Schizophrenia - Episode 14

Episode Transcript

(00:09):
Welcome to Psychobabble dash Me. I'myour host Danielle Bartley, along with mayor
mar Weeks. Hi everybody today,our episode is going to talk about schizophrenia.
But before we start, let's putout a disclaimer. This episode may
be triggering for some people and isin no way meant to replace mental health
treatment or therapy. So drummer allplease, Oh the ever popular statistics.

(00:34):
Okay, So, according to theWorld Health Organization, twenty four million people
worldwide suffer from schizophrenia, or,to put it in smaller terms, one
in every three hundred people. JohnsHopkins Medicine says one percent of Americans suffer
from schizophrenia. So, and theNational Institute of Health says the instance of

(00:54):
schizophrenia is greater in men than inwomen. So, Danielle, when does
the peak onset usually occur for?So? Men is early twenties, and
they say, and women it's latetwenties. And nobody really has ever been
diagnosed as a young child or overforty five. Right, They say that

(01:17):
there are some children who get it, but it's usually, like you said,
it's very rare, and if theydo get it, it's like from
nine to twelve years old. Yeah, and they're like displaying some abnormal behaviors
and things like that early and thenprobably once it manifest yeah. Yeah.
So the different factors for this areobviously you know, genetics components, right,

(01:41):
Yes, So it tends to runin families. Remember we had those
brothers who were when we worked ona unit. One was in the army
when he got it. They weretwins, and then the other one was
in college when they got it,and they were both separated and they were
both diagnosed at the same time.Do you remember these I do, huh?
And then they say environmental factors alsoplay a role. So what they

(02:05):
think is that like you already havethe genetic predisposition, you have that abnormality
in your neurotransmitters, and then stressor substance abuse can like trigger the onset
of Yeah, I mean I remember, it's sticking in my head so much
like patients that do drugs and alcohol. It's not the cause of it,
but it triggers them and then itcomes out or I remember that a lot

(02:29):
on the unit. And then,like we said, the neurotransmitter the dopamine
levels are increased in certain areas andin other areas they're lower, and they've
found through recently through like pet scansand stuff, that there's actual changes in
the neuroanatomy or in the brain anatomyover time of people who suffer from schizophrenia.

(02:53):
So schizophrenia, it's let's see here, it's something that impacts people all
over the world, which we talkedabout, and greatly affects the person's thinking,
emotions or speech patterns and the waythat they it's difficult for them to
like navigate a healthy lifestyle, andit affects everybody around them, family members,

(03:15):
do you remember how you know,devastating it is different family members,
and then to get them treatment andhave because a lot of times, yeah,
they don't think they have a problem. They don't, and then non
compliance is a huge thing, andthen they'll they'll do very well. I
mean, people do really well onmedications, but then they think, oh,
I'm going to well, they stopit and then they have a psychotic

(03:37):
break, which we'll talk about thesigns and symptoms, and then the families,
you know, back to square one, devastated. So there's three to
four stages of schizophrenia. The fourstage is the treatment and then the sometimes
they have a fifth stage was intheir intermission, but so when it starts,

(03:59):
it's called the prodromal stage, andthis is when you so if you
have a family member, some ofthese things are what you want to look
for. So they start with somesocial isolation and withdraw from other people.
They have strange behaviors, blunted orinappropriate affects. So that means, you
know, like they might be talkingabout their dog dying and laughing, or
their face might just be like completelyflat, digressive, vague or over elaborate

(04:27):
speech. Sometimes they don't speak alot, or sometimes they just go on
and on. It doesn't make sense, like they'll jump from one topic to
another. Believes that are strange ormagical thinking. I remember one person thought
that if they were making the rainand the rain was like burning them,
or some like weird things like that. Yeah, it's very grandious at times

(04:49):
too. Think that they're famous,think that people are in love with them,
right, and then lack of initiation, interest or energy, And that's
the first So that's really before theystart with the more psychotic race. The
act of stage is the characteristic symptomsthat we're going to go over a psychosis,
including the delusions, hallucinations of paranoia, and then the residual stage is

(05:15):
usually the positive symptoms are mostly controlled, which are those hallucinations, delusions,
and paranoid thoughts, but they haveall those negative symptoms and we'll go over
those here in a minute, right, b Yes, the criteria schizophrenic for

(05:35):
the DSM is okay, So firstwe want two or more of the following
symptoms. We're going to go overover one month period more often than not,
and must have at least one ofthese first three that we're going to
talk about. So the first onehas delusions. So a delusion is something
that they believe much more in asingle thing that isn't true. Examples of

(05:58):
this sort of thinking that they're they'refamous, or remember I told you like
that that they're famous. A lotof times, they'll have religious delusions,
believing other people are in love withthem. There's a whole web of belief
that caused them to act radically,right, and most I mean usually they're
negative thoughts, yeah, right,Like they're paranoid and they think people are

(06:24):
after them, stuff like that alot of the times, right, Yeah,
And then we have hallucinations, whichhallucinations can be auditory hallucinations, and
sometimes pastons will say that they hearmumbles people speaking to them. They'll be
command or not command. You gottareally worry when a bason says that they're

(06:45):
having command hallucinations, like you know, thoughts of harm to themselves or others
telling them to kill themselves. Always, if somebody is ever having thoughts of
harm to self or others, callnine one one, get them help immediately.
There's alt their smell taste hallucinations.A lot of patients will have.
The visual hallucinations can be anything frommashadowed bugs, the spiders, the people.

(07:12):
And then they also taxtile hallucination,so they think, like you know,
they feel things, so someone's something'scalling on them or well, I
mean usually that's what it is.Taxile in touch, right, yes,
and then disorganized speech, so that'stheir incoherent answer. You know, you'll
ask them how are you feeling todayand they'll say the sun is shining.

(07:34):
You know, it just doesn't makeany sense, mean anything, right,
it's just illogical, grossly disorganized orcatatonic behavior, so bizarre and appropriate behavior
actions or gestures. And then nextis the negative symptoms that they experience.
So some of the negative experiences isanadonia, meaning that if they don't to

(08:00):
the pleasure things that they like toused to do, of all abolitions,
which is a little bit leap,an inability to initiate or engage in goal
directed activities. So their motivation isimpaired, like they just they can't they
can't do things. You just don'tfeel this, so like they're lacking self

(08:22):
care hygiene, right, they can'tcommunicate, they isolate themselves completely. And
then what we call the emotional disorder, and that's what we talked about before.
Their aspect, which is their facialappearance can be flat or it doesn't
go along with what they're talking about. They often speak less or use fewer

(08:43):
words. They're monotone, poor eyecontacts, right. And then obviously,
asying else said, their level offunctioning is affected and the disturbance has to
last for at least six months andat least one month of the quote active
symptom which are the you know,the ones we talked about previously. And

(09:05):
obviously it can't be related to youknow, drug abuse or something else.
And I read this which I didn'tknow. It says if the person has
a history of autism or communication disordersand children, the diagnosis with schizophrenia is
only made if illusions are hallucinations plusthe other side and the simps there present
for one month and I think thewhole time I worked, I only met

(09:28):
when we worked at that impatient placefor kids. Yeah, one child who
had schizophrenia and they were I thinklike nine or ten. But it's very
very rare. Yeah, like yousaid before, for children. So some
complications, if left untreated with schizophreniacan result in severe problems affecting area of

(09:50):
their life, which include often signssuicide that sent to suicide and talks of
suicide. Definitely call nine to oneone immediately and get them treat. They
often have underlying different disorders too,like anxiety, depression, a lot of
alcohols use and drugs including nicotine theyself medicate. Obviously, inability to work

(10:11):
and attend school, financial problems,and a lot of homelessness, social isolation,
which we talked about, health andmedical problems because they're not taking care
of themselves. You know, they'redrinking, they're swimsing. Yeah, if
they have a history of hypertension,they're not going to the doctor to treat
it and being victimized and aggressive behaviorall day. It's uncommon, if you

(10:33):
want to say that. And alsothe schizophrenic effects they're thinking and over time,
like we said, it changes thebrain chemistry, so they have what
we call slower processing speeds, soit takes them longer to problem solved.
They have issues with memory, theyhave issues with language, Like Daniel said,

(10:56):
hostility, aggression towards others of uncommon. And I looked some said that
they're more likely to commit violent crimesfor ten times, four to seven times
more likely than the general population.But then I read another article that said
that there's no clear uh connection.Uh, I do know. I remember,
like, I've never met anyone whosuffered from schizophrenia that had nice hallucinations,

(11:22):
do you know what I mean?They're always they were always scary,
they were always telling negative ugly youknow, you should die. They were
never never good And and I neverhad anyone either who said that the voices
completely went away. They were notable, They were not able to once

(11:43):
they were medicated, it was likea background noise and they were no longer
able to decipher what they were saying. I don't know about you, have
you ever had anyone who they completelywent away with. No, if I
did, it's rare. I can'teven I can't even remember. But I
do agree with you that it decreasesthem and lessons, right, but they

(12:05):
don't completely go yeah, right.And then they're also more likely to attempt
suicide according to the National Institute ofHealth, eighteen to fifty five percent to
try to kill themselves, though they'renot successful, and they do have a
ten year ten years less expected lifeexpectancy, and that is because of the

(12:30):
completed suicides according to the National studAs hell anything else you went over before
we start going over some of these, no, just that oftentimes, you
know, families will want to likehave testing done for them. There really
is no innoceense testing for it.Like Merrimer talked about the MRI and cc

(12:52):
scam. But we're not getting goingout there getting mrils. No, no,
no, no, yea and thatand those changes occur after you've ad
the disease for a long time.Yeah, So we're just looking at,
you know, just a complete psychevaluation, like we talked about family history,
what are the symptoms, how longthey've had them, looking at the

(13:13):
diagnosis criterion, the CSM five andwe do a lot of I think we
do a lot of teaching if theyhave family also, because so what they
always taught us in school was thatyou don't argue with these people right about
what they're seeing or and you don'tagree right Like I always would say,

(13:33):
I understand that you're seeing that personin the corner, but I'm not seeing
them. Yeah, take this medicine, right, yes, definitely. So
I just remember how hard it wason families. I don't know why.
I just like I just keep ongoing back to that and like I almost
even have goosebumps and like get upsetover it because families would like struggle of

(13:56):
getting them help and you know,just yeah, are you okay? Yeah,
okay, but I just yeah,because it's a life it's not something
that goes away. It's not likeright, yeah, yeah, it's like
pipolar disorder. It's a life longdisease that they're going to have forever.
And that's the that's the point.It's a disease, which we want to

(14:18):
keep reiterating to help get rid ofthe stigma. It's not something that you
can help and there is treatment now, right, right, So there's like
what we call first generation, secondgeneration, and third generation medications. Right,
So the first generation are the oldones that mostly work on those positive
symptoms, the hallucinations, the delusionsof the paranoid thought, and they have

(14:41):
a lot of side effects. Iknow that. Like inpatient sometimes we would
resort to like holdall as a firstmedication because it clears people, yeah quickly.
And then the second generation those areall yeah, the ones that have
less side right, the fair quellsyou respare at all, the geodon in

(15:07):
vega, latudas aprexa, raylar noilar, yeah yeah, raylar capsula which I've
never used, exalting abilify our all. Third generation yeah, okay, but
anyway, that doesn't matter because youdon't really give two craps which generation it

(15:30):
is. The problem is also thatthese third generations that seem to work better
and have less side effects. Unfortunately, because of the state of our healthcare,
the insurance companies won't pay for untilyou usually until you fail the second
generation ones. Right that it isgetting better though, especially you know what,

(15:54):
it is a lot better in Ohiothan West Virginia. West Virginia,
I would have getting the drug covered. I would have to jump through hoop
it's ridiculous and they make you failnot only one, but two or three
and the date and you have tobe on it per month. Right,
And the problem with like Danielle andI said, those so the first ones

(16:15):
are like the last ones we goto, but the second ones have so
many more side effects, Like wetalked about the metabolic syndrome, right,
and people get very very large withthese and then right just wake gain it's
just sedation. It can affect yourwhite blood cells, your blood sugar,

(16:40):
your liver function, your cardiac functions. And we don't want to scare people.
Not everyone gets these side effects,and then if they do, we
have other medications to help with thatand we monitor, you know, we
do all the labs to monitor allthat. But anyway, that's my little
ramble about healthcare. And then thething that I like is the long acting

(17:04):
injectibles. Yeah, we tell peoplesome of those and what they Yeah,
get them. So there's a Bilifyair purposol, which is a Bilifi mantenna
which is four three hundred, fourhundred milligrams once a month. But there
is now one that Aristota that issix weeks to two months. Yeah,

(17:27):
the how to the candle it.I think I only have one pat on
that, but he's been on thatforever in Vega Suspenna and Vega Trinsa.
So they've come out with these longterm injectables, which is awesome because if
you know, in schidsphrenia, oftentimesthey're non compliance. So the medication is
in them and then they can takethem once a month and then, like

(17:49):
I said that in Vega and nowit has a three month and now it
has a half year, which iscalled which is six months. But I
like to all say, if they'reon a three months, you know,
keep an eye on that, right, make sure, yes, yeah,
yeah, that's I had a patientwho was a I want to say little
girl because I'm old, but shewas probably in her in her late twenties,

(18:12):
and that she had failed all somany medications and then they put her
on one of the injectibles I can'tremember which one. I want to say
would be abilified, and I meanshe wasn't cured, but she was so
much better. Yeah, and shecould live a normal life, took care
of herself. She's still lived inher mom with her mom because she couldn't
live alone. But she didn't haveall these paranoid thoughts and hallucinations anymore,

(18:36):
and she was complying and they canwork right, right, It's amazing.
And then some of the other treatmentsindividual therapy, so that's once they get
you know, clear cleared, andby clear, we mean that they're no
longer having all those hallucinations and illusionsand stuff. So so social skill training,
family therapy, V occasional rehab andsupport employing man. I know at

(19:00):
our facility, we have a gentlemanthat he does vocational rehabs and he goes
to all the job there's you know, finds what's suitable for the patient and
I refer them to him, andit's a wonderful service to have. Oftentimes,
case management is huge. Whenever we'retalking and they're they're amazing. They
you know, keep an eye,they're they're there our eyes and out in

(19:23):
the community. Take them and getthem food baskets. And you know,
I talked to my case managers dailyabout and I couldn't do my job effectively
with about them. Yeah, andthen just resources that are out there for
people and families is NOMIN which we'vetalked about, which is the National Alliance
and Mental Health MHA, which isMental Health America, and there's a Schizophrenical

(19:48):
Psychosis Action Alliance, and there's alsothe National Institute of Mental Health. And
when I was researching this, Ifound a online a test that people can
to see if they're schizophrenic. Idon't know how accurate it is, but
I think if a family member tookit, if they had suspicions, because
I don't think you're going to getsomeone who has in the throes of a

(20:11):
psychotic break to take it, theycould look at it and then know that,
yeah, I need to get thisperson some help, you know what
I mean. And also, wheneverI was one the research on this,
oftentimes patients don't think anything's wrong,and the families, once again, hopefully

(20:32):
I don't cry against the families sometimesfeel like, you know, they're banging
their head on the wall to getthem treatment. If a patient is that
harm to themselves or anyone else,they can fill out what's called an involuntary
commitment because we cannot force anybody toget treatment, but the involuntary commitment papers
filled out will at least get themfrom the hospital. But you have to

(20:56):
research your state. Every state isdifferent, so that's just another little piece
of information for families that you knowright and you can if they're not taking
care of themselves, they're actively psychotic. That's reason enough to start the paperwork.
I know in some states you needa psychiatrist orner's practitioner. In other

(21:18):
states, the family can do it. I would contact your local community mental
health facility and find out what thelaw is and then go from there.
If you're concerned about someone and needto get them help, and there's I
think there's a there are some statesthat actually can do involuntary commitment on alcohol.
I read that, Oh really,yeah. I found that that was
because stations are taking care of themselvesand they self they self medicate with drugs

(21:45):
and alcohol. Oftentimes they seem tothink that it makes the hallucinations or delusions
less, but in reality, itjust makes it so much worse. Right,
Okay, that's it, right,that's wonderful show. Just remember you're
not alone. Bye bye everybody.Heyt the fat as a s