This leaflet contains a lot of information, so we have broken it
down into sections to make it easier to read...
- Why do we use the 's' word?,
What is schizophrenia?,
Symptoms, Causes, Outlook.
- Treatment, Medication, Psychological treatments,
How treatments
compare, What
will happen without treatment?
- Social life, The Community mental health
team, Care Programme Approach
(CPA)
- Self-Help, For families, Compulsory admission to hospital
- Further help, Some myths, Further reading, References, Production, Feedback
About this leaflet
This leaflet is for:
- anyone who has been given a diagnosis of schizophrenia
- anyone who thinks they might have schizophrenia
- friends and relatives of someone who has been given this
diagnosis.
In it you will find:
- what it is like to have schizophrenia
- what may cause it
- the different treatments available
- how to help yourself
- some information for relatives.
Why do we use the ‘s’ word?
"Schizophrenia" is a word that many people associate with
violence and disturbance. The media regularly uses it in this way,
although it is unfair and inaccurate. Many people feel stigmatised
by being described as having "schizophrenia".
We use the word "schizophrenia" because there does not seem, at the
moment, to be a better one to describe this particular pattern of
symptoms and behaviours. Even if you don't find the use of this
term helpful, we hope that the information in this leaflet can
still be useful.
What is schizophrenia?
Schizophrenia is a mental disorder that
affects around 1 in every 100 people. It affects men and women
equally and seems to be more common in city areas and in some
minority ethnic groups. It is rare before the age of 15, but can
start at any time after this, most often between the ages of 15 and
35.
Symptoms of
Schizophrenia
These are often described in two groups - positive and
negative.
"Positive" symptoms:
These unusual experiences are most common in schizophrenia, but
can occur in other mental disorders.
A hallucination happens when you hear, smell, feel or see something
- but there isn't anything (or anybody) actually there to account
for it. In schizophrenia, the commonest hallucination is that of
hearing voices.
What's it like to hear voices?
They sound utterly real. They seem to be coming from outside you,
although other people can't hear them. You may hear them in
different places or you may hear them coming from a particular
object, such as a television. The voices may talk to you directly,
or they may talk to each other about you. It can sound as if you
are over-hearing a conversation. Voices can be pleasant but are
often rude, critical, abusive or just plain irritating.
How do people react to them?
Sometimes you may feel that you have to do what they say, even if
they are telling you to harm yourself or to do something you know
is wrong. Much of the time you can ignore them. Sometimes they will
get you down.
Where do they come from?
Voices are not imaginary, but they are created by the mind. Brain
scans have shown that the part of the brain that is active when
someone hears voices is the part that is active when they are
talking, or forming words in their mind. It is as though the brain
mistakes your own thoughts for real voices coming from our
surroundings.
Do other people hear voices?
People with other mental disorders, such as severe depression, may
also hear voices that talk directly to them. In depression, these
voices are critical and repeat the same word or phrase over and
over again.
Some people hear voices which do not interfere with their daily
life. They may be pleasant, or not very loud, or only happen from
time to time. These do not usually need any kind of
treatment.
Other kinds of hallucination
Visions and hallucinations of smell, taste or being touched can
also happen, but these are less common.
A delusion is a belief that you hold with complete conviction,
although it seems to be based on a misinterpretation or
misunderstanding of situations or events. While you have no doubts,
other people see your belief as mistaken, strange or unrealistic.
They find that they can't really discuss this belief with you. If
they ask you why you believe it, your reasons don't make sense to
them, or you can't explain it - you "just know".
How does it start?
- You may suddenly start to believe it. This may follow a few
weeks or months when you have felt that there has been something
strange going on, but that you couldn't explain what it was.
- You develop a delusional idea as a way of explaining
hallucinations that you are having. For example, if you have been
hearing voices commenting on your actions, you may decide that you
are being monitored by some government agency.
Paranoid delusions
These are delusional ideas that make you feel persecuted or
harassed. They may be:
- unusual - you may feel that MI5 or the government is spying on
you. You may believe that you are being influenced by neighbours
who are using special powers or technology.
- everyday - you may start to believe your partner is unfaithful.
You do so because of odd details that seem to have nothing to do
with sex or infidelity. Other people can see nothing to suggest
that this is true.
Delusions of persecution are obviously distressing for you. They
can also be upsetting for the people you see as your persecutors,
especially if they are close to you, like your family.
Ideas of reference
You start to see special meanings in ordinary, day-to-day events
and believe that they are specially connected to you. For example,
that radio or TV programmes are about you, or that people are
communicating with you in odd ways, such as through the colours of
cars passing in the street.
Coping with delusions
- Delusions may, or may not, affect the way you behave.
- It can be difficult to discuss them with other people because
you realise that they won't understand.
- If you feel that other people are trying to harm or harass you,
you will probably just keep away from them. Occasionally, you may
feel so threatened that you want to retaliate.
- You may try to escape your feelings of persecution by moving
from place to place.
It becomes harder to concentrate - you probably can't:
- finish an article in the newspaper or watch a TV programme to
the end
- keep up with your studies at college
- keep your mind on the job at work.
Your thoughts seem to wander. You drift from idea to idea
without any obvious connection between them. After a minute or two,
you can't remember what you were originally trying to think about.
Some people describe their thoughts as being "misty" or "hazy" when
this is happening.
When your ideas are disconnected in this way, it can be hard for
other people to understand you.
You may feel that:
- your thoughts are vanishing - as though someone is taking them
out of your mind
- that the thoughts you are thinking are not yours, but that
someone else has put them in your mind
- your body is being taken over, or that you are being controlled
like a puppet or a robot.
People explain these experiences in different ways. Some people
have technological explanations, such as the radio, television or
laser beams, or believe that a device has been implanted in them.
Other people may blame witchcraft, angry spirits, God or the
Devil.
"Negative" symptoms:
These are less obvious than positive symptoms.
- Your interest in life, energy, emotions and 'get-up-and-go'
just drain away. It's hard to feel excited or enthusiastic about
anything.
- You can't concentrate. You may not bother to get up or go out
of the house.
- It can be difficult to wash or tidy up, or to keep your clothes
clean.
- You may feel uncomfortable with people - that you have nothing
to say.
Other people can find it hard to understand that negative
symptoms are actually symptoms, and that you aren't just being
lazy. This can be upsetting, both for you and your family. Your
family feel that you just need to pull yourself together. You can't
explain that ... you just can't.
Negative symptoms are much less dramatic than positive
symptoms, but they can be just as troublesome.
Does everyone with schizophrenia have all these
symptoms?
No. Someone can hear voices without negative symptoms, but may not
have thought disorder. Some people with delusional ideas seem to
have very few negative symptoms. If someone only has thought
disorder and negative symptoms, the problem may not be recognised
for years.
Loss of insight
After a while, the symptoms can be so intense that they take over
your life. It can feel as though everyone else is wrong, that they
just can't understand what you can.
- Before help or treatment, around half of those having
schizophrenia for the first time will feel depressed.
- Around 1 in 7 people with continuing symptoms will have
depression. This may not be recognised because the signs can be
mistaken for negative symptoms.
- Although antipsychotic medication has been blamed for this in
the past, it seems that treatment with medication actually reduces
depression in schizophrenia.
- If you have schizophrenia and feel depressed, make sure that
you tell someone and that they take you seriously. See our leaflet
on 'Depression' for further information on signs, symptoms and
treatment.
What causes Schizophrenia?
We don't yet know for sure. It is likely to be a combination
of several different factors which will be different for different
people.
Genes
Genes1 in 10 people with schizophrenia have a parent with the
illness. Studies of twins can help to show how much is due to genes
and how much to upbringing.
Identical twins have exactly the same genetic make-up as each
other, down to the last molecule of DNA. If one identical twin has
schizophrenia, their twin has about a 50:50 chance of having it
too. Non-identical twins don't have the same genetic make-up as
each other. If one of them has schizophrenia, the risk to the other
twin is just slightly more than for any other brother or
sister.
These findings hold true even if twins are adopted and brought
up in different families. This suggests that the difference is
truly due to genes rather than upbringing.
| Relatives with schizophrenia |
Chance of developing schizophrenia |
| None |
1 in 100 |
| 1 parent |
1 in 10 |
| 1 identical twin (same genetic make up) |
1 in 2 |
| 1 non-identical twin (different genetic make up) |
1 in 7 |
Research suggests that genes account for about half of the
risk of developing schizophrenia. We don't yet know the combination
of genes responsible for this.
Brain damage
Modern brain scans show that, compared with people who don't
suffer from the illness, there are differences in the brains of
some people with schizophrenia. For some people with schizophrenia,
parts of their brain may not have developed normally, because
of:
- problems during birth that affect the supply of oxygen to the
baby's brain
- viral infections during the early months of pregnancy.
Street drugs and alcohol
Sometimes, the use of street drugs seems to bring on
schizophrenia. These include ecstasy (E), LSD (acid), amphetamines
(speed) and crack. We know that amphetamines can give you psychotic
symptoms, but they actually stop when you cease taking the
amphetamines. We don't yet know whether these drugs on their own
can trigger off a long-term illness but they may do if you are
vulnerable. Using street drugs and alcohol can make matters worse
for people who already have schizophrenia. Some people use street
drugs and alcohol to cope with their symptoms.
Cannabis (hash, marijuana, pot, ganja, skunk, dope,
spliffs, joints)
- There is now good evidence to suggest that the use of cannabis
doubles the risk of developing schizophrenia.
- If is more likely if you start using cannabis in your early
teens.
- If you have smoked it frequently (more than 50 times) during
your teens, the effect is even stronger - you are 6 times more
likely to develop schizophrenia.
Stress
Difficulties often seem to happen shortly before symptoms get
worse. This may be a sudden event like a car accident, bereavement
or moving home. It can be an everyday problem, such as difficulty
with work or studies. Long-term stress, such as family tensions,
can also make it worse.
Family problems
At one time, it was thought that schizophrenia was caused by
communication problems within the family. There is no evidence to
support this idea. However, family tensions can worsen
schizophrenia.
Childhood deprivation
There is some evidence that, as with other mental disorders,
early experiences of deprivation and abuse can make it more likely
that you will develop schizophrenia.
Many people with schizophrenia now never have to go into
hospital and are able to settle down, work and have lasting
relationships.
In the long term:
For every 5 people who develop schizophrenia:
- 1 in 5 will get better within five years of their first episode
of schizophrenia.
- 3 in 5 will get better, but will still have some symptoms. They
will have times when their symptoms get worse.
- 1 in 5 will continue to have troublesome symptoms.
What will happen without treatment?
Some people have one symptom of schizophrenia, such as hearing
voices, but none of the other symptoms. They may not need any
treatment or special help. However, if the voices become too loud
or unpleasant (or if other symptoms develop), then treatment will
probably be needed.
Suicide is more common in people with schizophrenia. This is
more likely if someone is having active symptoms, has become
depressed, is not receiving treatment or has had their level of
care reduced.
Research suggests that the longer schizophrenia is left
untreated, the greater its impact on your life. The sooner it is
identified and treated, the better the outlook.
If the symptoms are identified early, and treatment is
started:
- you are less likely to have to go into hospital
- you are less likely to need intensive support at home
- if you do go into hospital, you will spend less time there
- you are more likely to be able to work and live
independently.
Treatment
If you have the symptoms of schizophrenia for the first time,
medication should be started as soon as possible, usually by a
general practitioner.
You may well not need to go into hospital, although you will
need to see a psychiatrist and a community mental health team.
Assessment and treatment can now be done at home by community
teams. Even if you do have to go into hospital, it will usually be
for only a few weeks. Afterwards, any help or treatment can
continue at home.
Medication can help the most disturbing symptoms of the
illness. However, it does not provide a complete answer. It is
usually an important first step which makes it possible for other
kinds of help to work.
Support from families and friends, psychological treatment and
services such as supported housing, day care and employment schemes
are vitally important.
Why take medication?
The aim is to reduce the effects of the symptoms on your life.
Medication should:
- weaken delusions and hallucinations gradually, over a period of
a few weeks
- help you to think more clearly
- increase your motivation and ability to look after
yourself.
How is it taken?
- Medication for schizophrenia comes as tablets, capsules, or
syrup. It's hard for anybody to remember to take tablets several
times a day, so there are now some that you only need to take once
a day.
- If you find it hard to take tablets every day, you may find it
easier to take antipsychotic medication as an injection. This is
called a 'depot injection' and is given at weekly or every 2,3 or 4
weeks. Most of the depot injections are older, "typical"
antipsychotics, but one of the atypicals, Risperidone, is now
available in this form.
"Typical" antipsychotics
In the mid-1950s, several medications appeared that could
reduce the symptoms of schizophrenia. They became known as
"antipsychotic" medications. These older drugs are called
"typical"or "first-generation" antipsychotics. They work by
reducing the action of a particular chemical messenger in the brain
called dopamine.
Side-effects
- Stiffness and shakiness, like Parkinson's disease, along with
feeling sluggish and slow in your thinking. In most cases, this
will mean that you are taking too much of the medication. It should
be reduced to a level at which these symptoms disappear. If you
need higher doses, these side-effects can be controlled with
anti-Parkinsonian medication.
- Uncomfortable restlessness (akathisia).
- Problems with your sex life.
- A long-term side-effect is tardive dyskinesia (TD for short) -
persistent movements, usually of the mouth and tongue. This affects
about 1 in 20 people every year who are taking these
medications.
Some Typical antipsychotics:
| Tablets |
Trade Name |
Normal Daily Dose (mg) |
Max. Daily Dose (mg) |
| Chlorpromazine |
Largactil |
75-300 |
1000 |
| Haloperidol |
Haldol |
3-15 |
30 |
| Pimozide |
Orap |
4-20 |
20 |
| Trifluoperazine |
Stelazine |
5-20 |
|
| Sulpiride |
Dolmatil |
200-800 |
2400 |
| Depot Injections (may be given 2-4 weekly) |
Trade Name |
Normal 2 weekly dose |
Max. 2 weekly dose |
| Haloperidol |
Haldol |
50 |
|
| Flupenthixol decanoate |
Depixol |
40 |
|
| Fluphenazine decanoate |
Modecate |
12.5-100 |
|
| Pipothiazine palmitate |
Piportil |
50 |
|
| Zuclopenthixol decanoate |
Clopixol |
200 |
|
"Atypical" antipsychotics
Over the last 10 years, several newer medications have
appeared. They work on a different range of chemical messengers in
the brain (such as serotonin) and are called "atypical" or
"second-generation" antipsychotics. They are less likely to cause
Parkinsonian side-effects, although they may cause weight gain and
problems with sexual function. They may also help the negative
symptoms, on which the older drugs have very little effect. They
also seem much less likely to produce tardive dyskinesia. Many
people who use these newer medications have found the side-effects
less troublesome than those of the older medications.
Side-effects
- Sleepiness and slowness
- Weight increase
- Interference with your sex life
- Increased chance of developing diabetes.
- In high doses, some may produce the same Parkinsonian
side-effects as the typicals.
Some Atypical antipsychotics:
| Tablets |
Trade Name |
Normal daily dose (mg) |
Max. daily dose (mg) |
| Amisulpiride |
Solian |
50 - 800 |
1200 |
| Aripiprazole |
Abilify |
10-30 |
|
| Clozapine |
Clozaril |
200-450 |
900 |
| Olanzapine |
Zyprexa |
10-20 |
20 |
| Quetiapine |
Seroquel |
300-450 |
750 |
| Risperidone |
Risperdal |
4-6 |
16 |
| Sertindole |
Serdolect |
12-20 |
24 |
| Zotepine |
Zoleptil |
75-200 |
300 |
| Depot Injections |
Trade Name |
Normal 2 weekly dose |
Max. 2 weekly dose |
| Risperidone |
Risperdal Consta |
25 |
50 |
Clozapine
- This is an atypical antipsychotic medication and the only one
that has been shown to be more effective for people who do not
respond to other sorts of antipsychotic. It also seems to reduce
suicide in people with schizophrenia.
- It has many of the same side-effects as other atypical
antipsychotics, but may also make you produce more saliva.
- The main drawback is that it can affect your bone marrow. This
leads to a shortage of white cells which makes you vulnerable to
infection. If this happen, the medication needs to be stopped as
quickly as possible to allow the bone marrow to recover. Weekly
blood tests need to be done for the first 6 months of taking
Clozapine, then 2 weekly and eventually 4 weekly.
How well does medication
work?
- These medications work well for many people - about 4 in 5
people get help from them. They control the disorder, but do not
cure it. You have to go on taking the medication to prevent the
symptoms returning.
- Even if the medication helps, the symptoms may come back. This
is much less likely to happen if you carry on taking medication,
even when you feel well.
How long will I have to take medication
for?
- Most psychiatrists will suggest that you take medication for a
long time.
- If you want to reduce or stop your medication, discuss this
with your doctor.
- You should usually reduce your medication gradually so you can
notice any symptoms returning, before you become unwell again.
What happens if you stop your
medication?
If you stop taking the tablets, the symptoms of schizophrenia
will usually come back - not immediately, but often within 6
months.
Getting back to normal
What happens after your positive symptoms have been
controlled? Schizophrenia can make it difficult to deal with the
demands of everyday life. Sometimes, this is because of the
symptoms. Sometimes, the illness may have gone on for so long that
you may just have got out of the habit of doing things for
yourself. It can be difficult to get back to doing ordinary things,
like washing, answering the door, shopping, making a phone call or
chatting with a friend.
Is medication enough?
Medication is very useful. However, even if you are taking
medication, you will usually need to use other types of help to
give yourself the best chance of a good recovery.
Psychological Treatments
Cognitive Behavioural Therapy (CBT)
This may be done by clinical psychologists, psychiatrists or nurse
therapists. The therapist helps you to:
- identify problems that are most troublesome for you. These
could be thoughts, experiences or ways of behaving.
- look at how you tend to think about them - your "thinking
habits".
- look at how you react to them - your "behaving habits".
- look at the effect your thinking or behaving habits have on the
way you feel or the way you behave.
- work out if any of these thinking or behaving habits are
unrealistic or unhelpful.
- work out if there are other ways of thinking about these
things, or reacting to them, that would be more helpful.
- try out new ways of thinking and behaving.
- see if these work. If they do help you, use them regularly. If
they don't, find better ones that do work for you.
This kind of therapy can help you to feel better about
yourself, and to learn new ways of solving problems. We now know
that cognitive therapy can also help you to cope with troublesome
hallucinations or delusional ideas. Most people have between 8 and
20 sessions lasting about 1 hour. For CBT to be effective, you
should have at least ten meetings over a period of about 6
months.
Counselling and supportive
psychotherapy
These don't directly affect the symptoms of schizophrenia, but may
be helpful if:
- you need to get things off your chest
- you need to talk things over in greater depth
- you need some support with the daily problems of life.
Family work
This is not to do with trying to find reasons for the
schizophrenia. Family meetings are designed to help you and your
family cope better with the situation. They can be used to discuss
information about schizophrenia, ways to support someone with
schizophrenia, and how to solve practical problems that may be
caused by the symptoms of the illness. Around ten meetings are
needed over a period of about 6 months.
Cognitive remediation
This is being researched and is not yet widely available. It is a
kind of "mental gym" that has shown some promise in helping to
improve memory, and concentration in people with
schizophrenia.
How treatments compare
- Apart from clozapine (see page 8), there is little evidence at
the moment to suggest that there are large differences in
effectiveness of any of the typical or atypical
antipsychotics.
- It is also not possible to say in advance whether one
antipsychotic will work better for you than another.
- In practice, you may need to try one antipsychotic and see how
you get on with it. If it isn't working or you have troublesome
side-effects, discuss trying another with your psychiatrist.
- On the whole, people seem to find the side-effects of the
atypical antipsychotics are easier to put up with than the
side-effects of the typicals. So, treatment should usually start
with an atypical.
- Clozapine does seem to work better than other antipsychotics
for some people. However, its potentially serious side-effects mean
that it would usually only be used after other treatments have
failed. If you have had two antipsychotics (including one atypical)
for 6-8 weeks, without real benefit from either, Clozapine can be
considered.
- We know that CBT is helpful in people who are taking
medication, we do not know how well it works if someone is not
taking medication.
- Research is being carried out to find out if early
schizophrenia can be treated just with CBT.
- If you want further information about treatments, read the NICE
guidelines (listed at end of the leaflet)
- If you are unhappy with the treatment you are receiving, you
can ask for a second opinion from another psychiatrist.
Social life
Day Centres
You may not be working, or may be unable to go back to work.
Even so, it's good to get out and do something every day. Many
people go regularly to a day hospital, day centre, or community
mental health centre. These can offer a range of activities - 'keep
fit', creative pursuits like painting and pottery, education or
help with getting back to work. You can get active again and spend
some time with other people.
Work Projects
These provide training to help you develop your skills. They
will often have contacts with local employers and can support you
when you go back to work.
If your illness goes on for a long time, you may need a
specialist rehabilitation service.
Supported accommodation
This could be a bedsit or flat where there is someone around
to help you with day-to-day problems.
Support from the CMHT (community mental health team)
A mental health worker from your local community mental health
team should see you regularly. Community psychiatric nurses can
give you time to talk, and can help sort out problems with
medication.
Occupational therapists can:
- help you to be clear what your skills are and what you can
do
- show you how to improve things you aren't doing so well.
- work out ways of helping you to do more for yourself and can
help you to improve your social skills (how you get on with other
people)
- help you to get back to work.
There may be help for families. This usually involves giving
information about the illness and treatment, and helping to sort
out some of the practical problems of day-to-day living. This may
involve regular meetings for a while with a member of the CMHT.
The psychiatrist will usually organise your medication and take
responsibility for your overall care.
The care co-ordinator will be responsible for making sure that
your package of care actually happens.
Care Programme Approach (CPA)
This is a way of making sure that people with schizophrenia
get appropriate care and support. It involves:
- A care co-ordinator who is responsible for organising all the
different parts of your care and treatment.
- Regular review meetings every 3-6 months. These involve you,
your care co-ordinator, your psychiatrist and any other people who
are giving you care or support. This can include your family or
carers.
- A care plan that is reviewed at the regular CPA meetings. It is
re-written each time and you will have a copy to approve or
change.
- Plans are made with you at these meetings about what to do if
you find yourself becoming unwell again, or run into
difficulties.
- Carers are entitled to have an assessment of their needs every
year.
Self-help
- Learn to recognise early signs such as:
- Going off your food, feeling anxious or not sleeping.
- Other people comment that you've stopped bothering to change
your clothes, clean your home or cook for yourself.
- Mild symptoms - feeling a bit suspicious or fearful, worrying
about people's motives, starting to hear voices quietly or
occasionally, finding it difficult to concentrate.
- Try to avoid things that make you worse, such as:
- stressful situations such as spending too much time with
people
- using street drugs or alcohol
- getting anxious about bills
- disagreements with family, friends or neighbours
- Learn relaxation techniques.
- Make sure you regularly do something you enjoy.
- Find ways of controlling your voices:
- spend time with other people
- keep busy
- listen to a personal stereo (TV and radio also work, but may
annoy your family or neighbours)
- remind yourself that your voices can't harm you
- remind yourself that your voices don't have any power over you
and can't force you to do anything you don't want to
- join a self-help group for people with similar experiences to
yours
- Identify someone you trust to tell you if you are becoming
unwell again.
- Learn about schizophrenia and your medication:
- talk it over with your nurse, mental health worker or
psychiatrist.
- ask for written information about your diagnosis and
treatment.
- if your medication is not working well, ask about alternative
medications.
- Look after your body:
- try to eat a balanced diet, with lots of fresh vegetables and
fruit.
- try not to smoke - cigarettes harm your lungs, your heart, your
circulation and your stomach.
- take some regular exercise, even if it's only 20 minutes out
walking every day. Regular vigorous exercise (double your pulse
rate for 20 minutes 3 times a week) can help improve your
mood.
- If there is an inaccurate or abusive item about schizophrenia
in the press, a radio talk show or on TV, don't get depressed, get
active. Write a letter, e-mail them, phone them up and tell them
where they are wrong. It works!
For families
It may be hard to understand what is happening if your son or
daughter, husband or wife, brother or sister, or partner develops
schizophrenia. Sometimes, no-one realises what is happening.
What do you see?
Your relative may become odd, distant or just different from how
they used to be. They may avoid contact with people and become be
less active. If they have delusional ideas, they may talk about
them, but may also keep quiet about them. If they are hearing
voices, they may suddenly look away from you as if they are
listening to something else. When you speak to them, they may say
little, or be difficult to understand. Their sleep pattern may
change so that they stay up all night and sleep during the
day.
You may wonder if this behaviour is just rebellious. It can
happen so slowly that, only when you look back, can you see when it
started. It can be particularly difficult to recognise these
changes during the teenage years, when young people are changing
anyway.
Was it my fault?
You may start to blame yourself and wonder 'Was it my fault?' You
may wonder if anyone else in the family is going to be affected,
what the future holds, or how they can get the best help.
Can I talk to the mental health team?
Families have often been left out of discussions about their
relative because of worries about confidentiality. This should not
be the case now. If someone with schizophrenia is living with or
being supported by their family, their family should be able to
have the information that will allow them to care most effectively
for them. Even if there are difficulties in this area, they cannot
stop the family from informing the mental health team about what is
going on with their relative.
Families need as much help and information as possible and the
mental health team needs to listen to their worries and concerns.
It can advise on drugs and their side-effects, as well as
suggesting small, manageable tasks that may help recovery.
The Princess Royal Trust for Carers and the Royal College of
Psychiatrists have published a checklist of questions for families
to help them to find out what they need to know. Several voluntary
organisations concerned with schizophrenia (see list at the end of
this leaflet) provide useful information and support.
What can we do?
Families also need advice. Someone with schizophrenia will be more
sensitive to stress, so it is helpful to avoid arguments and keep
calm - perhaps easier said than done!
Compulsory admission to hospital
Someone with schizophrenia may not always realise they are
ill. They may refuse treatment when they badly need it. The Mental
Health Act (in England and Wales), and similar legal arrangements
in other countries, allows a person to be admitted to hospital
against their will. This is only used if someone needs assessment
or treatment, they cannot or will not accept it, and:
- their health is at risk or
- they are a danger to themselves or
- they are a danger to other people.
If this is to happen, three professionals must agree that it is
necessary. They are:
- a doctor, usually a general practitioner who knows the
person
- a doctor with special training in mental health, usually a
psychiatrist
- an "Approved Social Worker", also with special training in
mental health.
If you are kept in hospital under this law, you can appeal
against the decision. You should be told how to do this when you go
into hospital.
You can find out more about this in the other books listed in
the "further reading" section of this leaflet.
Further help
Advice line: 0208 974 68 14 (open 10am -3pm Monday,
Wednesday and Friday; 10am- 1pm Tuesday and Thursday) or
email:
advice@rethink.orgNational voluntary organisation that helps people with any
severe mental illness, their families and carers.
Helpline: 1890 621 631(Mon-Fri, 9am- 4pm); email:
info@sirl.ie
Publishes a wide range of literature on all aspects of mental
health.
Helpline: 0845 767 8000 (1pm to 11pm every day of the
year).
A national mental health helpline offering emotional support
and practical information for people with mental illness, families,
carers and professionals.
Some myths
Isn't schizophrenia a split personality?
No. Too many people have the idea that someone with schizophrenia
can appear perfectly normal at one moment, and change into a
different person the next. This is nonsense.
We misuse the word schizophrenia in two different ways. By it, we
may mean 'having mixed or contradictory feelings about something'.
This is just part of human nature - a much better word is
"ambivalent". Just as commonly, we may mean that someone behaves in
very different ways at different times. Again, this is part of
human nature.
Doesn't schizophrenia make people dangerous?
People who have schizophrenia are rarely dangerous. Any
violent behaviour is usually sparked off by street drugs or
alcohol, which is similar to people who don't suffer from
schizophrenia.
Although there is a higher risk of violent behaviour if you
have schizophrenia, it is almost insignificant compared to the
effects of drugs and alcohol in our society. If we stopped all the
violence caused by schizophrenia, we would only succeed in
preventing 1% of all the violence in society. People with
schizophrenia are far more likely to be harmed by other people,
than other people are to be harmed by them.
Schizophrenia never gets better
1 in 5 people with schizophrenia recover completely (see '
Outlook').
Further reading
Understanding NICE guidance - information for people with
schizophrenia, their advocates and carers, and the public. National
Institute for Clinical Excellence 2002: London
http://www.nice.org.uk/nicemedia/pdf/CG1publicinfo.pdf
- Does severe mental illness run in families? Genetic
counselling for schizophrenia and allied disorders Dr Adrianne
Reveley, Rethink 1998 (3rd edition). Available free of charge.
- Surviving schizophrenia - a family manual.
Consumers and Providers E. Fuller Torrey, Quills (Harper) 2001 (4th
edition). £12.99 (including p&p).
Getting into the system - lving with serious mental
illness 1 by Gwen Howe and Jessica Kingsley. (1997) ISBN
1 85302 457 0.
Mental health assessments by Gwen Howe
and Jessica Kingsley (1998) ISBN 1 85302 458 9.
References
Arsenault, L. et al. (2004) Causal association between
cannabis and psychosis: examination of the evidence. British
Journal of Psychiatry, 184: 110-117.
Appleby L. et al. (1999) Aftercare and clinical
characteristics of people with mental illness who commit suicide: a
case-control study. Lancet, 353: 1397-1400.
Bebbington P. (2001) Choosing antipsychotic drugs in
schizophrenia: A personal view. Psychiatric Bulletin, 25: 284 -
286.
Bebbington P. et al. (2004) Psychosis, victimisation and
childhood disadvantage: Evidence from the second British National
Survey of Psychiatric Morbidity. British Journal of Psychiatry,
185: 220-226
Fanous A. et al. (2001) Relationship Between Positive and
Negative Symptoms of Schizophrenia and Schizotypal Symptoms in
Nonpsychotic Relatives. Archives of General Psychiatry, 58(7): 669
- 673.
Loebel, A. D., Lieberman, J. A., Alvir, J. M., et al (1992)
Duration of psychosis and outcome in first-episode schizophrenia.
American Journal of Psychiatry, 149, 1183-1188.
Mulholland, C. & Cooper, S. (2000) The symptom of
depression in schizophrenia and its management. Advances in
Psychiatric Treatment, 6, 169-177.
Spencer, E., Birchwood, M. & McGovern D. (2001) Management
of first-episode psychosis. Advances in Psychiatric Treatment, 7:
133 - 140.
Tarrier N. et al. (2004) Cognitive-behavioural therapy in
first-episode and early schizophrenia: 18-month follow-up of a
randomised controlled trial. British Journal of Psychiatry, 184:
231 - 239.
Walsh E, Buchanan A. & Fahy T (2002). Violence and
schizophrenia: examining the evidence. British Journal of
Psychiatry, 180: 490 - 495.
Production
Produced by the Royal College of Psychiatrists' Public
Education Editorial Sub-Committee
Series
Editor: Dr Philip Timms
Expert Review: Professor Thomas Barnes
Editorial Board: Dr Ros Ramsay, Dr Martin Briscoe, Deborah
Hart
User & Carer input: Royal College of Psychiatrists' Special
Committee for Patients and Carers
Illustrations by Christine Roche ©
The Royal College of Psychiatrists produces:
- a wide range of mental health information for patients, carers
and professionals
- factsheets on treatments in psychiatry such as antidepressants
and cognitive behavioural therapy
These can be downloaded from our website: www.rcpsych.ac.uk/info
A range of materials for carers of people with mental health
problems has also been produced by the 'Partners in Care' campaign.
These can be downloaded from
www.partnersincare.co.uk.
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