How to understand patients and help them

 

Helping People with Psychiatric Illness

 

This page is linked to other resources that provide further information on some of the themes. Users of this site are suggested to double click on the links provided to learn more about your symptoms.

  •  What is a psychiatric illness?

Psychiatric illness is caused by problems in 'thinking' and 'feeling'. People with psychiatric illness describes strange experiences which others around him do not experience.  He does not always understand what has happened to him. Often the person does not even know that he is behaving differently.  In all types of psychiatric illness, the person's ability to carry out daily activities or work, or talk with friends and family, changes. Psychiatric illness may begin suddenly, over just a few days, or it may develop more slowly over many months. A person with psychiatric illness may show strange behavior at certain times and seem normal at other times, acting just as he did before the illness.

When do we consider a person psychiatrically ill and not just a "strange person?"  Every community has a few people who are odd or different.  Many people dress and act different from their neighbours but they do the usual activities around their house and go to work. They act strangely and it is their usual way of doing things. Psychiatric illness, however, creates a big change from the way the person used to behave in the past.

It is however useful to have a psychiatric evaluation if the person or significant others related to the person find that there is a need to evaluate the strange behaviours.

  • What causes psychiatric illness?  

(1) Stress: Stress comes from different situations, within the family or work and it causes 'Post traumatic stress disorder' (PTSD), the treatment of which is getting redefined. PTSD needs no treatment if it resolves by itself (which happens in most cases). However it needs interventions if it results in tendency for personal harm or harm to others.

(2)  Chemical imbalance: The brain has special substances called brain chemicals that communicate one's feelings and thoughts between brain cells.  Changes in these substances cause psychiatric illnesses. These abnormalities are often caused by inheritance and lasts longer and sometimes permanently.

(3)   Abuse of drugs: Alcohol and illegal drugs can damage brain cells to cause psychiatric symptoms and worsen a pre-existing psychiatric illness or cause some new symptoms.

(4) Injury to the Brain: Damage to a person's brain can result in strange behaviour or confusion. They are often managed by neurologist and during the later stages by psychiatrists.

(5)  Aging: Some people develop strange behaviour because of unusual changes in their brain, as they get old. When this happens, the person may become very confused and often gets lost, even in his own home.  He may become very worried and sometimes become angry or sad. This set of symptoms are called 'Dementia'. It can also occur in young people and are generally treated by Geriatricians.

  • How are people with psychiatric illness different from others?

People with psychiatric illness do not all act the same way.  Family members are usually the first ones to notice the change. Some ways that a person might act differently from the usual are:

(1)   A person may be worried. Sometimes he cannot sleep and cannot stop worrying.  No matter what other people say, he keeps worrying.

(2)    He may suddenly feel his heart is beating very quickly, his breathing becomes very fast and he is afraid for no reason.  He is unable to think clearly and does not know what to do.  This feeling lasts a short time and returns at any time.

(3)  People with psychiatric illness can look very different. Sometimes they do not comb their hair or change their clothes for days.  Their facial expressions can change.  They can lose a great deal of weight in a short period. 

(4) Some people complain about their body. They always seem to have pain, it can move around the body or they have headaches or say they "feel sick".  Even after the doctor has done tests, and says there is nothing wrong, they continue to worry. Even after many expensive tests and visits to specialists who say they are healthy, the person with psychiatric illness still believes there is something wrong.

(5) Sometimes a person walks around for hours and cannot sit still because he is anxious and worrying about silly things.  Other people may be unusually happy (too happy in fact), making all kinds of strange, unrealistic plans.

(6) Some people lose all interest in their family or job. They may sit at home alone and not visit others.  Sometimes, people with psychiatric illness stay in one room and do not want to eat or talk to anyone.

(7) The person may begin to say strange things and make strange decisions that no one in the family can understand.

(8)  He may become suspicious of people at home or at work for no reason.  He may think that others are talking about him.  Sometimes he may believe that others want to hurt him.  People with this problem often do not believe what family and friends say and it is hard to convince them that there is no danger.

(9)  A person with psychiatric illness may falsely believe things that everyone knows are not true and may tell other people about these things.

(10)  When the illness is severe, a person may see or hear things that are not there; as a result, he may talk to himself.

(11)   Sometimes when he is very disturbed he may speak strangely,  that his family cannot understand what he is saying.  The words may be mixed up.

(12)  A person who is severely ill will sometimes just stop moving for long periods for no reason and become severely withdrawn.

(13)  Some persons may believe that they are someone else.

(14)  A person with psychiatric illness may seem like he does not know that anyone else is in the room.  However, often he is watching and listening to what is going on around him even though he is withdrawn.

(15)  He may think that someone else controls his actions, for example, a "voice" tells him that his neighbor wants to steal his things.

(16)  Sometimes people with a medical problem also have symptoms of psychiatric illness.  A person with a broken back can react to the incident and become depressed when he realizes he will never walk again (PTSD).  A person can also have a medical and a psychiatric illness simultaneously. (Post-traumatic stress disorder(PTSD) or co-morbid psychiatric illness)

(17)  Some women become very sad and tearful after the birth of their baby, that precipitates a psychiatric illness. If left alone without help, she may harm herself and the baby.

  • Does psychiatric illness get worse?

There are many kinds of psychiatric illnesses, which makes the question difficult to answer.  Each psychiatric illness has different ways of progressing.

(1) Some people may be ill only once and never have problems again. 

(2) Some psychiatric illnesses do not get worse and stay the same way for a long time. 

(3)  For some people, the strange behaviour will go away for a period only to come back again later.

(4) Other people may become worse over weeks or months. They may become severely disturbed.

  • Can psychiatric illness be cured?

There is still a lot to be understood about psychiatric illness.  With the right help, in most persons, the problems and strange behaviour can be controlled and not cured. They can lead a normal life in the majority of cases.  However, some others may have problems for their whole life.

  • How is psychiatric illness different from mental handicap? 

(1) A person with psychiatric illness may have normal or high intelligence.  However, because of the brain disease, her behaviour becomes strange and it appears as though she cannot learn.  Mental handicap is caused by damage to the brain before or near the time of birth. He is born with low intelligence and will always have difficulty learning.

(2) People with psychiatric illness are often given medicines when their behaviour becomes strange.  Medicine will not help a person with a mental handicap to think or learn.

(3)  A mentally handicapped person may also behave in a strange way but that is because he has not learned how to do things correctly. Such people may learn to do certain things with special training.

(4) A person with a mental handicap can also become mentally ill and may need help for the illness.

  •  Warning signs of serious psychiatric illness  

Some behaviours that can distress the family are also signs of severe illness:

  • Not washing or changing clothes for a long time; 
  • Being active all the time (hyperactivity) with little or no sleep; 
  • Sitting like a statue for hours without moving;
  • Moving about quickly without any purpose and waving his arms and shouting;  
  • Talking to himself all the time or not allowing others to speak;  
  • Talking without making sense;  
  • Refusing to be with family members and spending most of the time alone; 
  • Eating or drinking too little with a great deal of loss of weight;
  • Crying for a long time for no reason.

These warning signs tell the family and friends to get help immediately.

 

  • Ways to help

There are a number of ways to help a person with the psychiatric illness.

1.     Medical Treatment: Medication is one of the ways to change strange behaviour quickly and correctly. Sometimes people need a short stay in the hospital.

2.     Counselling: Counselling helps the person to talk about his difficulties, understand why he is behaving strangely, how to correct his behaviours to an acceptable manner and to feel that someone else understands and cares for him. It helps a person to overcome interpersonal conflicts and modify his unacceptable behaviour (PTSD).

3.     Routine Activities and exercise: Keeps the person involved with his routines and helps him to return to normal behaviour early so that he can become self-dependent quickly.

Medical treatment

Medicines do not "cure" psychiatric illness like antibiotic drugs cure an infection, but it changes thoughts and feelings and can make people function appropriately again. Different medicines are used for different illnesses.  Some medicines help make the person think normally so they no longer have strange thoughts.  Other medicines change feelings and behaviour, calm down the overactive person or help a person who does not want to do anything due to severe sadness, to start doing his daily activities again.  Medicines take time to start working, 10 days to 2 weeks. If the medicines work, these persons begin to be easier to talk to, they feel calmer, and their abnormal behaviours decrease.

Counselling

Counselling is a process that helps the person to identify his problems, his feelings about those problems and what changes he can make to deal with those problems (PTSD).  Counselling can also educate people with an interpersonal problem to understand why they have a problem and why they need help.  It is also a way to support them while they are stressed and deal with interpersonal difficulties.

Counselling is also beneficial in people with abnormal personalities to correct their value system in relation to their society (Personality disorders).

Counselling helps to improve social skills in chronic patients while they are medically treated.

Many persons with a severe psychiatric illness cannot answer questions or their answers do not make any sense.  In these cases counselling is not useful at that time. 

Daily activities

Daily activities at home or at work will help the person with psychiatric illness to get well faster. They provide a routine for the person's day. The person with psychiatric illness should be reminded to bathe and dress appropriately. Later, begin to assist in simple household activities. The person should be encouraged to do as much as possible even if it takes longer or is not done well.  The time spent each day doing activities should increase gradually.  

  • QUICK REFERENCE TO HELP A VERY ILL PERSON

The information below gives some ways to help people who are very upset or show very difficult behaviour.  The first thing to do is to find a doctor. However, the doctor is often far away or not able to come, and the family and the community need to take action immediately

  • Unfriendly and suspicious patients think others want to harm him and are overly watchful of things going on around him. He also has ideas that are unreal.

1. Do not argue with the person about their ideas or thoughts or try to prove them wrong.

2. Change to a concrete topic that is not related to suspicions.

3. Be friendly and accepting.  Do not get angry with the person.

4. Do not whisper or talk secretly when the person is in the same room or nearby.

5. Do not talk or do things behind the person's back.

  • Restless, constantly walking back and forth or very excited, moving around without a reason:

1.  Do not try to hold on or restrict the person.

2.  Talk to him and get his attention.

3.  Firmly but without anger, ask him to come to you and do what you say.

4.  Tell him his behaviour is disturbing you and you would like him to stop.

  • Avoids people and won't let others come near

1.   Approach the person slowly and in a friendly manner.  Stop in front of him but beyond his reach to avoid aggression and greet him in the usual way. 

2.  Talk to him first about things you both can see and discuss e.g., Is that chair comfortable?

3.   If he answers, continue with small talk.

4.   If the person stops talking, try again to get him to answer.  If he becomes restless, thank him and leave.

5.   Repeat this small talk many times until he allows you to come near and talks to you about how he is feeling.

6.  Have the family members continue their activities near the person so that they can watch him.

7.  Family members should continue to talk to the person even if he does not answer.

  •  Aggressive behaviour and suddenly strikes out

1.  Stay calm and do not show that you are frightened but quickly go for help.

2.  Speak in a firm loud and commanding voice: "I would like you to stop this behaviour".

3.  Remember that the person does not always know what he is saying or doing.

4.  Give the person an activity which requires him to use his energy and get distracted.

5.  Do not let him use objects that are sharp or that can be used as a club.

6.  Instruct other persons not to argue with the person and to stay away until he calms down.

7.  Talk to him about his behaviour when the person is calm.  Make suggestions about other activities he can do that will help the anger disappear.

 

CLINICAL DEPRESSION

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There are several types of clinical depressions, which involve disturbances in mood, concentration, self-confidence, sleep, appetite, activity, and behaviour as well as disruptions in friendships, family and/or work. A clinical depression is different from experiences of sadness, disappointment, and grief familiar to everyone resulting from day to day stress (PTSD). 

 A period of depressed mood, which lasts for several days or a few weeks, is a normal part of life and is not necessarily a cause for concern (PTSD). Although these feelings are often referred to as "depression," instead of "sadness" they typically do not constitute a clinical depression because the symptoms are relatively mild and of short duration. Moreover, these are often related to stressful life events and improve with positive life changes. 

 

A person experiencing clinical depression, however, is likely to be experiencing substantial changes in their mood, thinking, behaviours, activities, and self-perceptions. A depressed person often has difficulty making decisions; for example, the day-to-day tasks may seem overwhelming. A depressed person may also dwell on negative thoughts continuously, focus on unpleasant experiences which he does not forget ever, describe himself/herself as a failure, report that things are hopeless, and feel as though he is a burden to others.  The changes in mood brought on by depression frequently result in feelings of sadness, irritability, anger, emptiness, and/or anxiety.

 

There are also some types of depressions, in which depressive episodes alternate with episodes of agitation and euphoria, They also show features such as overactivity, over talkativeness, overspending, elation and get unrealistic ideas such as being a great person, during these times.

FOR MORE ON

BIPOLAR DIORDER/MANIC DEPRESSIVE DISORDER

 

A severe depressive episode can also result in thoughts of death and suicide.

 

The following checklist includes symptoms typical of clinical depression. It is important to note, however, that only some of these symptoms are necessary for a diagnosis of depression.

 Symptoms of Depression

1.     A significantly depressed mood or general absence of expressions.

2.      Inability to experience pleasure or feel interested in daily life.

3.     Inexplicable crying spells, sadness, and/or irritability.

4.      Sleeplessness or excessive sleep nearly every day. A substantial change in appetite, eating patterns or weight.

5.     Fatigue or energy loss.

6.     Diminished ability to concentrate.

7.     Feelings of hopelessness or worthlessness.

8.     Inappropriate feelings of guilt.

9.     Lack of sexual desire.

Causes of Depression

Clinical depression is typically caused by a combination of biological, genetic, and stress factors. A recent death or loss, family conflict or divorce, financial difficulties, major life transitions, and other stresses can precipitate a pre-existing depressive episode in a genetically vulnerable person occassionally. It should be emphasized that depressive episodes in clinical depression occur without any identifiable causes at random. Consumption of sleeping tablets, alcohol and addictive substances also can worsen a depressive disorder. Consumption of these substances can also 'mask' the symptoms of depression in some people. It is important to remember that depressive disorders are treatable conditions. They are not the result of weakness, personal failure, or a lack of willpower.

Things to Do

1.  Eliminate the use of alcohol, sleeping tablets or addictive drugs.

2.  Engage in some form of physical activity, such as walking one hour every day.

3.  Get an adequate amount of sleep regularly, at least for eight hours.

4. Consult a physician if you are experiencing any medical problems.

5. Seek early psychiatric intervention, that will reduce  your depression and bring you back to normalcy.

Things to Avoid

1.  Do not make long-term commitments or important decisions during a clinical depression unless necessary.

2.  Do not assume that things are hopeless.

3.  Do not assume responsibility for events that are outside of your control and feel guilty.

4.  Do not avoid treatment as a way of coping with illness by self.

 Treatment of Depression

If symptoms related to a depressive condition are interfering with your ability to do the routine, day-to-day activities or they are disturbing significant people around you, you should seek professional help. There are highly effective interventions available for the treatment of depression. When you seek treatment, the recommendations you receive will depend on the symptoms you have, their duration and severity, and the past history of depression. 

There are side effects associated with the antidepressant medications, but the medication is often an effective and substantially low-risk form of treatment for depression.

There are two drugs that needs special mention. One is "Lithium" and other is "Sodium Valproate".

Lithium carbonate is a metalic salt like sodium chloride or common salt. It replaces the sodium inside the brain cells and control the abnormal emotions that fluctuate from severe depression to excessive elation. Hence it controls the bipolar illness (MDP) very effectively in about 80% of patients and leaves the normal emotions intact giving a chance for people to live a normal life. Lithium is eliminated from the body through the kidneys. Hence kidneys needs to be healthy always, if one has to use lithium to prevent bipolar illness. It cannot be used in elderly, people with cardiac illness, diabetes, brain disorders and such other illnesses. Hence frequent follow up is required to evaluate if the kidneys are all right, dosage is adequate and can control the illness without producing side effects etc. Patients who are on lithium needs to be very responsible to take it exactly as adviced by the treating psychiatrist, because it can produce many side effects if it is misused. It is advisable to collect the instruction sheet from your psychiatrist about the do's and dont's when lithium is used.

Sodium Valproate on the other hand is more useful in reccurent clinical depressions and less effective in manic elated phases. It is eliminated through liver and hence liver status needs to be monitored regularly. It may also produce allergies in few people, hence intitially small doses are given until allergies are ruled out.

In some resistant cases of bipolar illnesses, a combination of both drugs become necessary to control the illness since the bipolar illness is one of the most difficult illness to treat and most disturbing for their families to manage at home.

Counselling can be useful to resolve interpersonal problems associated with depression, espcially in cases of PTSD. 

Relaxation exercises and walking for an hour that reduce anxiety levels in depressed persons are always beneficial for all people with depression.

  • SUICIDE PREVENTION

Danger Signals

At least 70 percent of all people committing suicide give some clue to their intentions before they make an attempt. Becoming aware of these clues and the severity of the person's problems can help prevent a tragedy. 

If a person is going through a stressful situation, watch for other signs of crisis. Many persons convey their intentions directly with statements such as "I feel like killing myself," or "I don't know how much longer I can take this" (Suicidal thoughts). 

 

Others in crisis may hint at a detailed suicide plan with statements such as "I've been saving up my pills in case things get really bad" or "Lately I've been driving my car like I really don't care what happens" (Suicide plans).

 

In general, statements describing feelings of depression, helplessness, extreme loneliness, and/or hopelessness may suggest suicidal thoughts. It is important to listen to these "cries for help" because they are usually desperate attempts to communicate to others the need to be understood and be helped.

 

Often persons thinking about suicide show outward changes in their behaviour. They may prepare for death by giving away prized possessions, making a will, or putting other affairs in order. They may withdraw from those around them, change eating or sleeping patterns, or lose interest in prior activities or relationships.

 Myths about Suicide 

  •  MYTH: "You have to be psychiatrically ill even to think about suicide".
  • FACT:   Most people have thought of suicide from time to time.  Most suicides and suicide attempts are made by intelligent, temporarily confused individuals who are expecting too much of themselves, especially in the midst of a crisis.

 

  • MYTH: "Once a person has made a serious suicide attempt, that person is unlikely to make another".

 

  • FACT: The opposite is often true. Persons who have made prior suicide attempts are at greater risk of actually committing suicide; for some, suicide attempts may seem easier a second or third time.

 

  • MYTH: "If a person is seriously considering suicide, there is nothing you can do”.

 

  • FACT:   Most suicidal crises are time-limited and based on unclear thinking. Persons attempting suicide want to escape from their problems. Instead, they need to confront their problems directly in order to find other solutions - solutions that can be found with the help of concerned individuals who support them through the crisis period, until they are able to think more clearly.

 

  • MYTH: "Talking about suicide may give a person the idea of suicide".

 

  • FACT:   The crisis and resulting emotional distress will already have triggered the thought in a vulnerable person. Your openness and concern in asking about suicide will allow the person experiencing pain to talk about the problem, which may help reduce his or her anxiety. This may also allow the person with suicidal thoughts to feel less lonely or isolated, and perhaps a bit relieved.

 

How Can you Help:

Most suicides can be prevented by sensitive responses to the person in crisis. If you think someone may be suicidal, you should remain calm. In most instances, there is no rush. Sit and listen to what the person is saying. Give understanding and active emotional support for his or her feelings. Most individuals have mixed feelings about death and dying and are open to help.

Don't be afraid to ask or talk directly about suicide. Encourage problem-solving and positive actions. Remember that the person involved in the emotional crisis is not thinking clearly; encourage him or her to refrain from making any serious, irreversible decisions while in a crisis. Talk about positive alternatives that may establish hope for the future.

Although you want to help, do not take full responsibility by trying to be the sole counsel. Seek out resources that can lend professional help, even if it means breaking the person's confidence. Let the troubled person know you are concerned, so concerned that you are willing to arrange help beyond that which you can normally offer.

OBSESSIVE-COMPULSIVE DISORDER

WHEN A HABIT ISN’T JUST A HABIT

All of us have patterns in our lives. We follow routines during most days, taking the same route to work or spending our free time in much the same ways. We all have patterns of behaviour, and most of us have reasons for doing things the way we do. In some people, however, the patterns are not just patterns. 

They are patterns that have run wild, patterns with a mind of their own. Such people have strange rituals. They wash their hands too many times a day or do similar meaningless activities. They check to see that the lights are turned off so many times that they are late for work or cannot leave the house at all. To make matters worse, they are filled with unbearable anxiety or dread that something terrible will happen if things do not work their way. 

 

These frightening thoughts continue without a stop for prolonged periods. They are not able to switch off their unwanted thoughts as though the thoughts switch does not exist. Thoughts are not under one's control anymore. These people have obsessive-compulsive disorder.

 

This disorder causes people to become haunted by repetitive thoughts (obsessions) or compelled to perform senseless, time-consuming rituals (compulsions), or both. Many people who have this disorder feel ashamed of their thoughts and behaviours and hide their condition. In recent years, awareness of obsessive-compulsive disorder (OCD) has increased, and effective treatments have become available.

 WHAT IS OBSESSIVE-COMPULSIVE DISORDER? 

Obsessive-compulsive disorder (OCD) is an illness that traps people in seemingly endless cycles of repetitive thoughts without being able to stop them (obsessions) and in feelings that they must repeat certain actions over and over (compulsions).

The obsessions that intrude uncontrolled into the person’s every day thinking may be frightening, disgusting, painful, or trivial.  Most people with OCD realize that their obsessions do not make sense, but they are not able to control or suppress them.

 

They may be able to explain in great detail what their obsessions are, but not why they appear. In most cases, the obsessions cause extreme anxiety. Feelings of discomfort or dread can build up to an unbearable level. To relieve their anxiety, some individuals with OCD feel they have to do something. These feelings that they must repeat certain actions or rituals are their compulsions - (the things they feel they have to do to avoid some dreaded event or to prevent or undo some harm to themselves or others, as suggested by their obsessions). Often the rituals have to be performed according to some rules. The rituals may be very simple and hardly noticeable, or they may be very elaborate. Rituals may be time-consuming, sometimes taking hours to finish so that they interfere with the person’s daily routine.

 

Rituals do lessen anxiety, discomfort, or feelings of disgust, but only briefly. The fears and tensions soon return, causing the individuals to start their rituals all over again. People with OCD do not like the obsessive thoughts, nor do they want to engage in time-consuming rituals. They do not get any pleasure from being the way they are. Most people with this disorder realize how senseless it all is. Recognizing the bizarre nature of their obsessions and compulsions, many conceal their condition from others. Eventually, people with OCD may be discovered, or their obsessions and compulsions become so time-consuming that they can no longer function at home, on the job, or without developing conflicts with others.

TREATMENT 

Most people with OCD can be helped with medication. It allows people to lead normal lives. People can also be taught to reduce their anxiety from their obsessions. The affected persons are encouraged to expose themselves to the objects or situations that cause them problems. They are then asked to delay performing the rituals they usually use to deal with them, or they are asked to perform the rituals less extensively.

OCD is not only distressing to the persons affected, it is also disturb the people who live with them. Family members react to living with a person with OCD in a number of ways. They may demand that the person stops ritualizing. They may give reassurance. They may even participate in the rituals themselves to pacify the individual and to avoid arguments. These may seem like the best tactics, but they do not improve OCD and only worsens it. If possible, families should not participate in the person’s rituals.

 

SOCIAL PHOBIAS

 

Social phobias start in adolescence and are based on a fear of scrutiny by other people, leading to avoidance of social situations. Social phobias can be discreet, for example for public speaking, eating in public or meeting with the opposite sex or diffuse, involving all situations outside familiar circles. Direct eye to eye contact may be particularly bothersome in some cases. 

 

Social phobias are associated with low self-esteem and a fear of criticismThey experience features of anxiety such as rapid heartbeats, trembling, sweating, upset stomach, diarrhoea, muscle tension, blushing, and confusion. In some cases, these symptoms may be severe enough to take the form of a panic attack.

 

Some people with social phobia may use alcohol or drugs as a way to self-medicate to help them get through social situations. Although alcohol or drugs may seem to help initially, they eventually become another problem in the life of the person with a social phobia.

 

Social phobia can result in a person dropping out of school, chronic unemployment and financial dependence, alcohol abuse, suicidal thoughts, and not getting married or having children. 

 

Social phobia is related to an imbalance of a chemical that transports signals between nerve cells in the brain. It also runs in families, especially among close relatives like parents and their children. Both medication and in the early stages, cognitive behaviour therapy along with medications, have proven successful in treating social phobias. 

 

SCHIZOPHRENIA

Schizophrenia starts relatively early in life and gradually progresses to affect most behaviours of the person. One notices that he hears some voices when he sits alone, and gradually starts responding to these imaginary figures when he is alone. (Link here gives you sample of imaginary voices).

Another major symptom is known as "paranoid delusions". These are unshakable convictions that are not culturally appropriate. (Link gives the explanation of delusions).

Both these symptoms occur in other psychiatric illnesses too. However, in schizophrenia they occur gradually, over years, along with deterioration in behaviour and personality. Their verbal communications also become odd and difficult to understand. (Link explains how thought gets blocked and talk becomes odd).

Another symptom is the gradual deterioration of personal and social behaviours such as, personal hygiene, sleep, work, socialisation, motivation, daily chores etc. This deterioration is less prominent in patient with "Paranoid Schizophrenia" and patient may live without noticable personality changes for several  years. (Link gives presentation from a patient who cannot feel emotions).

Current treatment of Schizophrenia is primarily medical with very good results. Psycho-social therapies are used to rehabilitate patients early to normal, self-supporting life. (Link describes treatment of Schizophrenia).

There is also considerable role for care-givers in the treatment of Schizophrenia without whose help results can be poor. (Link gives some tips to the care-givers).

ALCOHOLISM

For more information watch the links

1.Alcohol and your brain

2.Is alcohol becoming a problem

3.How to recognize signs of alcoholism

4.Alcohol Abuse

5.Tips to quit drinking

6.Alcohol and suicide

7.Alcohol effects on your body