Schizophrenia
Introduction There is always a misconception about this illness that it is due to Jadoo, Tona and Sefli Amal. Because the patient of this illness has visual and auditory hallucinations That’s why most first consult the Amils & Peers. The common signs and symptoms of this illness are as follows:- Irrelevant talk, anger, aggression, violence, hatred towards relatives, anorexia, insomnia, hallucinations, and the patient thinks that others are against him. Few patients become withdrawn and they don’t care for their personal hygiene, have lack of interest in family and work. Some patients try to commit suicide. Causes There is no specific cause of this illness but there are two factors on which most of the researchers agree. i) Genetics: In this illness there is some disturbance in the chemicals within the brain. This is present ever since birth. If there is a family history of Schizophrenia then there are more chances of this illness. If this illness is in the nearest siblings, the chances of this illness is 50% and if there is a history in step siblings then the chances are only 10%. ii) Stresses: If there are many stresses in life then there are much more chances of developing this illness. Treatment Early treatment of this illness is very essential. If the treatment is started early then the chances of recovery and cure are better. One should know that this is a psychiatric illness and should be treated by psychiatrists. The important thing to remember is that if there is no improvement in the early stage, one should not be disheartened, because treatment may take many months to be effective. The complications during early stages of treatment The patient of Schizophrenia may develop a few new symptoms of drug side effects in the early days of treatment and due to this he often stops taking medicines. The signs and symptoms which can develop are dryness of mouth, tremors in hands and body, stiffness, slurring of speech, irregular menses in females and ejaculatory disorders in males. The following are important for the treatment of Schizophrenia. 1. Medicines (See chart of Anti psychotics) The medicines used in this illness take 4-6 weeks to be effective. The drug compliance is very important. A minor carelessness in this regard may cause delay in improvement and relapse. There should be no alteration in the dosage of drugs prescribed by the therapist. Even after complete recovery, the medicines should be continued for some time. Some patients need life long medicines to function properly. Antipsychotics are of two types i.e. the older (typical) and the newer (Atypical). Both are equally effective except for Clozaril (Atypical group) which has been proved to the effective in 30-40% of cases resistant to other antipsychotics. The two groups differ in the side effect profile and also that the older (typical) ones are much cheaper, a consideration of importance in a poor country like ours. The accompanying chart on Anti psychotics spells out the minimum and maximum dose as well as side effects and other characteristics of the drugs. Injections: Besides tablets injections are also available. These play an important role as most patients do not have the realization that they are ill and therefore resist taking medicines. It is easier to administer injections to such patients rather than force them to take tablets. Three types of injections are available. (a) Inj. Haloperidol (Serenace-Halodol): Available in 5mg ampules. Very useful in immediate noramlisation of a violent psychotic patient. The method being that 10mg I/M is given every hour till the patient is relaxed or 50mg have been given. No more should be given for the next 24 hrs. but after that give as needed. (b) Inj. Clopixol Acuphase: This is available in 50mg & 100mg ampules. This takes 5-6 hrs to start action and continues its effect for 2-3 days. Thus if this is combined with the above then the patient can be sedated for 2-3 days. (c) Depot Injections: Their effect lasts from one to six weeks. Used routinely for chronic as well as acute patients. They are effective and since given usually every two weeks. It is easy to treat disturbed patients. However Anti parkinsoman medicines should always accompany them. These injections can be given to admitted as well as out patients. The following are available at present. (i) Inj. Fluphenazine 25mg (Flucate, Fluphen, Modecate). Dose is 25mg – 100mg. This is the cheapest in this category. (ii) Inj. Flupenthixol (Fluanxol). Available as 20mg, 40mg and 100mg ampules. The dose is 20mg to 200mg. (iii) Inj. Clopenthixol (Clopixol). Available as 200mg ampules. The dose is 200mg to 400mg. This is more sedating than the first two. (2) Electro-convulsive Therapy (ECT) (For details about ECT read the special issue of the Bulletin) ECT, along with the medicines, is very effective in the treatment. Ten or even more ECTs are usually needed. There are a few temporary side effects of this therapy i.e. headache, giddiness, body ache, temporary impairment of memory and very seldom bone fracture, (to avoid which, ECT can be given under G.A. but this procedure is very costly.) (3) Need for admission in the hospital Usually the patient of Schizophrenia needs admission in the hospital for treatment because the patient does not think himself in need of treatment. The patient does not want to come to the hospital as an outpatient and even to use medicines. In severe conditions he may inflict injuries to himself and to others. Some patients even stop taking food and drink because they think that the food is being poisoned and this may be a threat to their life. In a few cases the family problems and stresses may aggravate the illness. In this case the patient should be kept in hospital away from the home problems. The most important advantage for admitting the patient is that he remains under strict observation and treatment in the hospital. Moreover the family is relieved of the burden of constant care and can go about their normal business. Prognosis: This is a major illness. 50% of the patients recover completely from this illness, 40% remain well when they take medicine regularly. Ten percent are not helped. Better results in prognosis may be expected if the following conditions are met:
Duration of Treatment 50% of the patients recover completely but significant improvement takes two to three months. The treatment should be continued for one year or more. Chances of Relapses The first symptom of this illness is insomnia. If the patient at any time is not sleeping well, then the therapist should be consulted. In most relapses the signs and symptoms remain the same as in the previous episode, so the relatives should contact the psychiatrist as soon as they appear. Precautions after recovery The symptoms of this illness may reappear in stressful conditions. The following factors are very helpful in avoiding relapse: 1. Punctuality in routine life. 2. The person should try to sleep at least seven hours every night. Do not work at the place where there are changes in the timing of work. 3. Narcotics should be avoided 4. Problems should be dealt with separately one after the other. 5. The family members should have a sympathetic and loving attitude towards the patient. Schizophrenia and Marriage The patient may be allowed to marry only when he/she has recovered fully. If the illness is of severe nature and there is no significant improvement in the condition, marriage can be harmful. The effects of Schizophrenia on personal ability and work depends upon two factors: 1. The severity of illness 2. The type of job Schizophrenia and problems of women Usually this illness is a matter of worry for all but if it is in females then it becomes the question of the dignity of the family as well. The family members do not consider it an illness but presume that the person is involved in bad habits and doing immoral things. They try to get the girl married as soon as possible but in doing so the condition becomes even worse. Patient Histories 1. Saeeda Saeeda is a 40 years old lady. She was married 21 yeas ago. She does not have
any child. Doctors told her that she couldn’t become a mother so she
gaveup this hope. She does not care for her personal hygiene. She became withdrawn and remains alone for hours. She is sleeping little. She thinks that every body is her enemy. Then she was admitted in the hospital and was given medicines. Ten ECTs were also given. Saeeda was discharged from the hospital after one month. She had improved a lot during this period. She was advised for depot injection flucate 25mg after every fifteen days and Tab. Kemadrine TDS. Saeeda is now doing well on this treatment and has settled in daily routine work at home. 2. Mehjabeen Twenty five years old Mahjabeen has been suffering from this illness for the last eight years. She was well when she was in Matric. When she took admission in college there was a sudden change in her behaviour and attitude. She became quiet and withdrawn. She did not want to talk to others. She took admission in English language course but left abruptly after a few days. Then she started talking irrelevantly, became over-talkative, and started going out of the home. She also expressed her desire to marry Waheed her cousin. Sometimes she says that she is already married, one night she became nude and wanted to go to her cousin’s room in that condition. She was admitted to the hospital and the following medicines were advised. Inj. Flucate (Modecate) 25 mg. I.M. stat and every 1-2 weeks Tab. Kamadrin 5 mg. 1+1+1 Ativan for sleep if needed ECT Treatment twice a week for a total 10. She started improving and all her delusions and hallucinations disappeared and she became normal and well again. |
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