MHM Magazine

10 | MENTALHEALTHMATTERS | Issue 4 | 2021 MHM a flat affect, asociality, anhedonia and amotivation. COGNITIVE DYSFUNCTION On top of psychotic symptoms symptoms, the condition is characterised by cognitive dysfunction, which is wide- ranging and can be detrimental if left untreated. In the acutely ill, positive symptoms such as disorganised speech and behaviour, along with negative symptoms such as poverty of language and thought are common. These, coupled with affective symptoms, often result in severe anxiety and depressive symptoms, which usually leads to hospitalisation. SOCIAL COGNITION Social cognition refers to a person’s ability to process and respond to social cues and scenarios. People with schizophrenia often struggle tremendously in this area. One particularly troubling aspect of social cognition dysfunction is impaired facial affect recognition. Another is impaired theory of mind – the ability to relate to and empathise with others. The effects of these often mean that socialising and maintaining a job (mostly due to anxiety around socialising at break times) are almost impossible, affecting the potential for sustaining a meaningful livelihood and independence. Thankfully, there is a wealth of ongoing research into social cognition in schizophrenia and these symptoms are generally easier to treat. LACK OF INSIGHT Another core feature of schizophrenia that distinguishes it from other mental health conditions and which determines the course of treatment, is lack of insight. While completing his PhD at the University of Stellenbosch, Professor Chiliza and his colleagues conducted a research study that illustrated this point. The study involved first- episode schizophrenia patients who were treated and closely assessed for twenty-four months. What the research found was that most patients responded well to treatment and improved in symptoms and, seemingly, in insight too – they were, after all, coming back every month to receive treatment. But a second component to the research involved a self-administered tool measuring insight, that the patients had to complete after treatment. The results of this component of the research showed that in almost all the patients, insight had not improved at all. This is a defining marker of the condition and leaves healthcare providers faced with a very serious challenge: How do you treat people with a chronic illness – expecting them to return for follow-ups, and to continue taking medication, etc., – if they don’t believe they have the condition at all? THE NATURAL COURSE OF SCHIZOPHRENIA When treating any chronic illness, the natural course the condition takes can have wide-reaching implications on approach to management. With schizophrenia, most people who present with psychotic symptoms have their first episode between the ages of 20 and 25-years-old. What tends to happen is that patients will receive treatment and within a few months show significant improvement. It’s at this stage that with most