Beginning in his youth, schizophrenia—a psychiatric illness that can significantly impair a person’s functioning—manifests as disturbances in thought, as well as emotional, behavioral, and cognitive changes. Highlighting the importance of family support in schizophrenia—a condition characterized by symptoms such as hearing voices or seeing visions that do not exist, reduced speech, withdrawal from others, a blank facial expression, decreased self-care, swearing, shouting, or remaining silent and motionless—Assistant Professor Dr. Emre Tolun Arıcı stated, “Our most important task is to prevent stigmatization and prejudice, which are the biggest problems in schizophrenia,” he said. Arıcı noted that current treatment methods have increased the likelihood of successfully treating schizophrenia.
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Schizophrenia, a brain disorder, affects 4 out of every 1,000 people. While schizophrenia is estimated to affect 12 million men and 9 million women worldwide, it is believed to affect more than 300,000 people in Turkey.
Every year, April 11 is observed as “World Schizophrenia Awareness Day.”
Assistant Professor Dr. Emre Tolun Arıcı, a psychiatrist at Üsküdar University NP Feneryolu Medical Center, shared important insights about schizophrenia.
“Schizophrenia is a psychiatric disorder that begins in young adulthood, can be observed in every society and at every sociocultural level, and can significantly impair a person’s functioning,” said Assistant Professor Dr. Emre Tolun Arıcı,
“The illness is characterized by disturbances in thought, as well as emotional, behavioral, and cognitive changes.
Although the onset and course of the illness can vary from patient to patient, it generally follows a chronic course—similar to hypertension or diabetes—with intermittent periods of exacerbation. The onset can last for many years with subtle symptoms such as social withdrawal and depression, or it can begin suddenly within days following a stressful period, with symptoms like suspicion, hearing voices, and insomnia,” he said.
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“We can identify three main groups of symptoms in schizophrenia,” said Arıcı, continuing:
Positive symptoms: Delusions and hallucinations
The first is the presence of what are called “positive symptoms,” namely delusions (unrealistic thoughts) and hallucinations (hearing nonexistent sounds, seeing images, smelling foul odors, or feeling tactile sensations). Common positive symptoms include delusions such as believing he is being followed, believing he will be harmed by a person or group, believing his thoughts can be read or manipulated, and hearing the voices of people or religious entities commenting on or speaking negatively about himself. Not all of these symptoms need to be present at the same time in every patient. Furthermore, these symptoms may not persist throughout the course of the illness; they may occur during periods known as “flare-ups” and subside with treatment.
A blank facial expression, withdrawal from others, and a lack of motivation are
observed. The second group of symptoms is known as “negative symptoms.”
Negative symptoms are similar to those of depression. They include a reduction in gestures and facial expressions, a blank facial expression, low motivation, lack of interest in social activities, inability to start a task, lack of initiative, inability to experience pleasure, reduced speech, and withdrawal from others.
The third group of symptoms: Disorganization
The third group of symptoms, referred to as “disorganization,” is characterized by disjointed speech and behavior. Symptoms in this group include jumping from one topic to another while speaking, giving inappropriate responses, dressing oddly, neglecting personal hygiene, shouting, using profanity, or what we call “catatonia”—a state of complete immobility, silence, and lack of response. Schizophrenia is classified into various types based on the presence of these symptoms and the course of the illness; patients may present to their doctor with a wide variety of symptoms. Furthermore, the response to treatment, as well as the patient’s social, occupational, and family functioning and the course of the illness, can vary significantly from person to person.”
Current treatments are increasing the likelihood of successful treatment for schizophrenia
“The increase in treatment options available today, along with the use of new medications, has improved treatment outcomes,
” said Assistant Professor Dr. Arıcı,
“The goals of treatment include alleviating symptoms, reducing stressors, treating comorbid conditions such as depression, and improving family, social, and occupational functioning. It also involves educating the family about the illness and providing psychological support. Medications are important in treatment; in addition to antipsychotics, antidepressants, mood stabilizers, and anxiolytics may be used. Long-acting antipsychotics in depot form may be preferred. The decision regarding treatment is made by the physician on a case-by-case basis. Medications are selected by taking into account the type, course, and severity of the illness, as well as potential side effects. A common question regarding medication use is how long it should be taken; medication treatment must be continuous and may be required for many years, sometimes even for life. Through regular outpatient follow-ups, the response to medication, side effects, and blood test results, blood pressure, pulse, and weight are monitored at specific intervals. Medication is mandatory. Psychotherapy is one of the treatment options used in conjunction with medication. Both individual and group therapy sessions are beneficial. At community mental health centers, art and occupational therapies—known as ergotherapy—are also utilized in treatment, whether on an outpatient basis or during inpatient stays. Treatment for the illness takes place within the community; the goal is to prevent, as much as possible, the need for inpatient stays and periods of “relapse,” when symptoms intensify. “Hospitalizations are performed, as with other illnesses, when there is a risk of the patient committing suicide or harming others, or when the patient refuses to take medication. ECT treatment may be used during hospitalization to rapidly alleviate symptoms in at-risk patients,” he said.
Family support is of great importance
Assistant Professor Dr. Emre Tolun Arıcı, a psychiatrist at Üsküdar University NP Feneryolu Medical Center, emphasized that family support is crucial in schizophrenia, just as it is in many other psychiatric disorders, and concluded his remarks as follows:
“Families must first and foremost be informed about the course of the illness, its symptoms, the medications used, and the appropriate approaches; they can seek assistance from the patient’s psychiatrist or therapist regarding these matters. They must support the patient in adhering to regular doctor’s appointments and medication use, and, if necessary, take responsibility in this regard. For patients who exhibit social withdrawal and apathy, the family plays a key role in facilitating socialization and supporting patients in developing hobbies. During periods of disease flare-ups, it is important for families to be understanding, avoid criticizing symptoms, and adopt an approach that instills confidence. It is crucial not to forget the patient’s personal qualities, life, and privacy beyond the illness. Above all, it is important for families to avoid stigmatizing attitudes and to educate those around them about the condition.
The Biggest Problem in Schizophrenia: Stigma and Prejudice
Contrary to popular belief, the rate of violence and criminal behavior among people with schizophrenia is not higher than in the general population; in fact, it has been reported that they commit fewer crimes. Self-harm, suicide, and death are more common among these patients. From time to time, we come across inaccurate news reports on this topic in the media; people who mistreat animals or commit acts of violence against others are labeled as “schizophrenic.” Such reports have a very negative impact on both our patients and their families. The illness often leads to social withdrawal and isolation, and unfortunately, societal prejudices and stigma also contribute to this. Some people with schizophrenia (though not every patient experiences this) may go through periods known as “flare-ups” during which their tendency to harm others increases—this is more common when the patient goes untreated. These episodes can result from thought disorders, such as delusions that his family will kill him, that he is a demon, or hearing voices commanding him to kill. “As mental health professionals, our most important task is to prevent the stigma and prejudice that are the greatest challenges in schizophrenia.”
