Wednesday, June 27, 2007

Monday, June 18, 2007

Schizophrenia: It's NOT about Split Personalities

I had one patient who came into the clinic behaving rather "Siow" (mad). She believed that the CIA was after her because she had some secret information that would reveal something about the PAP which will cause the ultimate collapse of the government. The patient was a homemaker. She claims the CIA were waiting for her outside the clinic to nab her and I had to help her or else this information will be lost forever. We got her husband to bring her to IMH where she was treated with an anti-psychotic drug. A few months later, she stopped having such delusions. She has been well since and has returned to work. (The details have been altered to protect the identity of the patient)

Schizophrenia is often misconstrued as having a split personality like the classic Dr Jekyll and Mr Hyde. As you can see from the story above, it is anything but that. A more accurate portrayal of Schizophrenia would be the character of the great economist, John Nash played Russell Crowe in the movie "A Beautiful Mind". In that movie, John Nash was under the delusion that he is part of a group of elite scientist on a mission to decode the German cryptic communications .

Rather then thinking of Schizophrenia as one person with 2 different personalities, it is perhaps better to think of Schizophrenia as a person who has his feet in different realities. It may be akin to a person who is so immersed in the Virtual Universe of "2nd life" or other forms of role-playing games, that the online persona is as real as the real world outside.

Who does it affect

It tends to occur in both men and women from ages 15 to 25 and 1 in 100 people will have it to some degree. It tends to run in families.

How do I tell if my friend may be Schizophrenic?

There are 4 features to look out for:

1. Hallucinations and Delusions: When I was working with the recalcitrant Schizophrenics in Australia, a lot of the women there thought they were the Virgin Mary. The men thought they were Jesus. One day one "Jesus" met another one who also claimed to be "Jesus". Now they worked out that both of them can't be "Jesus" so one managed to persuade the other one that he was the real "Jesus" and the other fella was his most trusted disciple "Peter". The both of them then went about happily preaching to the rest. I never really found out what happened with "Jesus" met his mother, the Virgin Mary.

2. Periods of Low Activity: Sometimes in between periods of Hallucinations and Delusion, they sufferer may under go periods where they are flat. They don't talk much, don't have much motivation to do anything and don't express their emotions.

3. Disorganized speech and thinking: This is one of the key aspect of Schizophrenia. You might have come across "Siow" people who come up to you to beg for money while you are having a meal at a coffeeshop. They either talk to themselves a lot or when they talk to you it is hard to follow their train of thought.

4. Grossly Disorganized Behaviour: Again you will also be familiar when these "Siow" people exhibit bizarre behaviours like scolding an invisible person, exposing themselves or other "silly" and socially unacceptable behaviour.

What all this means for you, the sane person?

It must be emphasized that Schizophrenia can be treated and the patient can actually live a normal life again! I think a lot of people have the misconception that once you became insane, you are basically a "gone case" for the rest of your life. So if you spot any of the behaviors in your friend or family members, do seek help early.

What you can do

For Early Psycosis

There is a Early Psychosis Intervention Program which you can receive help from a multidisciplinary team of Drs, psychologist, social worker etc. The website is at www.epip.org.sg
In doubt, bring your friend to see your Family Doctor for the initial assessment who can even start some simple medications before referring you to the EPIP.

For Acute Cases

For cases where the sufferer is likely to 1. Harm others, 2. Harm himself or suicidal or 3. The behavior is severely disorganized, the person should be sent to the hospital for to be hospitalized. Any of the major hospitals should be able to handle the problem.

The Mental Disorders and Treatment Act

This act gives the power to a medical officer to admit and detain the person for a period of 72 hours.

Can Schizophrenia be cured?

One third of cases have favorable outcomes. One third have intermittent relapse of their symptoms and the rest remain chronically disabled despite treatment.

More information can be found at the EPIP website