If you have ever heard nondescript voices, from nowhere that lure you into complete dissociation from the reality then perhaps we need to have an honest banter, over a cup of coffee, at least here until we have conquered COVID-19 cataclysm, and we can meet again. I drove into a rehabilitation center in East Africa a couple years to pick a friend. He described the experience as not only harrowing but also a complete waste of time trying to change him into someone else. He looked like a giant from a torturous three months of feeding and confinement trying to clean him from drug addiction. At our first stop at a countryside tavern, he begged for a tot of vodka and a packet of cigarettes, the same substances he was trying to cut fetters from. Something has always told me that it was not the vodka that was making him nervous or his love for cigarettes, it was something rather eerie that the program was not able to pick out, or diagnose. He talked of depression, and sheer urge to be always alone thinking about stuff that we could agree is frivolous, at his age and by his “well “education. From a distance, like a shimmering ray of light that brings the virgin rays of the sun in summer, I could see him drifting away from reality, and signs of schizophrenia setting in. So much has been said about how schizophrenic people have multiple personalities, or are violent or it is due to bad parenting and we try to unravel those myths and what it feels to be schizophrenic. And because schizophrenia is an array of conditions, and as broad as it is, we cannot possibly exhaust all of it now, but if you have an idea, then you can always seek mental health expertise from your psychiatrist if you think that you are schizophrenic or are taking care of a schizophrenic relative. Schizophrenia can simply and in lay language be defined as a long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.

Research has shown that schizophrenia affects men and women about equally but may have an earlier onset in males. Rates are similar around the world. People with schizophrenia are more likely to die younger than the general population, in part because of high rates of co-occurring medical conditions, such as heart disease and diabetes.

Early symptoms of Schizophrenia

Schizophrenia is a challenging brain disorder that often makes it difficult to distinguish between what is real and unreal, to think clearly, manage emotions, relate to others, and function normally. It affects the way a person behaves, thinks, and sees the world.

The most common form is paranoid schizophrenia, or schizophrenia with paranoia, as it’s often called. People with paranoid schizophrenia have an altered perception of reality. They may see or hear things that don’t exist, speak in strange or confusing ways, believe that others are trying to harm them, or feel like they’re being constantly watched. This can cause relationship problems, disrupt normal daily activities like bathing, eating, or running errands, and lead to alcohol and drug abuse in an attempt to self-medicate. Many people with schizophrenia withdraw from the outside world, act out in confusion and fear, and are at an increased risk of attempting suicide, especially during psychotic episodes, periods of depression, and in the first six months after starting treatment.

In some people, schizophrenia appears suddenly and without warning. But for most, it comes on slowly, with subtle warning signs and a gradual decline in functioning long before the first severe episode. Often, friends or family members will know early on that something is wrong, without knowing exactly what.

The most common early warning signs include:

  • Depression, social withdrawal.

  • Hostility or suspiciousness, extreme reaction to criticism.
  • Deterioration of personal hygiene.

  • Flat, expressionless gaze.
  • Inability to cry or express joy or inappropriate laughter or crying
  • Oversleeping or insomnia; forgetful, unable to concentrate.

  • Odd or irrational statements; strange use of words or way of speaking.

When untreated, symptoms may exacerbate to the following five types of symptoms characteristic of schizophrenia: delusions, hallucinations, disorganized speech, disorganized behavior, and the so-called “negative” symptoms. However, the symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all the symptoms, and the symptoms of schizophrenia may also change over time.

Risk factors for Schizophrenia 

Researchers believe that a number of genetic and environmental factors contribute to causation, and life stressors may play a role in the disorder’s onset and course. Since multiple factors may contribute, scientists cannot yet be specific about the exact cause in individual cases. The following factors are thought to play a role in the onset of schizophrenia and associated mental challenges;

  • Having a family history of schizophrenia

  • Some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development.
  • Taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood.

Complications that may arise as a result of Schizophrenia

Just like any other medical condition, when left unmitigated by a mental health expert, schizophrenia has many complications that can affect almost every area of life negatively, making life less bearable. The following complications and not limited may stem out of untreated schizophrenia;

  • Suicide, suicide attempts and thoughts of suicide.
  • Anxiety disorders and obsessive-compulsive disorder (OCD).
  • Depression.
  • Abuse of alcohol or other drugs, including nicotine.

  • Inability to work or attend school.
  • Financial problems and homelessness.
  • Social isolation.

  • Health and medical problems.
  • Being victimized.
  • Aggressive behavior, although it’s uncommon.

Case management and available options

There is no cure for schizophrenia, however, with the right treatment, it’s possible to limit symptoms and reduce chances of further episodes. Everyone’s experience of schizophrenia is different. It may get better or worse, you may have episodes of being unwell, or its effects may be more constant. Up to 3 in 10 people may have a lasting recovery, and 1 in 5 may have significant improvement. Around half of people diagnosed with schizophrenia will continue to manage it as a long-term illness.

  1. Medication-Your doctor may offer you antipsychotic medications. These help to reduce the symptoms of schizophrenia, but will not cure it. You should work with your doctor to find the best medication for you. A care giver or family member can also help decide.

If the side effects of the medication are too difficult to cope with after trialing it for a few weeks, you can speak to your doctor about trying something else. It’s important not to stop suddenly as this can cause withdrawal symptoms. You should review your medication with your doctor at least once a year.

  1.  Therapy-After the symptoms of schizophrenia are controlled, various types of therapy can continue to help people manage the illness and improve their lives. Therapy and supports can help people learn social skills, cope with stress, identify early warning signs of relapse and prolong periods of remission.

There are a number of things that family and friends can do to help a person with schizophrenia. One of the simplest and most effective is to create a positive environment around the person. Remember that if you schizophrenia, you are not schizophrenia, your illness is a part of you but that must not define you. Just like John Forbes Nash, Jr. (Nobel Prize winning mathematician and subject of the award-winning book and movie A Beautiful Mind said   “I thought of the voices as… something a little different from aliens. I thought of them more like angels … It’s really my subconscious talking, it was really that… I know that now.” You too can have a beautiful story altogether. Stay well.