( taken from Royal College of Psychiatry leaflet on Schizophrenia)
A disorder of the mind that affects how you think, feel and behave. Its symptoms are described as ‘positive’ or ‘negative’.
These are unusual experiences. Many people have them from time to time and they need not be a problem. In schizophrenia, they tend to be much more intense, troublesome, pre-occupying and distressing.
A hallucination happens when you hear, smell, feel or see something - but it isn't caused by anything (or anybody) around you. The commonest one is hearing voices.
They sound utterly real. They usually seem to be coming from outside you, although other people can’t hear them. You may hear them coming from different places, or they may seem to come from a particular place or thing. Voices can talk to you directly or talk to each other about you – it can be like over-hearing a conversation. They can be pleasant, but are often rude, critical, abusive or just plain irritating.
You may try to ignore them, talk back to them – or even shout back at them if they are particularly loud or irritating. You may feel that you have to do what they tell you, even if you know you shouldn't. You may wonder if they are they coming from hidden microphones, from loudspeakers, or the spirit world.
Voices are not imaginary – you really do hear them - but they are created by the mind. Scans have shown that the part of the brain that 'lights up' when you hear voices is the same area that is active when you talk, or form words in your mind. The brain seems to mistake some of your thoughts, or ‘inner speech’, for voices coming from outside you.
You can also hear voices in severe depression. They tend to be simpler, repeating the same negative or critical word or phrase over and over again.
You can also hear voices which don't interfere with your life. They may be pleasant, or not very loud, or only happen from time to time. These voices do not usually call for any kind of treatment.
You may see things that aren't there, or may smell or taste things that aren't there. Some people have uncomfortable or painful feelings in their body, or feelings of being touched or hit.
A delusion happens when you believe something – and are completely sure of it – while other people think you have misunderstood what is happening. It's as though you see things in a completely different way from everyone else. You have no doubts, but other people see your belief as mistaken, unrealistic or strange. If you do try to talk about your ideas with someone, your reasons don’t make sense to them, or you can’t explain – you ‘just know’. It's an idea, or set of ideas, that can't be explained as part of your culture, background or religion.
These are ideas that make you feel persecuted or harassed. They may be:
You start to see special meanings in ordinary, day-to-day events. It feels as though things are specially connected to you – that radio or TV programmes are about you, or that someone is telling you things in odd ways, for example, through the colours of cars passing in the street.
You find it harder to concentrate – it's more and more difficult to:
Your thoughts wander. You drift from idea to idea – but there's no clear connection between them. After a minute or two you can’t remember what you were originally trying to think about. Some people describe their thoughts as being ‘misty’ or ‘hazy’ when this is happening. When your thoughts are disconnected in this way, it can be hard for other people to understand you.
You can also feel that:
Some people explain these experiences by thinking it's the radio, television or laser beams, or that a device has been implanted in them. Other people blame witchcraft, angry spirits, God or the Devil.
People can find it hard to understand that negative symptoms are really symptoms – not just laziness. This can make it difficult for both you and your family. Your family feel that you just need to pull yourself together. You can’t explain that … you just can’t. Negative symptoms are less dramatic than positive symptoms, but can be really hard to live with.
No. You can hear voices and have negative symptoms, but may not have delusional ideas. Some people with delusional ideas seem to have very few negative symptoms. If you only have thought disorder and negative symptoms, they may not be recognised for years. Other aspects include:
It affects around 1 in every 100 people over the course of their life.
It affects men and women equally and seems to be more common in city areas and in some ethnic minority groups. It is rare before the age of 15, but can start at any time after this, most often between the ages of 15 to 35.
We don’t yet know for sure. It is probably a combination of several different things, which will be different for different people.
Although only 1 in 100 people get schizophrenia, about 1 in 10 people with schizophrenia have a parent with the illness.
An identical twin has exactly the same genetic make-up as his or her brother or sister, down to the smallest piece of DNA. If one identical twin has schizophrenia, their twin has about a 50:50 chance of having it too.
Non-identical twins have a different genetic make-up to each other. If one of them has schizophrenia, the risk to the other twin is just slightly more than for any other brother or sister. These findings are much the same even if twins are adopted and brought up in different families.
|Relatives with schizophrenia||Chance of developing schizophrenia|
|None||1 in 100|
|1 parent||1 in 10|
|1 identical twin (same genetic make up)||1 in 2|
|1 non-identical twin (different genetic make up)||1 in 8|
Brain scans show that there are differences in the brains of some people with schizophrenia – but not in others. Where this is the case, it may be that parts of the brain have not grown normally because of:
Sometimes, street drugs seem to bring on schizophrenia.
Amphetamines can give you psychotic symptoms, but they usually stop when you stop taking the amphetamines. We don’t yet know whether these drugs, on their own, can trigger off a long-term illness, but they may do if you are vulnerable.
Some people start using drugs or alcohol to cope with symptoms, but this can make things worse.
Difficulties often seem to happen shortly before symptoms get worse. This may be a sudden event like a car accident, bereavement or moving home. It can be an everyday problem, such as difficulty with work or studies. Long-term stress, such as family tensions, can also make it worse.
At one time people thought that communication problems in the family could cause schizophrenia. This doesn’t seem to be the case. However, if you have schizophrenia, family tensions can certainly make it worse.
As with other mental disorders, schizophrenia is more likely if you were deprived or physically or sexually abused as a child.
A few people with schizophrenia do become violent – they usually hurt themselves but sometimes hurt other people. This can be caused by feelings of persecution or voices telling them to do it – often a combination of the two. It is much more likely if the person has used drugs or alcohol.
Many people with schizophrenia now never have to go into hospital and are able to settle down, work and have lasting relationships.
For every 5 people with schizophrenia:
If you just hear voices, don't mind them and they don't interfere with your life, you probably may not need any special help. However, if the voices become too loud or unpleasant (or if other symptoms develop), then you should talk it over with a doctor.
Suicide is more common in schizophrenia – particularly if someone has symptoms, has become depressed, is not getting treatment or is getting less help than they used to.
The evidence is beginning to suggest that if schizophrenia is treated early:
If you have the symptoms of schizophrenia for the first time, you should start medication as soon as possible.
You may not need to come into hospital, but you will need to see a psychiatrist and a community mental health team. They will usually be able to plan your treatment with you at home. Even if you do have to come into hospital, it will only be until you are well enough to manage at home.
This can help the most disturbing symptoms of the illness – but it is not the whole answer. It is usually an important step which can make other kinds of help possible. Other important parts of recovery are support from families and friends, psychological treatments and services such as supported housing, day care and employment schemes.
Medication reduces the effects of the symptoms on your life. Medication should:
The symptoms will usually come back – not immediately, but usually within 3 – 6 months. You can find more information about antipsychotic medication on our website.
Schizophrenia can make everyday life hard to deal with. This may or may not be due to the symptoms. Sometimes you may just get out of the habit of doing things for yourself. It can be difficult to get back to doing ordinary things like washing, answering the door, shopping, making a phone call or chatting with a friend.
This can be done by clinical psychologists, psychiatrists or nurse therapists. It helps you to:
This kind of therapy can help you to feel better about yourself and to learn new ways of solving problems. We now know that CBT can also help you to control troublesome hallucinations or delusional ideas. Most people have between 8 and 20 sessions, each lasting about 1 hour. To help the symptoms of schizophrenia, you may need to carry on with ‘booster’ courses from time to time.
These can help you to:
These try to help you and your family cope better with the situation. They can be used to discuss information about schizophrenia, how best to support someone with schizophrenia and how to solve the practical problems that can crop up. Meetings are held over a period of about 6 months.
Occupational therapists can:
There may be help for families, with regular meetings for a while. These can help the family to:
You may not be working, or may be unable to go back to work. Even so, it’s good to get out and do something every day.
Many people go regularly to a day hospital, day centre, or community mental health centre. These have a number of things you can do – keep fit, creative pursuits like painting and pottery, education or getting back to work activities. You can get active again and spend some time with other people.
These facilities don't exist in some areas where there is, perhaps, more emphasis on helping people to be included in ‘mainstream’ activities for everybody, whether or not they have had psychological difficulties.
Some services can now provide support from people who themselves have had a psychotic illness.
You may need to develop your skills for work. Vocational workers will often have contacts with local employers and can support you when you go back to work.
These use art activities to help people to:
These activities are usually done in groups.
( taken from Royal College of Psychiatry leaflet on Schizophrenia)
Drinking alcohol is a common pleasure but for a variety of reasons, some people drink too much and it becomes a risk to their health.
Alcohol is measured in units. A unit of alcohol is equivalent to 10ml of pure alcohol, which is roughly half a pint of normal strength lager, a small glass of wine or a single measure (25ml) of spirits. The recommended daily limits of alcohol consumption are no more than three to four units a day for men and no more than two to three units a day for women.
Some signs that you could be misusing alcohol include regularly exceeding the recommended alcohol limit, feeling that you should cut down on your drinking, being annoyed when people criticize you for drinking too much and needing a drink first thing in the morning to steady your nerves or get rid of a hangover. Being unable to remember what happened the previous night is also an indicator.
How alcohol misuse is treated will depend on how much a person is drinking. Treatment options depend on the nature and extent of the problem. For example for the individual who is physically dependent it may require hospitalization and assisted detoxification with the use of medications for a comfortable withdrawal. Most individuals benefit from counseling : including self-help groups and talking therapies and sometimes medication to help reduce the cravings for alcohol. Sometimes longer periods of rehabilitation may be required especially for those with chronic dependency with multiple relapses.
There are several medications used to treat alcohol misuse. Some are used to reduce withdrawal symptoms during detoxification and others help you stay sober during the long process of recovery by reducing cravings or stopping you gaining pleasure from drinking alcohol. Occasionally medications can also be used as a deterrent.
Most sufferers find that talking to trained healthcare professional to be a useful and important part of treatment. Therapy can help you understand the reasons for your drinking, and give you skills to control or stop the urge to drink.
Your partner or family may also be invited to attend counselling with you and be involved in your treatment.
Cognitive behavioral therapy (CBT) is a talking therapy that emphasizes a problem-solving approach to alcohol dependence. It helps to identify unhelpful and unrealistic thoughts and beliefs that may be contributing towards your alcohol dependence.
Treatment for alcohol abuse and dependence usually includes group therapy within a day care setting and can provide regular, intense support and treatment for those who cannot stay away from home. It provides the opportunity for people struggling with dependence to discuss their alcohol dependence amongst others with the same problem and to explore the reasons why it they became dependent and how best to overcome it. Day care settings also provide the opportunity for patients to attend on a daily or regular basis to receive the support they need to help manage abstinence and develop skills to prevent relapse.
If you're a heavy drinker, you may need to be supervised by health professionals while you give up. This is partly because the physical withdrawal symptoms associated with stopping drinking can carry risks. Detoxification or "detox" is a planned withdrawal from drinking alcohol and may involve taking a short course of medicine to help prevent withdrawal symptoms. Patients simultaneously attend a group therapy programme to develop an understanding of their problem and skills to combat their desire to drink.