By Leandrae T. Lapinig
Some people may think depression is the country’s top mental illness as there are several people – some of them were even famous – who died committing suicide as a result. in the Philippines, as most people think. Actually, it’s schizophrenia and most Filipinos are unaware of it.
In 2014, the Johnson & Johnson’s Philippine Health Information System released its findings on a survey on mental health conditions in the country. The data were gathered from 10 government hospitals and private hospitals.
The study singled out schizophrenia as the top brain disorder in the Philippines, affecting at least 42% of patients who seek psychological consultation.
According to the study, most of the schizophrenic Filipinos were men aged 20 to 44. “Many of them are male because they are more aggressive, especially if they are floridly psychotic,” Dr. Tomas Bautista, a psychiatrist of the Philippine General Hospital at the University of the Philippines, said in a press conference.
With the passing of the Republic Act 11036 or the Mental Health Law (which promotes and protects the rights of people with mental health conditions) in 2018, people with schizophrenia are finally starting to get the attention they deserve.
Hard to diagnose
One of the reasons why schizophrenia is underreported is because diagnosis is hard to come by. “I have been under treatment with five different psychiatrists at different times,” admitted Anastacia Lim in an article she wrote for Philippine Star in 2004. “My first doctor diagnosed me as having an obsessive-compulsive schizoid personality. Later, the doctor’s impression was manic depression. Lately, after I was confined at the National Center for Mental Health for 13 months, I was diagnosed to be suffering from schizophrenia.”
Being a schizophrenic is not a bed of roses. “I have been treated for more than two scores of years, but even before that, I already knew I was suffering from this illness, which doctors say is genetic,” Lim wrote. “I knew that I was sick then because I felt I never belonged. I felt misplaced and displaced and did not seem to fit with any company, despite the fact that I was a model student who graduated valedictorian from elementary and high school and was consistently on the dean’s list through college. Even now, wherever there are people, sometimes I still feel out of place.”
Affecting about 20 million people, the Geneva-based World Health Organization (WHO) listed schizophrenia as the ninth leading cause of disability around the globe. This mental health problem is described as “among the worst disorders afflicting humankind.”
The WHO says people with schizophrenia are 2-3 times more likely to die early than the general population. “People with schizophrenia are more likely to die younger than the general population, in part because of high rates of co-occurring medical conditions, such as heart disease and diabetes,” the American Psychiatric Association (APA) explains.
Chronic brain disorder
Schizophrenia is a chronic brain disorder that is very complex, which is why so many misconceptions abound. Schizophrenia does not mean split personality or multiple-personality although literally it means “split mind.”
“Schizophrenia is a mental disorder characterized by loss of contact with reality (psychosis), hallucinations (usually hearing voices), delusions (false beliefs), abnormal thinking, flattened affect (restricted range of emotions), diminished motivation, and disturbed work and social functioning,” points out The Merck Manual of Medical Information.
Research in the United States has shown that schizophrenia affects men and women about equally but may have an earlier onset in males. Rates are similar around the world, including in the Philippines.
“About 90 percent of patients in treatment are between 18-55 years old,” reports the Department of Health (DOH). “More than one-half of all male schizophrenic patients and one-third of all female patients are first admitted to psychiatric hospitals before 25.”
Signs and symptoms
According to the Merck manual, the onset of schizophrenia may be sudden, over a period of days or weeks, or slow and insidious, over a period of years. “People with schizophrenia may not make sense when they talk,” says Psychology Today. “They may sit for hours without moving or talking, or many seem like they are talking to themselves.”
Symptoms may be triggered or worsened by environmental stresses, such as stressful life events. Not taking medications as prescribed, use of alcohol or illicit drugs tend to increase symptoms.
The APA says symptoms fall into several categories. These are: positive psychotic symptoms (hallucinations, such as hearing voices, paranoid delusions and exaggerated or distorted perceptions, beliefs and behaviors), negative symptoms (a loss or decrease in the ability to initiate plans, speak, express emotion or find pleasure), disorganization symptoms (confused and disordered thinking and speech, trouble with logical thinking and sometimes bizarre behavior or abnormal movements), and impaired cognition (problems with attention, concentration, memory and declining educational performance).
“Call your doctor if you or someone experiences those symptoms,” urges The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. “Schizophrenia can be a devastating disorder, and medical care is vital. Be aware that it may not be easy to persuade someone who is becoming mentally ill to acknowledge symptoms or see a physician.”
According to the health department, a person diagnosed with psychosis can be legally hospitalized against his or her will, “particularly if he or she is violent, threatening to commit suicide, or threatening to harm another person.”
Some researchers believe schizophrenia is a single disorder, whereas others believe it is a syndrome (a collection of symptoms) based on numerous underlying disorders. “Subtypes have been proposed in an effort to classify people into more distinct groups,” the Merck manual states. “However, among individuals, the subtype may change over time.”
Unknown causes
Until now, what precisely causes schizophrenia is not known. “But researchers believe that a combination of genetics, brain chemistry and environment contribute to development of the disorder,” the Mayo Clinic claims. “Problems with certain natural occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia.”
Although the precise cause of schizophrenia isn’t known, there are some factors that seem to increase the risk of developing or triggering the disease, according to the Mayo Clinic. These include having a family history of schizophrenia; some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development; and taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood.
Treatments
Left untreated, schizophrenia can result in severe problems that affect every area of life. According to the Mayo Clinic, complications may cause or be associated with include suicide, suicide attempts and thoughts of suicide; self-injury; anxiety disorders and obsessive compulsive disorder; depression; abuse of alcohol or other drugs, including tobacco; inability to work or attend school; legal and financial problems and homelessness; social isolation; health and medical problems; being victimized; and aggressive behavior (although uncommon).
There is no known cure for the chronic disease and it requires lifelong treatment, even when symptoms have subsided.
Antipsychotic drugs, rehabilitation and community support activities, and psychotherapy represent the three major components of treatment. “The general goals of treatment are to reduce the severity of psychotic symptoms, prevent the recurrence of symptomatic episodes and the associated deterioration in functioning, and provide support to allow functioning at the highest level possible,” the Merck manual informs.
The modern era of medical treatment for schizophrenia began in 1952 with the use of tranquilizer chlorpromazine. This drug (and modern relatives like haloperidol) for the first time controlled acute symptoms, reduced hospitalization from years to days, and lowered rate of relapse by more than 50 percent.
On antipsychotic drugs, The Medical Advisor cautions: “Not everyone responds to these drugs. Long-term control is less successful than short-term alleviation. Also, prolonged medication may bring harmful side effects, especially the neurological muscle disorder known as tardive dyskinesia, which causes facial movements, such as grimacing and sucking emotions.”
Most schizophrenics can benefit from psychotherapy once their acute symptoms have been brought under control by antipsychotic medication. “Psychotherapy by itself is of little value without medication,” reminds The Medical Advisor. “However, supportive and sympathetic psychotherapy is needed to help the patient diagnosed with schizophrenia understand the disease and reenter society and family life.”
For people with schizophrenia, keeping a semblance of a normal life means finding a place for one’s self in the sun. “It means being aware of one’s responsibilities and duties, which make one part of the milieu,” said Lim, who was already 65 when she wrote the piece. “It calls for a continuing effort to do something useful – even small things like making one’s bed, sweeping the floor, washing the dishes, watering the plants, keeping one’s self busy with some handicraft like crocheting, or even praying.
“It means being ever vigilant and alert and attuned to one’s environment,” she continued. “It means not being too wrapped up in something like pleasure, ease or comfort that would divert one from doing what one has to do. It means not leaving undone what one has to do, otherwise, one would feel unfulfilled and be prone to depression. Having a sense of accomplishment is very important.” – ###
