Schizophrenia is categorised as a severe mental disorder, which results in changes in behaviour, thinking, memory, speech, thought, and even movement.

These result in significant changes in an individual’s capacity to function, both in the social and occupational spheres.

Unfortunately, the disease usually begins in late adolescence and early adulthood, during the most critical phase of an individual’s life cycle.

This is the phase during which individuals complete their secondary or tertiary education, get employment, form relationships, get married and start families. Thus, schizophrenia results in a huge cumulative loss to society as a whole.

This article is to explain how depressive symptoms have been recognised to coexist with schizophrenia. This is to be expected considering the impact the illness has on the individual.

How does schizophrenia occur?

Individuals usually progress through a “prodromal phase” of illness before the first episode of schizophrenia occurs. During this prodromal phase, individuals experience low self-esteem, disturbed sense of self, disturbed self-image, and begin to experience transient hallucinations and suspiciousness.

Depression and anxiety begin at this phase. Depression, which is compounded by low self-esteem and disturbed self-image, may even lead to suicidal thoughts and attempts.

Anxiety symptoms often manifest as social anxiety. This social anxiety worsens the social withdrawal. Keeping in mind that these symptoms start before the actual acute phase of the illness begins, one can empathise with the sufferers.

Withdrawn from family and friends, individuals start to abuse drugs as a means of coping with a myriad of symptoms.

During the acute phase of schizophrenia, florid hallucinations and delusions torment and terrorise the individual.

With their perceptions, senses and sense of reality taken over by the illness, patients are confused, frightened and lose the ability to reason or make sense of what’s happening to them.

Depressive symptoms are present and hallucinations command the individual to harm him or herself. It’s during this phase that most families succeed in bringing the indivi-dual to the hospital, and the investigative and diagnostic process begins.

After the usually successful treatment with anti-psychotic medications, individuals are allowed home to recover.

What happens after that?

It’s during the post-discharge phase where individuals are at the highest risk of suicide. Having been told that they suffer from schizophrenia, individuals are devastated and understandably depressed.

With a myriad of blogs providing wrong information on the illness, individuals and family members can be misguided into stopping medication and follow-ups prematurely. Inevitably, visits to alternative healers will ensue.

Alternative therapies have been found to be helpful in most societies, provided medications and follow-ups are also adhered to.

Alternative healers often provide an “acceptable model” of the illness. Thus, it’s easier for patients and family members to accept cultural models of mental illness, i.e. it’s caused by a djinn or black magic.

Many traditional healers in Malaysia actually encourage individuals to continue with their anti-psychotic medication.

However, there are the unscrupulous few who manipulate and financially drain families who are already in dire straits.

During the chronic phase of the illness, individuals with schizophrenia begin to manifest the negative symptoms of the illness. There is loss of motivation, self-neglect from apathy, emptiness of thought and continued social withdrawal.

They have to deal with stigma, where they are or feel ostracised by the community. They can’t earn an income, which leads to further loss of self-esteem.

Social withdrawal aggravates the stigma. Depression during the chronic phase is often unrecognised or explained as “chronic symptoms” of schizophrenia. Suicide attempts can occur during this period as well.

How can schizophrenia be treated?

Treatment is multi-dimensional. A psychosocial assessment is done and antipsychotic medications are prescribed if schizophrenia is confirmed.

These medications, if taken as prescribed, are not only effective, but also crucial in removing all auditory hallucinations and resolving the psychosis.

Anti-schizophrenic medications, if taken as prescribed, are not only effective, but crucial in removing all auditory hallucinations and resolving the psychosis. Photo: TNS

Anti-schizophrenic medications, if taken as prescribed, are not only effective, but crucial in removing all auditory hallucinations and resolving the psychosis. Photo: TNS

Psychosocial and occupational therapy would be needed as well, to help patients become functional again. Simple daily activities are monitored to ensure that self-care is not neglected.

Symptoms such as low motivation and social withdrawal are harder to treat. Patients with severe depression may be prescribed with antidepressants to help them cope. If depression is not treated, suicidal tendencies are definitely a concern.

Will schizophrenia patients live a normal life again?

This is a chronic illness, which means continued treatment and support are needed.

Generally, statistics show that about 20%-30% can go back to work in a sheltered environment where employers are aware of their disability and make allowances for their needs, such as going back for hospital admissions.

Many Malaysians are compassionate and employ people with this illness.

Similarly, many schools and universities are very supportive in giving counselling and encouragement to help their students cope with treatment and depression.

Students are allowed to complete a course within their abilities or to opt for courses with a lighter workload.

What can family members do to help?

It is important that they learn to do it the right way. Psychiatrists and psychotherapists can advise family members on how they can help patients cope in their daily lives.

Patients tend to feel depressed, hence, being over-involved and over-protective might stress them out. On the other hand, do not neglect the patient. Find a balanced way to help and care.

Many major hospitals have support groups for family members as there is a learning curve in dealing with this illness.

People with a family history of schizophrenia, as well as other mental illness, are recommended to take steps to lower their risk by living a healthy lifestyle and having a positive outlook on life.

Reduce mental stress by optimising diet, having proper exercise, being disciplined and avoiding illegal substances. Maintain a healthy family and have good relationships with family members where anyone can express his/her feelings, share personal problems and find solutions together.

Meditation, yoga, mindfulness and other stress-reduction techniques are often described as recent discoveries, but are actually age-old Eastern methods that help one cope with stress.

For people diagnosed with schizophrenia, with proper treatment and continued support, they can return to normal function, but in sheltered environments. It is good to be hopeful. There are many types of assistance available, including training for jobs.

Our care and compassion can certainly encourage people with schizophrenia to be functional members of the community.

Always lend a listening ear and have empathy for them so that they know that life is still worth living.


Dr Shane Varman is a neuropsychiatrist. This article is courtesy of IMU Healthcare. For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.