Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia can be disabling and affects daily functionating. This condition is characterized by a combination of delusions, hallucinations, and disordered thinking and behaviour.

Delusions are false beliefs that are not based on reality. There are different types of delusions. Individuals with delusions may belief that the have a superpower, are extremely wealthy, famous or have an ability to communicate with God.

This is usually not the case. Some delusions are often center around the fear of being harmed. These individuals belief that people, often close family member or friends are against them and want to cause physical harm to them. Delusions occur in most individuals with schizophrenia.

Hallucinations are also a common feature of schizophrenia. This involves seeing things that are not there or hearing voices that are not there and cannot be heard by other people. Hearing voices that are not there is the most common hallucination. Other forms of hallucinations may include smelling things that are not there and having the sensation of being touched or insects crawling on their bodies.

Schizophrenia can cause people to have difficulty concentrating and maintaining a train of thought, which manifests in the way they speak. People with disorganized speech might speak incoherently. They may also use words that have meaning only to them or mix up words with no particular meaning ; often referred to as “word salad”. They can often shift quickly between topics with no relation between the various topics. At times they repeat the same thing over and over. This can progress to a  point where it’s impossible to comprehend what the individual is saying.

These individuals can develop disorganised behaviour and are unable to carry out simple daily tasks. They can develop unpredictable or inappropriate emotional response. Their behaviour can be bizarre and lacks purpose.

Individuals with schizophrenia can develop negative symptoms. They may appear to lack emotion, the don’t make eye contact or don’t make appropriate facial expressions and the tone of their voice doesn’t change. They may lose interest in everyday activities and become withdrawn.

The diagnosis of schizophrenia is clinical and does not require any special tests. Tests may be done to exclude other medical conditions. The diagnosis is made based on the presence of 2 or more of delusions, hallucinations, disordered behaviour or negative symptoms. The symptoms need to have been there for a period of at least 6 months.

It is important to recognized any of the above symptoms early and seek medical help. Mental health is stigmatized in Botswana and often people with such symptoms will be referred to with derogatory terms such as “ditsenwa” and not be afforded the help they need.


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