On the 10th of October, it will be World Mental Health Day. This is a day set aside by the World Health Organisation, WHO, for people all over the world to focus on the importance of Mental Health to human society, and to pay especial attention to the scourge represented by Mental Illness in all its varieties. It is a truism to repeat the slogan ‘There is no Health without Mental Health’. There are a lot of important issues associated with Mental Health and Illness tha
t justify a constant effort to keep the subjects in the public eye. Some of the facts are as follows:
Mental illness of different types, most frequently Depression, are among the highest causes of Disability Adjusted Life Years (DALYs) – which is a major measure of the loss of productive life suffered as a result of different types of illness all over the world.
In Nigeria, more than 90 percent of people with a diagnosable mental illness never get to see a doctor or receive treatment of any sort. The cost of untreated mental illness to society in terms of lost productivity every year is humongous – estimated in the hundreds of billions of naira.
This year, the theme of the World Mental Health Day is Living With Schizophrenia.
What is Schizophrenia?
It is an illness, or a group of illnesses, in which the individual loses touch with reality, and may experience a variety of strange feelings, such a conviction that he is being controlled by others, or his thoughts are being ‘broadcast’ and made available to other people, or that thoughts are being put in his mind or taken away from him. He may hear voices of people running commentaries on his actions.
There are a whole range of other symptoms that a person suffering from this curious but common illness may experience, including some types which manifest with so-called ‘Negative Symptoms’ (flat facial expression, lack of motivation etc). There a number of different sub-types of the illness, with slightly different pictures and outcomes.
Schizophrenia is an illness that probably has been with man from the beginning of time. It is slightly more common in men than women. It may affect any age group, from childhood to late old age, although it most commonly begins in people in their 20 and 30s.
How common is it?: It is a relatively common illness – about one out of every hundred human beings may expect to suffer the illness at some time in their lives.
Although there are cultural differences in the content of the experience, Schizophrenia is known to occur with roughly the same likelihood in all races and cultures.
Many of the obviously mentally ill destitutes who wander about on the streets of Nigerian towns are suffering from long-standing schizophrenia. In a similar way, many of the clients who are admitted to long-stay mental health facilities are suffering from Schizophrenia.
Causes
Genetics – a person with one parent who suffers from Schizophrenia has a higher risk of developing the illness than another person who has no such history. The risk is significantly increased if both parents suffer from the condition.
Family and Social Environment – some early theories suggested that certain patterns of family interaction could predispose some people to developing Schizophrenia in later years. Mothers especially were made to feel guilty if their children went on to develop the illness. There is no conclusive evidence on the matter. On the other hand, certain events such as Emigration, and belonging to an alienated minority are associated with a relatively higher incidence of Schizophrenia.
Drugs – some drugs of abuse such as cannabis (indian hemp) may cause symptoms similar to Schizophrenia as an acute illness, while long term use may lead to symptoms indistinguishable from Chronic Schizophrenia. Factors such as stress may precipitate the onset of Schizophrenia in a person who is vulnerable to the condition.
Abnormalities in brain substance: certain physical changes in the brain are found on MRI and CT scan in many people who have had the condition for a long time. Whether this is ‘cause’ or ‘consequence’ of the illness has not been fully established.
Abnormalities in Brain Chemistry: the effective activity of the first generation of drugs discovered for treating the condition was found to be due to reduction of activity at dopamine receptor sites in a part of the brain known as the ‘meso-limbic’ system. This suggested that excessive neurochemical activity at these sights might be responsible for the symptoms of Schizophrenia.
Again whether this is ‘cause’, ‘consequence’ or ‘incidental’ is not fully established, though the fact that the medicines that target those sites have the effect of improving the symptoms suggest a strong relationship.
Recognition of Schizophrenia: A person with Schizophrenia may be observed talking aloud as he responds to voices he is hearing. The speech may be incoherent. There may be a variety of false beliefs (for example that his life is in danger) and unusual experiences as earlier described. Because the individual is out of touch with reality, he may not be aware that he is ill and in need of treatment and so may resist any effort to help him.
How can I help ? The first important requirement is that a person who is showing obvious disturbance in behaviour or thinking should be assisted to get access to expert assessment and treatment as soon as possible. The fact that the sufferer may be out of touch with reality and lacking insight into his condition implies that he may not willingly submit to examination.
To be concluded.
Dr. Femi Olugbile is Permanent Secretary, Lagos State Ministry of Health
Mental illness of different types, most frequently Depression, are among the highest causes of Disability Adjusted Life Years (DALYs) – which is a major measure of the loss of productive life suffered as a result of different types of illness all over the world.
In Nigeria, more than 90 percent of people with a diagnosable mental illness never get to see a doctor or receive treatment of any sort. The cost of untreated mental illness to society in terms of lost productivity every year is humongous – estimated in the hundreds of billions of naira.
This year, the theme of the World Mental Health Day is Living With Schizophrenia.
What is Schizophrenia?
It is an illness, or a group of illnesses, in which the individual loses touch with reality, and may experience a variety of strange feelings, such a conviction that he is being controlled by others, or his thoughts are being ‘broadcast’ and made available to other people, or that thoughts are being put in his mind or taken away from him. He may hear voices of people running commentaries on his actions.
There are a whole range of other symptoms that a person suffering from this curious but common illness may experience, including some types which manifest with so-called ‘Negative Symptoms’ (flat facial expression, lack of motivation etc). There a number of different sub-types of the illness, with slightly different pictures and outcomes.
Schizophrenia is an illness that probably has been with man from the beginning of time. It is slightly more common in men than women. It may affect any age group, from childhood to late old age, although it most commonly begins in people in their 20 and 30s.
How common is it?: It is a relatively common illness – about one out of every hundred human beings may expect to suffer the illness at some time in their lives.
Although there are cultural differences in the content of the experience, Schizophrenia is known to occur with roughly the same likelihood in all races and cultures.
Many of the obviously mentally ill destitutes who wander about on the streets of Nigerian towns are suffering from long-standing schizophrenia. In a similar way, many of the clients who are admitted to long-stay mental health facilities are suffering from Schizophrenia.
Causes
Genetics – a person with one parent who suffers from Schizophrenia has a higher risk of developing the illness than another person who has no such history. The risk is significantly increased if both parents suffer from the condition.
Family and Social Environment – some early theories suggested that certain patterns of family interaction could predispose some people to developing Schizophrenia in later years. Mothers especially were made to feel guilty if their children went on to develop the illness. There is no conclusive evidence on the matter. On the other hand, certain events such as Emigration, and belonging to an alienated minority are associated with a relatively higher incidence of Schizophrenia.
Drugs – some drugs of abuse such as cannabis (indian hemp) may cause symptoms similar to Schizophrenia as an acute illness, while long term use may lead to symptoms indistinguishable from Chronic Schizophrenia. Factors such as stress may precipitate the onset of Schizophrenia in a person who is vulnerable to the condition.
Abnormalities in brain substance: certain physical changes in the brain are found on MRI and CT scan in many people who have had the condition for a long time. Whether this is ‘cause’ or ‘consequence’ of the illness has not been fully established.
Abnormalities in Brain Chemistry: the effective activity of the first generation of drugs discovered for treating the condition was found to be due to reduction of activity at dopamine receptor sites in a part of the brain known as the ‘meso-limbic’ system. This suggested that excessive neurochemical activity at these sights might be responsible for the symptoms of Schizophrenia.
Again whether this is ‘cause’, ‘consequence’ or ‘incidental’ is not fully established, though the fact that the medicines that target those sites have the effect of improving the symptoms suggest a strong relationship.
Recognition of Schizophrenia: A person with Schizophrenia may be observed talking aloud as he responds to voices he is hearing. The speech may be incoherent. There may be a variety of false beliefs (for example that his life is in danger) and unusual experiences as earlier described. Because the individual is out of touch with reality, he may not be aware that he is ill and in need of treatment and so may resist any effort to help him.
How can I help ? The first important requirement is that a person who is showing obvious disturbance in behaviour or thinking should be assisted to get access to expert assessment and treatment as soon as possible. The fact that the sufferer may be out of touch with reality and lacking insight into his condition implies that he may not willingly submit to examination.
To be concluded.
Dr. Femi Olugbile is Permanent Secretary, Lagos State Ministry of Health
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