in schizophrenia, such as haloperidol.
People with schizophrenia are 4.6 times more likely to be diagnosed with substance use disorder. The most commonly used substances include nicotine, alcohol, and cannabis yet may also include stronger, more dangerous drugs, such as heroin or methamphetamine. The theories as to why schizophrenia and substance use disorder are commonly co-occurring include the idea that many will self-medicate their psychiatric symptoms. There is a high risk that self-medicating may spawn a substance use disorder. Other theories assert the fact that, just as with schizophrenia, there is a genetic predisposition to addiction issues. Genetic research is ongoing.
Schizophrenia, especially when co-occurring with substance abuse, is a complicated condition and requires a commitment to a life-long treatment protocol. It is not one prescription and done. A person must be dedicated to recovering and remain dedicated to their treatment plan. Early on, hospitalization may be recommended, but this is not always the case. A psychiatrist and a team of other professionals, including those with training in addiction, will review the options and coordinate care with a case manager.
Facing a dual diagnosis can be a frustrating reality. Fortunately, there is hope for patients and families who are facing the difficult task of addressing schizophrenia combined with a substance use disorder. A person with a dual diagnosis can receive proper treatment in qualified hands. Many programs will address the core fundamental issues of mental health problems co-occurring with substance use and self-medication.
Other Obstacles to Treating Schizophrenia
One of the biggest reasons that a treatment plan fails is because the patient stops taking their medications. This is called noncompliance, and according to the Journal of Clinical Psychiatry, it is due to the patient not believing they are sick, which is referred to as anosognosia. Anosognosia is not denial; it is caused by physical changes in the brain.
In this scenario, it is more vital than ever for family and friends to be there as a support system for individuals diagnosed with schizophrenia. While the patient may not want to believe they are ill, being surrounded by a support system that is able to acknowledge how much better a patient is functioning and how healthy the patient appears while on their treatment plan can aid in keeping him or her on the proper track. Instead of insisting they take medication that they don’t believe they need, focus on individual symptoms and stress the need for medication that directly treats those specific symptoms.
There is more hope now than ever before. Medications have become more readily accessible. A variety of counseling and treatment plans can work for people from all socioeconomic ranges. No longer are people with serious mental health conditions dismissed as “beyond help” or considered less than important in the world. Every person with mental health issues is deserving of respect and should be given every opportunity to live a happy and productive life outside of the confines of illness. Seeking help is a sign of strength and is proof of the desire to live a life like everyone else. We should always be the hand they can reach out for when times seem dark. Help is available.