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What is schizophrenia?

Schizophrenia is a severe disturbance of brain function that affects about 30,000 New Zealanders. This serious mental disorder distorts a person's behaviour, ideas and moods. It affects people differently ? up to a quarter of those affected may have only a few short episodes and then recover fully, whereas others have symptoms throughout their lives. There is evidence that schizophrenia has a biological cause and is not due to previous stressful events, such as abuse.

What are the symptoms?
Schizophrenia is often referred to as a psychotic illness. 'Psychosis' describes the symptoms associated with losing touch with reality. Psychotic symptoms may occur suddenly or develop slowly over a period of months or years.

Symptoms of schizophrenia may also be found in other illnesses. A person may be diagnosed with schizophrenia if psychotic symptoms and uncharacteristic behaviour continue for at least six months.

Psychotic symptoms are not necessarily constant ? they may appear now and then during acute episodes. Regular medication and ongoing support help to prevent such episodes, or relapses.

Schizophrenia also causes other changes in mood and motivation, which may be more constant and long term, but are perhaps more difficult to detect.

In short, a person's behaviour and feelings may change drastically, which is very confusing and frightening for that person and their friends and family, particularly as most families will have no other affected members.

Main psychotic symptoms
Delusions ? the person may develop unusual and steadfast beliefs. They may think they have 'special powers', that they are being watched or spied upon, or that their thoughts are being broadcast to the world. Such delusions cannot be changed by logical argument or contrary evidence.

Hallucinations ? the person may hear, see, taste, smell, or feel things that are not there. 'Hearing voices' no one else can hear is the most common hallucination. The voices may be threatening, frightening or commanding the person to do harmful acts; however, some people hear reassuring or neutral voices.

Disordered thought ? the person may have trouble connecting ideas into a logical sequence, or may jump rapidly from one topic to another, so that it is difficult for the person to hold a conversation. This may also be accompanied by inappropriate emotional responses (words and moods do not match), and the person may laugh when speaking of a serious or frightening event.

Main mood and motivation changes
Loss of motivation ? the person may find doing ordinary tasks such as washing, cooking, or planning ahead very difficult. Solving everyday problems becomes a chore.

Social withdrawal ? the person may seem unaware of their illness or other people's feelings. Their concentration and memory may be poor, and they may find it difficult to communicate as they would normally.

Changes in mood ? the person may appear anxious, panicky, depressed or in an abnormally good mood. Their emotions may be 'flattened' ? for example, the person may appear quite 'wooden' and unable to express joy or sorrow, or they may have a preoccupation with death.

How common is schizophrenia?
In general, about 1% of all people develop schizophrenia. If one parent has schizophrenia, the child has about a 10% chance of developing it. It can affect anyone at any age but, mostly, symptoms begin at between 16 and 25 years of age. Schizophrenia affects slightly more men than women, and men tend to develop it at a younger age. Children may have schizophrenia, but this is very rare.

What causes schizophrenia?
The exact cause of schizophrenia is unknown but it is likely that some people are born with a vulnerability to or risk of developing this illness. A combination of genetic and environmental factors need to be present for it to develop. Studies have explored the role of injury to the developing brain and looked at a range of possible causes, such as viral infection during pregnancy or birth complications, but there are no clear answers.

Some illicit drug use can result in symptoms similar to those of schizophrenia. In those people predisposed to mental illness, illicit drugs may trigger or worsen schizophrenia or other psychotic disorders (without actually being the cause of the illness). Alternatively, someone who is in the early stages of psychosis may be using marijuana, for instance, to cope with their symptoms.

How is it treated?
In schizophrenia, several chemical pathways in the brain can be interrupted and information processing is poorly controlled. This disruption leads to a wide variety of problems, which must be treated in various ways.

The recommended treatment approaches for schizophrenia include:

--very early identification and treatment while the illness is in its first stages (delays in treatment reduce the overall level of recovery)
--treatment for those with long term psychotic disorders
--appropriate use of antipsychotic drugs (many newer drugs have fewer side effects than older ones)
--a comprehensive psychosocial education/treatment programme, including education and support for the person and their family, counselling, stress management and supported employment opportunities
--ongoing support (including housing where appropriate), monitoring and treatment for those at risk of repeated relapse and hospitalisation.
With early treatment and good medical care, the symptoms of schizophrenia can be reduced or even eliminated. Many people with schizophrenia lead regular lives and have jobs and lasting relationships.

People with schizophrenia benefit enormously when their families, friends and workmates understand the illness and are educated about the ways to best provide help should it be needed.

Treatment is often more successful when supportive families are involved, and it is essential that there is a good three-way working relationship between the individual, the family and the health professionals.

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