The World Mental Health day is observed on the 10th of October. The events outlined for the celebration offers stakeholders the opportunity to increase the awareness of citizens on mental health matters. The theme for the 2014 edition of the World Mental Health Day is “Living with Schizophrenia”. It is expected that the populace will be better informed about Schizophrenia; in addition advocacy for better management of the condition will be created.
Schizophrenia is a chronic mental disorder that is characterized by a schism in an individual’s thinking, behavior, feeling and actions. There are different subtypes of Schizophrenia but some of the common symptoms include; suspiciousness, unusual thoughts, changes in sensory experiences (hearing, seeing, feeling, tasting or smelling things that others do not experience),disorganized communication (difficulty getting to the point, rambling, illogical reasoning) and grandiosity (unrealistic ideas of ability or talents).
Schizophrenia produces a gradual decline in functioning. The longer Schizophrenia is left untreated the greater the disruption to the individual’s ability to study, work and maintain good interpersonal relationship.
Empirical studies reveal that over 50 percent of people with Schizophrenia live in the developing world. The implication of the latter finding for the most populous Nation in Africa is obvious to all. Furthermore research findings reveal that about one (1) percent of the Global population suffers from Schizophrenia. The World Health Organization in 2011 reported that about 24 million people globally are living with Schizophrenia, and are aged mainly 15-35years.
People living with Schizophrenia die 15-20 years earlier than the general population due to life style issues e.g smoking that affects their physical health. Other physical health issues include the increased risk of cardiovascular disease which has been attributed to the tendency of people with schizophrenia to be overweight, diabetic and hypertensive. Studies in Nigeria show that the latter risk factors mentioned above (metabolic syndrome) is prevalent in Nigerian subjects with Schizophrenia and these findings are consistent in other studies that report the incidence of metabolic syndrome in people with severe mental illness as being 2-3 times greater than the general population. Furthermore other physical health issues arise in patients with schizophrenia due to the abuse of psychoactive substances, thus it is imperative for mental health professionals to identify and manage such conditions in people living with Schizophrenia.
Most individuals with Schizophrenia are unemployed coupled with the fact that payment for health care services in Nigeria is currently mainly by out of pocket payment. Increasing the coverage of the National Health Insurance Scheme will reduce the financial burden associated with the management of Schizophrenia. Provision of rehabilitative services as part of the management will reduce the incidence of unemployment among persons with Schizophrenia. Also it has been reported that about 70 percent of the Nigerian Population live in the rural areas where access to mental health services is lacking. This latter scenario which is an impediment to access to evidence based care by people living with Schizophrenia in Nigeria, can be addressed if mental health services are provided at Primary Health Care Centre’s across the country.
The exact cause of Schizophrenia is unknown it is believed to result from interplay of genetic, behavioural and other factors. A child whose parent has Schizophrenia has about a 10 percent chance of developing Schizophrenia. An identical twin (monozygotic twin) of a person with Schizophrenia has the highest risk(about 40-65 percent chance) of developing the illness. Individuals who have second degree relatives (aunts, uncles, grandparents, or cousins) with the disease also develop Schizophrenia more often than the general population. It is noteworthy that it is not only the patients themselves that live with Schizophrenia, relatives, careers, the society etc also have to live with the condition. Many studies in Nigeria reveal that the burden of Schizophrenia on the family is high. The burden on family members is due to the time they take off work to provide care and support for a family member with Schizophrenia in addition to the financial resources spent and coping with the behavioural syndromes associated with the illness. Organization of family intervention for relatives of people with Schizophrenia has been found to improve the prognosis of the illness. People with severe mental illness like Schizophrenia are more likely to be homeless, unemployed or living in poverty.
Presently a diagnosis of Schizophrenia does not necessarily connote a lifetime of deterioration in personality and slide in socio-occupational functioning.
Schizophrenia can now be better managed using pharmacotherapeutic, occupational therapy and psychosocial interventions, thus patient symptoms can be alleviated resulting in better prognosis (outcome) and improved socio-occupational functioning. Recent studies show that about 25 percent of subjects with Schizophrenia recover fully while 25-35 percent improve considerably and live relatively independent lives,20 percent improve but need extensive support and between 10 and 15 percent do not improve.
Concerted efforts should be made by all to provide evidence based cost effective treatment for patients with schizophrenia and their relatives at the primary, secondary and tertiary levels of health care in Nigeria. People with schizophrenia should be supported with respect to seeking legal redress for any infringement of their fundamental human rights.
The role of the family in relapse prevention cannot be overemphasized; a concept of note in this regard is that of ‘expressed emotion’ which is used to describe criticism, hostility and over involvement in the affairs of   persons with Schizophrenia. Patients with Schizophrenia who experience high expressed emotion are more likely to experience frequent relapses compared to those with low expressed emotion.
Finally more attention should be placed on implementing evidence based methods of ensuring treatment adherence among people with Schizophrenia.
(Lawani Ambrose, is a psychiatrist who lives in Benin)
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