Dr Martin Holly, Czech Republic talks about how to reassure patients about their diagnosis of schizophrenia and other important issues about the condition.
Q: When you first tell a patient they have schizophrenia, do you tell them this is a lifelong condition?
A. In Dr Holly’s hospital, patients are told very soon after diagnosis that schizophrenia is a long-term condition. However, they are also told of the Bleuler Rule, created at a time when pharmacological intervention was not possible. This suggested that approximately one-third of patients are likely to experience just one or two schizophrenic episodes in their lifetimes, are at low risk of experiencing exacerbations of the disease and, therefore, may not need to be treated long-term. Two-thirds, however, may experience more severe episodes and may require long-term therapy.
Q. Having made a diagnosis of schizophrenia – do you tell patients at that point how long they are likely to need to be on medication?
A. Therapy is usually administered following a first episode, as per guidelines, and given for 1 year. At this time a reassessment is made as to how the patient is doing and the decision to continue therapy is made. Regular discussions about the need for long-term therapy follow thereafter.
Q. What factors have a large contribution to the quality of life of a patient with schizophrenia?
A. Patient prognosis is improved when pharmacotherapeutics are administered. To ensure compliance - because it is crucial that patients take their medicine regularly - considerable time is usually spent in the clinic ensuring that any side-effects are recognised and dealt with promptly and effectively. Time spent talking to the patient together with more formal talking, psychosocial and rehabilitation therapies all contribute to improvements in the overall well-being of the patient and their life quality. Patient well-being is further supported by assertive community treatment in which teams of psychiatric nurses undertake home visits. Such ongoing assistance helps prevent rehospitalisation.
Of course it is difficult to generalise about the factors that contribute to the enhancement of a patient’s quality of life – each patient is different. Each has a different disease with different negative symptoms and a different disease course and support has to be tailored to the patient’s needs. Generally, continued family or other social support, employment of some type, and suitable accommodation, in sheltered conditions if necessary, are all important.
Q. What proportion of patients with schizophrenia have the potential to achieve improvements in relationships?
A. Given the right therapy, most patients have the potential to achieve improvements in relationships.
Q. Do you think of schizophrenia as a neurodevelopmental disorder or as a neurodegenerative disease?
A. Schizophrenia, in Dr Holly’s opinion, is a neurodegenerative disease with neurodevelopmental aspects. Genetic components to the condition are recognized and intrauterine studies have been undertaken that indicate that insults to the foetus [such as infection and extreme maternal stress] at this time can increase the risk of schizophrenia.
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