The Q&A below is transcribed from a phone interview with Dr. Ghulam-Mustafa Surti, associate medical director for Ambulatory Emergency Services and chief of the Kent Unit at Butler Hospital, for Honest Conversations.
Can you explain psychosis?
The one big thing for a lay person to know is that the word psychotic isn’t synonymous with schizophrenia. Psychotic is a symptom. For example, if I say I have chest pain, it’s a symptom. It doesn’t mean I’m having a heart attack. Psychotic really means “not in touch with reality,” which could mean disorganized thought process, not thinking clearly, disorganized speech, hallucinations – somebody’s talking to them or they’re hearing things when nobody is around them. They might have visions, which are very, very rare, or they’re very paranoid that people are talking about them. But, it doesn’t mean they have schizophrenia. Psychotic symptoms could be side effects of medicines. Some medical illnesses can make you psychotic. Alcohol can make people psychotic. Many drugs including marijuana, synthetic marijuana, LSD, PCP and ecstasy can cause psychotic symptoms. So, it’s a complicated thing.
How do you diagnose schizophrenia?
It’s like a diagnosis of cancer. You don’t make a diagnosis of cancer unless you’re sure of it. You need a period of at least one year of psychotic symptoms on and off to made a diagnosis of schizophrenia, and you need some active symptoms for at least a month. I don’t like to take a chance with that diagnosis unless I’m 99.9 percent sure about it. But, it also doesn’t mean you shouldn’t treat it. If somebody is psychotic and you’re not sure if it’s schizophrenia or not, you still have to treat the symptoms the patient is suffering from. So in this case you treat the symptoms first, even if it’s secondary to any medical issue.
What are the characteristics of schizophrenia?
Schizophrenia usually starts with the first symptoms between ages 18 and 28. It’s a very young age when this happens. Usually there’s some trigger to it. People move houses, move across the state to go to college, join the armed forces, experiment with drugs and alcohol, or go through a break-up. Those are all stresses. When people have a genetic risk for schizophrenia, the stress triggers it. If you have one parent with schizophrenia, there’s a higher than 25 percent risk that one child will have schizophrenia. If both parents are schizophrenic, there’s an even higher chance – it’s almost 40 percent. No one has identified the specific gene but it’s there.
How do you treat schizophrenia?
A big myth is that it can’t be treated. It can be treated. We don’t have a cure for it. The path is staying on the medication and leading a healthy lifestyle. People say, “Do I have to take meds for the rest of my life for this?” Yes, you do because you have a chronic illness, just like diabetes and hypertension. It doesn’t mean that in two months if you’re feeling ok you can stop your meds. It’s important to understand that people with schizophrenia don’t have control over it. Many family members have the misconception that the person can control it, but they can’t. What they can control is staying away from things that might trigger symptoms, like substances, and keeping their lives simple and organized.
Why is schizophrenia closely associated with substance abuse?
There are a lot of people who have a dual diagnosis of schizophrenia and substance abuse. Most of the time, they are self-medicating because they’re not getting the right treatment. So, somebody could be hallucinating and he or she isn’t getting medicine. Then they’re drinking all day to calm themselves and go to bed. It doesn’t resolve the problem, but it kind of puts them to sleep. The relief they feel doesn’t last long and when they wake, their symptoms are exacerbated by the substance abuse.
Does schizophrenia cause aggression?
Another myth is that people with schizophrenia are aggressive and assaultive. Yes, they can be aggressive and assaultive, but only when they are not in treatment. So, they have to be monitored closely. There must be more awareness and less embarrassment about this illness.
What gives you hope?
One of the reasons for hope is the difference in medicines available, and the quality of life. These medications are newer, and have a lower risk of side effects. The quality of life is a lot better than it was 50 years ago. Structured activities also help, which are more available now. When someone has a psychotic break and they are in a hospital, it’s just like having a hip replacement. You don’t go back to work right away. You have to give yourself time. And that doesn’t mean going to sleep for a couple of months. It’s more like a rehab.
Another big reason I’m hopeful is our new centralized call center for behavioural health services. There is now one place to call so you’re not bounced around to different departments and outpatient services. When someone calls in, we can make an assessment on the phone and determine if someone needs to come to an inpatient setting, or if an outpatient setting is more appropriate. We’re truly here to help.
Butler Hospital’s Programs and Services
Butler Hospital is Rhode Island’s psychiatric hospital focused on treatments, teaching and research for behavioral health. Learn about our inpatient, outpatient and partial hospital programs.View Our Programs