1. 30 HEALTHTODAY•May 2016
Healthy Living
Mental Wellness
An Unquiet
MIND
Many people with schizophrenia
continue to suffer from a lack
of proper medical attention due
to a poor understanding of the
condition. We sit down with two
experts on this matter.
Words Lim Teck Choon
Prof Dr Ahmad Hatim Sulaiman
Department of Psychological Medicine
Faculty of Medicine
University of Malaya
Dr Hazli Zakaria
Psychiatrist and Senior Lecturer
University Kebangsaan Malaysia Medical Centre

2. May 2016•HEALTHTODAY 31
Healthy Living
Mental Wellness
A
zman (not his real name)
seemed to have it all. He
was an intelligent student
who had just received a
scholarship to study abroad, a good
athlete with a solid extracurricular
activity record and he was popular with
his friends.
His behaviour changed abruptly one
day, when he started hearing voices.
Azman withdrew from his friends
and family, claiming that they could
hear his thoughts and he did not like
that. He refused to leave his room,
neglected his personal hygiene and
became aggressive when he felt
provoked.
Azman’s family could only believe that
the young man had to be a victim of
a bomoh’s curse, presumably from
a rival jealous of his popularity and
success. They spent considerable
amounts of money seeking bomoh
after bomoh to cure Azman, but to no
avail.
According to Dr Hazli Zakaria, a
psychiatrist with a keen interest in
schizophrenia, Azman’s story is a
common one. Many Malaysians still
do not view mental disorders such
as schizophrenia to be a medical
condition, often instead associating
such conditions with invisible or
abstract elements (curses, spiritual
possession, etc). Therefore, they turn
to traditional healers whose methods
may not work.
It is a kind of tragic irony that modern
medicine already has a pretty good
approach to managing and medicating
schizophrenia, and people such
as Azman may be able to lead a
reasonably normal life if they had found
proper medical treatment sooner.
Making sense of
schizophrenia
Schizophrenia is, according to Dr Hazli,
a disease of the brain. It is a highly
prevalent disease that can affect
anyone.
When someone develops
schizophrenia, he or she usually
exhibits the following traits:
• Hallucination. The person sees or
hears things that do not exist.
• Delusions. The person adopts
beliefs that seem far-fetched and
unfounded in reality, such as a
belief that their parents or friends
are trying to harm the person.
• Changes in behaviour. The
above would cause the person
to exhibit behavioural changes,
such as showing lack of interest
in something he or she normally
enjoys and becoming more
withdrawn.
To date, we do not know yet the exact
causes of schizophrenia. The causes
could be biological in nature, such as
family history or abnormalities in the
brain. Stress and drug may also be
possible triggers for this disease.
What we do know is that people may
show symptoms even later in life, and
what happens, such patients may

3. Healthy Living
Mental Wellness
32 HEALTHTODAY•May 2016
According to Prof Dr Ahmad Hatim
Sulaiman, it is not true that someone
with schizophrenia will experience
worsening cognitive function over
time. Most patients will achieve
a reasonably stable remission of
symptoms and substantial levels of
satisfaction and happiness in their life.
Treatment of schizophrenia has 2
main objectives – to help the patient
stabilise his or her current mental
state, and to prevent future relapse.
Antipsychotic medications are
often prescribed to help control the
symptoms. They work by blocking the
effects of a chemical called dopamine
in the brain. Depending on the
patient’s condition, he or she may be
prescribed a combination of different
antipsychotic medications.
Additionally, the patient will also be
asked to attend therapy sessions,
during which his or her progress would
be reviewed. There would be advice
and support given to help the patient
recover and make steps to fit in
again among society.
Throughout all of this, the
patient will be working
with a team from various
fields and disciplines,
such as psychiatrists,
psychologists, mental
health nurses and even
social workers.
On treating the patient,
Prof Ahmad stresses that it
is a group effort. Both the
family and the healthcare
team need to work together
to ensure that the patient
recovers and stabilises.
This is especially important to
prevent relapses, he adds.
be subjected to many hurdles that
prevent them from seeking proper
medical care. These hurdles usually
stem from misconceptions and a poor
understanding of the disease.
Nothing supernatural
or shameful
Dr Hazli shares 4 facts about
schizophrenia that every Malaysian
should know.
1. It is just like diabetes, heart
disease or a broken leg – one can
live with schizophrenia and recover
from it.
2. Recovery is an ongoing process,
as treatment will help the person
stabilise his or her mental state
and fit in with the rest of society.
3. There may be periods when the
person may experience symptoms
again (relapses), and it is important
that the person seek proper
medical care when this happens.
4. Family and friends of the patient
should learn more about this
disease, so that they can
support the patient on the
road to recovery.
Dr Hazli encourages
families of people
showing symptoms of
schizophrenia to consult
a psychiatrist, so that
appropriate care and
medical attention can be
given to the patient as early as
possible.
Peace for the
troubled mind
Azman eventually sought treatment
at the University Malaya Medical
Centre, and in time, he recovered. He
was placed in the psychiatric ward
and was given oral medications for his
symptoms. After a week, he showed
signs of recovery and was discharged.
His doctor continued to monitor
Azman after his discharge. In the first
3 months, the young man behaved
normally, and all seemed well.
Can one get better?
According to UK’s Royal
College of Psychiatrists, for
every five people who develop
schizophrenia:
• 1 person will get better within 5
years.
• 3 people will get better, but
there are still some symptoms
and possible relapses in the
future.
• 1 will continue to show
troublesome symptoms.

4. Healthy Living
Mental Wellness
May 2016•HEALTHTODAY 33
When a relapse
happens
In Azman’s case, all seemed well for
the first 3 months, but he eventually
stopped taking his medications, as
he believed that he had completely
recovered. His family had stopped
monitoring his medications at that
point. Thus, Azman suffered a relapse.
The symptoms came back, this time
much worse than before, and Azman
had to be admitted to the ward again.
His second stay required medications
that had to be delivered through a drip
(intravenously), and he stayed in the
ward for 3 weeks. His medication was
also ‘upgraded’: he now has to take
his medication via injection once every
month.
To this day, Azman continues to take
his medication. Things are looking up
again. He found a job as a cashier,
and he could start supporting himself
instead of relying on his family. His
confidence is improving as a result.
“He recently told me he’s found the
courage to ask a colleague out for a
date. He’s confident that she is ‘the
one’,” Prof Ahmad says with a smile.
As Azman’s story demonstrates, one of
the main reasons for a relapse is the
discontinuation of medication. More
than 70% of patients who experience
a relapse within 1 year after the first
episode also stopped taking their
medications. Additionally, the risk
of hospitalisation increases sharply
with the number of times the patient
misses therapy.
As Prof Ahmad says, recovery is just
half the battle won, not the end game.
He, therefore, advises the following for
families who are supporting a loved
one with schizophrenia:
1. Continuously supervise and make
sure that the person is taking his
or her medication; medications
should not be stopped without the
approval of the healthcare team.
2. Help the person attend therapy
sessions.
3. Offer the person emotional
support whenever necessary. The
healthcare team can help if a
family needs guidance or advice in
supporting this person.
4. Encourage the person to lead
a healthy lifestyle, and to avoid
habits such as drug-taking that can
worsen his or her condition.
Finding the quiet room
It is an unfortunate fact that many
people with schizophrenia all over the
world suffer without proper care or
treatment. Sometimes, they are even
abandoned by their families to fend for
themselves on the streets.
Both Dr Hazli and Prof Ahmad assure
us that schizophrenia is nothing
to be ashamed of. Families should
understand that it is a mental condition
that can be treated; the person with
schizophrenia, with proper treatment
and support from his or her loved
ones, can have a chance at living a
reasonably well-adjusted life and find
happiness in the process.
“If you know someone showing
symptoms that may be those of
schizophrenia, bring him or her to
a psychiatrist,” advises Dr Hazli.
“The earlier the person receives
proper treatment, the better the
chances of recovery are,” adds
Prof Ahmad as he concurs with
Dr Hazli’s statement.
People with schizophrenia are not ‘gila’
– they can heal, if only we give them a
chance to do so. HT