I recently noticed my colleague’s change in behaviour over the past year. For the last nine years that I have known her, she was a happy and well-adjusted person whom the other team members looked up to as ‘big sister’. People went to her for advice. But this year, she has been having bizarre and erratic behaviour swings. What is strange is that when she is unhappy, she will tell you that she is sad, but she will be wearing a happy smile. I find this very odd, especially when she has never been like this in the past.

There are many causes for a sudden or gradual change in behaviour in a person you know well.

There could be a stressful traumatic event, such as a cancer diagnosis or a death in the family. The person could possibly have been attacked or abused as well, or has just gotten divorced.

Because of that, the person might be suffering from PTSD or post-traumatic stress disorder.

However, if this has been going on for some time, there is always the consideration of a mental health disorder.

Mental health disorders are underdiagnosed because most people don’t recognise them, don’t want to recognise them or don’t seek early treatment for them.

Mental health disorders are diagnoses of exclusion – meaning we need to exclude physical diseases as the cause before we can conclude that the person is suffering from a mental health disorder.

And you would have to fulfil certain criteria before being diagnosed of a certain mental health disorder.

How do I recognise PTSD?

PTSD has an obvious trigger – a terrifying event. This event can either happen to a person or they could have witnessed it.

Many soldiers, for example, suffer from PTSD after having been involved in a war.

The symptoms here can include having nightmares about the event, flashbacks or constant uncontrollable thoughts about the event.

During this time, the person is very anxious and many also have difficulty coping in real life. Their job and relationships may be affected. This can go on for months, or even years.

But with psychological counselling and conditioning, people with PTSD can get better over time.

Schizophrenia, PTSD, strange behaviour, mental health, mental disorders, Star2.com

PTSD has an obvious trigger. Many soldiers, for example, suffer from PTSD after having been involved in a war. — AP

I have read of an even more awful diagnosis for an erratic change in behaviour. It is schizophrenia. My friend, for example, has been talking about living ‘hell on earth’, but she is still smiling happily when she comes to the office. How is schizophrenia different from a PTSD?

Schizophrenia is a serious mental disorder in which a person’s thoughts are not functioning as per normal.

In schizophrenia, you not only have problems with thinking (cognition), but also with behaviour and emotions.

Because of an altered thought process, the patient interprets reality differently from you.

People with schizophrenia usually have:

• Delusions – these are absolutely false beliefs that have no grounding in reality.

For example, you believe you have been kidnapped by a UFO and have had an alien baby.

You may also believe you are a very famous person (when you are not), or another person is trying to harm you (when they are not).

Delusions are frequent in people with schizophrenia.

• Hallucinations – you see or hear things that are not there.

No, you are not imagining them either. You actually see or hear things as though they are right in front of you, just like a normal experience.

Hearing voices (auditory hallucinations) is the most common of them. These voices are usually combative, unkind, argumentative or demeaning to you.

Sometimes, these voices can even suggest that you do something harmful.

• Disorganised thinking and speech – we can guess about what a person is thinking from his speech. So a person with schizophrenia clearly shows disorganised thoughts and speech.

They may not answer you appropriately. They can give an answer that is completely unrelated to what you are asking.

They may even be in the middle of saying something, and then they suddenly stop.

This is because their thought process is interrupted. It can get so bad that a person’s speech may be unintelligible. This is called a “word salad”.

The person also displays extremely disorganised and abnormal behaviour, such as being agitated or child-like.

They can comport themselves in bizarre postures or be completely unresponsive.

Prior to this, however, people going on to schizophrenia become withdrawn, keeping to themselves and losing interest in all social activities.

Schizophrenia, PTSD, strange behaviour, mental health, mental disorders, Star2.com

Mental health disorders are diagnoses of exclusion – physical causes need to be excluded before it can be concluded that the person is suffering from a mental health disorder. — AFP

I am not sure what to make of my colleague. She is not ‘normal’ enough to be considered as behaving normally, and yet she does not have those symptoms of schizophrenia you outlined. I’m just afraid that she has the beginnings of schizophrenia. What should I do?

If you are really close to her, you can advise her to seek a psychologist/psychiatrist.

People who are about to get schizophrenia usually have no clue. So it’s up to friends and family to help them.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.