Schizophrenia : Road to Ability

 

Nearly in middle of my OPD a young female walks up to me along with her mother (a schizophrenia patient). I made few interactions about her condition and as I started writing the prescription, the accompanying female enquired “doctor is schizophrenia, a spilt personality disorder”? She further told me that this was what she read on internet and the mother had dual personality, of which the other personality only appears when medicine gets stopped. Her statement clearly stated that the people had a distorted concept, of a major mental illness like schizophrenia, which affects nearly one percent of world’s population.

On 24 Apr 1908, the Swiss psychiatrist Eugen Bleuler coined the term 'schizophrenia’, which was derived from the Greek words schizo (‘split’) and phren (‘mind’). The term was intended to be used for denoting ‘loosening’ of thoughts and feelings, but unfortunately it was mistakenly read as “split in personality”.

Split personality is categorized in ICD 10 under dissociative disorder where as schizophrenia is placed under group of psychotic disorder. As psychiatric syndrome the schizophrenia is characterized not only by psychotic symptoms like delusion, hallucination, disorganized speech/ behavior and negative symptoms like decreased motivation, diminished expression, but also various cognitive deficits (like speed of information processing, memory and executive function). Whereas the positive psychotic symptoms are clearly understood and brought constantly in attention of treating psychiatrist but negative symptoms are frequently ignored or just taken as part and parcel of the disease per se. Cognitive deficits are core feature of schizophrenia and are spread around domains of attention, working memory, verbal learning and memory and executive function. Impairment in this domain is present even before onset of psychotic symptoms and also in first episode of psychosis. These deficits significantly impair not only the working class but also patients who are not employed.

As we entered 21^st century, more and more research work has been focused on management of cognitive deficits beside treatment of other symptoms of schizophrenia. However in few instances patient related factors like non adherence to treatment, self adjustment of dose of medication, use of alcohol/ over the counter medication, critical comments by relatives, over indulgence with faith healers remedial measures etc play a vital role in poor outcome in schizophrenia.

However, in current scenario, especially in corporate world, psychiatric management of cognitive deficits is as vitally focused as other schizophrenia symptoms. With the advent of newer psychiatric medicines and psychotherapies, which focus on specific outcome, there is better functional status achieved by the patients. Gone are the days when patient used to spend their whole life in disability, suffering from either the disease or side effects of the medications.

Keeping the current scenario and developments in psychiatric treatment, I would urge all patient of schizophrenia to kindly visit their psychiatrist regularly for updated treatment advice.