Common Myths and facts regarding Schizophrenia

Myths

Myth 1: Persons with schizophrenia have a ‘split personality’

Schizophrenia is commonly misunderstood to mean that affected persons have a 'split personality'.

People diagnosed with schizophrenia often ‘hear voices’ (auditory hallucination) and may experience the voices as distinct personalities.

The ‘splitting’ or fragmentation referred to the breakdown of an individual’s thinking and feeling processes (i.e. split from reality), and does not involve a person changing between distinct multiple personalities (i.e. split in personality).

Therefore schizophrenia must not be confused with split personality or multiple personality disorder (now called 'Dissociative Identity Disorder'). People with schizophrenia have only ONE personality.

The essential feature of Dissociative Identity Disorder is the presence of two or more distinct identities or personality states that recurrently take control of behaviour.

There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness. This disorder is diagnosed more frequently in females than in males.

Myth 2: Schizophrenia is caused by witchcraft; evil spirits or supernatural forces

Some believe that witchcraft; evil spirits or supernatural forces cause schizophrenia. They believe that the persons must have incurred the wrath of ‘dirty things’ and regard the psychotic behaviours as demonic possession.

To these avid believers, only religious or spiritual rituals can cure the mentally ill. In Singapore, about 24% of patients with first-episode psychosis had sought the help of traditional healers at the first onset of illness.

Others reject schizophrenia as a medical diagnosis. They think that the signs and symptoms are too disconnected for a general diagnosis to be made.

Myth 3: People with schizophrenia are often considered violent and dangerous

People with schizophrenia are often considered violent and dangerous. This misconception is reinforced by the media exaggeration about particularly frightening and bizarre crimes of violence committed by schizophrenic patients. This is not true.

People who have schizophrenia are no more likely to be violent than any other group in the community. However there is an increased risk of self-harm including suicide among people with schizophrenia.

Ten percent of people with schizophrenia kill themselves.

Myth 4: Persons with schizophrenia have weak personalities

Others believe that people with schizophrenia have weak personalities and have ‘chosen’ their madness. Many also believe that schizophrenia is the result of bad parenting and childhood trauma.

To some, schizophrenia only occurred in the mentally retarded. In actual fact, the illness strikes individuals regardless of their intelligence level or academic achievements.

Unfortunately all these myths and misconceptions are barriers to the people being effectively treated for the disorder.

Facts

Fact 1: Causes of Schizophrenia

No one single cause has yet been attributed to schizophrenia. The cause of schizophrenia is generally accepted as involving the impact of stress upon a biological predisposition – the stress-vulnerability model.

Vulnerability is central in this model to the explanation of psychotic symptoms. The greater the individual’s level of vulnerability, the less stress is required to trigger the psychosis.

Genetic factors produce the vulnerability to schizophrenia, with environmental factors contributing to different degrees in different individuals.

The lifetime risk of 1% rises to 13% for a child with one schizophrenic parent, and to 35-40% for a child with two schizophrenic parents. The risk increases with the number of affected relatives. Twin studies found a concordance rate among monozygotic twins to be 42%, compared to 9% for dizygotic twins and siblings.

New scientific evidence over the past two decades led researchers to hypothesize that most cases of schizophrenia are caused by a defect in early brain development.

Many studies have reported the association between higher rates of obstetric complications with the subsequent risk for schizophrenia.

Obstetric complications include rhesus incompatibility, diabetes, anemia, hypertension in pregnancy, first trimester maternal starvation, second trimester maternal respiratory infections and viral infection during pregnancy.

Studies on the brain chemistry and structure postulate that neurotransmitter imbalance (especially dopamine and serotonin) play a significant role in schizophrenia.

The therapeutic effect of anti-psychotic medications in the treatment of schizophrenia is through interference with these neurotransmitters.

Computed tomography and magnetic resonance imaging studies have demonstrated that structural brain abnormalities are present in patients with schizophrenia.

The main findings include enlargement of the lateral and third ventricles and reduction in total brain volume and cortical grey matter.

Fact 2: Treatments are available

Anti-psychotic medications remain the cornerstone of treatment for schizophrenia. They reduce the biochemical imbalances that cause schizophrenia and help many individuals lead fulfilling, productive lives.

It was reported that 83% of patients achieved stable remission of psychotic signs and symptoms at the end of 1 year. However up to 80% of patients would have relapsed within the next five years.

Anti-psychotic medications appear to have a protective effect against relapse as discontinuation of drug therapy increase the risk of relapse by a factor of 5.

There are two major types of anti-psychotic medication:

Conventional anti-psychotics, which include haloperidol and trifluoperazine (high-potency) and chlorpromazine (low-potency). They are effective in controlling the “positive” symptoms but tend to have more neurological side effects.
New Generation (also called atypical) anti-psychotics treat both the positive and negative symptoms of schizophrenia.

Examples are risperidone, olanzepine, quetiapine, ziprasidone, aripiprazole and paliperidone.

These medications lead to fewer neurological side effects especially when prescribed in low doses.

However, the atypical anti-psychotic medications have been recently reported to be associated with a higher risk of metabolic syndrome (i.e. type II diabetes as well as weight gain and dyslipidemia).

Common myth about anti-psychotic drugs is that they may lead to addiction. Unlike other drugs, anti-psychotic medications are not known to produce a "high" (euphoria) state or a strong physical dependence.

Another misconception about anti-psychotic drugs is that they act as a kind of mind control.

Anti-psychotic drugs do not control a person's thoughts; instead, they help to diminish hallucinations, and delusions, thus allowing the schizophrenic person to think more rationally and make better informed decisions.

Psychosocial interventions need to be integrated with drug treatment and tailored to the individual’s needs. Supportive psychotherapy, effective coping strategies and problem-solving skills are also beneficial to the person.

Persons with schizophrenia are more likely to suffer from relapses if they live in a setting with high levels of emotional conflict, criticism, and over-protection/involvement.

Patients and caregivers should be taught to recognize "early warning symptoms" of relapse.

Some patients will also benefit from inpatient rehabilitation programmes that emphasize on social skills training and vocational training. Assertive Community Treatment, a community-based psychosocial rehabilitation programme enables them to continue to live in the community while working towards recovery.

Fact 3: Outcomes

Despite the serious effects of schizophrenia over a person’s lifetime, what was formerly pessimism has been replaced by some measure of optimism.

Early recognition and treatment of schizophrenia can result in less frequent admission to hospital, shorter periods of inpatient care, more rapid and complete recovery, decreased risk of relapse and ultimately improving the quality of life for both the persons with schizophrenia and their caregivers.

Generally, it has been estimated that for people with schizophrenia, 25% will experience a full recovery, 40% will experience recurrent episodes with some degree of social disability and periods of unemployment; and 35% will experience long-term schizophrenia, with a high rate of both hospital admission and social disability.