December 8, 2013

Schizophrenia

In the popular mind, there is often a misidentification of schizophrenia with dissociative identity disorder, known to the general public as multiple personality. These are two quite distinct conditions. Let me illustrate from my own experiences. First, schizophrenia.

In Toronto some years ago, a friend, Donna, was having serious problems at work.  I suddenly realized what her problem was when she explained a minor car accident.  The police did not want her going to Hamilton.  Donna was a court reporter.  Her psychotic break occurred at work.  She was transcribing a disciplinary hearing for the Upper Canada Law Society.  Suddenly, she began interrupting the proceedings.  She thought she was on trial.

I took her to Women’s College Hospital to try to get her admitted.  I sat with her during the nurse’s triage interview.  When asked what the problem was, Donna started rambling on about being a free spirit.  The nurse did not see much point in all of this and was about to send her home, when I said to the nurse, “Let me help you.”  “Donna, who is after you?”

“The licensing body.”

“And the police?”

“Yes.”

“And the church?”

“Yes.”

“I’m beginning the get the picture,” said the nurse.  Donna was admitted.  The psychiatrist spoke to me and said that it was a good thing she was hospitalized, as she was suicidal.  When asked her about that, she replied, “Yes, if they continue saying those things about me.”

Multiple personality (or dissociative identity disorder) is something quite different.  I had a client who had a confusing story about different SIN cards as well as supposed half-siblings who were interfering in her life.  The hard clue was her tale about an incident at the pharmacy.  She left her prescription to be filled, and when she returned later that day to pick it up, the pharmacist was puzzled.  “You were just by earlier to pick it up.”

As you can see, these are very different conditions.  Recently, Quebec’s Schizophrenia Society held a one-day seminar in Gatineau for professionals.  One of the presenters was Dr Pierre Lalonde, a psychiatrist and professor at the University of Montreal.  He began by saying that schizophrenia is a disease of the brain.  Different factors may be causative—inheritance, defects or injuries, and biochemical problems.  They may interact.  Factors in the environment such as a variety of stressors and substance abuse may also play a part.

In defining schizophrenia, Lalonde spoke of positive and negative symptoms.  Positive factors include delusions, hallucinations, disorganized speech, and grossly disorganized behavior.  Negative indicators include indifference, loss of verbal spontaneity, lack of interest, and difficulty remembering.  A person may lose learned skills such as bike riding or typing.  Reasoning is very often deficient. 

Turning again to Donna, after she was released from the hospital I had her over for dinner.  I prepared Spanish rice.  I threw uncooked rice into the skillet, and among the ingredients I added was a can of tomatoes.  Somewhat later she tried to make a similar recipe bud did not add the can of tomatoes or any other source of liquid.  She did not understand why the meal did not turn out.  She was also confused as to when she was to go to her work therapy, arriving on one occasion when the place was closed.

Medicine is an important part of treatment, but it is not enough, as Dr. Lalonde pointed out.  Education of the patient and those close to the patient is important too.  The person needs to understand why it is necessary to adhere to the medical regimen.  Donna told me, “I don’t like this medicine.”  “Yes,” I said, “it’s terrible.  Take it!”  Unfortunately, medicine is primarily effective with the positive symptoms.  To address the full range, it is important as well to use socializing measures such as self-help groups.  Donna felt superior to other people in her group and was not motivated to continue.  Medicine and case management make a powerful combination in assisting patients.

The goal in treatment is rehabilitation.  That is not the same as cure, usually something less.  Sufferers can often become capable of living full and productive lives, even though many need help throughout their lives.  If intervention occurs early in the disease, outcomes are apt to be more positive.