Schizophrenia

What is schizophrenia?
Schizophrenia is a serious and challenging medical illness, an illness that affects well over 2 million American adults, which is about 1 percent of the population age 18 and older.  Although it is often feared and misunderstood, schizophrenia is a treatable medical condition.
Schizophrenia often interferes with a person's ability to think clearly, to distinguish reality from fantasy, to manage emotions, make decisions, and relate to others. The first signs of schizophrenia typically emerge in the teenage years or early twenties, often later for females. Most people with schizophrenia contend with the illness chronically or episodically throughout their lives, and are often stigmatized by lack of public understanding about the disease. Schizophrenia is not caused by bad parenting or personal weakness. A person with schizophrenia does not have a "split personality," and almost all people with schizophrenia are not dangerous or violent towards others while they are receiving treatment. The World Health Organization has identified schizophrenia as one of the ten most debilitating diseases affecting human beings.
What are the symptoms of schizophrenia?
No one symptom positively identifies schizophrenia. All of the symptoms of this illness can also be found in other mental illnesses. For example, psychotic symptoms may be caused by the use of illicit drugs, may be present in individuals with Alzheimer’s disease, or may be characteristics of a manic episode in bipolar disorder. However, when a doctor observes the symptoms of schizophrenia and carefully assesses the history and the course of the illness over six months, he or she can almost always make a correct diagnosis.
As with any other psychiatric diagnosis, it is important to have a good medical work-up to be sure the diagnosis is correct. Drug use can mimic the symptoms of schizophrenia and may also trigger vulnerability in individuals at risk. Other medical concerns also need to be ruled out before a correct diagnosis can be made.
The symptoms of schizophrenia are generally divided into three categories -- Positive, Negative, and Cognitive:

• Positive Symptoms, or "psychotic" symptoms, include delusions and hallucinations because the patient has lost touch with reality in certain important ways. "Positive" refers to having overt symptoms that should not be there. Delusions cause individuals to believe that people are reading their thoughts or plotting against them, that others are secretly monitoring and threatening them, or that they can control other people's minds. Hallucinations cause people to hear or see things that are not present.
• Negative Symptomsinclude emotional flatness or lack of expression, an inability to start and follow through with activities, speech that is brief and devoid of content, and a lack of pleasure or interest in life. "Negative" does not refer to a person's attitude but to a lack of certain characteristics that should be there.
• Cognitive Symptoms pertain to thinking processes. For example, people may have difficulty with prioritizing tasks, certain kinds of memory functions, and organizing their thoughts. A common problem associated with schizophrenia is the lack of insight into the condition itself. This is not a willful denial but rather a part of the mental illness itself. Such a lack of understanding, of course, poses many challenges for loved ones seeking better care for the person with schizophrenia.

Schizophrenia also affects mood. While many individuals affected with schizophrenia become depressed, some also have apparent mood swings and even bipolar-like states.   When mood instability is a major feature of the illness, it is called schizoaffective disorder, meaning that elements of schizophrenia and mood disorders are prominently displayed by the same individual.   It is not clear whether schizoaffective disorder is a distinct condition or simply a subtype of schizophrenia.
What are the causes of schizophrenia?
Scientists still do not know the specific causes of schizophrenia, but research has shown that the brains of people with schizophrenia are different from the brains of people without the illness. Like many other medical illnesses such as cancer or diabetes, schizophrenia seems to be caused by a combination of problems including genetic vulnerability and environmental factors that occur during a person's development. Recent research has identified certain genes that appear to increase risk for schizophrenia. Like cancer and diabetes, the genes only increase the chances of becoming ill; they alone do not cause the illness.
How is schizophrenia treated?
While there is no cure for schizophrenia, it is a treatable and manageable illness. However, people sometimes stop treatment because of medication side effects, the lack of insight noted above, disorganized thinking, or because they feel the medication is no longer working. People with schizophrenia who stop taking prescribed medication are at risk of relapse into an acute psychotic episode. It’s important to realize that the needs of the person with schizophrenia may change over time. Here are a few examples of supports and interventions:

• Recovery Supports/Relapse Prevention: There is increasing recognition of the benefits of learning from "someone who has been there." NAMI’s Peer to Peer program is designed to help individuals with mental illness learn from those who have become skilled at managing their illness. Peer support groups are also recognized as invaluable as individuals living with mental illness report better recovery outcomes as the shared experience is recognized as extremely beneficial. NAMI C.A.R.E. support groups are available in many communities and are expanding to better meet this need.
• Family Support: Caregivers benefit greatly from NAMI’s Family-to-Family education program, taught by family members who have the knowledge and the skills needed to cope effectively with a loved one with a mental disorder. This program is available in all 50 states through many NAMI affiliates, and is offered in multiple languages in many communities.
• Hospitalization: Individuals who experience acute symptoms of schizophrenia may require intensive treatment, including hospitalization. Hospitalization is necessary to treat severe delusions or hallucinations, serious suicidal thoughts, an inability to care for oneself, or severe problems with drugs or alcohol. Hospitalization may be essential to protect people from hurting themselves or others.
• Medication: The primary medications for schizophrenia are called antipsychotics. Antipsychotics help relieve the positive symptoms of schizophrenia by helping to correct an imbalance in the chemicals that enable brain cells to communicate with each other. As with drug treatments for other physical illnesses, many patients with severe mental illnesses may need to try several different antipsychotic medications before they find the one, or the combination of medications, that works best for them.
  
  • Conventional Antipsychotics were introduced in the 1950s and all had similar ability to relieve the positive symptoms of schizophrenia. However, most of these older "conventional" antipsychotics differed in the side effects they produced. These conventional antipsychotics include chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), thiothixene (Navane), trifluoperazine (Stelazine), perphenazine (Trilafon), and thioridazine (Mellaril). Some of the risks that may be incurred from taking these medicines include dry mouth, blurred vision, drowsiness, constipation, and movement disorders such as stiffness, a sense of restless motion, and tardive dyskinesia.
  • "Atypical" Antipsychotics were introduced in the 1990s. When compared to the older "conventional" antipsychotics, these medications appear to be equally effective for helping reduce the positive symptoms such as hallucinations and delusions, but may be better than the older medications at relieving the negative symptoms of the illness, e.g., withdrawal, thinking problems, and lack of energy. The atypical antipsychotics include risperidone (Risperdal), clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon).Clozapine (Clozaril) is an atypical antipsychotic medicine with special benefits and risks that are too numerous to cover in this brief fact sheet.All these antipsychotics have serious side effects such as weight gain and the risk of diabetes, but they all do not carry the same relative risk for these conditions.

All medications have side effects.  Different medications produce different side effects, and people differ in the amount and severity of side effects they experience.  Side effects can often be treated by changing the dose of the medication, switching to a different medication, or treating the side effect directly with an additional medication.  NAMI’s fact sheets on medications, developed by independent pharmacists, are a starting point to understand the risks and benefits of any individual medication.   Individuals thinking of starting or changing their medication should always gather good information, consider the risks and benefits, consult with their doctor and loved ones and work together to develop the most safe and effective treatment plan possible.

• Psychosocial Rehabilitation: Research shows that people with schizophrenia who attend structured psychosocial rehabilitation programs and continue with their medical treatment manage their illness best. One example of an effective psychosocial approach for the most severely ill, or those with both mental illness and substance abuse, is the Program for Assertive Community Treatment (PACT), an intensive team effort in local communities to help people stay out of the hospital and live independently. Available 24-hours a day, seven-days a week, PACT professionals meet their clients where they live, providing at-home support at whatever level is needed.Professionals work with clients to address problems effectively, to make sure medications are being properly taken, and to meet the routine daily challenges of life, such as grocery shopping and managing money.

meaning of psychological health

This is a question that psychologists have grappled with for decades. The articles I reviewed for my own research with The Psychological Health Index date back to the early 1970's.
There is no question at all about the fact that psychological health is important with respect to how we function and adapt, and with respect to whether our lives are satisfying and productive.
What the researchers argue about is whether psychological health is a single factor, or whether distress and well-being are actually two seperate issues.
While the argument continues, the verdict is clear: general well-being does not simply mean that you are free from anxiety and depression.  It involves something more.   But for general purposes, it can usually be said that it's two sides of the same coin. Usually, people are either happy or they're not, and if their mood isn't good, they are often distressed to some extent.
Psychological health and well-being should also not be confused with the question of whether or not you suffer from mental or emotional disorder. The research on well-being concerns itself with the feelings of normal individuals, or subjects from the general population.  When we talk about psychological health, we are referring to how ordinary people are doing in life. In other words, if you are feeling distressed, that doesn't necessarily mean that you are mentally ill.
Ordinary life often presents the individual with extraordinary challenges, complexities, setbacks and hardships.  Psychological health concerns itself with how you cope, how your are doing in response and whether you find life to be interesting and enjoyable.  Although life is better when we are feeling good, there is no avoiding the fact that there will be ups and downs.
In the end, psychological healh and well-being is basically about: "how are you doing?"
If you consider well-being as two separate issues, the upside involves two factors:   is your mood generally positive, and do you enjoy a number of "positive emotional ties."   In other words, are you happy and do you have friends?   In addition to feelings of emotional satisfaction, a positive mood also depends on whether or not you generally feel calm and peaceful.
On the downside, emotonal well-being involves three factors: do you suffer anxiety, are you depressed, and do you feel like like you have lost control and can't do anything about your feelings. This is the other side of the coin, the experience of psychological distress.
These are the questions that The Psychological Health Index addresses. This questionnaire is a modified version of an instrument developed by the Rand Corporation for use in a variety of health and medical outcome studies. It is a short version of a longer "test,"  and even though it is just a few items long,  it has proven to be a remarkably useful way to ask people: "how are you doing?" ... "how is your mood today?"
My own reseach in this area has demonstrated that how you respond to the brief Psychological Health Index is significantly correlated with your perceived personal health status.   If your score on this instrument is negative, you are more likely to have more physical health complaints.
I ususally advise people to take this test every now and then, and not just once.  Things change and feelings change.  In the same way that it is a good idea for healthy individuals to monitor their blood pressure on at least an occasional basis,  it's a good idea to keep an eye on your mood.  Mood is a vital sign.

Depression – how it affects sex and relationships

Depression adversely affects every aspect of our lives – including our relationships – and when one partner is depressed, the relationship may suffer badly.
This is a great shame because a good relationship is very therapeutic for somebody with depression.
When we're low we need love, support and closeness more than ever – even if we're not good at showing it.

What is likely to happen if your partner has depression?

Depressed people usually feel withdrawn. They don't feel they can raise enough energy to pursue their normal routine, do things with the family or even notice when their partners are being attentive.
This can quickly lead to the non-depressed partner feeling that he or she is in the way, unwanted, or unloved. It can be easy to misinterpret the low moods as hostility, or as evidence that the depressed person wants out of the relationship.
Frankly, it’s really hard to stay calm and confident when the person you thought you knew is acting strangely and appears to be so unhappy. So if you’re finding your partner’s depression a real pain, try to take heart from the fact that this is natural.
Being the partner of a depressed person is very difficult.
So, even if you're at your wits' end because your loved one has lost the ability to concentrate on what you're saying, or to raise a smile, or to appreciate any of the good moments in life, try to accept that all these things are part of the illness.

Sex and performance

We don't know enough about the chemical changes that occur in the brain during depression and little research has been done on how these changes affect sex.
From a clinical point of view, however, it's clear that a depressive illness tends to affect all the bodily systems, dislocating them and often slowing them down.
This effect is most marked with regard to sleep, which is invariably disrupted.
But there can be adverse effects on any activity that requires verve, spontaneity and good co-ordination – and that includes sex.
So, many people who are depressed tend to lose interest in sex.
Admittedly, this isn't always the case, and some depressed people manage to maintain normal sex lives – sometimes even finding that sex is the only thing that gives them comfort and reassurance.

• In men, the general damping down of brain activity causes feelings of tiredness and hopelessness, which may be associated with loss of libido and erection problems.
• In women, this diminished brain activity tends to be associated with lack of interest in sex and very often with difficulty in reaching orgasm.

All these problems tend to diminish as the depressive illness gets better. Indeed, renewed interest in sex may be the first sign of recovery.

Sex and antidepressants

It's not just the illness that affects a person's sex-life – antidepressant medicines such as Prozac can interfere with sexual function.
One of the most common side-effects is interference with the process of orgasm so that it's delayed or doesn't occur at all.
If this happens – and you are keen to have and enjoy sex – you should ask the doctor about changing medication.

How depressed people can help themselves and their relationship

Some days will seem better than others. On your better days, try to make an effort to show love and appreciation to your partner.

• Try to go for a walk every day, preferably with your partner. Walking not only gets you out in the fresh air, which will give you a bit of a lift, but like other forms of exercise it releases endorphins in the brain. These are 'happy' chemicals that rapidly elevate your mood. And there's increasing evidence to suggest that exercise can be as good for combating depression as any antidepressant.
• Even on your worst days, try to spot happy moments like a bird singing or a new flower blooming in your garden. Try to train yourself to notice three of these heart-warming moments per day.
• You may have an odd relationship with food while you're depressed (you could have little appetite or constantly comfort eat), but try to eat five pieces of fruit per day. This is a caring thing to do for yourself and is good for your physical and mental health.
• Listen to music that matters to you.
• Have faith that the depression will pass and that you will enjoy your life again.
• Even if you don’t feel like full-on sex, do make the effort to have a cuddle. If you are worried that cuddling will project you into full sex when you don’t want it, just tell your partner that you’re not feeling like having sex, but that you would really like to cuddle up. If you do this, you may both feel a lot better. Touch and closeness can keep a relationship intact.

How to help your depressed partner

• Don't keep saying that you understand what your partner is going through. You don’t. Instead say: 'I can't know exactly how you're feeling, but I am trying very hard to understand and help.'
• Many people who are depressed lose interest in sex. Try to remember that this loss of interest is probably not personal, but connected with the illness.
• Don't despair. Some days you'll feel your love for your partner doesn't seem to make any difference to them at all. But hang on in there. Your love and constant support should be of great help in persuading your partner of his or her value.
• Do encourage your partner to get all the professional help available. Nowadays, there are plenty of alternatives to antidepressants. Cognitive behaviour therapy (CBT), for example, is becoming much more readily available on the NHS. Many GP practices can also provide CBT by means of Internet programmes. These can have a good effect quite quickly in many cases.
• Try to act as though your partner were recovering from a serious physical illness or from surgery. Give plenty of tender loving care. But don't expect improvement to be rapid.
• Do something nice for yourself. Being around a depressed person is very draining, so make sure you look after yourself. Have some time alone, or get out to a film or to see friends. Depressed people often want to stay home and do nothing, but if you do this too, you'll get terribly fed up.
• Remember that this period in your life will pass and that your partner is the same person underneath the depression that he or she was before.
• Try to take some exercise together. Most depressed people feel an improvement in their spirits if they do something active. And doing something that will raise the heartbeat – for example, sport or dancing – may well help you too.