A Handbook For People Diagnosed With

Summary

Understanding Schizophrenia
A Handbook for People Diagnosed
with Schizophrenia
This booklet is a collaboration between the
Queensland Centre for Mental Health Learning and
the Mental Health Clinical Collaborative

Information in this handbook was obtained from international
research and papers and the various brochures and booklets
compiled by the different mental health services and hospitals
throughout Queensland

Pictures and images were downloaded from photo.com and
www.uq.edu.au/news/images/media
All program materials have been designed in collaboration between the Queensland
Centre for Mental Health Learning (QCMHL) and the Mental Health Clinical
Collaborative. If you have any feedback or enquiries about this material please
contact QCMHL on 3271 8622 or email [email protected] or
http://www.health.qld.gov.au/qcmhl © Copyright State of Queensland (Queensland
Health) July 2007

Front Cover: The star symbol is drawn from the Queensland Health Document:
Sharing Responsibility for Recovery. The symbol was designed to reinforce the five
common elements identified as necessary in supporting each individual during their
recovery journey. Details of these recovery elements are included in this handbook

2
Foreword by Dr Aaron Groves
The handbook has been developed in consultation with consumers, service
providers and carers through a partnership with the Mental Health Clinical
Collaborative and the Queensland Centre for Mental Health Learning

The intention in compiling this resource was to provide an educational and
personalised document for consumers and clinicians in adult inpatient mental health
settings. It takes a recovery approach and contains a range of resource materials,
good practice approaches, and worksheets that can be adapted to meet the
individual needs of consumers

This handbook has been designed for consumers to use independently or in
collaboration with a health care professional to promote a shared understanding of
the consumer’s experience. The modular approach of the booklet is designed to
allow the individual to move through the information at a pace suited to their own
needs as well as provide a resource that extends beyond the inpatient facility

I believe that this handbook is a valuable resource

Aaron Groves
Director of Mental Health
Mental Health Branch
Queensland Health
3
Preface
This handbook was prepared for use in an inpatient setting with
adults. It is designed so that consumers can use it individually,
but it would be most beneficial if completed together with
mental health clinicians prior to discharge and most probably,
in an ongoing way after discharge in the community. It is
recommended that if consumers have any questions when
reading this handbook, that doctors or other members of the
treating team are consulted for assistance

Please note that throughout this handbook, worksheets have
been inserted for reference and to act as an example of how
you might complete them. These are examples only and we
acknowledge that every case is different and therefore
worksheet completion will be very individual

4
Table of Contents
Overview and Objectives of Handbook Page 6
Module One - Basic Information Page 7
Part A - What is schizophrenia? Page 7
Part B - What causes schizophrenia? Page 9
Part C - Symptoms of schizophrenia Page 11
Module Two - Recovery Page 17
Part A - What Helps and Hinders? Page 17
(Includes resource section)
Part B - Medication Information Page 27
Part C - Coping Strategies for Symptoms Page 34
Part D - Preparing Your Wellness and Page 38
Recovery Plan and Individual Care Plan
Part E – Outcomes Tracking Page 55
Part F - Can I be forced to accept treatment
if I do not want it? Page 56
References Page 59
Worksheets Page 60
Appendix A - Individual Care Plan Page 68
5
Overview and Objectives of Handbook
One of the main factors that can help in recovery from schizophrenia is
to have accurate information and education about illness and recovery

Some of the other factors that assist are support from family, friends,
community groups and professionals, adequate treatment, medication,
counselling and a healthy lifestyle

Whether you find yourself in a mental health inpatient facility for the first
time or after repeated admissions, the experience can be very daunting,
as you are likely to be experiencing symptoms that can make you feel
scared, confused or distressed

The purpose of this handbook is to instil hope and provide some
guidance on ‘where to go from here’. As such, while the initial sections
will provide a brief overview of the definition and cause of schizophrenia,
the main focus of the workbook will be on recovery

Worksheets are included throughout, so that you can personalise your
experience and have a record to help you communicate with your
treatment team and other people important to your recovery. By the end
of this workbook, you should have a basic understanding of what
schizophrenia is, how you experience schizophrenia and your plan for
recovery

6
Module One - Some Basic Information
Part A - What is Schizophrenia?
What is schizophrenia?
Schizophrenia is an illness that affects the brain and
leads to difficulties with thoughts, feelings and behaviours

Schizophrenia affects approximately one out
of every 100 people

For 75% of people diagnosed with
Schizophrenia it starts in adolescence or early
adulthood

Facts and Myths about Schizophrenia:
¾ Schizophrenia is not caused by bad parenting, childhood trauma, poverty or
alcohol
¾ Schizophrenia is not contagious
¾ Although people with schizophrenia sometimes hear “voices” that others can’t
hear, this illness does not mean that you have “split” or “multiple”
personalities
¾ Schizophrenia is not a person’s fault; it is a chemical brain disorder caused by
a combination of biological and genetic factors, and often triggered by
environmental stressors
¾ Schizophrenia is not a developmental disability or intellectual disability
¾ Those with a diagnosis of schizophrenia who are undergoing treatment are
not more violent or aggressive than those who do not have schizophrenia

7
Schizophrenia can affect anyone regardless of gender,
ethnicity, culture, sexuality, class, intelligence or level of
education

Schizophrenia symptoms may develop very quickly over several weeks or may
develop slowly over a few months or years

Some people might have only one period where they experience symptoms and
never experience them again

For others, Schizophrenia symptoms can come and go over a longer period

The good news is that there are many things that you can do to help maintain a
meaningful and positive life and minimise the chance and/or impact of a relapse

This booklet will provide a focus on recovery with more information and worksheets
for you to develop a personal recovery plan

Other mental and physical illnesses that can occur at the same
time as Schizophrenia
The more common mental health issues that can occur at the same time are
substance abuse, depression and obsessive-compulsive behaviour

Substance abuse can be present before a diagnosis, or some individuals start to
use substances in an attempt to control or decrease symptoms. However,
substance abuse has been found to have an overall negative effect on
recovery

A range of physical health complaints have also been associated with
schizophrenia, such as cardiovascular problems (heart issues), pulmonary problems
(e.g., asthma), neurological problems, endocrine problems (glands and/or hormonal
problems) and metabolic problems (such as obesity). There is little agreement in
research as to how common these conditions are. However, given their potential
seriousness, it is important to always maintain a focus on living a healthy lifestyle
and consult your GP about your general health and wellbeing

8
Module One - Some Basic Information
Part B - What Causes Schizophrenia?
There are many theories to explain the cause of schizophrenia, but the exact cause
remains unknown. The main theories look at the role of
genetics, biochemical factors, illicit drug use and environmental
factors

Family/Genetic Factors
There is evidence that genetics play some role in the development of schizophrenia
although this role is still not clear. Statistics have shown:
¾ When one parent has schizophrenia their child has at least a 1 in 10 chance of
developing schizophrenia

¾ When both parents have schizophrenia then the risk of their children developing
schizophrenia increases up to almost 40%

¾ In the case of identical twins, if one twin has schizophrenia, the second twin has
at least a 50% chance of also developing schizophrenia

It is important to note that genetics are only part of the puzzle, because most people
who develop schizophrenia have no relatives with the illness

Further, just because a person has schizophrenia does not mean that they will ‘pass
it on’ to their children

Biochemical Factors
Certain substances in the brain may cause a chemical
imbalance. For example, the neurotransmitters “dopamine”
and “serotonin” have both been linked to schizophrenia

Medications can help to correct imbalances in the
chemistry of the brain

Again however, biochemical factors are only a partial explanation as there is not
enough evidence to show that a chemical imbalance is the only cause of
schizophrenia

9
Brain Abnormalities
Research has found that there can be differences in the structure of
people’s brains with particular forms of schizophrenia, such as having
enlarged ventricles (Ventricles are the spaces which carry fluid
through the brain). However, the relevance of brain abnormalities is
still unclear as many people with schizophrenia don’t have enlarged
ventricles and their brain structure looks normal

Viral Theories
Another theory is that babies whose mother had a virus in the latter stages of
pregnancy are at higher risk of developing schizophrenia. There is no strong
evidence to support this theory however

Use of certain drugs
All sorts of recreational drugs can make the illness worse by increasing symptoms

Marijuana, Amphetamines (‘Speed’, ‘Ecstasy’) and Hallucinogens (‘Acid, ‘LSD’, and
‘Magic Mushrooms’) are particularly likely to cause an increase in symptoms

These drugs can also play a part in the onset of a first episode
of schizophrenia

Environment
Stressful events, although not really a cause of
schizophrenia, can lead to a decline of mental
health and trigger symptoms. Again, as
triggers are not always identified before symptoms
present, stress alone can not be seen as a sole cause
of schizophrenia

10
Module One - Some Basic Information
Part C - Symptoms of Schizophrenia
Symptoms mean “signs”, “warning signs” or indications that something is wrong

What does this mean to you?
Schizophrenia affects different people in different ways. Not everybody will
experience the same symptoms, nor are these symptoms always experienced to the
same degree

Symptoms of schizophrenia can also come and go at different times. These periods
are often referred to as “relapses” or “acute episodes”. This is when people
experience symptoms like hallucinations, delusions and confusing thoughts. These
symptoms are called “positive symptoms” although they are not positive in terms of
being wanted. “Positive symptoms” usually improve with decreased stimuli, calm
interactions and antipsychotic medication

There are other types of symptoms such as a loss of interest, loss of energy, loss of
emotional warmth or loss of humour. These are called “negative symptoms”. Some
of the newer medications and some non-medical strategies can help with these
symptoms

It is sometimes difficult when symptoms are being experienced, to tell what is real
from what you are experiencing at that time. Below are some examples of the
symptoms of schizophrenia. Often it is easier to identify your symptoms once you
are more well, or others can help you with this during your recovery

“Positive symptoms”: problems with your thinking:
¾ Your thoughts and therefore conversation may become jumbled, disjointed,
slow or fast

¾ You may feel as though your thoughts have an impact on other people or
events

¾ You may feel as if thoughts are being
“put into” or “taken out of” your head

¾ You may feel as though others know what
you are thinking
¾ You may find your thoughts suddenly
blocked

¾ One particular thought may become “fixed”
in your mind, and you can’t shake it off (this
can be a delusional thought, but not
necessarily so)

11
Delusions
A delusion is a fixed false belief held by a person, that remains even though there is
obvious evidence to the contrary

There are many different types of delusions. Some examples are:
¾ Thinking that other people want to hurt you or are out to get you

¾ Thinking that you are related to someone of great importance (e.g. royalty),
are a special person or religious figure (such as God)

¾ Thinking you have special abilities or powers

¾ Thinking that the TV, radio or newspaper has a
special message for you or is specifically aimed at
you
¾ Thinking that you are being controlled by someone
else
¾ Thinking that other people can read your mind, or that
you can read other people’s mind

Hallucinations
Hallucinations are false perceptions or sensations. These can be:
¾ Hearing
¾ Seeing
¾ Tasting
¾ Smelling or
¾ Feeling ………….something that is not really there

The most common type of hallucinations are auditory, or
hearing something that others can’t hear. For many
people this means hearing voices which seem to come
from inside their head or from their environment

These can seem very real, as though there is someone
beside you or in the next room talking

For most people, hallucinations are quite distressing, but
in some cases they can be pleasant. They can also be
very distracting and make it difficult to concentrate

The intention in compiling this resource was to provide an educational and personalised document for consumers and clinicians in adult inpatient mental health settings. It takes a recovery approach and contains a range of resource materials, good practice approaches, and worksheets that can be adapted to meet the individual needs of consumers.

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Frequently Asked Questions

What is the schizophrenia handbook?

The handbook has been primarily developed, therefore, as a guide for families when early signs indicate that a relative may have schizophrenia, and as a resource for these families when a diagnosis of schizophrenia has been determined. To this end, it has been put together with help from many families with relatives who have schizophrenia.

What is the purpose of the wtc health program handbook?

The purpose of this handbook is to provide you with information on the World Trade Center (WTC) Health Program (the Program). Disclaimer: This handbook is not a legal document. The purpose of this handbook is to provide general Program information in a way that is easy for you to use and understand.

How do i get a copy of the member handbook?

Previous versions of the Member Handbook are available upon request by emailing [email protected] The purpose of this handbook is to provide you with information on the World Trade Center (WTC) Health Program (the Program). Disclaimer: This handbook is not a legal document.

How do i certify a medically associated health condition?

To certify a medically associated health condition, your CCE or NPN doctor must explain how the health condition results from either treatment or progression of the underlying certified WTC-related health condition.