This is the final of four articles on schizophrenia in the Westmeath Topic. If you missed any of them or you would like a more detailed version than published in the Westmeath Topic, simply call in to Whelehans pharmacy and ask staff for a free copy. Also check www.whelehans.ie. With proper support and with modern treatment options, people with schizophrenia can lead a normal fulfilled life.
People with schizophrenia are often discharged from the hospital into the care of their families. It is important that family members know as much as possible about the disease. With the help of a therapist, the GP and staff from your local HSE community Mental Health Service, family members can learn coping strategies and problem solving skills. In this way the family can help make sure their family member continues with treatment and continues to take prescribed medication.
Cognitive behavioural therapy (CBT)
Psychological treatments include a variety of talking treatments, in particular a treatment called cognitive behavioural therapy (CBT). CBT is used as a treatment for various mental health and physical problems and is being increasingly used as a treatment for schizophrenia. CBT aims to help the person change the way that they think, feel and behave. CBT is actually a wide term which includes various types of therapy. You may be asked to keep a diary of important events in your life and the way you feel about them. Your therapist may challenge your beliefs and ask you to explain them. You may be asked to try out new ways of behaving and reacting.
CBT and other talking treatments are not alternatives to drug treatment. They are often used in conjunction with medication. The National Institute of Clinical Excellence (NICE) in the UK (an internationally renowned healthcare advice organisation) recommends up to 16 CBT sessions. This is because studies have found that, on average, CBT reduces the chance of being admitted or readmitted to hospital, can reduce symptom severity and can improve social functioning.
In summary, CBT has two phases or goals. The first is to raise your awareness of the condition and what behaviours, thoughts and emotions are leading to your mental health difficulties. The second is to use this knowledge to tackle the problem and to behave in a different way so as to relieve the underlying problems such as schizophrenia, anxiety or depression.
Schizophrenia and heart disease and smoking
Smoking and nicotine addiction is more common in people with schizophrenia. They are addicted to nicotine at three times the rate of the general population (75 to 90% versus 25 to 30%).
The full reason for higher smoking rates among people with schizophrenia is not fully understood; it is thought to be partly due to the way that smoking can temporarily improve cognitive function in people with schizophrenia including attention, memory and speech as well as be perceived (incorrectly) as relaxing. The rate of smoking in people with schizophrenia is also higher than for those suffering from other mental health illnesses including depression and bi-polar disorder. The risk of death from heart disease is two to three times higher among people with schizophrenia than the general population. The reason for this is mainly attributed to the higher rate of smoking among people with schizophrenia.
What is the outlook (prognosis)?
In most cases there are recurring episodes of symptoms (relapses). Most people live relatively independently with varying amounts of support. The frequency and duration of each relapse can vary. Some people recover completely between relapses. Some people improve between relapses but never quite fully recover. Treatment often prevents relapses, or limits their number and severity. In some case (approximately 2 in 10 cases), there is only one episode of symptoms that only lasts a few weeks. This is followed by a complete recovery without any further relapses. For about 20% of people with schizophrenia, medication is not very effective at controlling symptoms and they need long-term dependent care. For some, this is in secure accommodation. Depression is a common complication of schizophrenia. It is thought that up to a third of people with schizophrenia abuse alcohol and/or illegal drugs, this can make treatment more challenging. About 1 in 10 people with schizophrenia attempt or commit suicide.
The outlook is thought to be better if treatment is started soon after symptoms begin; symptoms develop quickly over several weeks rather than slowly over several months; the main symptoms are positive symptoms rather than negative symptoms; the condition develops in a relatively older person (aged over 25); medication is taken as advised; there is good family and social support which reduces anxiety and stress and abuse of illegal drugs or alcohol does not occur.
Newer drugs and better psychological treatments mean that prognosis is now better than it was in the past.
Disclaimer: This article is meant to give a general overview of the topic discussed; for more specific and detailed information, please speak to a health care professional
Whelehans Pharmacy, Pearse Street and Clonmore, Mullingar. Tel 04493 34591. Eamonn’s full comprehensive article on schizophrenia is available in Whelehans on request or check www.whelehans.ie. Simply ask our staff for a free copy. References are also available upon request