Schizophrenia Day 24 May
Years ago when I was a student in high school, my father who was a pharmacist pointed a man walking on the road from his medical shop and told me that he was a person with a condition known as schizophrenia. That man was walking with irregular steps, and his gait was not proper. My father also added his medicinal knowledge in his talk that there is a medicine known as Eskazine, which that patient takes regularly, and non-taking of Eskazine makes that patient in this manner.
In fact, at that time, I was under the impression that schizophrenia was a condition in which the patient cannot walk properly. I was also not aware that this is a condition related to the brain and in fact, originated from the brain. Even later, when I entered the profession related to pharmaceutical marketing, I knew that Eskazine was a drug produced by SmithKline & French, the present gsk from which I retired in 2005. Today, 24th May morning, as a counselling psychologist, I attended the world Schizophrenia day conducted in the Calicut Town Hall and thought of making this blog in the record. The program was organized by a service organization, Thanal the meaning of which is the shadow, Indian Medical Association, Kozhikode branch, Iqura Hospital, KMCT Medical College, IMA women’s wing chapter. IMA Kerala State committee for mental health, Chethana; a service society and Centre for neuropsychiatric rehabilitation.
Many eminent personalities such as Dr. P N Suresh Kumar, a well-known Psychiatrist, Dr Vinod Bhatathirippad; a cyber expert, Shri M P Veerendrakumar a member of parliament, Kozhikode Mayor Mr Thottatthil Ravindran attended the program. Dr Sureshkumar, in his talk, mentioned that the drugs for schizophrenia were invented in the year 1951 and effective medication for this mental condition helped a lot to normalize schizophrenic patients. The approach towards the schizophrenic patients had become humanly when since Doctors like Benjamin Rush made awareness in the minds of people that the abnormal behaviour of people with schizophrenia are not deliberate, but certain biochemical substances like dopamine make a patient behave abnormally.
Schizophrenia comes under the group of psychosis in mental illness. There is no influence of horoscope or any other superstitious reasons like a demon for schizophrenia as it was believed earlier. It is also not because of the improper grooming of children by the parents. Due to these irrational beliefs, there was a thought that there was no treatment or no control for schizophrenia. It was also thought that the patient should be kept in a mental asylum the whole life. However, these thoughts are unreasonable. Today with the invention of new drugs, it has been proved that schizophrenia is curable with the continuous intake of medicines. There are about one crore schizophrenic patients in the present world.
The patients affected are mostly between the age of 20 to 30 years. There is no difference between poor or rich because the reason is purely biological and genetical. If the father or mother has schizophrenia, the percentage of likelihood in the child is 7%. If both the parents are having the problem, the chances are 20%. Hence there is a risk of genetics. Though there are genetical chances, there is no risk in the married life or producing the children provided the patient is given proper treatment. If the brain scan is done, the ventricle part of the patient is seen with a large as against the small ventricle of an average person. The external conditions faced by the patient aggravates the condition, such as any family issues and negative comments from others. The people with schizophrenia will not be having an interest in anything which a healthy individual is having. They will be tending to withdraw from normal activities, and they do not keep their body clean and not interested in shaving combing the hair, etc. In the brain, there is an area known as the mesocortical pathway. if the part is lacking the neurotransmitter dopamine, the usual daily activities are affected. Among the various types of schizophrenia, the catatonic types of patients sit without any activity, even for several days even without any food. In delusional types of schizophrenia, the patient feels so many experiences and hallucinations. It grows to the extent of even killing others as they feel that they are getting that command to kill another person. In some other types, the patient laughs or cries continuously by sitting alone. They speak a grammarless language not known to others.
Whatever may be the condition of schizophrenia, the cure rate with medicine is 30-40% with continuous care. Apart from medicines, ECT or electroconvulsive therapy, psychological care and psychotherapy, and family therapy or care by the family are also important. The level of dopamine can be controlled only by medicines. Hence medicines play an essential role. For medication, hospitalization is not a must. Especially when the patient is financially weak, it is challenging to meet the hospital expenses.
The medicines for schizophrenia are usually antipsychotic first generation and second generation. Apart from that, benzodiazepines are given for mood stabilization. Antipsychotics are available in tablets and drops. Besides, there are long-acting injections which can be used once a month level. Side effects of medicines are generally felt like panic for the patient or patients relatives. There is a common and irrational belief that many of the drugs are harmful to the kidney. However, usually, it is not so. Some patients may be having excessive sleep, postural hypotension, which is also known as orthostatic hypotension i.e., low blood pressure in standing posture. Dyskinesia or difficulty in performing voluntary movements is another side effects. Increase in body weight is another side effect. Salivation also is seen in some patients. All these can be corrected by appropriately changing the drug. In some females, irregular menstruation and secretion of milk in the nipples are also observed. These are also reversible. In short, the benefits of drugs are lesser than the risk of side effects.
There are so many advantages by giving ECT to the patient. Here the relief is faster and with lesser side effects. With ECT, the violent patient can be suppressed without much difficulty and suicidal tendency can be prevented.
The belief that the use of medicines is to make the patient asleep or the patient has to be compulsorily made asleep is wrong. He can even go for his job while taking proper medicines. During the intake of medicines, seeing the normal behaviour of the patient, the medicines should not be stopped. In pregnancy, all the drugs are not safe. It is always better to have a discussion with the doctor regarding all these issues.
Schizophrenia is not a condition with a single issue. It is a condition with a group of problems which requires psychosocial rehabilitation.