Schizophrenia

Schizophrenia is a chronic mental health condition that is among the top 10 causes of disability worldwide, according to the World Health Organisation. It affects an individual's perception, thought and behaviour. 

In this episode, Dr Syengo Mutisya, a psychiatrist with two decades of clinical experience, demystifies the myths and misconceptions of this condition. She further highlights its treatment options and prognosis. 

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Transcript

SPEAKER_03 0:16

So, welcome to yet another episode of the Mental Wellness Podcast. We're here to educate and create awareness about mental health conditions in the country. In this episode, we're going to focus on an illness that is quite a mouthful for most of the patients we see and the public to pronounce schizophrenia, a chronic debilitating mental health condition that has been shown, according to research, that affects at least one percent of the global population. With me today is a senior psychiatrist over two decades of experience who's going to unpack what schizophrenia is, what are the symptoms, how do we approach treatment, what are the causes, and what does it mean to live with schizophrenia? Our guest is Dr. Katherine Siengo, a senior psychiatrist. And I'd like her to tell us. Welcome, Dr. E to the Thank you.

SPEAKER_02 1:20

Um this is an interesting topic. Like we were saying before we started the show, um, many people can't even pronounce the name, schizophrenia. And um in Kenya, many people would refer it to as madness. And that's uh the reason why when you tell anyone to see a psychiatrist, they'll say, But I'm not mad. That is the severest illness which people would refer to as madness, which is not right, it is just severe mental illness. So I would say schizophrenia is one of the severest mental illnesses.

SPEAKER_03 1:57

Okay. Yes. Yeah. And I think you'll tell us more about um the condition, how it affects people, when to what to watch out for as symptoms and and all that. Yeah, and so I think just diving into it, what exactly is schizophrenia?

SPEAKER_02 2:13

Okay. Yeah. So schizophrenia is an illness which will affect how one perceives things, how they feel, how they behave. And basically, with schizophrenia, if I can break it down to a language understood by everybody, uh the patient might hear things others can't hear, see things which others can't see. They might have what we call delusions, beliefs which are not expected for their environment, culture, socialization, education. Like somebody could be suspicious that their mother would poison them. Um and that might present with I have to make my own meals. Then if I find you have cooked, I have to cook my own meals. Um, behavior, uh some types of schizophrenia, the behavior gets disorganized. And the other important issue now is that uh schizophrenia is now uh looking like it is neurotoxic. So every episode leaves the brain worse than it was. Okay. Um, the other promising thing in treatment of schizophrenia, which I don't want us not to discuss, is that we used to say that if you have schizophrenia, your the mortality rate is higher than the general population. And also that life expectancy for those living with schizophrenia is lower. Uh as science advances, we are seeing some hope in that line because now we can manage the weight. Okay. So previously, one of the main reasons uh patients would stop treatment for schizophrenia was because of metabolic changes, which are basically weight gain. And now that there's a treatment to manage the weight, then I believe over time the story that uh schizophrenia increases mortality rate, or uh people with schizophrenia live shorter periods might change because if I manage the weight, then I prevent heart conditions, I prevent diabetes, I prevent hypertension. So, yes, schizophrenia has been one of the severest mental illnesses, but it's hope. With time, things are changing. Yes.

SPEAKER_03 4:43

Okay, okay. I think that's that gives a very good uh comprehensive overview of what it is and what people struggle with. Um and so one of the common questions that we get in the clinical setting is what caused it? What are the causes of schizophrenia?

SPEAKER_02 5:00

Yes, many people struggle with that. And one of the issues is the fact that I have gone to the doctor, they have done all the tests and they can't find anything. That's what the patient says. Well, they have done MRI, they have done all the blood works, and they can't find the cause. So what we emphasize, and a good psychiatrist would tell them that the tests were done to exclude another condition. So schizophrenia is a diagnosis of exclusion, and so are many other uh mental illnesses. So if we find that your brain is normal, it doesn't mean that you're not sick. It only means that you don't have a growth in the brain. There's no blood or bleeding in the brain, there is no growth, there's no um any other condition. And therefore, then we say it is schizophrenia. And that is one of the challenges with mental illnesses, because we are not able to say this is positive for malaria, positive for HIV, positive for schizophrenia. So then uh somebody will then ask, if all the tests are negative, then it must be witchcraft or it must be a curse, it must be something else, it must be magini. So then that's when now this uh podcast is good because we will then break down that the fact that schizophrenia will respond to medicine, then it means it's an illness. If it was just uh witchcraft, then Amganga would heal it. If it was uh spiritual, then the pastor or the priest would heal it, or the is it the Imam? Uh the Quran. Yeah. And I get many patients uh who have spent a lot of time wanasomewa Quran, or they are reading the Quran for them. Uh, and at the end of it, they come for treatment when they have really taken long. And again, one of the messages today should be that the earlier you start the right treatment, the better for the prognosis. Yes.

SPEAKER_03 7:13

Dok you give us a very good um description of the causes and points where you've even had patients who've gone for spiritual interventions, not much improvement, and come for treatment, and then they improve all of a sudden. I think that's a common thing that we we all we all come across. So having discussed that, is there a specific age of age of onset for of schizophrenia? Because I think that's that's a critical thing, because we do get patients at certain levels of their ages, and now they present and they're like, but our patient was fine all through since they were born, and now you're telling us they have this condition, yeah.

SPEAKER_02 7:52

Uh yeah, so like I remember from my medical school that diseases don't know books. Yes, yes. So the it is estimated there are two peaks. There's the adolescent peak and the late onset. And that happens with uh college students, university. Um, I know some of our senior colleagues, we knew them because they were the psychiatrists for the University of Nairobi. So you find there was that peak, a very bright student, um, their behavior changes, their thinking changes, and they're in second year or even first year. I had a classmate who broke down in first year. So there is that peak of adolescence, uh, late 20s, and then there is the late onset from 40s and above. But again, diseases don't know books, so it can uh start at any time. And back to the causes, I realized I didn't actually, I said what it is not, not what which what does not cause. I did say what causes. Yeah. So like many other mental illnesses and mental health problems, we find that um schizophrenia is actually still thought to be not one disease, several. And research is still uh working on that. And we also know that uh it tends to be linked with other things like even intellectual disability, autism. So in a family, you might have one person with schizophrenia, another one with intellectual disability, another one with autism. So it's a spectrum. We are yet to know what exactly it is. And so we can tell patterns which are associated with peaks of schizophrenia. For example, we used to think that certain viruses during cold seasons could predispose a relapse. And many Kenyans will tell you why is it that when it's cold is when the illness comes back. Uh, but then we know that there is of course the biological predisposition, the genetic predisposition. So once you trace back, you'll always find some generation down the lane, someone had schizophrenia. And even if there was no schizophrenia, you might find there was an autism somewhere, there was uh autism spectrum, there was intellectual disability, there was bipolar. So there is the genetic predisposition, and that genetic predisposition is not 100%. So the African culture of saying, let me not get a wife from a family which has mad people, is is not correct because even if you took two people with schizophrenia and they got a child, it's not necessarily that they love a child with schizophrenia. So even with two people who are known to have schizophrenia, it's not it's not even 50% chance that you love a child with schizophrenia. So that genetic predisposition is major. Of course, what makes people relapse could be psychosocial stress. But the main issue is about make chemical changes. And we say that because our treatments usually balance the chemicals in the brain.

SPEAKER_03 11:06

Neurochemicals in the brain, yeah. Yeah. I think, and that's what exactly is we what we try to do with treatment. I think that understanding that we have a psychiatrist, that there's a neurochemical imbalance, there are so many stresses that are affecting you, and all that could trigger and of course lead you to an episode and maybe first time. So out there in the public, we tend to see people with certain characteristics. Of course, a term that we as psychiatrists don't like is the label mad. But when we see these people, we say no, it's not madness. It's a certain specific like this is schizophrenia. You see, and so someone will look at you and like, what are you talking about? What are the symptoms, signs you've seen that now make you say this is schizophrenia?

SPEAKER_02 11:56

Okay. Actually, for those of us who practice in both public and private sector, you find that the the people who have not been treated and landed in public sector are the ones with this illness where they hear voices, see things, other people can't see, they are paranoid, they cannot trust people. And and I think one of the is it MacNaughton laws or which one it was that uh somebody thought they were going to be shot, so they decide to shoot someone else. So um, and the fact that uh you can be paranoid to the extent of thinking your own mother can poison you. Um so that is basically the the main cause symptoms, positive symptoms, which are basically hallucinations, delusions, disorganized behavior, but they're also the negative symptoms, and that's very important because the choice of treatment is guided by that. Negative symptoms include lack of motivation, you're just there. Yeah, and that is very common. And um, what people say is there was memories, but it's not the medicine. Sometimes it's actually the lack of the medicine which has led to lack of motivation and um the sadness, the just being there. Then if you keep getting relapses, then uh the brain's function deteriorates. So you find you could perform very highly in your career or in your academics, suddenly, I mean, slowly that goes down. So those are the negative schizophrenia. And just because I am not having hallucinations or delusions, uh does not mean I don't have schizophrenia. Because basically, even before the illness starts, um, there's a personality where we call schizoid personality. Somebody withdraws in school, they are aloof, they are noted as such odd child who is not fitting. So um the symptoms are both can be positive and negative, and that's important in the choice of treatment.

SPEAKER_03 14:01

So basically what you're saying is that you have an individual who was seemingly functional, and then all of a sudden there's a change in that. And so they don't want to talk to people, they keep to themselves, they don't want to do anything, and they can sit in a place for hours. I mean, just there, not talking to anyone, not even hearing, or even start doing certain um things, self-neglect where they don't even wash themselves, don't take care of themselves. I think that's what you're referring to us. Those are negative symptoms. Yeah. And I think those are things that they will bring to us as patients. Like that would be the area of concern. And mostly, as you said, in the public um health sector, of course, in the private, it has a different way in which it presents based on the function. These symptoms that we see of people who tend to be out of touch with reality when they're telling you they're hearing voices and you're not seeing any voices, they have these odd beliefs are all can, it's a cluster of symptoms that then now we can label as a schizophrenia. And so, what would a diagnosis of schizophrenia mean in that case? For someone who's been seemingly functional, what would that mean to them?

SPEAKER_02 15:06

Yeah, sometimes the news is shocking to the family and to the patient because that means that they might be on medication for life. And because the media uh movies show the exaggerated form, then people start imagining the worst. But the good thing is with proper education where somebody is compliant on their treatment, then they can live a normal life. But the problem is when someone stops the medication, the illness comes back, then the brain worsens. So, in fact, if there's any word we can get to the public is once the diagnosis is made, don't ever try to stop the treatment because stopping the treatment is killing the brain. And so your functioning gets worse. Even if we treat you and you recover, then the functioning has gone down. Every relapse brings your functioning lower, just like epilepsy. If you don't prevent conversions, then every conversion injures the brain. So I think now if you are to get the right diagnosis, right time, and for people to know if I keep stopping the treatment, then I am likely to function less. Now, in our setup, we find people saying it is the drugs which made my brother this way. It was the drugs which have made him to be not motivated. We don't want these drugs. Then now it worsens because they have said we don't want these drugs. The side effects as well. And um uh these things are with us. In fact, I tell people, I I when I came to do psychiatry, I just uh came to find the term schizophrenia because I lived with people with schizophrenia family members and I could see those symptoms. Um so you can when I look back, and I remember when I was in Madhari the first time, nurses would ask, why are you not scared of this patient? I couldn't tell them, you know, I've always lived with them, so to me, there's nothing strange with them. Yes, yes. I have people who say, no, my son cannot go to Madhari. What really is wrong with Madari? Madhari is a hospital with specialists. You don't want, you don't have to be admitted. You can go to outpatient and go see a doctor and you don't have to be admitted. And you'd rather go to Madhari hospital than stay at home. So I have this stigma where people say, no, my son, I take my son to no, they would rather stay at home. But the private hospitals are too expensive. So I don't know what is this fear. Maybe we encourage the public to just come and see Madare is a place, and you and me as psychiatrists.

SPEAKER_03 17:51

Yes.

SPEAKER_02 17:52

I don't know that we look up normal.

SPEAKER_03 17:55

Well, there's there's a lot of misconceptions out there. Yes. Um, and I think what what I find interesting is um I've had questions from relatives like, so the patients in Madare and any other mental hospital are normal patients. You're like, yes. You can sit and talk to them, like, yes, there are people just like you and me. They're struggling with an illness. That's what I'm saying.

SPEAKER_02 18:14

And when they're coming from the clinic, they are looking like you and me. Yes, yes, yeah, they're not the same person who's shouting and you're logging them up. Yeah, yeah.

SPEAKER_03 18:21

So the it's just the acute episodes where they tend to behave in a different way. But otherwise, when they're on treatment, they're actually normal and they can and they and they can function. I think that's and that's why we are doing this anyway, on the show to educate people to raise awareness and also misspell these misconceptions about um mental illnesses. I think this concept of um schizophrenia, mental illnesses, it's disorganized behavior and thought. And that scare part is where now just made me realize as a component of schizophrenia that I think it would be good for us to unpack the violence, aggressive behavior that is associated with schizophrenia. Yeah.

SPEAKER_02 18:57

Okay, so one could have could be violent or not. Because if you're telling me what I am seeing is not real and I am seeing it, then I would definitely get defensive. And we educate the caregivers that don't argue with them. Let the mid medicine work first. Because if I can hear you speaking, I can hear a voice, and you keep telling me I can't hear it, then uh you can't win that argument. True. So you leave the patient to believe what they believe and let the medication work. The good thing is even if somebody doesn't believe they are sick and you get them to the hospital, the injectable forms of treatment they can have. The movies uh have always shown us that schizophrenia equals violence. It's not necessarily true. And then uh the other thing, when I was comparing the private to the public. Yes, yes. And psychiatrists treating patients in the private, when they recover, they'll say, Oh, I'm just like that person in Madari. Actually, I tell them maybe you should go and visit and encourage those people. Because just because you have care and you go to a private sector, you're okay. But the person who has not gotten the right treatment is the one on the streets, the one we call mad. So any of patients with schizophrenia could get to the streets if they don't have treatment, if they don't have a medical cover. And there's evidence in the private sector that if you get treatment, then you can live a normal life. Yes.

unknown 20:26

Okay.

SPEAKER_03 20:26

So it means it's a treatable condition. It is, yes. It's not a condition that would mean someone won't work, won't function normally. The only thing is that they need to actually continue with treatment. Now that brings me to the point where, as you rightfully said, they start and stop. So you've given a diagnosis, you've initiated treatment, they feel okay, they stop treatment, symptoms come back, and so they're they're struggling with that acceptance of the diagnosis. People around them also tell them these drugs, as you rightfully said, are not good for you because you see they've made you look like this, they've made you feel this. What advice would you give, given your expertise and experience on this aspect of denial with especially when it comes to treatment? Yeah.

SPEAKER_02 21:12

I would say in any treatment of illness, just listen to the specialist. Because um and this applies across. So if you have epilepsy and you don't listen to other neurologists will say, clearly you do not know what the expert, I mean the specialist, uh, is finding and research changes every day. And schizophrenia, it's complicated by the treatment of schizophrenia is complicated by the fact that the drugs have side effects. Yes, yes. So I take these drugs and I am my weight doubles. And if I am a doctor or uh these days information is everywhere, I know that with this rate of increasing weight, I'm likely to now develop blood uh maybe higher. blood pressure or diabetes or cholesterol and all the other metabolic changes. So those are real issues that yes, the drugs have side effects. And some side effects like sexual dysfunction. Yes, yes. You'll find an adult who is married wants to stop taking the medicine and they don't say it's because it's affecting their sexual function. Culturally they don't even want to discuss with the doctor. They just say I don't want these drugs. And until until you ask them what is wrong with the drugs or are you having sexual dysfunction? That's when they open up. So the problem is their side effects. The issue is every drug has side effects. Any painkiller has a side effect. Mild things, even what we think is mild can cause liver liver failure. So what everybody needs to know is every drug has side effects and all chronic illnesses, including asthma, including SLE, including lupus, including HIV, all the drugs have side effects. And so if you come in for treatment with that knowledge, then you'll be able to discuss with the doctor I found these side effects, is there treatment for it? I found this. And like I'd said in the show earlier that the most complicated thing was the metabolic changes for our drugs. Now there's hope that GLP agonists can now work on that. And so a patient can know yes I'll take my medication but there is this other drug which can moderate that we can yeah.

SPEAKER_03 23:36

And so in the treatment of course we do have would you mention side effects we do have oral medications and what we call injectables. What are some of the most common side effects that we see that I think is important because oftentimes we'd start treatment and then the side effects kick in and then now you start that you you did educate earlier but now the reluctance comes what are the most common side effects that people should actually watch out for once they're put on treatment here.

SPEAKER_02 24:05

Actually ideally the initial treatment should be started in a hospital setup so that we work with you and find what works for you and the side effects. So depending on the age the schizophrenia we use basically antipsychotics and the antipsychotics depending on the age you could have severe side effects like the neck twisting which is very scary. The tongue enlarging and swelling and those are the scarest so when you start it in the hospital then as the nurses and the doctors will manage it and tell you no don't worry it won't happen again. At least we've seen it can happen. So we give you treatment for for that those who have used the first generation antipsychotics over time they get these side effects and I think that is what caused stigma in public hospitals that the the slow symptoms of twitches, slowness which cannot be treated or reversed then makes people get scared. So people will say if these drugs are going to make me be like so and so then I don't want to have them. We are still far in our mental health care because ideally we should have both first generation and second generation available even in public sector for us to choose. In fact you'll be surprised that many countries that it's a matter of this schizophrenia we have to use an injectable and these are the choices. They have three choices of second generation injectables. In Kenya we only have one one second generation. So we are and this is gov in some countries is government funded. Now you and me know that the second generation injectables in Kenya have been very expensive.

SPEAKER_03 26:00

The prices are coming down but still unaffordable unaffordable to most people in the population and it are the ones that would significantly reduce the the side effects now schizophrenia in itself being a chronic condition do we have other comorbid conditions that then now exist or coexist in the context of actually schizophrenia.

SPEAKER_02 26:21

Okay.

SPEAKER_03 26:22

Yeah.

SPEAKER_02 26:22

So you see once you're diagnosed to have schizophrenia when you start thinking about the implication of all this one could get depression as well could get anxious it is also associated with other anxiety disorders substance use. Yeah so like um those of us who went into psychiatry a long time ago there's a van that used to bring bread and cigarettes and it was okay then to have cigarettes distributed and the cigarettes sort of dealt with some of the side effects of the medication. Of course with public health campaigns we discovered that cigarette smoking or nicotine smoking was bad for everyone's health. So that practice was stopped. So substance use smoking nicotine or whatever form of nicotine use is highly associated. And now sadly we are seeing young people who do not have families to have schizophrenia becoming psychotic. They are using cannabis or other substances and when you dig in the background maybe then the families I cannot remember or they didn't interact or maybe there was a genetic predisposition but there wasn't stress enough to induce the illness. So you're finding people who have been using cannabis no family history and you stop the I mean you try and reduce the treatment and the illness comes back. They're not using cannabis the illness and those are the people end up being put in a reab for six months or nine months and their issue is not the cannabis the issue is they have an illness which needs medication forever.

SPEAKER_00 28:03

Yes.

SPEAKER_03 28:04

And and I think that brings me you mentioned cannabis and actually one of the biggest debates that is out there also in the public spaces and also I think in some spaces and and and forums even in research is the link between cannabis and schizophrenia.

SPEAKER_02 28:20

Yeah so what exactly is the link okay of course the research is still ongoing on activists will tend to support the the medical medicinal use but the young people using cannabis in Kenya I have no cancer I have no chronic illnesses they're using it for recreation and it has not been prescribed for them by anyone in Kenya it's illegal so we can't prescribe illegal drugs. So the young person who says I am using cannabis to treat my sleep or anything one um because it's not legal then we don't prescribe it so you're doing it the dose is not known the person mixing it can even mix it other things. True and the concentration I understand now we have different concentrations of THC. Yes yes yes so you can't actually measure that and so um cannabis everywhere um in fact the countries or uh where they have legalized marijuana it is political influence not medical yeah yeah the psychiatrists there will still tell you it is the wrong decision. Even in the UK the Royal College of Psychiatries the voice is cannabis is not good for your mental health. Whether it is killing your motivation and your student whether it is disorganizing your sleep withdraw anxiety it is never good for anyone so uh in countries where it's legalized we know there are more homeless people. So but because the majority want it like now in Kenya if you are to do a vote of 70% are young people they could as well say let's legalize it. You go for a referendum they say legalize it. But you and me would know that it is not a good public health move. Somebody will say if we legalized it we can regulate it. We have legalized alcohol have we regulated it so um legalization and medical use and health effects are totally different things. So for me people will say we are growing it to improve our income tobacco we grew it farmers made money but where are we?

SPEAKER_03 30:38

Yeah it has a fairly was was the gain of the income um better than the cost of treatment yes yeah in fact um what you're looking at is the implication between the economic aspect and the health aspect which I think is still a very big debate in our country if you look across all substances alcohol tobacco cut mogoka mira you know all that yeah so there's always that uh push and pull between the politics and of course the the health which is a very can get quite emotive in some areas I remember once we went to Senate to present um when the Mogoka debate was actually happening in the country and the political leaders from the Mogoka producing uh counties were very agitated with what you were saying because you're saying it's harmful and they're like no it's feeding our children it's educating us it's helping us economically so I do I do agree that we still have a long way to go as a country when it comes to to such um issues when we treat we in share treatment and they they basically come back to functionality. From your experience over the years don't necessarily have to give us an example because of patient confidentiality but do you have any successful stories of patients you've treated for schizophrenia?

SPEAKER_02 31:56

Yes for every patient I have managed is success. Success in the fact that at that time we alleviate the symptoms long-term success is relative because for me what I aim at achieving is we work with you keep your appointments but in in between the appointments if you find your caregiver or you see something which needs to book an early an appointment the better. If it means going to accident and emergency or casualty whichever hospital you're going to if a person understands that or the family understands that for me that's a measure of success. Not the amount the relapses because you could be found the right dose but then a stressor comes and you find that that dose is not working. So that doesn't mean we have failed but the fact that you can tell something is wrong or your family can bring you and say oh he's not well he's been compliant on his treatment but he's not well that would be the measure of success. The other measure would be people who are going back to work or productive because we measure mental health in terms of are you able to adjust to stress as in life? Life is full of stress. Yes. If you can bounce back then you're mentally well then are you able to be productive reach your potential contribute to the community um relate with people. So that's another measure so if somebody is able to make an income um live in the community and contribute because everybody must contribute to the society too you didn't just you are not born to just live and eat you should there's a way you can contribute to the society. And you should f everybody should find it. So for me that's another measure of success. Of course the the fact that when someone gets well they think now I am well I don't need to continue medication is a major problem. So if someone can understand the reason why you are well is because these drugs have balanced your neurochemistry then if you stop them and just because the illness the illness comes slowly you don't wake up today we left you okay and in the evening you are fully full blown psychotic. It comes slowly so today you'll say something and we're like what did he say? Then tomorrow you'll come and decide let me cook my food next time they are shouting at you why are you gossiping? The next time they are the neighbor saying you have been talking about me and the neighbor is wondering when did I talk about you so it doesn't come abruptly it's slowly. The illness the relapse is also slowly so it's not that you're going to stop the medication today and tomorrow you're psychotic. It can take a month the fact that it has taken you a month doesn't mean that you are okay without treatment. You know people say I stopped and I was okay so I don't need these treatments. But you're not okay the chemicals were slowly piling just because like diabetes if I don't take my diabetes medication today tomorrow I'll not be in an ICU. It might take a week or two for me to get into an emergency of diabetes a coma yes yes a coma or a severe form or even I don't stop my diabetic medication today and then next day the glucometer says the blood sugar is unrecordable. It happens it's too high. It happens slowly the same thing with schizophrenia. You stop medication today the chemicals pile over time it can take a month and you think you're okay then they'll say but when I didn't take these medications I was okay you are not fine the medic the chemicals were just piling.

SPEAKER_03 35:40

Yeah yes yeah and so on that note a common question um that normally arises at the clinic in the clinical setting is can it be cured?

SPEAKER_02 35:50

I would say uh schizophrenia there is recovery. Yes cure is relative for me cure would be are we finding the right diagnosis, the right treatment the right dosage? Are we managing the associated factors like substance use? Are we looking out for relapses early signs of relapse? That would be recovery for me. Are you going back to work? Are you productive? Maybe you didn't manage to graduate can you go back and graduate can you find a business can you start a business? Can you work in whichever way? Because even the person who cleaned this room has done a great job. Yes the person doing the lights yeah this show as a director as technicians everybody is doing their part so if you're able to find something to do to contribute to the society to me that is a success yes it's recovery.

SPEAKER_03 36:45

Yeah so basically what you're saying is that unlike malaria where you have parasites in the body you're given anti-malarials and then they're cleared from the system and you don't have malaria schizophrenia is a chronic illness. So we look at aspects of your life that should make you functional. Yes yeah unlike now so for instance I know what I normally use is when I get that question, I tell them diabetes hypertension are illnesses that you'll be with you for the rest of your life. But what we do is you're given ways in which we control and manage the symptoms so that you can continue doing what you need to do. I think that's what you're saying in summary that the cure is not really like the malaria one but it's more of recovery and what we can achieve when it comes to to functionality.

SPEAKER_02 37:32

Yes and uh that is not just for schizophrenia is for many other medical conditions. Yes yes uh so we want our patients not to feel like they're the only ones with this burden of taking medication forever. There are many other medical conditions people take medication for life so it is that burden you have you carry it. If it's diabetes you carry it if it's schizophrenia you carry it and then you see your doctors who we even the doctors do not know what schizophrenia entirely is. Research comes out every day.

SPEAKER_03 38:05

Yes I agree with you I agree with you because there's so many dimensions to it and there's always new information.

SPEAKER_01 38:10

Yes.

SPEAKER_03 38:11

Information coming up and so what would be your um as you head towards the end of this episode and and this discussion what would be your advice to one patients who've been diagnosed with schizophrenia to caregivers of people living in schizophrenia.

SPEAKER_02 38:28

Okay. Yeah so I think the important thing is correct diagnosis and accepting the diagnosis let's accept the diagnosis first. Have we accepted the diagnosis? Because if you don't accept the diagnosis then the other thing is stigma self stigma um there are people who will even cut off the name of the hospital true personally when I meet my patients in the social setup I just say this is my friend meet my friend I can't say like a pediatrician will be so happy oh I delivered yes yes yes it's it's very different for a gynecologist but for us you just say this is my friend and no one wants to be known that they are seeing a psychiatrist. That's very true. That's the odd side of our career and majority of the time the stigma is self-stigma. I'm here to see a a good human being will look at another one and be happy that they have schizophrenia or they have diabetes. Many people would actually empathize with you and try and help. But if I have self-stigma one I'll be coming to your office and saying I can't use your SICOF my colleagues cannot know that I am seeing a psychiatrist if I'm told today my son has schizophrenia it's heavy but if I don't accept it then I can't help them and I can't if you live in denial then it won't work. If today I don't accept I am me then I won't believe so the first thing is accept. Yes.

SPEAKER_03 40:09

I think that point brings me to a discussion I had with you over the phone a few weeks, I think last month or the other month where you're telling me it's easier for a parent to accept that their child has substance use as opposed to schizophrenia and and the whole point was around a case where we were having a discussion about that link between substance use and schizophrenia and the communication not being put directly that this is schizophrenia and this is not substance use. Yeah.

SPEAKER_02 40:34

Yes. Now we have many parents and relatives and families which decide to take their loved one to a rehab of course rehab is good. 90 days rehab is good but this rehab is there a psychiatrist is there a psychiatric nurse is there a psychologist who understands you can be put in a rehab to think about your life when you have schizophrenia but the goal is to learn life skills to learn social skills and to be supervised treatment not because your problem is cannabis so if you feel that you took this person for a rehab 90 days and they come back and the illness is there is because the goal of going to the rehab was wrong. It was to deal with cannabis the problem was not cannabis the person will stay there for three months without cannabis and they still need medication. So I think that is the main challenge. Yes.

SPEAKER_03 41:27

So it's been a great conversation um time really flies and time moves fast. Would like to hear your closing remarks um as we end the show.

SPEAKER_02 41:38

For me I would say anyone living with schizophrenia and anyone with a relative with schizophrenia it's an illness chronic illness like any other no one chooses to be sick. I don't think anyone would be asked do you want asthma they say yes. You want diabetes yes no one chooses yeah so if you have diagnosed to have schizophrenia someone else is diagnosed to have asthma someone else has diabetes someone else has HIV they are different diagnoses and none is good. Yeah so pick up your diagnosis and accept it and do what you can to live with what you have because you can't wish it away. And I really feel something I am very strict that I don't feel and I have just said I grew up with relatives with schizophrenia. So I feel it even now I have close relatives with schizophrenia living with schizophrenia and I feel it that sometimes I'm the only family member who says this guy is not using cannabis he needs medication and you have they get sick and my background is Catholic and they are calling the priest every time I'm like but you know it's the prayers will not be enough. Why do you do this? And very close relatives who are like okay we wish this time it would work. So I really feel for them and sometimes my patients' relatives think I am so strict I don't understand them. Sometimes maybe I need to deal with my part to to tell them yes but I've shared that one of the reasons I went into psychiatry was because I lived with people with mental illnesses. And I know it is a heavy diagnosis. But even today if my I have two sons if one of them was to be diagnosed with schizophrenia I have no choice but to accept yeah so if I don't accept then I can't help them. Yes.

SPEAKER_03 43:28

Acceptance is the key to recovery when it comes to the management of schizophrenia a chronic debilitating mental illness that affects at least one percent of the global population. That is the key message from our guest and expert today, Dr. Siengo Muticia, a consultant psychiatrist with over two decades of experience in psychiatry in both public and private uh sectors this has been another episode of the mental wellness podcast don't forget to like subscribe and share the link is in the by and I am Dr.

SPEAKER_01 44:02

Ibanzi