Schizophrenia: Curse or Conundrum?

Schizophrenia in Hong Kong

Typically diagnosed by a Hong Kong registered psychiatrist severe mental illness is a condition that involves deterioration over at least six months, and results in extreme dysfunctionality. Examples are severe schizophrenia and schizoaffective disorder, severe depression or bipolar disorder (some would require in-patient hospitalization for treatment of more than 28 days).

It may come as a surprise to many, but the number of such cases in Hong Kong has been rising steadily in the past few years. According to the latest data from the Hospital Authority, some 70,000 to 200,000 people in the city suffer from severe mental illness. Of those, at least 40,000 have been diagnosed with schizophrenia.

Its exact causes are unknown, but research suggests some people may be prone to schizophrenia, and a stressful or emotional life event could trigger a psychotic episode. The age of onset is usually during adolescence or early adulthood, affecting both men and women equally.

Schizophrenia - Staging

The symptoms appear gradually, then slowly get worse. In the acute stage, there is reality distortion, characterised by delusions and hallucinations (the most common form being that of hearing voices), or thought disturbances (expressed as noticeably illogical remarks or the use of peculiar words and phrases). In the chronic stage, the patient exhibits a virtually emotionless, 'flat' and apathetic personality, sometimes accompanied by motor (movement-related) symptoms.

There is a silver lining to this rather dark cloud life can unexpectedly bring however: The earlier schizophrenia is treated, the more successful the outcome tends to be.

Treatment of severe schizophrenia is based mainly on pharmacology, specifically antipsychotics medication. Therapy and rehabilitation are also employed, especially after the patient has been stabilised on medication.

Treatment can last between six months and two years for first-episode patients, with an 80% chance of a second episode. Maintenance treatment is often necessary as the majority of patients relapse without ongoing treatment. In particular, the psychotic symptoms of severe schizophrenia, often fluctuate over time, hospitalisation may be required depending on the level of danger presented by the patient to himself or to others. Suicide is a serious risk for those with schizophrenia, occurring at a significantly higher rate than in the general population.

Around 50% of people diagnosed with schizophrenia have positive outcomes when they receive appropriate treatment in time. One should immediately approach a psychiatrist or primary- care physician with experience in mental health assessment. Unfortunately, in Hong Kong as the waiting times for mental health treatment are the longest of all the specialist services offered in the public healthcare system - up to 166 weeks, or more than three years, in certain districts! What's more, a doctor's referral is required before one can join the queue.

The alternative - treatment from private-sector specialists, while much more accessible, is no spring breeze either:

Sample Price Table

All in all, the expenses involved in necessary, long-term, multimodal treatment can be crippling. But then what wouldn't a person give to help ease a loved one through the uninvited torment and suffering that is severe mental illness?

Solving the Puzzle

Although the occurrence of any mental illness is thought to be due to a variety of factors, including environmental and psychological, there is no denying the impact that the presence of certain genes has, proportionately, on the possibility that one could suffer a condition. Being forewarned about this through DNA testing enables one to be better prepared with knowledge and action plans in the eventuality that one does develop a mental illness.

Psychoeducation - information and skills-training provided to patients and their families to help them better understand and cope with a disorder - is another popular tool, as it has been shown to reduce relapse rates and symptom intensity in patients.

Last but not least, long term caring for a loved one with a mental illness can naturally take a toll on one's family members, not just physically but also emotionally. Assistance in the form of professional counselling, more than just the casual support of friends, is thus a very meaningful adjunct to the overall management plan of a patient's condition. Its role should not be ignored, as it contributes to the family's emotional resources and ultimately helps ensure the best possible outcome for a patient.

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