Understanding and Living With Schizophrenia

Schizophrenia is a severe and enduring mental illness that interferes with normal brain functioning. Schizophrenia most commonly strikes between the ages of 16 and 30 and symptoms shows comparatively earlier in males than females.
Photo from MentalHelp.net

Schizophrenia, that is known to affect about 10 people per thousand of adult population, can lead to suicide in 25 per cent of its patients if left untreated, a study shows.
May 24 is celebrated the world Schizophrenia day to raise awareness of the disease that is one of the 10 causes of disability. Interestingly the medical data shows that about 90 percent of people with untreated schizophrenia left untreated in developing countries. Dr Manu Tiwari, senior psychiatrist of Fortis Healthcare says,

Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support and family stress or instability are risk factors for suicide in patients.

What is Schizophrenia ?  

Schizophrenia is a severe and enduring mental illness that interferes with normal brain functioning. Schizophrenia most commonly strikes between the ages of 16 and 30 and symptoms shows comparatively earlier in males than females. It causes affected people exhibit odd and often highly irrational and disorganized behavior. In many cases, the disorder develops so slowly that the individual does not even know that they have had it for many years. But in other case it can strike suddenly and develop quickly. The illness may also have its onset in 40s and above, termed late-onset schizophrenia. The illness is characterized by disruption in the process of perception of senses, especially hearing and also thinking.

Symptoms of Schizophrenia

Some patients may show clear symptoms but others may seem fine until they start explaining what they are truly thinking. A sizable proportion of people with schizophrenia are dependent on others because they are unable to do a job and take care for themselves.

Some patients may show clear symptoms but others may seem fine until they start explaining what they are truly thinking. 
Photo by Ibrahim Rifath on Unsplash

 
Many of them resist to visit a doctor and arguing that there is nothing wrong with them.
Commonly,  people with schizophrenia have anosognosia or lack of insight. This means the person is unaware that she/he has the illness, which can make treating or working with them much more challenging.



The effect of schizophrenia is very critical for the patient as well as family, friends and society also.
   

Suspecting without sufficient basis - that others are exploiting, harming or deceiving her/him 
Photo by Christopher Campbell on Unsplash

Antagonism > Suspeciousness

Suspecting without sufficient basis - that others are exploiting, harming or deceiving her/him

Dis-inhibition >

Distractibility

Difficulty in concentrating and focusing on tasks; attention easily diverted by extraneous stimuli
  

 

Decreased Intellect

Perceptual Dysregulation

• Odd and unusual thought process and experiences

Unusual Belief and Experiences

• Firmly held very strange false beliefs, unreal perceptions, imaginary voices, visions and smells

Eccentricity

• Odd, unusual strange behavior, appearance or talking, bizarre thoughts 

Lack of Insight

• Lacking understanding of or willingness to change / correct their personal problems 

Forgetfulness

• Difficulties in learning, forgetting important information.

Impaired Reasoning

• Lacking good judgement, impaired ability to solve problems by thinking logically and in a sensible way.

Detachment

Intimacy Avoidance

• Avoidance of close relationship

Social Withdrawal

• Preferred to be alone; avoidance of social contracts and activity

Restricted Emotion

• Little reaction to emotionally arousing situation; constricted emotional experience and expression

Loss of Interest or Pleasure

• Inability to enjoy or take interest in things; lack of energy for life's experience

Negative Emotion

Depressed Mood

• Feelings of being down, miserable and hopeless

Self-Harm

• Suicidal thoughts or risk of harming self by self-injury or severe self-neglect

Symptoms and signs however varies in a range depending on the individual.

Psychosis

Schizophrenia or paranoid schizophrenia is technically featured as psychosis. It occurs when  a person loses the ability to discriminate between real and imagined experiences and therefore contact is lost with external reality.

Photo by Randy Jacob on Unsplash

Hallucination

Perceiving a sensation, usually hearing multiple voices that occur in the absence of anyone around is termed as hallucination. The voice quality is like that of a normal person but the only difference is that this happens in the absence of any real person speaking. Therefore for the person with schizophrenia, such voices are real. These voices could be abusive and hostile causing irritability. The person - because of preoccupation with voices - will not able to concentrate and have a social interaction. The person rarely complains of hearing voices as abnormal and does not believe their origin is from an ill mind. There is abnormality of experience of thinking also, as the person believes she/he is being conspired against with people watching or following them. Some patients have isolated themselves because of fear when severity of illness increased. The voices also could command to harm oneself or others and the person may act on those instructions. In simple terms some of these experiences are similar to dreams but with person being fully awake and alert.
    

Photo by Aiony Haust on Unsplash

   

Delusion

With hallucination these patients also experience delusions which are firmly held false beliefs, mistaken ideas that are not supported by evidence or held despite contradictory evidence. Delusions are necessarily in congruent with societal norms and some beliefs may constitute a delusion in certain cultures where they impact functioning while they may be perfectly normal belief in others.

Both hallucination and delusion are involuntary in nature, occurring spontaneously and without premeditation on the part of patients who experience them. Typically, attempts to correct patients' delusions are met with resistance and defensiveness. From their internal perspective, patients' delusions seem to be true.

Persons with schizophrenia have little choice but to take their hallucinations and delusions seriously as their malfunctioning brains cause them to experience these uncontrollably with the force of real sensations.                
Hallucinations are thus a virtual reality that persons with schizophrenia force themselves into the trap and the delusions that form around these hallucinations are a natural response to this unintentionally altered perceptions.
    

Causes of Schizophrenia

There are may be various causes that can be identified as possible cause when a person affected by the symptoms of schizophrenia. However those causes are only possibilities based on historical analysis.

Genetic inheritance

Schizophrenia is not just caused by just one genetic variation, but a complex interplay of genetics and environment. But if there is no history of schizophrenia in a family, the chances of developing it are less than 1 percent, However it is found that the risk rises to 10 percent when a history conforms.

Environment

There is no definite proof but different studies suspect trauma, exposure to viruses, malnutrition before birth may contribute to increase the possibility of developing schizophrenia.   
  

Chemical imbalance in the brain

Problems with certain brain chemicals including neurotransmitter called dopamine and glutamate may contribute schizophrenia.. Other neurotransmitter like serotonin may be one of them.

Substance use

Some experts have suggested that taking mind altering drugs during teen and in early 20s can increase the risk of schizophrenia.

Cause or Effect

Stressful experiences often precede the emergence of schizophrenia. Before

It is very hard to conclude whether schizophrenia is cause or effect of the crisis.
Photo by Gabriel Matula on Unsplash

any acute symptoms are apparent, people with schizophrenia  habitually become bad-tempered, anxious and unfocused. Sometime they can become hostile, irritable and abusive towards the family, colleagues or even with the neighbors. This can trigger relationship problem, divorce, unemployment etc.

The above factors with some unknown causes often blamed for the onset of schizophrenia, when it was really other way round - disease causes the factors. Therefore it is very hard to conclude whether schizophrenia is cause or effect of the crisis.

Treatment of Schizophrenia

There is no full cure of schizophrenia so far, however it can be treated and manged several ways. Psychiatrists generally do attempt to treat patient with family members, help at home and do try the least restrictive approach but it all depends on the severity of the illness, level of trust and family support.       
By starting treatment early with proper combination of

• medication

• psychological counseling

• self-help resources

many patients recover well. They complete their study and continue to perform in their employment in a supportive environment.

Final Thought

The primary schizophrenia treatment is medication. Unfortunately it needs long-term treatment,  most cases lifelong. though some people make significant recovery.

Photo by Cristian Newman on Unsplash

Many symptoms can be treated or controlled. The focus switches from treating the illness to recovery phase, to make the person lead a more independent life by way of rehabilitation care.

Since most persons do not believe they are ill, they refuse to take medications that are necessary to reduce their strange experiences. It is the trusting therapeutic relationship with the regular psychiatrist and presence of the motivating care-giving family member that will ensure the treatment is adhered to. With many awareness programmes, caring family members and even at times the persons themselves are now coming forward and seeking treatment and continuing care.               

How A Good Self-Help Programme Can Be The Best Answer to Obsessive Compulsive Disorder (OCD)

Photo by Cristian Newman on Unsplash

Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder which compels the mind to act out of compulsion or obsession. Excessive thoughts or obsessions that lead to repetitive behaviors or compulsions.
People with OCD tend to stay away from their normal lives. It is a common, chronic and long-lasting disorder and characterized by uncontrollable, unwanted thoughts and sometime ritualized, repetitive behaviors, they feel compelled to perform. Some patients recognize that obsessive thoughts and compulsive behaviors are irrational - but even so they feel unable to resist those thoughts and take corrective actions.

Signs and Symptoms of Obsessive Compulsive Disorder

People with OCD may have symptoms of obsessions, compulsions or both. These symptoms can cause serious interface into all aspects of life that include work, study, interpersonal relationships.

  Some common signs and symptoms that shape OCD are:

• Hesitation and agitation, includes constant irritating movements of hands and legs (picking of hair, biting of nails, shaking legs)
• Person may use a irritation movement as a coping mechanism on a daily basis
• Inability to focus, mind may be seen to be wondering
• Feeling isolated or helpless
• Performing compulsive rituals out of habit without a fail
• People with OCD are quite aware of the fact that they are letting their minds control their actions yet still feel the urge to continue what they are doing, this causes anxiety
• People with OCD tend to check thing repeatedly to make sure everything is correct

However to be more specific these symptoms can be divided into two parameters

Common Obsessive Thoughts :

• Fear of Germs or contamination
• Unwanted, forbidden or taboo thoughts involving  religion and harming themselves or others
• Intrusive sexually explicit violent thoughts or images
• Aggressive thoughts towards others or self
• Fear of losing or not having things that may be or may not be needed
• Excessive focus on religious or moral ideas or even towards a person
• Symmetry or having things in perfect order

Common Compulsive Behaviors :

• Excessive cleaning or washing of hands
• Repeatedly checking of loved ones 
• Repetitive counting, checking, tapping, ordering and arranging things
• Accumulating junk such as newspaper, old cloths, empty containers etc.

 

OCD is not a personality issue

Most importantly Obsessive Compulsive Disorder should not be mistaken with personality issue. A person might be very careful and check things more thoroughly than most others. She/he may be perfectionist and has very high standards about certain things. Usually these tendencies do not cause great problems

With OCD it is very different - typically OCD starts gradually and can be minor irritation over the years, eventually getting to a point where symptoms can no longer be denied.

Photo by Lukas Beer on Unsplash

OCD is an unusual and sometimes frightening condition. Many of us afraid on people with OCD are going mad and completely losing control of themselves. This does not happen. OCD also does not lead to other severe illness, like schizophrenia, but for some it can be just as disabling.

What really underlies OCD ?

Confusing imagination with reality and being out of contact with reality are linked to OCD, a new study finds. 
People with Obsessive Compulsive Disorder are known to dissociate themselves from reality.
Instead they rely heavily on their imagination.
A study based on survey on 75 people with OCD found that they experienced inferential confusion : essentially getting fantasy and reality mixed up.
Frederick Aardema, PhD  of the University of Montreal, said in a press release

Theories about OCD stipulate that it is not the content of thought that is involved in the development of obsessions but the way these thoughts are interpreted by the person. While most people will dismiss an idea if they feel it has no meaning, people with OCD will say that if they think that way they must be a reason  

Dr Aardema also said

It seems that people with OCD are so absorbed by their obsession due to inferential confusion that there is a break with reality.

Specifically, we found that individuals no longer rely on their sensory perceptions or common sense but on their imagination.

For example, they are afraid that their hands are contaminated with germs, so they wash them over and over again because they are convinced that their hands are dirty even though they are visibly clean

Ms Stella-Marie Paradisis, First author of the study, explained the nature of  inferential confusion

First, inferential confusion is a reasoning process in which obsessive doubt takes hold.

Individuals make subjective connections between different elements.

For example, the person believes that the water in a municipal swimming pool is contaminated because chlorine has been put into it, so inevitably there are bacteria in the water.

Second, schizo-typical personality is characterized by bizarre ideas, rigid belief, lack of discernment, and a tendency to over-rely on imagination.

For example, individuals are convinced that what they hear on the news or read in the newspaper concerns them personally and directly.

Finally, dissociation is characterized by loss of contact with reality and memory lapses in certain situations — a phenomenon that can be observed especially in people who display checking behavior.

Some people feel that they can behave so differently depending on the situation that they are two different people.

 The study was published in the Journal of Clinical Psychology on 7th April 2015

Risk Factors

OCD starts usually during childhood or in teenage. Most of the cases people are diagnosed by about age 19, typically with an earlier age of onset in boys than in girls, but onset after age 35 does happen. In the date chart  shows  Prevalence of Obsessive-Compulsive Disorder Among Adults and its occurrence.


The causes of OCD are unknown but following factors are considered as risks based on the various studies :

Genetics

Research shows that OCD does run in families and that genes likely
play a role in the development of the disorder. Genes appear to be only
partly responsible for causing the disorder though. No one really knows
what other factors might be involved, perhaps an illness or even ordinary
life stresses that may induce the activity of genes associated with the
symptoms of OCD.
Some experts think that OCD that begins in childhood may be different
from the OCD that begins in adults. For example, a recent review of twin
studies has shown that genes play a larger role when OCD starts in childhood (45-65%) compared to when it starts in adulthood (27-47%) 

Photo by Callie Gibson on Unsplash

 Brain Structure and Functioning

Research and imaging studies suggest that OCD involves problems in communication between the front part of the brain and deeper structures.These brain structures use a chemical messenger called serotonin. Pictures of the brain at work also show that in some people, the brain circuits involved in OCD become more normal with either serotonin medicines or cognitive behavior therapy (CBT) .

There are no laboratory or brain imaging tests to diagnose OCD. The diagnosis is made based on the observation and assessment of the person’s symptoms.

Environment

People who have experienced abuse (physical or sexual) in childhood or other trauma are at an increased risk for developing OCD.
In some cases, children may develop OCD or OCD symptoms following a streptococcal infection—this is called Pediatric Autoimmune Neuro-psychiatric Disorders Associated with Streptococcal Infections (PANDAS).A child may be diagnosed with PANDAS when :

• Obsessive compulsive disorder (OCD) and/or tic disorders suddenly appear following a strep infection (such as strep throat or scarlet fever); or
• The symptoms of OCD or tic symptoms suddenly become worse following a strep infection.

The symptoms are usually dramatic, happen “overnight and out of the blue,” and can include motor and/or vocal tics, obsessions, and/or compulsions. In addition to these symptoms, children may also become moody or irritable, experience anxiety attacks, or show concerns about separating from parents or loved ones.

Common Obstacles to effective treatment of Obsessive Compulsive Disorder

• Studies find that it takes an average 14 to 17 years from the time OCD begins for people to obtain appropriate treatment.

• Some people choose to hide their symptoms, often in fear of embarrassment or stigma. Therefore, many people with OCD do not seek the help of a mental health professional until many years after the onset of symptoms.

• Until recently, there was less public awareness of OCD , so many people were unaware that their symptoms represented an illness that could be treated.

• Lack of proper training by some health professionals often leads to the wrong diagnosis. Some patients with OCD symptoms will see several doctors and spend several years in treatment before receiving a correct diagnosis.

• Difficulty finding local therapists who can effectively treat OCD.

• Not being able to afford proper treatment. 

Treatments 

OCD is typically treated with medication, psychotherapy or a combination of the two. However this topic about Self-Help, I am therefore not elaborating further on this.

Obsessive Compulsive Disorder - Self-Help 

Obsessions and compulsions can take the life of the persons with it and leave them feeling helpless. No matter how overwhelming the problems are, there are many ways , they can help themselves. Of-course family members, peers and friends have a greater part to overcome the stress, anxiety and other related problems of OCD.   

Helping someone with OCD

The way we react to a person with OCD symptoms have a big impact on their outlook and recovery. Normally we see them in a way that the patient is doing or making mistakes willingly. This is not the case.  Negative comments , criticism and hatred can make OCD worse, while a calm, supportive environment can help to improve the outcome of the treatment.

Photo by Cherry Laithang on Unsplash

• Most importantly they need help - OCD behaviors are symptoms not character flaws so avoid criticism    

• As per the characteristics of the OCD behaviors, it is absolutely not possible for someone with OCD to comply with normal behavior. They tend to the rituals by their symptomatic instinct. In this case scolding them makes the OCD worse. Sympathetic approach is the best way forward.

• Be as kind and patient as possible - They need to overcome problems at their own pace. Praising their effort to overcome OCD and giving importance to their positive aspects of their life make them comfortable. Anxiety and hopelessness are normal and adaptive in nature. Therefore, dealing with those, never involves eliminating it rather managing it.

• Do not play with the sufferer's rituals -  Helping with rituals will only reinforce the behavior. Support the person not the rituals.

• Communication is important. Keep communication clear, positive and balance  between supporting and standing up to the OCD symptoms, not further distressing the life of the sufferer.

• Find the humor - laughing together over the funny things and absurdity of some OCD symptoms can help them deal and detach themselves from the disorder. It is very very important that the sufferer feels respected and in on the joke.

• Don't let OCD take over our family life - sit down as a family and decide how we can work together to tackle our loved one's symptoms. We must try to keep family life as normal as possible and the home a low-stress environment.

Programming Self-Help to overcome disorders

Yes it is very difficult for a suffer to take part in Self-assessment and does the corrective actions on their own. Family members and friends need to take significant role to draw the plan and make them implemented carefully into the life of the person with OCD.

Learning how to eliminate OCD rituals

It might seem smart to avoid the situations that trigger obsessive thoughts, but more the sufferer avoids them, the scarier they feel. Instead expose them to their OCD triggers, then try to resist or delay the urge to complete their relief-seeking compulsive rituals. If the resistance gets to be too hard, try to reduce the amount of time spend on their ritual. The calculated exposures to the triggers always reduce anxiety and make us less vulnerable each time. Fundamentally in course of time those triggers loose their impact in their outlook.

Anticipate OCD urges

If we study pattern and timing of the OCD urges, we can easily find something and timing that  trigger compulsions. Make a note and try to change the pattern so that they make less or cannot impact the behavior. At the same time create a solid mental picture then make a mental note that those are just a obsessive thoughts.

Challenge obsessive thoughts

Almost all of us face troubling thoughts and worries time to time. But obsessive compulsive disorder causes the brain stuck on a particular anxiety-proving thought, causing it play over and over in the sufferer's mind. To overcome the situation Journaling is the best way forward.                

Keep writing whatever comes into the mind, aiming to write in details even if the same words, phrases or the same urges come over and over.

• Writing will help to see how the repetitive the obsessions are.

• Writing down same words, phrases and thoughts hundreds of times will help to lose its power.

• Writing thoughts down is much harder work than simply thinking, so it is likely, the obsessive thoughts are disappear sooner than expected.

Create an OCD worry period

It is always helpful to be appreciative rather than suppressive. OCD thoughts cannot be ignored, instead when a sufferer accommodates the thoughts in a particular time to think about the urges, the subconscious mind comes into play.
Fix one or two time frame say for 10 to 15 minutes when the sufferers can think about their worries, anxieties. Family members should help them in the process. Speak out, think on the urges. At the end of the period take some long breaths and deliberately engage to other things. If this process work for 3 weeks it will be automatic and mind will train itself to the time-limit for worrying and subsequently other works gradually become urge free and normal.

Take Help of Quantum Sound

I am a big fan of this technique. We consciously or unconsciously react to the sounds that enter into our ears. Think of a sound you are now hearing, it may be soothing, blissful, noisy, irritable, we may want to ignore or to hear more consciously. Every sound wave is responsible for some degrees of reaction.
Find one or two sounds may be a mantra which gives blissful reaction to the sufferer of OCD, play it in low volume so that the sufferer need extra effort to hear consciously. Do this for few times every day. The early morning hours and before taking bed at the night are very good for raising our vibrational frequency and elevate our emotional well-being.

The Om Mantra I have chosen here. You can choose on your own whatever you think if that is helpful and blissful.

Lifestyle Modification

A healthy and balanced lifestyle plays a big role to counter anxiety and other related disorders.

Make sure that we exercise regularly

It is common for all of us.
Exercise is a natural and effective anti-anxiety treatment that helps to control OCD Symptoms by refocusing our mind. For maximum benefit try some guided aerobic exercise for about 20 minutes. When we pay mindful attention to the exercise process and our breathing pattern, our body and mind get significant relaxation.      

Get enough sleep

Anxiety and worry are the primary cause of insomnia. Think opposite, adequate sleep prevents anxiety and worry, When we maintain our sleep well, it's much easier to keep our emotion balanced. a key factor in coping with anxiety disorders such as OCD.

Avoid alcohol and nicotine 

These may give some temporary relief but it is proven clinically that alcohol and nicotine aggravate OCD symptoms.

Reach out for Support

OCD can get worse when the sufferer feel sidelined and stay alone.  It's important to build a support system  More connected the sufferers, the less vulnerable they'll feel. There are support groups available for people with OCD. They can be approached for any help and guidance.

 

 

These are some links that provide helps

How can I help myself?

SELF-HELP: MANAGING YOUR OCD AT HOME

What to Do During Obsessing and Stopping Your Compulsions – Offers self-help skills you can practice on your own and use to combat obsessions and compulsions. (Anxieties.com)

Family, Friends and Carers – Information on how to take care of yourself while helping a loved one with obsessive-compulsive disorder. (OCD UK)

Help for Partners and Families – Advice on how to support a loved one with obsessive-compulsive disorder. (Centre for Addiction and Mental Health)

Obsessive-Compulsive Disorder (OCD) Symptoms, Treatment, and Self-Help             
 Find a Support Group – A searchable database of OCD support groups. (International OCD Foundation) 


Baul Mon - A Center for Human mind with facility for indoor treatment of  Psychiatric Patients and Addicts          
mon KE niye - A Center that offers treatment without medicine. 
 

Take it easy. Don't allow OCD to rule a life. With little care OCD can be controlled and eliminated. Get well soon.