‘A voice is telling me to jump off a building’

by Eveline Gan

How do you convince someone who cannot separate fantasy from reality that he is mentally ill and requires medication? What should you do to get a deeply suspicious person to believe that his anti-psychotic pills are good for him?

Those are some of the many issues caregivers of schizophrenia sufferers face.

Schizophrenia affects one in 100 people, and worldwide more than 24 million people grapple with the chronic brain disorder that can cause one to hallucinate, have disorganised thoughts or hear voices in his or her head. In Singapore, it is one of the three top mental conditions.

Yeo Book Seang’s younger brother has been suffering from schizophrenia for 30 years. Speaking to Today in Mandarin, Book Seang, 55, said he has been his brother’s main caregiver ever since his parents passed away 10 years ago.

One of his main challenges is to ensure that his brother takes his medications twice daily. Without regular medication, the psychotic episodes would kick in as frequently as every two months.

“I must personally see that he takes his medicine every day. Without it, he’ll start quarrelling with people, hear voices that tell him to bomb someone or kill himself,” said Book Seang, who is constantly on tenterhooks as he never knows when his brother would have a relapse.

Missing medication

Most people with schizophrenia will require anti-psychotic medication for the rest of their lives. Yet, experts Today spoke to said that getting patients to take their medication is a challenge – they often miss doses or take incorrect doses.

Studies have shown that more than 80 per cent of schizophrenia patients suffer a relapse within five years after diagnosis.

“Stopping anti-psychotic medication is the most powerful predictor of relapse. About 55 per cent of hospital readmission occurs because patients do not take their prescribed medication,” said Professor Tim Lambert from Concord Clinical School at The University of Sydney in Australia. He was in town last month to talk about schizophrenia relapse prevention.

Prof Lambert is also the Head of Schizophrenia Treatment and Outcomes Research at the Brain and Mind Research Institute in Sydney.

Damaging effects of a relapse

For schizophrenia sufferers, a relapse can have dire consequences. They face a four-times risk of suicide, and each relapse also becomes more intense, leading to a longer recovery period.

Prof Lambert explained that with every relapse, the person’s brain function – in the frontal lobe – undergoes further irreversible damage.

The frontal lobes of the brain is where all the complex information processing such as reasoning, planning and strategising occurs. Abnormalities in this part of the brain can lead to “a disconnection between thinking and feeling”, explained Dr Ang Yong Guan, consultant psychiatrist and chairman of Action Group for Mental Illness.

He said: “What the person feels is not perceived by the prefrontal cortex of the brain for processing. As a result, schizophrenia patients are often trapped in a world of their own. They are not able to separate fantasy from reality.”

Caregivers’ stress

For Book Seang’s brother, missing his medication has led to countless relapses, causing his condition to worsen over the years. The relapses have also taken a toll on Book Seang. “The emotional burden and stress of caring for someone with schizophrenia is very high. Whenever something happens to him, I have to drop everything and go to help him. How can I hold a proper full-time job like this?” said the part-time kitchen helper.

With poor insight into their illness, many do not believe they need medication, said Dr Ang. The older generation anti-psychotic medications also had more severe side effects.

“It was tough making my brother take his medication. He said it made him feel very tired,” said Book Seang.

To address this problem, a new treatment in the form of a once-monthly injection is now available here. A doctor administers the injection once a month. Dr Ang said psychiatrists can use this new approach to treat patients who have difficulties taking their oral medication daily.

“Most people do not understand what this disease is, so they look down on people with this illness. Through this interview, I hope that the public will be more aware of the pressures that schizophrenia sufferers and their caregivers face,” said Book Seang.

-Today Online –  

Picture taken from: Thementalhealthblog.com