By Dr. Pakha Tesia
World Mental Health Day is observed on 10th October every year, with the primary objective of increasing awareness about mental health issues and mobilizing efforts in support of mental health.
Mental health refers to the broad range of activities related towards ‘mental well-being’ which is an important component in the World Health Organization (WHO) definition of health: “A state of complete physical, mental and social well-being, and not merely the absence of disease”. It is related to the promotion of well-being, the prevention of mental disorders, and the treatment and rehabilitation of people affected by mental disorders. Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.
This Day provides a unique opportunity for all stakeholders working on mental health issues to talk about their field of work, and what further needs to be done to make mental health care a reality for people worldwide. It also involves addressing the issues of stigma and false perceptions associated with mental illness.
The theme for this year 2014 is “Living with schizophrenia” and the focus is on living a full, productive and healthy life with schizophrenia. The spot light is on those who face every day of their lives with it, their families, friends, doctors and society as a whole, as we all have a part to play in raising awareness of schizophrenic illness.
According to the WHO, 26 million people are affected globally with the disorder, and majority of the patients (90%) with untreated disorder live in the Developing countries. Despite being a treatable disorder, more than 50% of people with schizophrenia cannot access adequate treatment.
Schizophrenia is a mental disorder often characterized by profound disruptions in domains of thinking, feeling, beliefs and behavior. Schizophrenia typically begins around 15- 25 years of age, however it can present for the first time in middle age or even later. Persons with Schizophrenia have difficulty with reality judgment and key symptoms include- feeling fearful, hearing voices talk about oneself, feeling suspicious against others including family members, abnormal beliefs like black magic, behaving oddly- talking or laughing to oneself, sudden anger and aggression, disinterest in day to day activities, unable to perform daily routine activities like going to school/college/work. Sleep and appetite disturbances are also common. Schizophrenia is a heterogeneous disorder and there are many clinical sub-types of Schizophrenia like Paranoid, Catatonic, Disorganized type depending on the presence of a set of symptoms. Gradual deterioration occurs in self- care, attitude towards others and enduring personality changes.
Schizophrenia patients have a higher risk of developing cardiovascular illness commonly diabetes and hypertension; and around 50% of patients show excess use tobacco and alcohol. Depression and suicide attempts also have a higher incidence among persons with Schizophrenia
Schizophrenia is a treatable disorder and help can be sought in a General Hospital Psychiatry Unit or at a Mental health care facility. Diagnosis of the disorder is done using diagnostic tools like the WHO- ICD 10 (WHO- International Classification of Diseases) or Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Evaluation process involves adequate clarification of the history from the family member/caregiver and detailed mental status examination of the patient.
Treatment of Schizophrenia is primarily anti-psychotic medication which acts on the brain dopamine receptors. The commonly used anti-psychotic medications are: Olanzepine, Risperidone, Quetiapine, Amisulpiride. In acute psychotic conditions, Electro convulsive therapy (ECT) is an effective option. Family psycho-education is an important aspect of therapy, which involves engaging the caregivers towards understanding Schizophrenia, its symptoms and course; factors implicated in development of the disorder i.e. genetic, environmental, stress and neuro-chemical imbalance. Also information is provided about the treatment modalities and relapse risk factors. Schizophrenia Psycho-education has been shown to improve caregiver understanding, coping and reduce their burden of care. Individual need based interventions include- Cognitive behavior therapy, cognitive retraining and Occupational Rehabilitation.
The treatment setting for patients with Schizophrenia may vary according to the clinical severity, co-morbidity and need of a given patient. The most common setting is the Outpatient clinic. Severe cases with acute psychosis benefit from Inpatient care and monitoring. Chronic sufferers benefit from Psychiatric Rehabilitation centers which are an important community resource for the mentally ill. Early diagnosis and good compliance to treatment are cornerstones towards predicting a good patient outcome.
Unlike the West, in India the family is the key resource for taking care of mentally ill persons. The reasons for this are twofold- Indian families are traditionally close knit and interdependent especially in times of adversity. The second reason is the paucity of mental health professionals to cater to the vast majority of population. Large scale international collaborative studies conducted by the WHO have established that persons with Schizophrenia have a better outcome in India than their Western counterparts and much of this is attributed to good family support towards these patients. Thus, the role of family members and society at large cannot be over emphasized as limited mental health resources make most persons depend on family members for their treatment and care. Regular follow up, medicine supervision, social support groups, productive lifestyle all help towards improving the quality of life of persons with Schizophrenia. Early identification of changes in behavior especially among young adults and early use of antipsychotic medication treatment are an important goal in the awareness about Schizophrenia
In clinical practice, the common treatment challenges include dealing with stigma, denial and lack of awareness about mental illness in general. Even after an initial response to medication many patients suffer from poor adherence to treatment which leads to prolonged illness with increased family and social burden.
In summation let us pledge to provide support and care to those with mental illness; because when the ‘I’ is replaced by ‘We’- Illness becomes Wellness.
(Dr Pakha Tesia is Consultant PsychiatristMD (NIMHANS, Bangalore) FIPS (Indian Psychiatric Society) Meghalaya)