Schizophrenia is not ‘Split Personality’. It is one of the psychotic mental disorders and is characterized by symptoms of thought, behavior, and social problems. Some of the symptoms include false beliefs, unreal thinking, hallucinations, social isolation and reduced or abnormal emotional expression and lack of motivation. Diagnosis of schizophrenia is clinical and is based on observed behavior and the person’s reported experiences.

The thought problems associated with schizophrenia are described as psychosis, in that the person’s thinking is completely out of touch with reality at times. They may see or hear things that don’t exist, speak in strange or confusing ways, believe that others are trying to harm them, or feel like they’re being constantly watched.

The vast majority of people with schizophrenia are not violent and do not pose any danger to others. They may be unresponsive or withdrawn; and may have difficulty expressing normal emotions in social situations. It is uncommon for schizophrenia to be diagnosed in a person younger than 12 or older than 40. It is possible to live well with schizophrenia.

Among the contributory factors we have genetics and early environment, psychological, environmental and social processes. Some drugs too can cause or worsen symptoms. Patients of schizophrenia have imbalance of brain chemicals (serotonin and dopamine) which are among the neurotransmitters found in brain. This imbalance leads to exaggerated or abnormal looking response to stimuli like light sound smell and taste. Such ‘abnormal’ responses are seen as delusions and hallucinations.

They may also have other conditions like anxiety or depression. In addition schizophrenia affects social life, professional life, relationships and family life. It may lead to unemployment, poverty, suicide and homelessness or abandoned by family.

Warning signs and symptoms:

• Hearing or seeing something that isn’t there for others
• Suspicion or feeling of being watched
• Abnormal speech
• Sudden and negative change in personality
• Falling academic or work performance
• Falling personal hygiene and appearance
• Feeling indifferent to important issues or situations
• Strange body postures or positions
• Increasing social avoidance
• Abnormal social response
• Inability to sleep
• Unreasonable bizarre behavior

Prognosis

Better prognosis or outcome

• People having a higher level of functioning before the start of their illness
• No structural abnormality of brain
• Shorter episodes

Poor prognosis or outcome

• Gradual or insidious onset
• Structural brain abnormalities
• Failure to return to functioning level after episode

Positive Symptoms

They represent a change in behavior. It involves a range of problems with thinking (cognitive), behavior or emotions.

• Delusions – These are false beliefs that are not based in reality. They can begin suddenly, or may develop over weeks or months. The person affected might think someone is trying to control their brains. They may believe they are being chased, followed, watched, plotted against or poisoned, often by a family member or friend. They may get convinced that another person is in love with them.  Other thoughts may be – exceptional ability or fame,  a major catastrophe is about to occur or  body is not functioning properly or being a special person.  Delusions occur in as many as 4 out of 5 people with schizophrenia.

• Hallucinations – These usually involve seeing or hearing things that don’t exist. But for them these are real. Hallucinations can be in any of the senses – vision, hearing, smell, taste or touch, but hearing voices is the most common hallucination. Some people describe the voices they hear as friendly and pleasant, but more often they are rude, critical, abusive or annoying. Voices of people plotting against them are very common.

• Disorganized thinking (speech) – Disorganized thinking is reflected in disorganized speech. Effective communication is almost impossible and answers to questions may not be there or be partially or completely unrelated. Some people find it hard to concentrate and will drift from one idea to another. Speech may include putting together meaningless words that can’t be understood, sometimes known as word salad.

• Disorganized behavior – Behavior is not focused. Task performance becomes impossible. Behavior may range from behavior with no sense to violent agitation. There can be ignoring or resistance to instructions. There can be abnormal body posture or movement. 

Negative symptoms

• There is reduced ability or lack of ability to function normally. Commonly seen are – not making eye contact, no or less facial expressions, no or less body movement, speaking monotone, reduced ability to plan or carry out activities, decreased talking, neglect of personal hygiene and social withdrawal

• Losing interest and motivation in life and activities, including relationships and sex.

• Lack of concentration in conversation or activities.

• Isolation, not wanting to go out of house, lack of interest in work or recreation.

• Apathy to people and life.

Paranoid Schizophrenia

This is the most common subtype. Paranoid Schizophrenia is characterized by feeling of suspicion, persecution or grandiose, or it could be a combination of these emotions. The main characteristic feature of the paranoid subtype is the presence of auditory hallucinations or prominent delusional thoughts about persecution or conspiracy against him. In this type of schizophrenia the patient has false beliefs called delusions that some individual or group of people is conspiring to harm him or members of his family. People with paranoid schizophrenia usually have less disordered thinking and behavior and higher level of ability to manage life and functioning than other schizophrenia. Such people may not look ‘odd’ other than feeling of unjust or aggression.  Nature and severity of symptoms may range from mild to severe. In severe form there may be disorganization of thoughts reflecting in speech and behavior.

Disorganized Schizophrenia

Disorganized Schizophrenia is characterized by incoherence of speech and thoughts. There are thoughts, speech and behavior which are inappropriate and incomprehensible. There can be purposeless or aggressive behavior. Hallucinations and delusions are less or even absent. Person with disorganized schizophrenia find it difficult to maintain daily life. There may be lack of emotional stability or no emotional expression at all. Socially inappropriate behavior may create social awkwardness. There can be impairment of communication.

Catatonic Schizophrenia

Catatonic schizophrenia is characterized by disturbance in posture and movement which can show as withdrawn or mute state or abnormal posture and movement. It is rare subtype. Person may assume odd position.  There can be repetitive or purposeless activity symptoms of echolalia (repeating words of others) or echopraxia (mimicking movements of others). They may maintain a pose or position for a long period of time.

Undifferentiated Schizophrenia

The Undifferentiated Schizophrenia is diagnosed when people have symptoms of schizophrenia but not specific enough to classify as other subtype. It can be stable condition of mixed symptoms or fluctuating symptom picture.

Residual schizophrenia

Residual Schizophrenia is characterized by the state when the person no longer has delusions or hallucinations but shows no motivation or interest in life. Idiosyncrasies in behavior may be present but they are not pronounced

A delusion is a belief with strong conviction despite evidence to the contrary. Delusions are false beliefs or misinterpretations of events & their significance.  This is pathological and is different from a belief based on false or incomplete information, confabulation, some dogma or because of perception. Delusions are a symptom of medical, neurological, or mental disorder and are of diagnostic importance.

Delusions may be present in any of the following mental disorders:

• Psychotic disorders including schizophrenia, schizoaffective disorder, delusional disorder, schizophreniform disorder, shared psychotic disorder, brief psychotic disorder, and substance-induced psychotic disorder
• Bipolar disorder
• Major Depressive Disorder with psychotic features
• Delirium
• Dementia 

Criteria of delusion are:

• Certainty that means it is held with absolute conviction
• Incorrigibility that means it is not changeable by compelling counterargument or proof to the contrary
• Impossibility or falsity of content that means it is implausible, bizarre or patently untrue 

Delusions are categorized into four different groups:

• Bizarre delusion – Delusions if they are clearly impossible and not understandable to same culture people and does not derive from or relate to ordinary life experiences.
• Non bizarre delusion – A delusion though false is at least possible e.g., the affected person mistakenly believes that he is followed by someone.
• Mood congruent delusion – Any delusion with its content correspond to or is consistent with either a depressive or manic state e.g., a depressed person believes that he or she is looked down upon by office colleagues or they highly disapprove of him, or a person in a manic state might believe she is a powerful and must control others.
• Mood neutral delusion – A delusion that has no relation to the emotional state for example a belief that there is something moving in his head is not related to either depression or mania. 

Themes

Delusions are also explained according to theme they display. Some of the more common delusion themes are:

• Grandiose delusions: In Grandiose delusions person is convinced that he or she has special powers, talents, or abilities or they are a famous person or character. This may be of super natural character, science fiction or religious characteristic. This super natural power could be to save or destroy others.
• Persecutory delusions: In Persecutory delusions person believes that he or she is being conspired against, followed, harassed, cheated, poisoned, drugged, spied on, sabotaged, ridiculed, attacked or obstructed in doing work or in pursuit of his or her goals. The individual believes that some harm is being done or going to occur. They also believe that there are people who have clear cut intention to do such harm and are targeting him or her.
• Delusion of control: A person believes that his thoughts, feelings or behavior are being controlled by someone else or external force.
• Cotard delusion: This is a false belief that he or she is dead and deny own existence.
• Delusional jealousy: A person believes that a spouse or lover is having an affair. There is no proof to back up their claim.
• Delusion of guilt or sin or self-accusation: Person believes he or she has done something wrong and has an ungrounded feeling of remorse or guilt of huge intensity.
• Delusion of mind being read: Person believes that his or her mind is being read by others directly or through some gadget.
• Delusion of thought insertion: Person believes that someone is inserting thoughts inside his or her mind.
• Delusion of reference: The person believes that insignificant remarks, events, or objects in his or her environment are related to him or her and have personal meaning or significance.
• Erotomania: Person believes that another person is in love with him or her. Any amount of denial will not convince.
• Grandiose religious delusion: Person believes that he or she is God sent or chosen one to act on behalf of or as God.
• Somatic delusion: These are false beliefs related to own body appearance, sensation or function. They believe body is abnormal or changed. This is different from hypochondriacal anxiety in which person has abnormal worry about being sick.
• Delusion of poverty: Person has belief that he or she is very poor or bankrupt.

A hallucination is sensory perception which is experienced in the absence of external stimulus. Hallucinations can be visual, auditory, olfactory, gustatory, tactile, proprioceptive, equilibrioceptive, nociceptive, thermoceptive and chronoceptive. Person will see, hear, smell, taste or feel sensation of touch even when there is nothing to cause such. They can occur as a result of:

• Substance abuse
• In mental illness such as schizophrenia
• In neurological condition such as Alzheimer’s disease
• Sleep deprivation
• Delirium tremens
• Migraine
• Charles Bonnet syndrome
• Drug-induced hallucination
• Sensory deprivation hallucination

They are different from other phenomena like:

• Dreaming in which person is sleeping
• Illusion in which there is distortion of real perception
• Imagery which is under voluntary control
• Pseudohallucination which does not mimic real perception
• Delusional perceptions in which real perception is given some additional and wrong significance.

Hallucinations may be manifested in a variety of forms

• Visual – A visual hallucination is perception of some external visual stimulus where there is none. Visual hallucinations are of two types, simple and complex.
  • Simple visual hallucinations (SVH) also called non-formed visual hallucinations and elementary visual hallucinations. These refer to lights, colors, geometric shapes, and indiscrete objects. These are subdivided into SVH without structure and SVH with geometric structures.
  • Complex visual hallucinations (CVH) also called formed visual hallucinations. CVH are clear images which are lifelike for example people, animals, objects, etc.
  • Auditory – Auditory hallucinations are the perception of sound without outside stimulus. Auditory hallucinations are the most common type of hallucination. Auditory hallucinations are of two types: elementary and complex.
• Elementary hallucinations are the perception of sounds such as hissing, whistling, crackling etc.
• Complex hallucinations are voices, music or other sounds. These may be clear or not clear, may be familiar or unfamiliar, friendly or aggressive, without purpose beneficial or harmful, suggestive neutral or commanding.
• Olfactory – In this person is smelling odors that are not really present. This is also called phantosmia. Odors can be pleasant or unpleasant. Common pleasant are odors of perfumes, flowers etc. Common unpleasant are rotten flash, vomit, stool etc. This is different from parosmia in which smell is present but is perceived differently. In some serious cases, person experience smelling colors.
• Tactile – Tactile hallucinations are of sensory perception simulating various types of touch or pressure to the skin or other organs. These can be pleasant or unpleasant. One type of tactile hallucination is formication in which there is sensation of ants or insects crawling on or underneath the skin.
• Gustatory – Gustatory hallucination is the perception of taste without a stimulus. These hallucinations can be pleasant or unpleasant.

Other hallucinations can be :

• Proprioceptive – Person feels body is twisted or strangely positioned.
• Equilibrioceptive – Person feels out of balance
• Nociceptive – Person feels pain or being hurt
• Thermoceptive – Person feels sensation of heat and cold
• Chronoceptive – Person has distorted perception of time and period

Childhood schizophrenia is schizophrenia seen in children younger than 13 years of age. The condition is similar to adults with difference of early onset and severity. As in adults, child may have complaints of thinking, emotions and behavior with symptoms of delusions and hallucination. It can have effect on child’s adjustment and development.

Symptoms

Early childhood signs and symptoms:

• Delay in language development
• Slow or late milestones
• Abnormal motor behaviors rocking or arm flapping

Schizophrenia symptoms in teenagers:

• Irritability or apathy
• Social isolation
• Falling performance in school
• Sleep disorder
• Strange behavior
• Aggression
• Delusions and hallucinations

Later signs and symptoms

• Delusions – False beliefs like being harmed, exceptional ability, another person in love with, body abnormalities some major problem about to occur.
• Disorganized behavior – Resistance to instruction to goalless bizarre motion and behavior.
• Disorganized thinking and speech – Communication is impaired or unrelated
• Hallucinations – Visual and auditory hallucinations are more common
• Negative symptoms – Apathy, lack of expression, lack of function, neglect of personal hygiene and loss of interest in everyday life. 

Causes

It seems to be same as adult schizophrenia. Genetics and environment both may play a role in causing schizophrenia. There could be altered brain structure and neurotransmitters. New research suggest role of brain inflammation.

Risk factors

• Family history of schizophrenia
• Pregnancy complications like exposure to viruses, toxins or malnutrition
• Immunological disorders
• Older age of the father
• Drug abuse

Complications

• Social withdrawal
• Poor performance
• Self injury or suicide
• Substance abuse
• Family conflicts
• Face harassment or abuse

Tests and diagnosis

• History and clinical assessment
• Personal history including history of substance abuse
• Family history
• Medical and psychiatric history
• Investigations to rule out medical causes
• EEG, CT and MRI

Treatments

• Medications
• Individual therapy
• Family therapy
• Social Rehabilitation
• Academic skills training
• Lifestyle and Holistic Management
• Hospitalization if required

Schizoaffective disorder is a condition in which a person experiences a combination of schizophrenia symptoms such as delusions, hallucinations and mood disorder symptoms such as seen in mania, depression. It is often not correctly diagnosed as shows a complex picture of mental health disorders and runs a very unique course in every individual. It becomes a major challenge for family due to severity of complaints and non functional state of person.

Symptoms

This may show a unique picture with varying severity and combination of symptoms. There may be periods of severity followed by improvement.

• Delusions
• Hallucinations
• Impaired functional ability
• Academic or professional deterioration
• Lack of social functioning
• Depressed or changeable mood
• Lack of self care and responsibility

Causes

The exact cause of schizoaffective disorder is not known. Factors that may contribute are:

• Genetics and Family history
• Abnormal brain structure and chemistry
• Traumatic life events
• Substance abuse
• Complications during pregnancy

Diagnosis

DSM criteria for the diagnosis of schizoaffective disorder include:

• A mood disorder along with schizophrenia
• Psychotic symptoms for at least two weeks
• Mood disorder runs major part of course of illness 

Tests and Investigations

• History and Clinical assessment
• Blood tests
• EEG, CT and MRI

Complications

• Social isolation
• Unemployment and poverty
• Deterioration of mental health
• Physical health complications due to neglect
• Substance abuse
• Suicide

Treatments

• Medications
• Psychotherapy and Hypnotherapy
• Family therapy
• Holistic Management

Symptoms

• Prefer to be alone
• Appear as cold, dull and indifferent
• Lack of social skill and difficulty in giving social responses
• Lack of meaningful relationships including sexual
• Unable to experience pleasure
• Unable to express feelings
• May underperform though may have high creativity

Causes

Exact cause of schizoid personality disorders is unknown. Both genetics and environment factors may play role. Child abuse and neglect or broken families may be the risk factor.

Diagnosis

This involves clinical assessment and investigation. Other similar conditions must be ruled out. One must meet criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association that it must includes four or more of these characteristics:

• One neither desire nor enjoy close relationships including family.
• One almost always chooses solitary activities.
• One has little, if any, interest in sexual experiences with another person.
• One take pleasure in few, if any, activities.
• One doesn’t have any close friends or confidants other than first-degree relatives.
• One seems not to care about praise or criticism.
• One seems emotionally cold, detached or unexpressive.

Treatment

• Medications
• Psychotherapy
• Group therapy
• Holistic Management

Symptoms

• Lack of close relationships
• Poor or inappropriate emotional responses
• Poor social interpretations
• Vague or meaningless speech
• Peculiar beliefs and behavior
• Excessive social anxiety
• Suspicious beliefs and ideas

Cause

The exact cause is unknown. There are many theories about the possible causes of schizotypal personality disorder such as biological and genetic factors, social factors and psychological factors. It could be due to problems during development of personality and learning of relationship making.

Risk factors

• Family history
• Dysfunctional family
• Childhood trauma or abuse

Complications

• Anxiety or depression
• Psychotic episodes
• Social isolation
• Poor performance in academics or work
• Rarely schizophrenia may result

Tests and diagnosis

• History and clinical assessment
• Family history
• Blood tests
• EEG, CT, MRI

Diagnosis of schizotypal personality disorder must include at least five of the following criteria:

• Incorrect interpretations of events
• Odd beliefs
• Unusual perceptions
• Odd or peculiar thinking, speech and behavior
• Suspicious or paranoid thoughts
• Flat emotions appearing cold and isolated
• Odd or peculiar appearance
• Lack of close friends or confidants other than relatives
• Excessive social anxiety

Treatment

• Medications
• Psychotherapy
• Holistic management

The causes of schizophrenia have been the subject of much debate. The exact cause of schizophrenia is not known yet. It is said to be result of various genetic, physical, psychological and environmental risk factors. Some of the factors put forward as cause are:

Genetics

Schizophrenia tends to run in families although no one gene is found to be responsible. People who have relatives with the disease develop schizophrenia more often than the general population. Studies of identical twins reveal that if one twin develops schizophrenia, the other twin has a 50% chance of developing the condition.

Brain Involvement

Recent studies suggest that schizophrenia may result when a certain gene that is key to making important brain chemicals malfunctions. This may affect the part of the brain involved in higher functioning skills.

Pregnancy and birth complications

It has been proposed that people who develop schizophrenia are more likely to have experienced complications before and during their birth, such as a low birth weight, premature labor or asphyxia during birth.

Stress

The main triggers of schizophrenia are stressful life events, such as bereavement, loss of job or home,  divorce or end of a relationship, psychological trauma like sexual or emotional abuse.

Drug abuse

Abuse of drugs has been linked to schizophrenia. Common drugs that can trigger are cannabis, cocaine, LSD and amphetamines.

Though experts are not confirmed but certain factors seem to increase the risk of developing or triggering schizophrenia, including:

• Family History of schizophrenia
• Poor nutrition
• Abnormalities in the brain
• Substance abuse
• Socio-economic factors
• Psychological trauma

Complications of schizophrenia can be serious. Schizophrenia is one of the most disabling of all psychiatric illnesses. Complications include:

• Suicide
• Self-injury
• Depression
• Anxiety
• Joblessness and poverty
• Homelessness
• Substance abuse and alcoholism
• Effect on family members and conflicts
• Social isolation
• Health problems

There’s no sure way to prevent schizophrenia. However, early recognition and treatment may help in getting condition under control before serious complications occur. Schizophrenia is a complex illness that may involve genes but other events of life may also play a role. Some of the precautions that can be taken to prevent schizophrenia are:

• A strong social network. Socializing helps in maintaining self-esteem, avoids loneliness and lower stress.
• Be cautious against exposure to chemicals. Avoid excess of alcohol. Avoid substance abuse.
• Healthy nutrition and plenty of exercise.
• If you have any indication or symptoms, seek professional help.
• Learn life management and stress coping skills.

Diagnosed of schizophrenia require that person must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). When schizophrenia is suspected, doctor collects medical and psychiatric history, conduct a physical examination, and medical and psychological tests:

• Tests and screenings – These include lab test complete blood count (CBC), blood tests to get assessment of body chemistry and rule out conditions with similar symptoms. There must be screening for alcohol and drugs. Other possible investigation asked by doctor may be imaging studies such as an MRI or CT scan.
• Psychological evaluation – This includes assessment of mental status by observing appearance and demeanor and getting details about thoughts, moods, delusions, hallucinations, substance abuse, and indications of violence or suicide.

Diagnosis of schizophrenia involves ruling out other mental health disorders and substance abuse, medication or a medical condition. Person must have at least two of the following symptoms most of the time during a one-month period and some complaints over six months:

• Delusions
• Hallucinations
• Disorganized speech indicating disorganized thinking
• Extremely disorganized behavior
• Catatonic behavior
• Negative symptoms with reduced or lack of ability to function normally

At least one of the symptoms must be delusions, hallucinations or disorganized speech.

Schizophrenia treatment involves medications and therapy to reduce complaints and reduce the risk of future psychotic episodes. Treatment with medications and psychosocial therapy can help in good management of the overall condition.

Medications are more effective in controlling positive symptoms. They are not as effective in controlling negative symptoms. They may cause some side-effects of their own.

Antipsychotic medications

These are the most commonly prescribed drugs to treat schizophrenia. They’re thought to control symptoms by affecting the brain neurotransmitters dopamine and serotonin.

• Typical antipsychotics include Chlorpromazine, Fluphenazine, Haloperidol (Haldol), Perphenazine
• Atypical antipsychotics include Aripiprazole (Abilify), Asenapine (Saphris), Clozapine (Clozaril), Iloperidone (Fanapt), Lurasidone (Latuda), Olanzapine (Zyprexa), Paliperidone (Invega), Quetiapine (Seroquel), Risperidone (Risperdal), Ziprasidone (Geodon).

Psychosocial interventions

• Individual therapy – This can help in learning about sickness, learning to cope with stress and identify early warning signs of relapse can help people with schizophrenia manage their life and illness.
• Social skills training – This helps in improving communication and social interactions.
• Family therapy – This helps in giving support and education to families dealing with schizophrenia.
• Vocational rehabilitation – This helps people with schizophrenia in preparing for jobs and also finding and managing jobs.
• Holistic Management – This includes counseling, psychotherapy, hypnotherapy, nutritional therapy, acupuncture and homeopathy. It is very helpful in both acute and long term management.

Traditional Chinese Medicine (TCM) differential diagnosis system evaluates patients on the basis of disturbance of elements. This is then further classified as excess or deficiency of heat, phlegm etc.  The ultimate result is disturbance of energy Qi. This can be combined with liver Qi depression and qi stagnation, blood deficiency, qi stagnation, blood deficiency of the heart and liver, liver fire rising upward with rising liver yang, kidney yin deficiency and phlegm fire affecting the mind,  kidney and spleen deficiency with dampness and non-interaction between the heart and kidney and heart fire.
Types of psychosis :

1. Depressive psychosis – It has Phlegm and Qi stagnation. It shows mental dullness, low mood or mood swings, excessive sleepiness, white greasy tongue and wiry slippery pulse.
2. Manic psychosis – It has Flaring up of phlegm fire. It shows sudden onset, aggression, headache, sleeplessness, restlessness, excess activity, red greasy tongue, rapid pulse.

Points for depressive psychosis:

Ht 7  PC 7  Du 20  UB 15

Heart shu point   L.I. 4  and Liv 3
UB 18  Liver shu point
Ren 17  St 40  Sp 6
UB 20  Spleen shu

For Manic Psychosis:

Du 14  PC 8  Ht 8  Liv 2  Du 26

Du 20, Du 16 PC 6

Ren 6, Ren 12, Stomach 25,

St 40 Luo connecting point

Human interaction plays a crucial role in treatment of schizophrenia. Confidence and trust on therapist lay foundation for recovery. Counseling and relationship with therapist can take many forms. In counseling, patients learn about their illness, about life skills and ways to avoid a relapse. Counseling can take place one-to-one or group setting. It helps to improve relationships, deal with symptoms, live a better life and meet goals. Group counseling helps in learning social skills. Counseling can help in understanding of self, own thoughts and correction of thoughts and behavior.

Social Skills Training – Social skill training helps in improving communication and social interactions. Person can learn behavior techniques and life skills that will help in social interactions and living better relationships.  This in turn reduces frustration and improves adjustment in life.

Cognitive Remediation – Cognition or thinking pattern is one core of complaints. It includes repetitive cognitive tasks, compensatory strategies, learning techniques, instructions, positive reinforcement and rewards. Therapy goes from simple component to more complex.

People with schizophrenia often have a difficulty in performing ordinary life skills such as self care and conversation. Psychotherapy can help in regaining confidence and live a better life.

• Individual therapy – In one to one therapy patient can learn to cope with stress, managing daily life and identify early warning signs of relapse which can help people with schizophrenia manage their illness.
• Group therapy – Group therapy can serve two purpose. One as support group helps in motivation. It gives confidence and better understanding of illness. Secondly it can help in learning how to manage life, relationships, work etc. It also improves treatment compliance. Group therapy can be helpful in decreasing social isolation.
• Family therapy – Education of family is crucial in total illness management. Family gets better understanding, stress levels go down and there is renewed hope for future. It helps in planning and long term management of illness. Family care may improve outcome of treatment.
• Cognitive behavioral therapy (CBT) – CBT can help in improving attention and thinking pattern. This can be an effective therapy to manage stress, motivation, issues such as anxiety and depression. This can help in improving day to day life quality.

Many complaints of schizophrenia do not respond to medication. If there is no physical brain damage then schizophrenia can be successfully treated with clinical hypnotherapy. It works at the subconscious level. Hypnotherapy can have effect on thinking process, emotions and behavior. Schizophrenic covers several aspects of a person’s life. All these issue must be addressed.

Some of the common hypnotherapeutic methods such as hypnotic suggestions, psycho-strengthening imagery, projective restructuring, neutralization of affect have been used and found effective.

Once a detailed assessment is done, therapist will shortlist complaints and will then design therapy strategy. First part of it is goal setting. Sessions can be designed based on symptoms and condition. It could be frequent sessions or weekly depending on state and need.

Effect of hypnotherapy both as therapy itself and as complimentary therapy is helpful in acute and long term management.

Nutrition plays big role in every sickness. Every body cell including brain cells are made of essential nutrients. New research states that many ailments have nutritional deficiencies as major factor. Schizophrenic patients have much lower levels of fatty acids in the frontal cortex of the brain. Nutrition for schizophrenia ensures elimination of nutritional deficiencies, which may trigger some of the symptoms. Moreover, prolonged intake of medication may cause side effects like weight gain and other complaints. It is necessary to maintain a food balance and have essential nutrients for brain function.  

Foods to include in diet

• Seeds and nuts for healthy fatty acids.
• Healthy carbohydrates from whole grain products
• Essential nutrients from green leafy vegetables and fruits
• Vitamins such as Vitamin A, B, C, D and E, Niacin and Folic Acid, antioxidants and essential minerals such as copper, iron, zinc and iodine to enable neurotransmitter balance and proper functions.
• Omega 3 fatty acids.

Foods to avoid

• Avoid sugar and food with low glycemic index
• Avoid processed or refined food products
• Avoid stimulants such as caffeine, alcohol and nicotine

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Homeopathic psychiatry is one of the most promising medical fields today. Homeopathic medicine is employed as an important part of therapy for severe mental illness including schizophrenia and others like anxiety, depression, bipolar disorder, OCD, phobias, memory disorders etc. Homeopathy is a system of medicine which stimulates the body to heal itself. When homeopathic medicines are prescribed properly, they work quickly to alleviate symptoms and improve overall health both mental and physical.

Advantages of homeopathic medicines are:

• Safe
• No side effects
• Quick acting
• Helps in both acute attacks and long term relief
• Helps in both positive and negative symptoms

The homeopathic medicines person specific and are selected after a full individualizing case analysis, which includes the medical history of the patient and physical and mental symptoms.. Homeopathic medicines are selected on the basis of symptoms, cause, family history and other conditions of the person affected. Homeopathic treatment does not end with prescription of medicine. Doctor will have careful watch on case and will change medicine based on condition.

Medicines useful if depression and suicidal tendencies are prominent:

• Ars-alb
• Aurum-met
• Aurum-mur
• Calc-carb
• Cimicifuga
• Natrum-sulph
• Psorinum

Medicines useful in sudden onset and acute crisis of schizophrenia

• Aconite
• Belladona
• Cannabis-indica
• Helleborus
• Hyoscyamus
• Stramonium

Medicines useful if ‘flat-effect’ is marked

• Causticum,
• Kali-brom
• Lachesis
• Lycopodium
• Rhus-tox
• Sulphur

Schizophrenia is a condition that severely affects patient and in turn entire family. It requires judicial approach for effective and long lasting management. One can make good use of treatment options to manage condition and improve overall life.

• Know about it – First thing first. Know about schizophrenia. This will make patient and entire family at ease. It is not black magic or spiritual illness. It is a medical condition and is treatable.
• Know about treatment options – Know about conventional medicines, acupuncture, homeopathy, psychotherapy, hypnotherapy, dietetics, yoga, meditation and tai-chi.
• Plan well – Be realistic and plan well. Do not lose hope. Define realistic goals and attain them.
• Family Counseling – Family must understand the condition and how to play effective role in managing the condition.
• Life management – Long term life management is crucial. Issues like overall health, finance, relationships & socialization, time management, recreation etc must be discussed and defined.
• Support – One can look for support by joining support groups or other activity groups. Motivation is key factor in long term management.