“Schizophrenia: A Debilitating Psychotic Illness and the Role of Palliative Medicine and Care in its Management”
Internal Medicine, Dow University of Health Sciences · Karachi, Pakistan
Submission: September 16, 2019; Published: September 20, 2019
*Corresponding author: Tehzeeb Sialvi, Internal Medicine, Dow University of Health Sciences · Karachi, Pakistan
How to cite this article: Tehzeeb Sialvi. “Schizophrenia: A Debilitating Psychotic Illness and the Role of Palliative Medicine and Care in its Management”. Palliat Med Care Int J. 2019; 3(1): 555603. DOI: 10.19080/PMCIJ.2019.03.555603
The word schizophrenia originated from two Greek words that mean ‘to split’ and ‘the mind’. It is a chronic and serious mental disorder that encompasses a great deal of the knowledge of psychiatric diseases. A key symptom of this illness, among others, is ‘the loss of insight’ which disorientates and detaches the person suffering from schizophrenia, from the daily life happenings and makes him/her indifferent to the reality including the awareness of his illness.
Schizophrenia has been a matter of debate for decades now. Psychiatrists, psychologists, psychoanalysts and other medical professionals have proposed various theories and given diverse explanations regarding the course, severity and prognosis of this disease. Factually, no definitive cure for schizophrenia yet has been devised; the palliative management being carried out through the prescription of certain medications and counseling the patient according to the biopsychosocial model. The average life-span of a schizophrenic is 15-20 years less than a normal individual, in my opinion, reason being the inadequacy and ineffectiveness of the palliative measures employed for this illness.
Among the medicines given for the symptomatic relief of this disorder, antipsychotic medications are the most commonly prescribed. The patient is given life-long treatment with these drugs, even if the symptoms subside. Not to ignore the serious adverse effects of antipsychotics, due to which these drugs are prescribed in the lowest possible doses; one of the many reasons of the unavailability of adequate palliation for all forms of manifest psychosis. The lack of patient compliance and in certain settings, the insufficiency of care-takers that make sure the medications are given on time, are also the factors which contribute in worsening the prognosis.
Another management option is the CBT i.e., Cognitive Behavioral Therapy which is a type of psychotherapy or talk therapy and aids in changing and influencing the thought pattern and emotions of a person with schizophrenia in a positive way. The patient is offered social, behavioral and occupational counseling, the goal being enhancement of his/her cognitive function and elevation of the role in society. This therapy yields great outcomes especially in early stages, yet is not hundred percent effective. The absence of insight in a psychotic patient makes it difficult to comply him to visit a psychiatrist and/or follow the doctor’s advised steps of management.
Another important issue to be mentioned here is that, for centuries, mental health problems have been regarded as a social stigma; people hesitating to talk about psychiatric disorders or attributing them to superstitious beliefs and supernatural phenomena, has been a common practice for years. As the era advanced, the societal approach towards these illnesses became a lot better, however, there are still some people around the world that hold weird and unreal explanations on the same. This ignorant approach towards and the lack of awareness about mental health issues and scanty knowledge on the urgent need and appropriate means of resolving them, is a hurdle in the way of treating schizophrenia, in my view. The delay in management worsens the condition and makes the prognosis even grave.
Coming towards the late stages of schizophrenia, where the above mentioned palliative measures are of no use, the last available resort is ECT i.e., the electroconvulsive therapy. It employs the passage of electric current through the brain to induce a seizure t. Previously, ECT was a hazardous procedure causing pain and discomfort to the patient. However, recent advances have introduced the use of anesthetic and muscle relaxant during ECT that have made it a safe and controlled procedure. It does have its side effects; retrograde amnesia being the most dreaded one. ECT can prove to be the cause of long-term deterioration in memory. It helps in easing the symptoms yet is highly underutilized. Even if it is used, schizophrenia cannot be completely reversed from such a late stage.
This sums up the reasons of inadequate palliative management options for schizophrenia along with no absolute cure. Psychosis is hence a chronic, debilitating illness that never leaves, despite all the advances in its treatment.