About schizophrenia

Schizophrenia is the most common and most serious illness of the psychotic disorder group. Patients lose contact with reality and hear or see things which are not real. Influenced by their ideas, they can then act unusually and disproportionately.

Schizophrenia is an episodic illness, i.e. it occurs in psychotic crises (so-called attacks) or later in repeated illness (relapses).

It occurs in 1 – 1.5% of the population (i.e. roughly 1 person in 100 will suffer from it).
Its frequency of occurrence is the same across different cultures and different continents.
It occurs equally frequently in men and women (there is only a difference in the start of the illness).

The course of the illness and journey to recovery are positively influenced by a number of factors, in particular a well-functioning family background, timely and well-managed medication and psychological treatment and systematic rehabilitation.

When and why it occurs

Psychosis sets in for people susceptible to schizophrenia after being faced with excessive mental stress (e.g. school leaving exams, first serious relationship).

Predisposition to illness includes oversensitivity (hypersensitivity) and increased vulnerability, and as such the quality of close relationships is important. Only the predisposition is inherited, not the illness itself. (But if one of their parents suffers from schizophrenia then the chances of a child getting the illness too are around 10 %.)

Schizophrenia begins at a young age – when adult life is just beginning – and as such it can affect patients for practically their whole life.

Illness most commonly occurs:

amongst men aged between 15 and 25 years
amongst women aged between 25 and 35 years

A psychotic episode never has just one cause, but rather a combination of numerous causes. Some are congenital (inherited, course of pregnancy), while others are influenced by the environment in which patients live, and the events they have experienced.

Beginnings of illness

Only rarely does illness occur suddenly and unexpectedly. An outbreak of illness can follow a period of a few months or years during which the person gradually changes:

they close in on themselves
they break off social contacts
communication worsens
they speak incoherently, to themselves
they carry out strange rituals
they may become easily annoyed
they lose interest in the outside world
they experiment with drugs

For patients, the world becomes incomprehensible; they experience a feeling of loss of control over reality. Things are unclear and take on ambiguous or symbolic importance.

Schizophrenia relapses, and it is therefore important that patients can recognise ‘warning symptoms’ which signal its return (insomnia, irritability, lack of concentration, a feeling that ‘something’s happening again’). By co-operating well with a doctor, they can learn to avoid the return of the illness.

Key symptoms

disorders of perception and thought (hallucinations, delusions, disorganised thinking)
mood disorders (depression, anxiety, mania)
reduced to loss of motivation
reduced emotional experience
behavioural disorders
cognitive disorders (memory, attention disorders)

Recovery

Schizophrenia is treatable.

It is important to recognise the first changes leading to the illness in time – the earlier treatment begins, the greater the chance of full recovery. A third of people recover completely, a third experience occasional relapses of the illness, and for the remaining third schizophrenia takes a chronic course.

People in danger of the illness often remain without specialist help for 1–2 years. Yet the first symptoms can occur 2–6 years before help is sought. Their families often deny the seriousness of the situation, trying to compensate for the problem themselves and assigning behavioural changes to growing up or drug use – most being afraid of psychiatric involvement.

Treatment depends on the current phase of illness

Symptoms are intense, or the patient behaves in such a manner as to endanger himself or others:

Intensive critical support and care for the patient is essential. In acute situations, symptoms of psychosis develop and medication is required.

Symptoms are reducing or disappear:

The family and patient receive information on the illness (pychoeducation). Psychotherapeutic measures are undertaken – individual, group and family therapy.

Medical condition is stabilised – a period of return to ordinary life:

The patient undertakes various forms of psychosocial rehabilitation, such as support in preparation for work (training and protected employment), help in return to study, range of leisure activities, counselling regarding accommodation, etc.

Work and social rehabilitation

Work training helps people with mental illness prepare for employment or study. It involves practising social skills, in particular in standard work situations. The objective is to boost self-confidence and develop the skills needed.

It has been proven that rehabilitation has a positive effect on treatment – crises are less frequent, can be caught earlier and hospitalisation can be avoided, or be less severe.

Meaningful employment can thus significantly aid recovery and help people with mental illness lead a good quality of life. Even just for the fact the patient gets out of the ever-present circle of hospital – ordinary life – emergency treatment through the process of work.

What does work rehabilitation give someone with schizophrenia?

they learn to structure their time
they learn to organise and plan their work
they learn new activities and improve their skills
they improve cognitive function, concentration
they practise communication
their self-confidence is boosted
they form real self-esteem
they learn to co-exist with their surroundings