Frequently asked questions
Are schizophrenia and psychosis the same thing?
Psychosis is a condition in which the psychotic person experiences the world in a specific, abnormal way, which does not reflect the actual reality. Schizophrenia, or rather a group of schizophrenic psychoses, is a term describing many different psychoses with different representation and course.
The term "schizophrenia" is not univocal in terms of diagnosis and therapy, and brings a variety of erroneous generalizations and myths. The group of schizophrenic psychoses, together with other psychoses, such as schizoaffective and paranoid disorder, belongs to a large group of mental disorders called psychoses. Methods of treatment of all psychoses are similar and the fact of describing psychosis as schizophrenic, paranoid or schizoaffective does not determine its further course or prognosis.
When does psychosis usually start?
A typical age for the first episode is the period between ages 18 and 25, in a broader sense – between adolescence and the age of 40. In the case of women the first episode usually occurs slightly later than in men, which is associated with the neuroprotective (brain protecting) action of female hormones - oestrogen. The first symptoms of schizophrenia, which are later diagnosed as schizophrenia, often occur several months or even years before the first acute symptoms of the illness.
These symptoms are very different – there may be symptoms found in other mental disorders such as neurosis and depression. At this stage the patient usually denies being ill. For this reason the person may not want to be treated. The sooner treatment is started, the more effective it is. Improvement is achieved during therapy of the first episode of schizophrenia, however this may take several months. Therefore, psychiatrists may find it difficult to answer the patient's or family's question: "How long will the treatment last until improvement is observed?".
Is psychosis hereditary?
In a sense, yes, but more importantly, we should explain what "in a sense" really means. As even if nobody in your family suffered from schizophrenia, the risk that you will be ill is 1:100. If, however, your brother, sister or one parent has had symptoms of schizophrenia, the risk of falling ill is still scarce - as it is 1:10. In addition, even if someone in the family has suffered from schizophrenia, and you are over 30 years old, the risk of falling ill is minimal. If your father, mother, brother or sister suffered from psychosis, the risk that your child will become ill is still low and is 1:30.
If you have psychosis, nobody will try to persuade you to forgo having children – there is a 1:10 chance your children will be affected. It is pertinent to note that genetic factors are related not only to one gene or several genes. Researchers are trying to find these factors, but even if they manage to identify them, there are still other factors than genetic ones, which are important for the formation of symptoms of schizophrenia in a particular individual – as, even if both parents suffered from psychosis, the risk that their child will have psychosis is less than 100%, event less than 50%, since it is about 40%.
What other factors, except for genetic ones, cause psychosis?
It can be established with certainty that schizophrenia or psychosis are not caused by improper upbringing, a trauma (whether physical or mental), or a "weakness of character". Schizophrenia is definitely not a punishment for sins or transgressions – one's own or family's. Factors linked to stress or increased susceptibility to stress in patients with schizophrenia are significant for exacerbation (relapses) of the illness. Greater susceptibility to stress occurs also in persons with other mental disorders, such as depressions or neurosis. Schizophrenia is usually tracked back to biological sensitivity (in the case of this illness when central nervous system is being developed an error occurs causing a person to be more sensitive to schizophrenia factors than other people; brain development disorders can be congenital or be a result of infection during pregnancy, difficulties at childbirth, meningitis or injury) and psychosocial background (individually predisposed persons may develop schizophrenia in response to emotional problems against the background of major life events, such as divorce, death of someone close, or a breakup).
Does my child have schizophrenia?
Psychotic disorders may occur in some people who use or have used stimulant drugs or alcohol, both during intoxication and when the abstinence symptoms (delirium tremens) emerge. Increasingly, psychosis similar to schizophrenia are actually caused by stimulant drugs, such as amphetamine or LSD. Therefore, having symptoms typical for schizophrenia does not necessarily imply that the affected person actually has schizophrenia – they may as well be caused by the use or overuse of stimulant drugs. The best way to find out if a child has schizophrenia is to ask the right question to the attending physician, for example to inquire when schizophrenia can be either diagnosed or excluded.
What to do if a patient refuses to take medications?
It often happens that a patient, facing remission of acute symptoms, feels healthy and wants to forget about the disease; it is then difficult for such patient to accept the proposals of medication or participation in psychotherapy because he/she would like to be treated as a normal, healthy person. While the proposal of prophylactic therapy, aimed to prevent disease relapses, is not at all to further see that person as patient. The objective of such therapy, after the experienced episode of psychosis, is to provide the affected person with measures to prevent that relapse, as well as with necessary knowledge how to use the measures. Establishing a proper patient – caregiver – therapist dialogue increases the chances of successful cooperation in therapy. If patient compliance becomes a problem, the attending physician should be contacted and an action plan should be developed.
Family and caregivers often feel responsible for controlling patient compliance. In this context, all or substantial part of their attention and communication with the patient may be focused on whether the patient remains compliant with their medications. If this is the case, the patient may start to perceive their relatives as a "medication police", which may deteriorate mutual relations and increase the risk of therapy discontinuation and relapse of the condition. A solution would be to use extended release injectable medications which could perhaps prevent the problems with non-compliance, whereby both family members and the patient would no longer be annoyed by the question 'Have you taken your medication yet?'.
Is in-patient therapy a necessity in schizophrenia?
Most of therapy take place outside the hospital, usually during the patient's stay at home with the family. However, sometimes hospitalization is necessary. Psychiatric hospitalization for people with schizophrenia becomes advisable when there was an episode of acute illness and:
- The patient is unable to control their behaviour to the point that there is a well-founded fear the patient may pose a threat to their safety or that of others (serious risk to human health and life);
- The patient denies that their condition has deteriorated, refuses to take medications, and it may be reasonably assumed that the patient's current condition will further deteriorate;
- Due to the deterioration the patient ceased to satisfy their basic needs, i.e. the patient sleeps outdoors, does not eat or drink;
The schizophrenic patient suffers also from a serious physical disease, or such side effects of medications occur that it will be impossible to cope with them without the person's stay in hospital.
At the same time, usually during the first episode, psychiatric hospitalization, which will enable accurate diagnosis of the illness and allow for planning of further therapy, is indicated even if there are no factors for hospitalization given above. If, however, hospitalization is not required, but outpatient treatment outcomes have been disappointing, a schizophrenic patient can be offered several interim forms of therapy, including day hospital care, home-based care, admission to a mental health hostel, or therapy in the domestic environment.
How to help a person with a relapse of psychosis?
This is what you should do:
- Help the person get to a psychiatrist – psychiatrists are "first contact" physicians – you do not need to have a referral; also, all services related to the treatment of psychosis in health service units (hospitals, psychiatric wards, mental health centres) that have contracts with the National Health Fund NFZ do not charge for their services; almost all antipsychotics are free (a prescription with a blue stripe);
- Strengthen the patient at the time of a nervous breakdown because of exacerbation of schizophrenia, or when during the first episode of schizophrenia the person is not aware that he or she should be treated;
- Learn as much as possible about schizophrenia – you take part in psychoeducation sessions;
- Encourage the patient to take medications, or to consult a doctor in case of doubt associated with the therapy;
- Notice the warning signs of relapse – do not ignore them;
- Try to notice the warning signs of suicide – the majority of patients talk about their suicidal thoughts, do not ignore them; at the same time remember that even as many as one in ten schizophrenia patients may commit suicide; suicidal tendencies are the result of relapse of schizophrenia and disappear with the resolution of symptoms of schizophrenia; make the schizophrenic person aware that suicide is a loss for everyone, and not a solution for their and your problems; in case of strong suicidal tendencies call an ambulance (dial 999), instead of looking for the psychiatrist who is in charge of the ill person;
- Negotiate with the ill person the ways to deal with crises – those associated with schizophrenia and not connected with it;
- Do not expect too rapid improvement, but do not treat schizophrenia as an incurable disease – do not isolate the ill person but at the same time do not be overprotective; during remission most patients can function as normal, active people in different life roles (family member, friend, employee, pupil, student);
- If you only can, participate in self-help groups for people with schizophrenia and their families – at meetings of such groups you will learn how others have coped with your current problems.
How long do you have to take medications in schizophrenia?
Antipsychotics are the mainstay in the pharmacological treatment of schizophrenia. It is very important to continue therapy during remissions, in the periods when patients usually feel well, and both patients and their families may think pharmacological treatment is no longer necessary. A sufficiently long period of taking these drugs protects the patient against relapse of schizophrenia.
Medication should never be discontinued without first consulting the prescribing physician. Regular and long-term therapy with anti-psychotics is the most effective method to forestall a relapse. The duration of remission in schizophrenia depends on the number of previous episodes, response to treatment, patient's support, resistance to stress, and many other factors. If remission continues long enough and is not accompanied by any stressful circumstances or a co-morbidity, the prescribing physician may be consulted about possible modifications or temporary discontinuation of antipsychotic medications.
However, the risk of relapse should be weighted against possible benefits. The first effects of antipsychotic drugs are expected to emerge after 4 to 6 weeks of therapy. If symptoms show no visible improvement after this time, the attending physician usually decides to switch over to new medications. With some drugs, the desirable outcome is seen even later – after 2 or 3 months of treatment. Therefore, therapy should never be discontinued without the attending physician's approval. If response to the current therapy is disappointing, the physician should be consulted.
Can you continue education and/or professional work is you suffer from schizophrenia?
Over the last half century, the goals of therapy have evolved considerably. 50 years ago, the main purpose was to sedate patients, 30 years ago – to reduce delusions and hallucinations. Currently, the goals are quite different and relate to the so-called functional remission, that is a situation when a person suffering from schizophrenia returns to a good level of functioning in the family, at school or work, among friends, to leisure activities.
This has been made possible with the arrival of novel anti-psychotics and new strategies of environmental and psychosocial therapy. This is evidenced by the criteria of permanent remission or recovery in schizophrenia, published by experts in the field several years ago. Remission in schizophrenia is defined as a condition in which a patient fulfils all of the following criteria:
- Remission of all negative and positive symptoms according to the Brief Psychiatric Rating Scale (BPRS) (within the last 2 years);
- Working at least on a half-time basis or learning at least at a part-time school or extramural studies within the last 2 years;
- For people of retirement age – active participation in family life, recreation and volunteering;
- The ability for an autonomous, independent daily functioning; the ability to independently initiate activities;
- Meetings to maintain social ties with non-family members at least once per week.
Can schizophrenics marry and have children?
Having a family and being in a family is one of the basic elements of human functioning. There are no legitimate grounds to claim that people who suffer from schizophrenia are not capable of living in marriage or partner relationships, or unable to have and bring up children (the inheritance risks are discussed in the article What Causes Schizophrenia? in the category What is Schizophrenia and How is it Diagnosed? in the tab Schizophrenia). The current therapy options, including in-patient and community treatment strategies make it easier to establish and maintain intimate relationships.
What if people find out?
People probably already know about it. The sense of shame caused by being diagnosed with schizophrenia is as common as it is unreasonable. This can be attributed to the legacy of a former in-patient approach to the treatment of schizophrenia - only a century ago, the majority of schizophrenic patients were almost permanently hospitalized. Even today, many of them face social stigma, and people are ashamed or frightened to reveal that their son or daughter has schizophrenia. Nowadays, members of families of schizophrenics – largely due to psychoeducation – complain mainly of the transparency of their child's condition; also, they are aware it takes a long time to achieve remission, but they take pride in every small victory of their loved ones over the disease.