Schizophrenia - Fact Sheet
A person with a dual diagnosis of Acquired Brain Injury and schizophrenia requires a high level of understanding and specialised support. With the right support schizophrenia is highly a treatable illness.
- What is schizophrenia?
- How is Traumatic Brain Injury related to schizophrenia?
- Symptoms of schizophrenia
- Causes of schizophrenia
- Warning signs of coming episode
- Steps to getting treatment
- Treatments for schizophrenia
- How family and friends can assist.
What is schizophrenia?
Schizophrenia is a potentially severe mental illness that can make it difficult to know what is real and what is not. Schizophrenia impacts on the functioning of the brain, resulting in changes in behaviours, feelings and thinking [1].
During an acute episode, a person often experiences ‘Psychosis’. “Psychosis” means a loss of contact with reality. During psychosis a person may have difficulty thinking and experience hallucinations or delusions during which the individual’s perception of reality, or belief about reality, is impaired. For example, a person may hear voices and smell or taste things that other’s do not, the person may have experience unusual beliefs. Other symptoms include disorganized speech and behaviour, apathy, difficulty organising tasks, and paranoia.
The illness occurs in cycles, with periods of no symptoms to relapse into an acute episode of psychosis. Symptoms may develop gradually over months or develop rapidly leading to an acute episode [2]. With appropriate treatment and support, a person living with a diagnosis of schizophrenia can lead a productive and fulfilling life. It is treatable.
Some misconceptions exist in the community about schizophrenia. General misconceptions of schizophrenia include:
- It is the same as a split, multiple or dual personality. This is untrue and myth created by films.
- People with schizophrenia are violent and aggressive. The majority of people living with schizophrenia are not violent.
- Schizophrenia is the result of a character weakness. Schizophrenia is a medical condition that requires treatment by medical professionals.
How is Traumatic Brain Injury (TBI) related to schizophrenia?
- Research that has been conducted to date has indicated some relationship between traumatic brain injury and the development of schizophrenia for those with a genetic predisposition and for those exposed to traumatic events and stressors [3, 4, 5].
- More generally, research indicates that traumatic brain injury increases the risk of developing a mental illness, including Depressive disorders, Anxiety Disorders, and Post-Traumatic Stress Disorder [6].
Symptoms of schizophrenia
Schizophrenia has a wide range of symptoms, which are often broken down into categories; positive symptoms and negative symptoms.
Negative Symptoms
This refers to a reduction in normal behaviours rather than a change or increase in behaviours. Some examples include:
- Limited or reduced emotional responses or apathy
- Difficulty expressing thoughts
- Reduced speech
- Social withdrawal
Positive Symptoms - refers to a distortion or exaggeration of normal functions, it is some thing added to a persons usual behaviour, speech or thinking.
- Delusions – False or inaccurate beliefs that appear very real; such as thinking US intelligence is spying on you. These believes are often fixed during an acute episode and logical argument cannot convince the person.
- Hallucinations – Auditory or visual, which means hearing or seeing things that do not exist. Hallucinations may also come in the form of taste or smell.
- Disorganised speech – a person may make up words or speak in a disorganised manner.
- Disorganised thinking – Every day thoughts and ideas may be disorganized, preventing a person from functioning normally and having clear speech. Engaging in conversation may be very difficult as a result.
No single symptom is enough for a diagnosis of schizophrenia. A diagnosis must include a pattern of signs and symptoms, in conjunction with impaired occupational or social functioning. If schizophrenia is suspected it is important to see your GP for an initial consultation and referral to an appropriate mental health specialist.
Causes of schizophrenia
It is largely unknown what causes schizophrenia. Schizophrenia is a complex a disorder, for which it is difficult to link to any one cause. However, there is evidence for a number of risk or contributing factors, including:
- Genetics: First-degree relatives of someone with schizophrenia are ten times more likely to develop the disorder than someone without a relative with schizophrenia.
- Neurobiological: There is a connection between schizophrenia and structural differences in the brain for example, enlarged ventricles have been found in sufferers of schizophrenia.
- Neurochemical: There is a connection between schizophrenia and chemical imbalance of certain brain neurotransmitters e.g. dopamine, serotonin
- Drug-related: Although this topic is still controversial, the consumption of legal and illegal drugs is linked with a greater risk of developing schizophrenia. Drug’s that have been associated include Marijuana and alcohol abuse.
- Environmental: High levels of stress or stressful events may trigger the onset of schizophrenia in individuals with a genetic predisposition.
Warning signs of coming episode
Often an acute episode is preceded by a prodromal (warning) phase, with a variety of behaviour changes that may include:
- Decline in performance at work or school
- withdrawal from social activities
- loss of attention to personal hygiene and grooming,
- Loss of interest in things they usually enjoy
- unusual behaviours
- odd statements
- increased anxiety
The prodromal or warning phase can stretch on for two years until psychotic symptoms appear [2]. The psychotic or acute episode itself is typically characterised by delusions and hallucinations, which can affect any of the senses although auditory hallucinations (“hearing voices”) are most common. These symptoms are often characterised as been frightening for the person experiencing them. These symptoms often impact on a person’s ability to concentrate on studies, work and conversations.
STEPS to Getting Treatment
The earlier schizophrenia is diagnosed and treated, the better the outcome. Some steps for getting an assessment and support:
- Initial Assessment – you may like to consult your GP for an initial assessment of symptoms of schizophrenia, this will also assist in ruling out other medical conditions. Following an assessment a referral can be made to a mental health professional or service [2].
- You may be referred to a psychiatrist or professional within the public mental health system [2].
- Having ongoing case management is important. Case managers put together the treatment plan and provide information and resources on supports in the community [2].
Treatments for schizophrenia
Antipsychotic medications are the standard treatment for schizophrenia, due to the biological basis of the illness. For advice on medications for schizophrenia a psychiatrist needs to be consulted. The symptoms and issues associated with schizophrenia can not be treated by medication alone.
Medication is most effective in conjunction with additional supports such as:
- Case management to assist with locating services and support a person is entitled to.
- Psychosocial rehabilitation programs to assist with development of social and living skills, which may have been reduced due to mental illness. Things such as social skills training, assistance with domestic tasks and finances.
- Psychological therapies, which can be helpful following stabilisation of symptoms through medication. Psychological therapy may assist a person to develop helpful coping strategies and to improve levels of confidence and feelings toward yourself and the illness. Cognitive Behavioural Therapy has supporting evidence for its effectiveness in reducing symptoms of schizophrenia and reducing stress levels.
- Support Groups – face to face or online.
- Education about schizophrenia; having a clear understanding of the illness can help those impacted have a greater sense of control over the illness and enhance coping. It is particularly important to educate yourself on the early warning signs of an upcoming episode to get adequate assistance.
- Maintain a regular routine and set of activities e.g. hobbies and enjoyable social outings
- Attend programs, read books or talk to a professional about relaxation strategies such as breathing exercises to minimise and cope with stress.
How Family and Friends can assist
A person with schizophrenia requires high levels of support and understanding from their family, friends and wider network. The symptoms of schizophrenia can be frightening and have a large impact on those skills needed to maintain employment, social networks and maintaining a house hold.
Family and friends must avoid judgment, such as making comments the person is weak or by downplaying the person’s symptoms. Family should avoid arguing or trying to convince the person that any hallucinations or delusion the person may be having are not real or stupid. The symptoms often appear very real and frightening at the time, providing empathy and support to the person during that period is very important. Schizophrenia is a medical condition and the problems associated with schizophrenia are very real.
Families should seek to educate themselves as much as possible on schizophrenia. This can assist family members in understanding the illness and ways to best help their loved one. It can also assist in detecting those signs that a loved one’s health is declining, so treatment can be put in place early. Resources may be obtained from the internet, attending support groups, conferences and from organisation in the community such as the Mental Illness Fellowship, GROW and ARAFMI
References & further resources
SANE Australia http://www.sane.org/information/factsheets/schizophrenia.html
[1] The Mental Illness Fellowship of Australia has a wealth of information people with a mental illness, their family and friends. http://esvc000144.wic027u.server-web.com/papers_the_fact_sheets.htm
[2]The Royal Australian and New Zealand College of psychiatrists (2005). Schizophrenia: Australian Treatment Guide for Consumers and Carers. Retrieved on 25 August 2009,from, http://www.health.gov.au/internet/main/publishing.nsf/Content/7A1EECF65DD9A90CCA25725A00211781/$File/schizo.pdf
[3] Malaspina, D., Goetz, R.R., Friedman, J. H., Kaufmann, C. A., Faraone, S. V., Tsuang, M., Cloninger, R., Nurnberger, J. I., & M. C Blehar. (2001). Traumatic Brain Injury and Schizophrenia in Members of Schizophrenia and Bipolar Disorder Pedigrees. The American Journal of Psychiatry, 158, 440-446. http://ajp.psychiatryonline.org/cgi/content/full/158/3/440
[4] Arehart-Treichel, J. (2001). Head Injury May Tip Schizophrenia Scales. Psychiatric News http://pn.psychiatryonline.org/cgi/content/full/36/7/37
[5] Shoumitro, D., Lyons, I., Koutzoukis, C., Ali, I., & McCarthy, G. (1999). Rate of Psychiatric Illness 1 Year After Traumatic Brain Injury. Am J Psychiatry, 156, 374-378. http://ajp.psychiatryonline.org/cgi/content/abstract/156/3/374
[6] Rao, V & Lyketsos, C. (2000). Neuropsychiatric Sequelae of Traumatic Brain Injury. Psychosomatics, 41, 95-103. http://psy.psychiatryonline.org/cgi/content/abstract/41/2/95
[7] Koponen, S, Taiminen, T., Portin, R., Himanen, L., Isoniemi, H., Heinonen, H., Hinkka, S., & Tenovuo, O. (2002). Axis I and II Psychiatric Disorders After Traumatic Brain Injury: A 30-Year Follow-Up Study. Am J Psychiatry, 159, 1315-1321 http://ajp.psychiatryonline.org/cgi/content/abstract/159/8/1315
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