This is the second in an occasional series on health issues.

One of my patients once told me that Schizophrenia is a bit like finding oneself in a busy marketplace in a foreign country and alien culture, you are bombarded by sights and sounds that do not seem familiar.

The people around don't understand what you are saying and you do not know who you can turn to for help, a situation that makes you feel overloaded and stressed.

Schizophrenia is not, as it is popularly described, a split personality, rather it is a condition arising in the brain that affects a number of processes to do with one's interpretation of daily experiences, thoughts, feelings and emotions.

Schizophrenia occurs in about one percent of the population throughout the world.

We know that there is a genetic component to Schizophrenia. It can run in families and most likely in vulnerable individuals who are exposed to something in their lifestyle and environment that is yet to be fully elucidated.

Schizophrenia however, cannot be caught and is not due to bad parents or a difficult childhood.

Schizophrenia generally occurs for the first time in young adults and often begins with what is described as pre-morbid syndrome, sometimes two or three years before the onset of the symptoms.

Typically someone who appears to be doing well in life begins to change, perhaps losing interest in school, work or college and often becoming more distant from family and losing interest in friends.

A number of different symptoms can occur and can be sudden or gradual.

The sensation of hearing a voice, whispering or someone talking to them, often making insulting comments, or hearing several voices discussing them or providing a running commentary of their actions and thoughts.

These experiences are called auditory hallucinations.

Other symptoms include difficulty in identifying thoughts based on those that are fantasy or imagination to the point that the individual finds it difficult to appreciate what is real and unreal.

These experiences are referred to as delusions.

Over time other features of Schizophrenia can occur.

These are changes in motivation, and emotions which can effect that person's abilities to perform tasks and skills that they had previously acquired, for instance, personal self care, making conversations with others, managing household tasks or ability to perform and function at school or at work.

These deficits can lead people with Schizophrenia to have unhealthy lifestyles.

Smoking and alcohol use are high and the consumption of marijuana and cocaine are common and can make their symptoms worse.

Poor or unhealthy diets, lack of exercise and obesity can put them at added risk of conditions such as heart disease or diabetes.

Managing and treatments of Schizophrenia must take a holistic approach to the individual and family needs. People who have Schizophrenia in Bermuda are supported and treated by Clinical Teams based at St. Brendan's Hospital.

These teams consist of psychiatrists, psychologists, mental health nurses, occupational therapists, social workers, dieticians and support staff, and all bring particular and relevant skills to aid the particular individual with Schizophrenia.

Each patient is assigned a case manager who takes responsibility for insuring that the individual has access to the support and treatment required.

The emphasis is on working with the individual and if need be the individual family to build up a trusting network of care in what is described as a therapeutic alliance.

Greater understanding of Schizophrenia, development of newer medication with fewer side efforts and improvement with rehabilitation therapies allow us to be more optimistic about helping people with Schizophrenia.

Our goals should be to make it possible for people with Schizophrenia to maximise their potential and live happy, rewarding and fulfilled lives.

@EDITRULE:

Dr. David Price MD CHB, MRC Psych., is a consultant psychiatrist at St. Brendan's Hospital. His special interest is in rehabilitative psychiatry. He was educated at Manchester Medical School and was also trained in and around the north west of England. He joined St. Brendan's in September 2001.