Psychiatrist Zafar Sharif of Columbia University talks about schizophrenia and the challenges faced by patients with the condition.

SchizophreniaSchizophrenia is a brain disease, and is something that affects about 1% of the population. It is uniform across different socio-economic strata, uniform across different races, and fairly uniform across the world. So it is not because you’ve done something wrong that you get this illness – it really affects everyone to an equal degree.

Usually the onset of schizophrenia is in the late teenage or early adulthood years. The main symptoms of the illness can be divided into subdomains. Patients begin to withdraw from society – they don’t want to interact with people, and stay to themselves. They may begin to engage in odd behaviours, for example holding items. They may begin to not talk to people, or not interact with others. They may begin to get frank psychotic symptoms which are delusions, for example thinking that people are chasing them, controlling them or trying to kill them. They may hear things or see things that aren’t there.

The normal coherent thought process or speech that is understandable to others may break down, so they may use words in different ways, put words together that don’t belong together, or use words in sentences that just don’t make sense. This is what we call thought disorganisation – the thought structure breaks down.

They may stop taking care of their hygiene – stop taking showers, combing their hair or brushing their teeth – and generally schizophrenia is associated with a significant drop in functioning. So if they’re in school, their grades begin to drop significantly; or if they’re working, they won’t be able to work.

Although there is a lot of variability in schizophrenia, some people are impaired less than others. For most people, schizophrenia becomes quite disabling as it progresses.

There is some evidence that the first 5–10 years of schizophrenia are really critical. In this timeframe, the more times a patient has what we call an acute relapse, where the symptoms get worse, the worse the illness becomes over the long term.

SchizophreniaSo it’s certainly important in the first 5–10 years especially, and even in the longer-term, that patients continue to take medication, because the medications that we use are effective for the symptoms of schizophrenia, and are also effective in reducing the relapse of schizophrenia.

A good analogy for schizophrenia and the treatment of schizophrenia is what we see in other chronic medical illnesses. For example, if a patient presents with a high blood pressure of 200 over 120, (which can be a life-threatening blood pressure), the immediate goal of treatment is to bring the blood pressure down, but then patients will need to stay on medicines so that the blood pressure doesn’t go back up. Similarly with diabetes, your blood glucose could be very high. The first goal is to bring it down, but then you need to continue to take medicines (insulin or other oral hypoglycaemic agents) to keep your blood glucose within a certain range.

Schizophrenia is identical in terms of its treatment goals. We have to treat the acute symptoms, but it is really important that in long-term treatment, patients continue to take medicines so that the disease doesn’t come back with the same severity that it had before. It’s really important to recognise this for patients and also for family members.

More information

Psychiatrist Zafar Sharif This is the first of three videos. To watch the next video in the series, see Schizophrenia 2: Treating Schizophrenia.
Schizophrenia For more information on schizophrenia and its treatments, and some useful tools, animations and videos, see Schizophrenia.

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