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An Unquiet Mind

Dr Hazli Zakaria   Psychiatrist and Senior Lecturer, University Kebangsaan Malaysia Medical Centre

Prof Dr Ahmad Hatim Sulaiman   Department of Psychological Medicine, Faculty of Medicine, University of Malaya

Azman (not his real name) seemed to have it all. He was an intelligent student who had just received a scholarship to study abroad, a good athlete with a solid extracurricular activity record and he was popular with his friends.

His behaviour changed abruptly one day, when he started hearing voices. Azman withdrew from his friends and family, claiming that they could hear his thoughts and he did not like that. He refused to leave his room, neglected his personal hygiene and became aggressive when he felt provoked.

Azman’s family could only believe that the young man had to be a victim of a bomoh’s curse, presumably from a rival jealous of his popularity and success. They spent considerable amounts of money seeking bomoh after bomoh to cure Azman, but to no avail.

According to Dr Hazli Zakaria, a psychiatrist with a keen interest in schizophrenia, Azman’s story is a common one. Many Malaysians still do not view mental disorders such as schizophrenia to be a medical condition, often instead associating such conditions with invisible or abstract elements (curses, spiritual possession, etc). Therefore, they turn to traditional healers whose methods may not work.

It is a kind of tragic irony that modern medicine already has a pretty good approach to managing and medicating schizophrenia, and people such as Azman may be able to lead a reasonably normal life if they had found proper medical treatment sooner.

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Making sense of schizophrenia

Schizophrenia is, according to Dr Hazli, a disease of the brain. It is a highly prevalent disease that can affect anyone.

When someone develops schizophrenia, he or she usually exhibits the following traits:

  • Hallucination. The person sees or hears people or things that do not exist.
  • Delusions. The person adopts beliefs that seem far-fetched and unfounded in reality, such as a belief that their parents or friends are trying to harm the person.
  • Changes in behaviour. The above would cause the person to exhibit behavioural changes, such as showing lack of interest in something he or she normally enjoys and becoming more withdrawn.

To date, we do not know yet the exact causes of schizophrenia. The causes could be biological in nature, such as family history or abnormalities in the brain. Stress and drug may also be possible triggers for this disease.

What we do know is that people may show symptoms even later in life, and what happens, such patients may be subjected to many hurdles that prevent them from seeking proper medical care. These hurdles usually stem from misconceptions and a poor understanding of the disease.

Nothing supernatural or shameful

Dr Hazli shares four facts about schizophrenia that every Malaysian should know.

  1. It is just like diabetes, heart disease and a broken leg – one can live with schizophrenia and recover from it.
  2. Recovery is an ongoing process, as treatment will help the person stabilise his or her mental state and fit in with the rest of society.
  3. There may be periods when the person may experience symptoms again (relapses), and it is important that the person seek proper medical care when this happens.
  4. Family and friends of the patient should learn more about this disease, so that they can support the patient on the road to recovery.  

Dr Hazli encourages families of people showing symptoms of schizophrenia to consult a psychiatrist, so that appropriate care and medical attention can be given to the patient as early as possible.

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Peace for the troubled mind

Azman eventually sought treatment with University Malaya Medical Centre, and in time, he recovered. He was placed in the psychiatric ward and was given oral medications for his symptoms. After a week, he showed signs of recovery and was discharged.

His doctor continued to monitor Azman after his discharge. In the first 3 months, the young man behaved normally, and all seemed well.

Can one get better?

According to UK’s Royal College of Psychiatrists, for every five people who develop schizophrenia:

  • 1 person will get better within 5 years.
  • 3 people will get better, but there are still some symptoms and possible relapses in the future.
  • 1 will continue to show troublesome symptoms.

According to Prof Dr Ahmad Hatim Sulaiman, it is not true that someone with schizophrenia will experience worsening cognitive function over time. Most patients will achieve a reasonably stable remission of symptoms and, subsequently, substantial levels of satisfaction and happiness in their life.

Treatment of schizophrenia has two main objectives – to help the patient stabilise his or her current mental state, and to prevent future relapse.

Antipsychotic medications are often prescribed to help control the symptoms. They work by blocking the effects of a chemical called dopamine in the brain. Depending on the patient’s condition, he or she may be prescribed a combination of different antipsychotic medications.

Additionally, the patient will also be asked to attend therapy sessions, during which his or her progress would be reviewed. There would be advice and support given to help the patient recover and make steps to fit in again among society.

Throughout all of this, the patient will be working with a team from various fields and disciplines, such as psychiatrists, psychologists, mental health nurses and even social workers.

On treating the patient, Prof Dr Ahmad Hatim Sulaiman stresses that it is a group effort. Both the family and the healthcare team need to work together to ensure that the patient recovers and stabilises.

This is especially important to prevent relapses, he adds.

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When a relapse happens

In Azman’s case, all seemed well for the first 3 months, but he eventually stopped taking his medications, as he believed that he had completely recovered. His family had stopped monitoring his medications at that point. Thus, Azman suffered a relapse.

The symptoms came back, this time much worse than before, and Azman had to be admitted to the ward again. His second stay required medications that had to be delivered through a drip (intravenously), and he stayed in the ward for 3 weeks. His medication was also ‘upgraded’: he now has to take his medication via injection once every month.

To this day, Azman continues to take his medication. Things are looking up again. He found a job as a cashier, and he could start supporting himself instead of relying on his family. His confidence is improving as a result.

“He recently told me he’s found the courage to ask a colleague out for a date. He’s confident that she is ‘the one’,” Dr Ahmad says with a smile.

As Azman’s story demonstrates, one of the main reasons for a relapse is the discontinuation of medication. More than 70% of patients who experience a relapse within 1 year after the first episode also stopped taking their medications. Additionally, the risk of hospitalisation increases sharply with the number of times the patient misses therapy.

As Dr Ahmad says, recovery is just half the battle won, not the end game. He, therefore, advises the following for families who are supporting a loved one with schizophrenia:

  1. Continuously supervise and make sure that the person is taking his or her medication; medications should not be stopped without the approval of the healthcare team.
  2. Help the person attend therapy sessions.
  3. Offer the person emotional support whenever necessary. A counselor can help if a family needs guidance or advice in supporting this person.
  4. Encourage the person to lead a healthy lifestyle, and to avoid habits such as drug-taking that can worsen his or her condition.

Finding the quiet room

It is an unfortunate fact that many people with schizophrenia all over the world suffer without proper care or treatment. Sometimes, they are even abandoned by their families to fend for themselves on the streets.

Both Dr Hazli and Dr Ahmad assure us that schizophrenia is nothing to be ashamed of. Families should understand that it is a mental condition that can be treated; the person with schizophrenia, with proper treatment and support from his or her loved ones, can have a chance at living a reasonably well-adjusted life and find happiness in the process.

“If you know someone showing symptoms that may be those of schizophrenia, bring him or her to a psychiatrist,” advises Dr Hazli.

“The earlier the person receives proper treatment, the better the chances of recovery are,” adds Dr Ahmad as he concurs with Dr Hazli’s statement.

People with schizophrenia are not ‘gila’ – they can heal, if only we give them a chance to do so.

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