Schizophrenia

Schizophrenia is a serious mental illness that changes how a person thinks, feels and behaves. It also changes how they perceive the world, themselves and other people.

About 1% of the population of most countries has schizophrenia although symptoms may differ from culture to culture. Symptoms vary widely between people who have schizophrenia. They may be mild or severe. Some people experience one episode of the illness and having received treatment they do not relapse. Others have more frequent episodes but remain well for a lot of the time. Still others remain unwell and require a high level of ongoing support and treatment. 

Medication is usually a central part of the treatment. This can be very effective although side effects can be problematic. Counselling, social support, assistance with employment, accommodation, finances and education are also important in assisting the person and their family to cope with the illness.

Symptoms of Schizophrenia

Delusions

These are false personal beliefs that are not subject to reason or contradictory evidence and are not explained by a person’s usual cultural concepts (US National Institute of Mental Health).

Hallucinations

These refer to a person’s perception of something that does not really exist in their environment. The most common form of hallucination is auditory, e.g. when a person ‘hears’ voices.

Disordered thinking

A person may think very quickly or in bizarre or confused ways, making it difficult for others to follow their train of thought.

Flat or inappropriate affect

'Affect' means feelings or emotions, so a person is often unresponsive or finds it difficult to feel appropriate emotions at an appropriate time.

Cognitive impairment

A person has difficulty with mental processes like memory or concentration.

Withdrawal

A person will not want to interact with others and spends a lot of time alone.

Loss of motivation

A person loses their 'drive' to do things, including basic self-care.

What causes schizophrenia?

The causes of schizophrenia are not yet clearly understood although a combination of factors is seen as the most likely. These include:

• genetics
• a biochemical imbalance in the brain
• environmental stressors
• drug use

Treatment of Schizophrenia

Medication

Antipsychotic medication is usually prescribed for those with schizophrenia. This medication helps to control the symptoms, particularly the delusions or hallucinations that a person may experience. There are two main kinds of medication that are commonly prescribed. They are known as the ‘typicals’ and the ‘atypicals.’ The ‘typicals’ refer to the medications that have been widely used over many years, while the‘atypicals’ refer to the newer drugs. Although the newer drugs often produce fewer side effects some people respond better to the older medications.

'Typical' antipsychotic medications

• Clozapine (Clozaril, Clopine)
• Chlorpromazine (Largactil)
• Olanzapine (Zyprexa)
• Haloperidol (Haldol)
• Risperidone (Risperdal)
• Thioridazine hydrochloride (Melleril)

Each person is different and medication options need to be explored with a psychiatrist on an individual basis.

Rehabilitation services can assist the person to find and maintain accommodation, education, social skills, contacts and employment.

Cognitive Behavioural Therapy (CBT) can be useful in helping the person learn ways of managing their schizophrenia. Supportive or insight-oriented counselling may also be beneficial.

Hospitalisation may be necessary at times if the person becomes unwell or their medication needs to be changed or stabilised.

Support groups offer people with schizophrenia and their families the opportunity to meet people in a similar situation, share experiences, and find support, education and reassurance.

Psycho-education is useful in helping to understand the illness and reduce stigma.

How Relatives and Friends Can Help

• Learn more about the illness by joining an organisation like the Schizophrenia Fellowship
• Share your experiences of caring with the professionals treating your relative
• Encourage your relative to comply with medication
• have important phone numbers ready in case you need them, e.g. the crisis team or other friends who can help
• Draw up an ‘action plan’ with your relative when they are well.
• Discuss the person’s early warning signs and decide what to do if the person seems to be deteriorating
• Be realistic about what your relative may be able to achieve and praise small steps towards progress
• Take time off from your caring role when you can.

Where to get help

• Call the Mental Health Information Service on 1300 794 991 for information about relevant local services.
• Contact your local Community Mental Health Centre (look under ‘Community’ in the White Pages).
• Make sure you have regular contact with a local doctor (GP). Even if you are seeing a psychiatrist your GP will play an important role in monitoring your general health.
• Ask your GP for a referral to a psychiatrist.
• Schizophrenia Fellowship of NSW (02) 9879 2600 www.sfnsw.org.au
• Association of Relatives and Friends of the Mentally Ill (ARAFMI)
• (02) 9332 0700 or 1800 655 198 (rural NSW) www.arafmi.org
• Richmond Fellowship, tel (02) 9701 3600, www.rfnsw.org.au
• Aftercare, (02) 9810 7100

What is the difference between psychiatrists and psychologists?

Psychiatrists are medically trained doctors who have gone on to train further and specialise in the treatment of mental illness. They can prescribe medication. Psychologists are trained in human behaviour and have studied the brain, memory, learning and human development. They provide various services including assessment, psychological testing and various types of psychotherapy and/or counselling.

Medicare Rebate for Psychologists

A Medicare rebate is now available for up to 12 sessions per calendar year with a registered psychologist who has a Medicare Provider Number. To obtain the rebate you must be referred by an appropriate medical practitioner, i.e. a GP, psychiatrist or paediatrician. The practitioner will ensure that you meet the eligibility requirements and develop a management plan for your condition. The cost and rebate from Medicare will vary depending on the consultation length and fee charged. If the psychologist bulk bills there will be no extra cost.

For further information about the rebate or to locate a psychologist in your area contact the Australian Psychological Society: http://www.psychology.org.au/ Tel: 1800 333 497