SchizophreniaWatch

A UK website, principally for carers about and carers for schizophrenia; family, community, and professional service caring, who should - must ! - give voice for the best interests of those cared for: they can't, they won't, they don't, voice for themselves

Page 2.
getting nowhere ?

The site is edited by a retired psychiatrist who has looked after someone with the schizophrenia condition, at home, affected by the negative form of schizophrenia, for the last twenty years. [The blue highlit links take you to another page.. ] You return via the back arrow at the top of your screen or from a link at the bottom of a page


page 4 ......

This is my understanding of the background to the development of schizophrenia: its proximate cause, it's treatment, it's Care.

contact me if you want to help me out with my views, email me [ contact me if you want to help me out with my views, email me: at
email me

There is a limited general psychiatry section .... links

The academic papers that support why and how the illness continues to be, are put together on a companion website.
schizophrenia brain
[ apologies if this link may not work - go to www.brainandschizophrenia.co.uk ]



This is my conviction as to how schizophrenia comes about.

Schizophrenia comes about because of a brain change in those people developing the illness.

References with links.

The hippocampus area of the brain, in their case, proliferates only half the new cells of what is it's normal achievement. [ normally 700 new cells daily: Spalding et al Spalding et al ] ]
The consequence of this change is a failure to perform the process of selecting from what is perceived to be going on outside, the information that is salient experience, usefully to go into longterm store, whilst disregarding what is already known, from what is currently going on.

What does the brain do with surplus information that has some how 'got in'.
Abnormal stimuli get taken in, and have to be 'quarantined'. But how and wherein the brain might this happen.



1.

Without the updating of what is useful, people with schizophrenia are at a disadvantage, when coping with day to day expectations requiring decision making, especially completing sequences in decisions that require holding a concurrent awareness of the changing context to those decisions.

A good example comes in conversation, when the longer it goes on, the more likelihood there is of veering off the subject, forgetting the context, held from the beginning, so that there are intrusions of idiosyncratic words and associations, and an eventual peetering out.
2.

Hippocampal new cells encode information stimuli temporarily, for eventual brain storage,. They also retrieve such information , again temporarily, whilst being used to provide the changing context, as working memory proceeds.
3.
In schizophrenia when the hippocampus fails to proliferates enough new cells, it cannot cope with sorting out all the stimuli coming in.
It is likely to be overloaded with incoming information stimuli.
Those with schizophrenia will experience information overload in normal circumstances; especially when anxious or made anxious.


This is what happens during distraction in normal people.
[ Distraction ]
What is going on in overload, is by passing the selecting process of the hippocampus, ending up instead in the striatal memorising stream.
The striatum stream is where incoming stimuli carrying information are given significance [ hey! cortex - this has to get attention ... serotonin receptors] and is given emotional priority [ deal with this, please: striatal dopamine ] to the cortex that receives and deals with storage of relevant experience]. It then requires an explanation, a stabilising coherent account of 'why' this abnormal incoming stimuli has got in to the striatal route, requiring some 'sense'of dealing with it, leading to the delusional story.

abnormal salience especially when distractors are present

Hence forward, sufferers have to live in two somewhat different worlds: reality, and the variable influence of the delusional account.

How is it that sufferers do not argue against the delusional story? I think this comes from the story having been developed through the striatal memory route, and consolidated like a procedural experience .
That route is for routinised repetition behaviour, belief that has become habituated , automated , less open to flexibility. Suitable for enduring stability, as in learning a skill, such as riding a bicycle or relying on a basic structure of grammar. They don't have to be learnt again and again.
Consolidation via the striatal route might be less open to reflection, to 'second thoughts'

Why do people with shizophrenia hear 'voices'.
My explanation is that this is what happens, In many normal people during 'brain idling' or 'mind wandering': there will be people heard 'talking'
- in schizophrenia people this kind of 'mind wandering' comes out of the delusional narrative, a delusional explanation 'placed' outside the way the brain exercises 'it's' usual internal checking scrutiny system ? Perhaps from a process of consolidating during sleep. ?.
It is often critical , commenting adversely, threatening, intrusive and commanding.

How is it that all medications that help and prevent relapse are dopamine blockers? [ 'dopamine's role is by influencing the priority of such stimuli for the person concerned'. It also takes part in giving memories their longterm 'status'. ] It is dopamine that establishes the emotional value - fear or joy - in this case registers the continual anxiety when reduced hippocampal neurogenesis makes the stimuli recognition world an uncertain place for the sufferer.
Clinically it is unresolved anxiety that leads to relapse, particularly if it comes out of troubled carers, family and professionals.


Bear in mind that a basic, continuing, fault in schizophrenia is how and what to hold 'on standby, when and where to use it with what is going to come up in the day and the week;what to carry along in 'stand by' memory, what else there is going on in any transaction.
New cell production in the hippocampus does that job normally.
With reduced neurogenesis, now they do not produce enough.
They are stuck with skills, interests and stored experience that they held before the age when the illness started: those with some continuing schizophrenia , have to try and make do with less new cells , less quick 'stand by' context. They do not 'move on' from the age when the illness presents

Socially, give more time, especially have more patience, and less hurried interruption is required

Keep in touch with their lives, in a way that lets you intervene for the patient's best interests. [ see ... page 2 ]
'Best Interests' rules legally. It is what gives you authority in caring, on equal terms with the professional Teams. Often you know patient better. Their capability.
To respond on the patients behalf to the professional 'mantra' .. 'it's their choice' they are adults...we can't intervene. Professional staff that have their own best interests as their lead, 'it was their choice' - we have to respect choice .. as well, 'to gain theirtrust'.

Choice to do something that is against their best interests should not be respected, until assessed as to whether there is an illness influence: an indication to check with other observers the level of illness in general behaviour, an indication to check medication behaviour.
Conceding choice without taking care to check on enduring capability is not providing professional care.


There are things, if in place, which will give sufferers from residual schizophrenia a meaningful living. Without them they will be vulnerable to relapse.

1.
Acceptable medication regularly taken.

2.
A routine in the day and week that gives reassuring predictability for the sufferer and provides them with a structured living routine. It gives 'anchoring' points to a future that otherwise can otherwise fall into chaos. It is most effective when the routine includes occupational activities in sheltered places away from the home in company that is patient and persistent. More time and less intrusion is required
The provision should take account of the experience and interests before their age when the illness arrived. Building up to three sessions, spaced in the week. It should be a lead from the professional services, the 'experts with experience ... that this is in their best interests; this their professional Care plan that meets there need not to relapse, be readmitted. The decision not by the family - who might face resentment and recrimination, that the professional team does not get. That gives family carers some of their own life. Sufferers who can return or continue in the family home already know a routine.

There should be an Occupational Therapy staff and local Day Centre available to every community Team.

3.
Residential arrangement that accepts monitoring visit and maintenance.

Living with uncertainty is often present when living with schizophrenia

People with schizophrenia learn with sufficient ... protected from distraction, practice and repetition, just as we all do.

What professional lead does not recognise as a disability to be addressed is that practice for schizophrenia, has to take into account much more time, in settngs with less distraction, a setting that gives time and space and mentoring for that practice
More time and 'warming' time, needs to be taken whenever anything new is to be expected of the 'client' sufferer .
That includes any initial expectation - even meeting the new people , wherever anything new is expected. Are THEY to be trusted and ready to be aware of what the patient - now patient/client - carries with the disabilities within the illness.

Sufferers are often being 'forced' to pay attention to 'noise' in the environmemt as well as attending to the matter in hand.

Practice does work. But too often the setting does not meet the things that people with schizophrenia require to be enabled to continue

Try to establish a practiced routine in the day and a regular programme in the week .

If sufferer is at home, some outside activity of interest or occupational activity in a day centre or other sheltered area will provide the settling routine that can be returned to by patient/client as an anchoring regularity during the future day and week

Next need is a regular support system to watch out for their best interests; very often now from family backing, family observation, that has established and kept the [ authority ] agreement to intervene practically , when obligations of personal maintenance get forgotten - bills repairs, domestic maintenance etc have to be attended to.

How does fewer new memory cells affect what you say with and ask from your family sufferer.

They are fetching up less information from store to deal with and cope with what is going on now.

To start out again after illness, life now is better when simplified. Try to set aside any distracting matters when having to deal with matters going on now

Think how to respond to what is now a smaller working memory.

Don't be critical of what they say, or interrupt to move things on. They have not lost intelligence. They have less ability to draw upon as much as may be needed instantly, to keep up, if things move ahead too quickly, or on to new material.
Allowing time is very important. Time to think and maybe come back later to what was the issue,
Speak in slower time, in smaller 'chunks', in simpler terms. Listen more to what you are saying will mean for them.

Remember the background of experience, interests, competence, before the age at which the illness arrived : that is what they will be most able to share.

Finding for them more time is the most important thing. Therefore a sheltering environment.

Taking part in a conversation which is a 'to and fro exchange' can be difficult because their holding on to the continuing context can go astray .
Sufferers will often seem to ignore what the other is saying,
but return to what they themselves were and are saying - pursuing their own thread.
It can be exasperating and irritating - to give up your 'control' of the flow - better to recognise it is all too much for the moment, better to back off, let time go by, allow 'pausing'- start again . an anxious situation



Sometimes there is enough working memory after illness to survive with a little support, on a previously well supported established routine, at a simplified level, by a fall in standard of living; for a while; eventually failures accumulate. Not enough available working memory is the critical fault in schizophrenia from the age of onset of the illness.

The support they need in compensation is an established basic daily and weekly routine at a level :that suits their interests and their abilities.

1.
; Day centre activities fill the gap when there is nothing else to attend to, and nothing to look forward to;

2. a proper application of the Mental Health Act Observation Order , when in florid trouble - no beds - giving enough time of a stay to obtain all the information needed from community observation so as to continue to exercise an authoritive advice in the community;

3. the social worker to visit to the family get the details of the beakdown, to get the family social history, the carer assessment, vitally to give a contact route in to the community team service.
They used to be good at that.


'it's their choice'. Sufferersjust get left out of public NHS resource distribution,; the worried well grab the attention.



this next link highly recommended
Triangle of Care Absolutely essential reading for carers, the three items by Alan Worthington at the bottom of the Page ! especially the first one - Particularly the last sentence,

a page for Those in the early days of caring - revising ....
... and see next below !!!
Nearly every mental health Primary Care Trust purchaser in England has to pay for Out of Area patient transfers, to beds elsewhere.
In Cornwall for example there may be ten patients away at any one time.
The idea of reducing in-patient beds was not a clinical decision- though presented as 'community care [ not in place before discharge ] - but saving money because of overall funding restraint, imposed on and by management.
The effect of all the efficiency savings - delivering care near the patient is just to increase the burden of responsibility and the burden of caring for famiies that do not have the resources nor the authority nor sufficient knowledge of the disability in schizophrenia, and the problems that brings with it, to claim from whatever institution should be meeting it, what supporting continuity care requires in terms of life activities for the one in continuing care
Carers have to travel miles away to and fro to see their family members, to stick up for their needs,speak for their rights .
An insider said there are times when there are no spare beds in the whole country.

Why are the NHS clinical leads letting us down?

Consultant Psychiatrists - in their House Journal the Psychiatrist raise doubts about delivering 'Continuity of Care' with all the different community Teams.
One comments :- " the issue that most of us (clinicians and patients) have faced sometimes painfully recently..... where and when might we get a bed?

Management efficiency did not realise, weren't told. or didn't believe that the uncertainty in serious psychiatric illness, means there must always be some slack in the system, that used to be given by 'beds'

One explanation for this 'covert' dissatisfaction, is that Consultant Psychiatrist leads could not publicly protest that cutting in- patient admission beds would reduce service abiity. They would have been supported by family and community carers, but had lost partnership with these, still have, although both should have been, and be, on the same side. Together they could have stood up to the purchasing Trust management that had a different priority.


A different response to the cognitive deficit in schizophrenia - ?? a lot drop out *** New !!! ??