FEATURES NEWS THE RISING NEPAL (DAILY)

Dr.Niranjan Prasad Upadhyay

SCHIZOPHRENIA, a brain disease, is one of the most critical and emotionally devastating illnesses known to man. Like cancer and diabetes, schizophrenia has a biological basis. It is not caused by bad parenting or personal weakness. Schizophrenia is, in fact, a relatively common disease. Primarily, it is a chronic, severe, and brain disabling disease. Though schizophrenia (major mental health hazard) affects men and women with equal frequency, the disorder often appears earlier in men, usually in the late teens or early twenties, than in women, who are generally affected in the twenties to early thirties.

Negligible

In Nepal, existing mental health service is negligible and mass of mentally ill patients either stay at home or they are under the care of traditional healers. Mental, neurological and psychological disorders comprise a huge public health burden. A comprehensive programme directed against their biological and social causes could substantially reduce suffering, the destruction of human potential and economic loss.

People with schizophrenia often suffer from symptoms such as hearing internal voices not heard by others, or believing that other people are reading their minds, controlling their thoughts, or plotting to harm them. These symptoms terrify them. Their speech and behavior can be so disorganised that they may be incomprehensible or frightening to others. Schizophrenia is characterised by profound disruption in thinking and feelings, affecting language, thought, perception, and sense of self.
World Health Organisation (2001) highlights that around 45 million persons world-wide above the age of 18 suffer from schizophrenia at some point in their lives. The disorder has been found in all nations where studies have been conducted. It begins at a young age and can impair functioning capacity of the victims as they lose acquired abilities. The severity of the symptoms and long-lasting, chronic pattern of schizophrenia often cause a high degree of disability. Medications and other treatments for schizophrenia, when used regularly and as prescribed, can help reduce and control the distressing symptoms of the illness.

Recently, Discovery Health Channel stresses that the first signs of schizophrenia often appear as confusing, or even shocking, changes in behaviour. Coping with the symptoms of schizophrenia can be especially difficult for family members who remember how vivacious the person was before he became ill. The sudden onset of severe psychotic symptoms is referred to as an "acute" phase of schizophrenia. Psychosis(major mental disorder) a common condition in schizophrenia, is a state of mental impairment marked by hallucinations, which are disturbances of sensory perception, and/or delusions, which are false yet strongly held personal beliefs that result from an inability to separate real from false experiences. Less obvious symptoms, such as social isolation or withdrawal, or unusual speech, thinking, or behavior, may be seen.

The symptoms that are most commonly associated with the disease are called positive symptom that denote the presence of grossly abnormal behaviour. These include thought disorder, delusions, and hallucinations. Delusions are common among individuals with schizophrenia.

Generally, hallucinations can be heard, seen, or even felt; most often they take the form of voices heard only by the afflicted person. Such voices may describe the person's actions, warn him of danger or tell him what to do. At times the individual may hear several voices carrying on a conversation. Less obvious than the "positive symptoms" but equally serious are the deficit or negative symptoms that represent the absence of normal behaviour.

While schizophrenia can affect anyone at any point in life, it is somewhat more common in those persons who are genetically predisposed to the disease. The first psychotic episode generally occurs in late adolescence or early adulthood. However, approximately 15 per cent of people with schizophrenia respond only moderately to medication and require extensive support throughout their lives, while another 15 percent simply do not respond to existing treatment.

An individual with schizophrenia may not be aware that he or she is ill, it is often indispensable for a friend or relative to make certain that proper treatment is sought. Once the person is released from the hospital, families are often left with the responsibility of ensuring that the person is taking medication and is continuing to receive whatever other treatment is necessary. The best way to treat a person with schizophrenia is with compassion, understanding, and support. The person should not be made to feel as if the disease is his or anybody's fault.

Schizophrenia is the only largest cause of admissions to mental hospitals. Various theories of the origin of the schizophrenia have centered on psychological, anatomical, biochemical, social, genetic, and environmental causes. There is strong evidence that genetic inheritance often plays a role in the disease. Mainly, stressful life experiences may trigger the diseases.

Necessary

Hospitalisation is often necessary in cases of acute schizophrenia. Treatments are both of a biological nature(e.g. medication)as well as psychosocial (e.g. psycho education of the family and rehabilitation). Depending on the seriousness of the disease, the person may use day programmes, rehabilitation facilities, and be treated in an outpatient setting. This allows the mental health expert to adjust medication dosages as necessary over the course of the disease. The person may also need assistance in readjusting in the society once his or her symptoms are controlled. Supportive counseling or psychotherapy may be appropriate for these individuals as a source of friendship, encouragement, and practical advice during this process. Relatives and friends can also assist in rebuilding the person's social skills.

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