Schizophrenia among Young Adults

The coronavirus disease 19 (COVID-19) pandemic is having a critical impact on healthcare systems across the world, as well as on mental health in the general population; however, evidence regarding the impact of the COVID-19 pandemic on people living with schizophrenia and on the onset of psychotic symptoms is currently emerging.

As the coronavirus pandemic rapidly sweeps across the world, it is inducing a considerable degree of fear, worry and concern in the population at large and among certain groups in particular, such as older adults, care providers and people with underlying health conditions.

People with schizophrenia are twice as likely to be hospitalized with COVID-19 than people without the disorder. They’re also 3 times more likely to die from the virus, according to a study recently published in Oxford’s Schizophrenia Bulletin.

The researchers wanted to examine the effect of the COVID-19 pandemic on people with severe mental illness. An earlier study suggested the cognitive impairment and sociodemographic characteristics of people with schizophrenia put them at a high risk for infection. Overall poor physical health of this population may contribute to hospitalizations and deaths.

Hospitalized schizophrenia patients were mostly men. They had a higher mean age and a higher prevalence of smoking, obesity, diabetes, and chronic obstructive pulmonary disease (COPD) than those not hospitalized. Schizophrenia patients who died from COVID-19 were younger on average than the hospitalized group, but were mostly men who, like the hospitalized group, had a high ratio of smoking and COPD.

There is no health without mental health.

Unlike every other mental illness, schizophrenia is unique in that its first onset is nearly always in young adulthood — not childhood or as a teen, and rarely after one’s 30s. Most people who are diagnosed with schizophrenia have their first symptoms and episode in their 20s — early to mid-20s for men, a little later (late-20s) for women.

Dr Koh Chin Hong

According to Dr Koh Chin Hong, a psychiatrist in Lam Wah Ee Hospital, schizophrenia is a kind of mental disorder, also recognized as a brain disorder where there is a neurotransmitter imbalance. When a young adult develops schizophrenia, they will have disorder in many aspects of their brain functions.

The core symptoms are hallucination, delusion, disorganized speech, disorganized behaviour and negative symptoms. To diagnose a person with schizophrenia, the person must present at least two out of these five symptoms, for at least a month. They must show deterioration in their social and occupational function.

Besides these five symptoms, most schizophrenia patients also suffer from difficulties in their cognitive functions, which are the ability to think, analyse, make decisions and plan. They might also have problem with emotional regulation or control, like feeling depressed or having anxiety.

Dr Koh said that to understand the trigger of schizophrenia in young adults, we need to first understand the causes of schizophrenia. For time being, the definite cause of schizophrenia is still not known but there many so called risk factors that might contribute to a person having this condition. The risk factors include generic inheritance, life stress or chronic drugs abuse.

The severity of a patient’s condition depends on the trigger. Different patients react differently to the trigger. Recognizing the trigger is very important in order to prevent future episodes of relapse. For example, a young adult feels stress due to poor time management, he should learn to balance his time in order to reduce the stress trigger.

Misconceptions

However, Dr Koh also said that there are certain things that people misunderstood about schizophrenia. It depends on the cultural background of the patient. In some cultures, they believe that schizophrenia is caused by demon possession. This makes them go for spiritual healing instead of seeing a psychiatrist.

The other myth is that when you get schizophrenia, you are weaker than other people. This is very wrong because anyone and everyone is at risk of developing schizophrenia, even those with very strong will or highly educated. It is simply not correct to equate schizophrenia as a weakness.

The complexity of schizophrenia may help explain why there are misconceptions about the disease. Schizophrenia does not mean a split personality or multiple personalities. Most people with schizophrenia are not dangerous or violent. They also are not homeless, nor do they live in hospitals. Most people with schizophrenia live with family, in group homes or on their own.

Dr Koh’s opinion on undiagnosed cases is that the amount of undiagnosed schizophrenia is highly dependent on socioeconomic status of an area. For example, places like Kuala Lumpur and Penang which are well developed, the detection rate will be higher. But for places like Sabah and Sarawak or other rural areas, the amount of undiagnosed cases will be higher due to the lack of awareness.

For untreated schizophrenia, the longer the symptoms get untreated, the harder the treatment will be. They might require a longer duration of treatment and higher dosage of medicine to achieve recovery. Their recovery process also will not be as good as those who seek help early.

It is easier to say "my tooth is aching" than to say "my heart is broken". - CS Lewis

Joshua Tan

According to Joshua Tan, a psychologist, treatment can help many people with schizophrenia lead highly productive and rewarding lives. As with other chronic illnesses, some patients do extremely well while others continue to be symptomatic and need support and assistance.

While there is no cure for schizophrenia, research is leading to new, safer treatments. Experts also are unravelling the causes of the disease by studying genetics, conducting behavioural research, and using advanced imaging to look at the brain’s structure and function. These approaches hold the promise of new, more effective therapies.

Most of the time, in any active case, young adults suffering from schizophrenia need medication. After the symptoms of schizophrenia are controlled, various types of therapy can continue to help people manage the illness and improve their lives. Mental health therapy (counselling) and support can help people learn social skills, cope with stress, identify early warning signs of relapse and prolong periods of remission.

Joshua highlighted that a young adult with schizophrenia can live a fulfilling life and have robust relationships with proper management and support system in place. Firstly, when you want to relate with someone on a deeper level, it is always best to be honest about your condition – “Honestly is the best policy”. It is nothing to be shameful to have a mental condition that is totally not the doing of the person. This is not like the condition is due to bad choices. It just happens.

Because schizophrenia typically strikes in early adulthood, individuals with the disorder often benefit from rehabilitation to help develop life-management skills, complete vocational or educational training, and hold a job. For example, supported-employment programs have been found to help young adults with schizophrenia obtain self-sufficiency. These programs provide people with severe mental illness with competitive jobs in the community.

Joshua said that for young adults living with schizophrenia, family support is very important to their health and well-being and it is important for families to be informed and support themselves. Social support is also an important part of maintenance and recovery.

Joshua also said that the key is to understand that schizophrenia is a brain condition and many a time, the patient’s behaviour is involuntary. Therefore, friends and family should not take it too personally when the behaviour of the patient comes across as disrespectful or bizarre.

It is important to remember that a diagnosis of schizophrenia is not a life-sentence for your loved one. To help someone with schizophrenia, it is important that friends and family members: accept the illness and its difficulties; not buy into the myth that someone with schizophrenia can’t get better or live a full and meaningful life; do your best to help your loved one feel better and enjoy life.

If you are lonely, in distress, in despair, or having suicidal thoughts, Befrienders offers emotional support 24 hours everyday. Kindly contact them at 03-76272929 or visit their website https://www.befrienders.org.my/.

Attached below is a simple diagram of how mental illness affect our body.