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Information on Schizophrenia and Support Services

Allan Schwartz, LCSW, Ph.D.

This article will address two main issues with regard to schizophrenia: I. It's symptoms and II. Where best to live.

I. It has been said that "schizophrenia is the great equalizer." It does not discriminate against race, religion, ethnicity, geographical area, social status, education or wealth,  money and power. People from all walks of life can and do fall to the sickness called schizophrenia. In most cases, the result if poverty. Those afflicted with this illness become unwanted by their families who often reject them because they find them to be too burdensome. They are unable to work and earn a decent living or afford to live in nice places. In other words, schizophrenia is a tragedy.

The estimates are that one percent of the world population develops this mental illness. Also, one percent of those with this psychosis commit suicide.

Today, large numbers of people with schizophrenia become drug abusers and that serves to further exacerbate their symptoms and undermine their medications.

There is no doubt that Schizophrenia is one of the most baffling and frustrating of all the illnesses that beset the human race. The reasons are that there is still no way to cure or even prevent this illness. It is not even clear what the causes might be. More research is being done and more is learned everyday. Despite this, there is still no way to ward off the onset of the illness.

Schizophrenia is also a sickness that affects every aspect of a person's life, from the way they think, perceive and experience things in sensory motor ways. It interferes with a person's functioning to the point where they lose touch with the real world and, with that, become unable to distinguish what is reality from what is imagined.

First and foremost, all the experts agree that schizophrenia is a disease of the brain. The human brain is an incredibly complex organism that is made up of ten billion neurons or nerve cells. Each of those ten billion neurons have dendrites or long hair like structures that end in an empty space called a synapse. Across that synapse lie the hair-like dendrites of other neurons. Messages are carried along these ten billion neurons and these messages and their safe arrival at the correct part of the brain is essential to our ability to hear, see, feel, taste, touch and smell. All of this information allows us to perceive or experience the real world. We then "think" and those thoughts are carried back along those dendrites. The "thought messages" may tell mouth what to say, or the arm or legs how to move and where to move to. If something goes wrong in this system our ability to function suffers.

Let us return to each one of those ten billion neurons with each one ending in dozens of hair like dendrites. You see, the messages that travel must move along the neuron until they reach one of the dendrites. Then, a chemical liquid is squirted into the space between the dendrites. The message, which is electrical, basically swims along the tiny puddle of liquid in the synapse until it reaches the next neuron on its journey to the part of the brain whose job it is to decipher the message (and I am not being really accurate just for clarity).

That liquid, in which the electrical message swims from neuron to neuron, is called a neurotransmitter. If you stop and think about it the entire thing is amazing. There are ten billion neurons. Each one has dozens of dendrites. Each dendrite is located in a synapse and there are trillions of synapses and each synapse becomes temporarily filled with a neurotransmitter that must be reabsorbed once the message goes through and all of this happens all day and within an instant, a milli, milli second. It means that our heads, our brain, is awash in these chemicals. All we need is a slight error and we do not feel well.
 
Do you wonder why so many of us, if not all of us, suffer some type of mental illness at least once during our lives? Wow.

In schizophrenia, things go wrong not only with the neurotransmitters but in the ways in which the very neurons themselves are structured. In other words, the system of brain communication with the body and back again is distorted by errors among the neurotransmitters and the ways in which many neurons are misshapen.

Schizophrenia usually begins between the 17 and 25 years of age. There are examples of its starting early in childhood or later in life. There are usually early symptoms for as early as two years before the first episode of this disease.

There are two major types of symptoms experienced by people with schizophrenia. They are referred to as Primary and Secondary symptoms.

1. Positive symptoms are delusions and hallucinations.

Delusions are unreal thoughts that plague the imagination of the individual with the disease. They may believe that someone is trying to poison, shoot, talk about, plot against or harm them.

Hallucinations are sensory experiences that are outside of what other people experience because they are not real. For example, if I have a delusion that we are being invaded by aliens from Mars, I may actually hallucinate or hear reports on the radio and see things on the television about this Martian invasion.

In addition to delusions and hallucinations, patients experience other positive symptoms such as Disordered thinking and extreme Agitation.

Anti psychotic medications do a good job of relieving agitation, reducing or eliminating hallucinations. However, delusions tend to remain intact although less intense, depending on the individual.

2. Negative symptoms.

While anti psychotic medications help to reduce the level and intensity of the positive symptoms of this disease, the negative symptoms are much more stubborn.

These secondary symptoms include: Lack of drive, apathy, social withdrawal and isolation, and emotional bluntness or flatness.

A brief note on medications:

Thus far, even the newest anti psychotic medications have very distressing side effects for patients. Some of these side effects are dangerous because they seem to cause diabetes, blood pressure, heart functioning and the reflex system. The older medications cause various types of twitching and drooling when administered for a long time and at high doses. All of this had made compliance with medications difficult. Yet, without medications patients slip quickly away into psychosis with all of its dreaded symptoms.

Each patient and patient's family needs to address medication questions and concerns to the treating psychiatrist for the most reliable answers since each case is quite different.

II. Where to Live?

One of the most difficult situations faced by families and patients is where to live. Families often become "burn out" in their attempts to help those members who have this sickness. Most often it is better for all concerned if the person with this psychosis lives in some type of supervised residence for the mentally ill. There are those cases in which the patient is married and can live at home with their spouse.

The best source of information about residential facilities for those with severe mental illnesses are the treating psychiatrists. However, there are additional sources of information. The following is a list of the types of residences available followed by resource information:

Types of residences for the mentally ill:

1. Independent Living: in a subsidized apartment or using federal aid for rent

2. Supervised apartment: Clients share their own apartment, or share an apartment with one or two other clients. Staff members are on call to assist you, and they stop by routinely to see how you're doing.

3. Home-share: A client shares a home with several other clients. The case manager visits at the home and helps with anything.

4. Foster care: Client lives with a family that has received training and support in providing a place to live for a person who has a mental illness disability.

5. Community care home (group home): This type of group living arrangement serves only people with mental illness disabilities. Professionals and trained staff are available on the premises to assist you.

6. Halfway house (group home): This arrangement is particularly helpful for a patient with a dual diagnosis of addiction and mental illness. Professionals at the halfway house offer help to the resident needing assistance with this type of dual recovery.

7. Boarding home (group home): Clients share a home with other clients, and people are available to assist. This type of housing is different from a "community care home" in that the people who are available to assist are not mental health care professionals. However, they have received training to assist people with mental illnesses.

8. Clubhouse: The participants are called "members" instead of "patients" and the focus is on their strengths and not their illness. They work in the clubhouse, whether it is clerical, data input, meal preparation or reaching out to their fellow members. This is seen as the core to the healing process. One of the most important steps members take toward greater independence is transitional employment where they work in the community at real jobs. Members also receive help in securing housing, advancing their education, obtaining good psychiatric and medical care and maintaining government benefits. Membership is for life and members have all the time they need to build their new life in the community.

9. Residential treatment facility (group home): This is another type of group living arrangement that treats people with disabilities caused by mental illnesses. A large staff of professionals is available, and people usually stay in this type of facility for long periods of time. Clients attend classes or workshops to learn skills to become more independent.

10. Temporary respite bed: This temporary living arrangement is available for people having a crisis. Staff members are available to help clients through the crisis period.

11. Nursing home: This type of facility offers 24-hour care and is staffed by physical and mental health professionals. The client using this type of service is generally the elderly mental health patient.

Resource links to housing and aid programs:

1) Mental Health America's list of Federal programs providing housing aid for people with disabilities to live independently in the community.

2) The Fountain House is the original Clubhouse for the mentally ill, founded in New York and now with 250 centers in 43 states. Fountain House has programs for housing, education, outreach, advocacy, social and recreational activities.

3) There is an International Directory of Club Houses.

4) The local NAMI (National Alliance for the Mentally Ill) chapter or support group will have some useful resources in each geophraphic area.

5) The local Public Housing Authorities (found listed under county or city offices in the government pages of the phone book) are responsible for allocating Federal funds for low-cost and subsidized housing. They will know what is available in the area.

6. http://www.Schizophrenia.com is an extremely helpful source of information and support for family members. They provide information that answers the most common questions.

One article cannot provide all the answers. However, the lists above are a way to get started for all of those struggling with schizophrenia, whether the patient or the family.

Your questions and comments are welcome.

Allan N. Schwartz, PhD.




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