Friday, February 29, 2008

I went to school today
Saw a bird perching on the swing
It twisted and shrivelled into nothing
Then the ashes flew up
There was someone in my head
(His name is Sam)
And he told me to fly too
I like Sam for he is good to me
So I tried to fly but I couldn’t so I climbed
Up to the very top of the swing
Sam was angry because I hadn’t obeyed him exactly
He told me to jump or I would stop being a
Heroine from a fairytale
So I did
I hit the ground and it felt as if something
Had stabbed me all over though I couldn’t see any knives
I realised the all-important truth: the teacher had the knife
I cried buckets.
There is something about freedom
Which I will see soon

To Evelyn

Ever since I found out that Evangeline and Esther are down with schizophrenia, I feel very much indebted to my eldest daughter, Evelyn. Even though I have tried very hard all these years to be a responsible mother, I seem to have neglected Evelyn in many ways. All my attentions were on the twins.

Being always filial and understanding, Evelyn never complained. But deep down I know she does need my care and concern as much as Evangeline and Esther do. Evelyn, Mum hope you can really forgive me and understand that despite the fact I have put in more time to look after her sisters, Mum love you just as much.

Thursday, February 28, 2008

A Brief Introduction To Schizophrenia -- Treatment

Treatment

There are two main aspects in the treatment of schizophrenia, namely medication and psychosocial treatment.

Medication

In the treatment of schizophrenia, there are different therapeutic options:

Ÿ Older, so called conventional antipsychotics
Ÿ Newer, so called atypical oral antipsychotics
Ÿ Long-acting atypical medication

Consistent taking of medication can allow a person with schizophrenia to lead a relatively normal life.

However, many patients with schizophrenia do not take their medication regularly. By taking a pause in the treatment the schizophrenia symptoms can come back. Research has shown that about 75% of people with schizophrenia relapse within a year to 18 months if antipsychotic drug therapy is stopped or taken inconsistently. Relapses are to be avoided, as they will lead to a new confrontation with the disorder, a further loss of social contacts and likely it will get worse every time.

Side effects of antipsychotic medication

Like virtually all medications, antipsychotics are not always free of unwanted effects along with their beneficial effects. Drowsiness, restlessness, muscle spasms, weight gain, tremor, dry mouth or blurring of vision are not unusual in the early phases of drug treatment. Most of these can be corrected by lowering the dosage or can be reduced by switching to another medication. Different patients respond differently to treatment and experience different side effects when taking antipsychotic drugs.

Psychosocial treatment

Medication alone is not a treatment. Schizophrenia patients often find it difficult to find or hold on to a job. Psychosocial support allows patients to build up social contacts, motivation or daily care. It generally focus on improving social functioning, be it in the hospital or in the community, at home or at work.

Ÿ Rehabilitation: rehabilitation programs focus on social and occupational training. Programs may include help in improving job skills, money management skills, use of public transport, social skills or problem solving skills. These training programs are especially important in a community-centered approach, supporting schizophrenia patients to lead their lives outside the hospital.

Ÿ Individual psychotherapy: In psychotherapy you have regular talks with your physician, psychologist or social worker. The sessions may focus on current or past problems, experiences, thoughts, feelings, or relationships. By sharing experiences with a person who has knowledge about schizophrenia, you may gradually gain a better insight in your situation and your mental problem. You will probably also feel supported, which can encourage you to overcome the difficult aspects of your condition. Family intervention: It is very important for caregivers to learn all they can about schizophrenia and its particular problems. For families experiencing difficulties in coping with the disease, family “psycho-education” may be an advisable solution. In this type of education caregivers are thought various coping strategies and problem-solving skills. This may help families deal more effectively with the condition of their relative.

Reference
Janssen Pharmaceutica, NV - Turnhoutseweg 30, 2340 Beerse, Turnhout RPR nr.0403.834.160 © Janssen Pharmaceutica, NV 2008 Last updated on 26 Jul 2007 http://www.janssen-cilag.com/
Why do we have to go school? I don't like school. The people are always staring at me, laughing at me, gossiping about me. Today I overheard Cassandra and her gang's conversation, saying that I am an idiot, laughing at my actions. They thought that I can't hear them but I can hear them perfectly well. They must be devising some evil plan to embarrass me tomorrow but I will not let them do that. Everybody in the school is laughing at me! As I walk along the corridor, the people are always laughing, laughing at how fat I am, laughing at how I walk. I don't like these people.
Lessons are so boring! The teacher just rattles off about things that I don't understand. I slept during most of the lessons or just stare blankly into space. I told mum that I don't want to go school but she says that it is important to me. What's so important about school?

Wednesday, February 27, 2008

My Little Princesses

The proper function of a man is to live, not to exist. – Jack London

I never called my twins schizophrenic. I want my daughters to live a life just like everybody else does, with meaning and hope. To me, they are no different.

However to others, they are different.

Evangeline and Esther have to take medication on a daily basis. This is important in controlling the symptoms and eventually reaching the stage of remission whereby the symptoms will be so mild that they can literally lead a more or less normal life, or else they can relapse very fast.

But with Evangeline and Esther’s conditions, it is hard for them to keep up with the daily medications on their own. They tend to forget about it and sometimes even have difficulties in remembering whether they have taken it or not. So I will always keep pillboxes marked with the days of the week so as to help them as well as myself to keep track of medication schedules. This turns out to be useful most of the times.

Not surprisingly, they are uncomfortable with taking medications everyday. Their classmates often laugh at them. They are like labels which mark them as sick, different, abnormal, laughing stocks, weird… All these are too much for them bear. So once in a while they will refuse to take medications. And as a result of poor compliance, symptoms such as delusion and hallucinations resurface again. It is really heart-breaking for me to look at them suffering and find myself could do nothing about it.

Also, medications give them side-effects. The antipsychotic drugs they are taking now cause them to experience drowsiness, restlessness, muscle spasms, weight gain, tremor, dry mouth and blurring of vision. Though the effects reduce after lowering the dosage, but the problem with weight gain is really bad. Evangeline has gained almost 6 kg after one year of taking the drug. I am afraid that this may affect her health by increasing the risk of heart disease or diabetes. There are other health problems which are associated with excessive weight, such as lower back pain, cancer or breathing problems, I have read about in books. So currently, I am looking for suitable alternative drugs which may help to reduce the side-effects on them.

To an outsider, Evangeline and Esther are introverted and withdrawn despite the fact that they seem to enjoy each other’s company. Even though medication has helped to put their symptoms under control, it does not help to improve their social skills. They show a lack of interest in almost everything around them. Having to live in the hospital once in a while and being very much taken care of, they sometimes find difficulties in doing simples things such as boarding a public bus and ordering food. But they are sixteen now, and I am worried about their future if this continues.

In order to improve this condition, I often bring them out on weekends for family activities, like picnic and shopping trips, so as to expose them to the outside world where on one knows about their illness. This makes them to feel just like normal individuals and apparently they enjoy it.

I do not expect Evangeline and Esther to achieve great things in life. As long as they can enjoy life to the fullest, I am happy.

A Brief Introduction To Schizophrenia -- Diagnosis

Diagnosis

Diagnosing schizophrenia is difficult as there is no single symptom which is unique to the disorder. There are no tests that can positively identify schizophrenia in a person. Therefore, the diagnosis depends on excluding other causes that may bring about schizophrenia-like symptoms, such as: substance misuse, epilepsy, brain tumours and thyroid dysfunction.

There are two major systems currently used for the diagnosis of schizophrenia, the Diagnostic and Statistic Manual of Mental Disorders and the International Classification of Disease. These classifications have the effect of improving inter-rater reliability but they do not make diagnosis an objective activity.

Diagnostic & Statistical Manual of Mental Disorders (DSM-IV) Criteria for Schizophrenia:

A. Characteristics of Symptoms: two or more of the following, each present for a significant portion of time during a one month period (or less if successfully treated):
Ÿ Delusions
Ÿ Hallucinations
Ÿ Disorganised speech (e.g. frequent derailment or incoherence)
Ÿ Grossly disorganised or catatonic behaviour
Ÿ Negative symptoms, i.e. affective flattening, alogia or avolition
(Note: Only one "A" symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behaviour or thoughts, or two more voices conversing with each other).

B. Social/Occupational Dysfunction: for a significant portion of time since the onset of the disturbance, one or more major areas of functioning, such as work, interpersonal relations or self-care is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic or occupational achievement).

C. Duration: continuous signs of the disturbance persist for at least six months. This six month period must include at least one month of symptoms that meet criterion A (i.e. active phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of disturbance may be manifested by only negative symptoms or two or more symptoms listed in criterion A present in an attenuated form, e.g. odd beliefs, unusual perceptual experiences).

Exclusion Criteria: the remainder of the criteria (D-F in the DSM-IV text) specify that the signs and symptoms above are not better accounted for by another disorder, either psychiatric (i.e. mood disorder, schizoaffective disorder or pervasive developmental disorder), substance abuse (e.g. amphetamine intoxication or withdrawal) or a general medical condition (e.g. hyperthyroidism).

International Classification of Disease (ICD-10) Criteria for Schizophrenia:

Either at least one of the syndromes, symptoms and signs listed below under (1) or at least two of the symptoms and signs listed under (2) would have been present for most of the time during an episode of psychotic illness lasting for at least 1 month.

1. At least one of the following:
Ÿ Thought echo, thought insertion or withdrawal and thought broadcasting.
Ÿ Delusions of control, influence or passivity, clearly referred to body or limb movements or specific thoughts, actions or sensations, and delusional perception.Hallucinatory voices giving a running commentary on the patient's behaviour or discussing him/her between themselves or other types of hallucinatory voices coming from some part of the body.
Ÿ Persistent delusions of other kinds that are culturally inappropriate or implausible, such as religious or political identity, superhuman powers and ability etc.

2. At least two of the following:
Ÿ Persistent hallucinations in any modality, when accompanied by either fleeting or half-formed delusions without clear affective content or by persistent over-valued ideas or when occurring every day for weeks or months on end.
Ÿ Breaks of interpolations in the train of thought, resulting in incoherence or irrelevant speech or neologisms.
Ÿ Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor.
Ÿ Negative symptoms such as marked apathy, paucity of speech and blunting or incongruity of emotional responses (these usually result in social withdrawal and lowering of social performance). It must be clear that these are not due to depression or neuroleptic medication.
Ÿ A significant and consistent change in the overall quality of some aspects of personal behaviour, manifest as loss of interest, aimlessness, idleness, a self-absorbed attitude, and social withdrawal.

Exclusion Criteria: The ICD-10 criteria specify that schizophrenia should not be diagnosed if the symptoms are better accounted for by a mood disorder, 'overt brain disease' or drug intoxication or withdrawal.

References:
Adapted from http://www.sfnsw.org.au/schizophrenia/diagnosis.htm. SFNSW Inc...Locked Bag 5014 Gladesville NSW 1675...ph: 02 9879 2600...fax: 02 9879 2699...Email: admin@sfnsw.org.au

Tuesday, February 26, 2008

A Brief Introduction To Schizophrenia -- Symptoms

Symptoms

By reading through some of the causes of schizophrenia in the causes section, you may have gotten an inkling of the symptoms of the disorder.

So now let us watch a video clip on the common symptoms of schizophrenia. In this clip, some of the way of diagnosis and treatments can also be found.



The symptoms of schizophrenia are often divided into two groups:
Ÿ Positive symptoms: excesses or distortions of normal mental functions, e.g. hallucinations and delusions
Ÿ Negative symptoms: a loss or reduction of normal functioning and are more difficult to evaluate because they may be influenced by a concurrent depression or a dull and unstimulating environment, e.g. apathy and poverty of speech

Positive symptoms

Ÿ Hallucinations: They are often being described by family and friends as a wild imagination. The perceptions are sensory and involve sound, sight, touch and smell. Hearing voices is the most common type of hallucination in schizophrenia patients. The voices may describe the patients' emotions or activities, carry on a conversation, warn of dangers or even tell the patient what to do next.

Ÿ Delusions: People who experience delusions are convinced that their opinions and beliefs are real, despite evidence to the contrary. About one third of patients suffer from paranoid-type symptoms and often have delusions of persecution or suffer from irrational beliefs that they are being cheated, harassed, poisoned, or conspired against.

Ÿ Disorganised thinking: Schizophrenia often affects a person's ability to think straight. Thoughts may flash by; concentration is difficult and the patient is often easily distracted, unable to focus his/her attention. People with schizophrenia often find it difficult to decide what is or is not relevant to a situation. They are unable to connect thoughts into logical sequences and their thoughts become disorganised and fragmented. This lack of logical thought process, called thought disorder, can make a conversation very difficult and result in social isolation.

Ÿ Agitation: Schizophrenia patients are often extremely agitated.

Negative symptoms

Ÿ Lack of drive or initiative: A distinct lack of drive or initiative is often observed in patients. They seem to have lost their enthusiasm or interest in things.

Ÿ Social withdrawal: People with schizophrenia tend to become isolated and often prefer their own company and avoid contact with others. When forced to interact, they often have nothing to say.

Ÿ Apathy: Often people with schizophrenia appear totally indifferent to their surroundings and are not interested in taking part in things. Motivation can decrease significantly, as can interest in or enjoyment of life. In severe cases, a person can spend entire days doing nothing at all, even neglecting basic hygiene.

Ÿ Emotional: unresponsiveness or blunting People with schizophrenia often display blunted or flat emotions. They suffer from severely reduced emotional expression and may not be able to show normal emotions. For example, they may speak in a monotonous voice, show little facial expression and appear extremely indifferent.

Reference:
Janssen Pharmaceutica, NV - Turnhoutseweg 30, 2340 Beerse, Turnhout RPR nr.0403.834.160 © Janssen Pharmaceutica, NV 2008 Last updated on 26 Jul 2007 http://www.janssen-cilag.com/