Today, on International Schizophrenia Day, we share with you an interview with the psychiatrist Dr. Patrício Manuel da Silva Ferreira of the Sisters Hospitallers of Braga, Portugal, who talks about a disease that affects 24 million people in the world: schizophrenia.
What are the main symptoms of schizophrenia?
Considered the most frightening disease in psychiatry, it can have a very polymorphous presentation. It was the work of Emil Kraepelin, who grouped together a number of previously described clinical pictures and realized that they had some similarities: clinical course and prognosis. With the onset of symptoms in young people, the patients evolved poorly. In addition, the first clinical descriptions were made at a time when there was no pharmacological treatment, so the pictures at that time were more apparent and had a worse prognosis than those of today. When people speak of schizophrenia, they always think of delusions and hallucinations, but the truth is that these are easily observable symptoms that are not very specific to this disease. There are several types of symptoms of this disease, from alterations in the content or form of thought, to alterations in sensory perception or motor disturbances or, even more difficult to observe, the so-called “negative” symptoms of schizophrenia. Some examples are cognitive disturbances, loss of the ability to associate ideas or affective disturbances.
What is the most commonly used treatment for schizophrenia and how does it help patients?
Studies over the years have shown that the disease is associated with certain brain circuits and neurotransmitters. Dopamine has been the neurotransmitter most responsible for the disease, which seems to have increased activity in some areas of the brain and decreased activity in others, leading to these dysregulations and symptoms.
This is where drugs have come in. Antipsychotics are the drugs used in this pathology that have greatly improved the prognosis of this disease, and it is now known that the earlier they are started in the course of the disease, the better the prognosis. It is also known that the fewer outbreaks that occur, the better the patient’s functionality and, therefore, the better the prognosis. Progress has been made in this regard to ensure better adherence to treatment, with the advent of long-acting injectable therapy. There are now monthly, quarterly and, more recently, semi-annual injectable solutions. In other words, with two doses in a year it is possible to keep a patient compensated, with fewer crises and fewer hospitalizations.
How is the hospitaller charisma reflected in the treatment and care of patients with schizophrenia in your daily clinical practice?
As it is a serious illness and despite the available therapies, the outcome is often not the best, many patients are subjected to several psychiatric hospitalizations and often, due to the social context, they are integrated in long term hospitalizations. The Sisters Hospitalleres’ Centers become their home and their staff become their daily companions. The Hospitaller Charism, present in those who care for them, ensures that the patient receives the necessary treatment, always with the highest quality, understanding and respect for the person, but fundamentally welcoming those who have often been excluded from the community and misunderstood in their pathology.
What are the greatest challenges for people with schizophrenia in terms of social and occupational integration?
Unfortunately, even today, having a diagnosed mental illness is still an obstacle to normal professional integration. Society continues to stigmatize the mentally ill. In severe mental illnesses, such as schizophrenia, in addition to the above, the pathology itself has the greatest impact on the person’s capacity, both in terms of social skills and ability to perform normal tasks. The main challenge is, therefore, to rehabilitate, enhance and maximize what the patient is still able to do, and a good prognosis is that he/she remains active and integrated into society.
What role does family support play in the management and treatment of schizophrenia? How can someone living with schizophrenia be supported in their daily life?
Given the characteristics of this illness and the fact that the patient is often in denial about his or her illness, it is essential that the family is able to ensure that medication is taken regularly, otherwise further decompensation and consequent functional deterioration will occur. Family support is also important to show understanding and empathy without blaming, accusing or holding the patient responsible for their illness. Supporting someone living with schizophrenia means, as mentioned above, helping to maximize the patient’s remaining capacity, understanding the patient’s limitations, and communicating simply and clearly.
What are the most common myths about schizophrenia and how can they be debunked?
The main misconception about schizophrenia is that people with schizophrenia are very dangerous and violent. It is also often associated with drug addiction and that it is a disease of the addicted population.
Demystifying these concepts involves psychoeducation but, above all, global information about mental illness, because stigma is widespread. Bringing patients and society together is crucial to break down barriers and destroy myths.
What is your main message for those living with schizophrenia and their loved ones on this World Awareness Day?
As a serious illness with no cure in light of current medical knowledge, treatments have steadily evolved and improved the overall prognosis of this condition. It is increasingly possible for patients with schizophrenia to lead a life close to normal, as long as they are controlled and medicated. Rehabilitation and community integration should always be the main goal.
