 Hi, so when people think of schizophrenia, they typically think of the symptoms that present with it. So things like hallucinations, delusions, disorganized thinking, and the list goes on. But I think it's just as important to acknowledge schizophrenia beyond the diagnostic label. Because ultimately, schizophrenia is a mental health disorder that affects how a person relates to themselves, how they relate to their social circle, and ultimately how they relate to society. So that's really our main focus for the discussion today. Really taking a social approach on how schizophrenia can impact a person's relationship that they have with society. So for those who are just joining us for the first time, welcome. I'm just going to give a really brief introduction to myself and a bit about the series, which is the Ask an Expert series. I'm Monica. I'm the host of the Ask an Expert series, and I'm a neuroscience graduate and a current medical student. I'm really keen on all things psychiatry and neurology. So I created this series to really tackle the medical misinformation that is sometimes prevalent in psychiatry and in neurology. So if you're also really keen on this kind of thing, then you can get in touch with me. Contact information is in the description box below. But moving on, I just wanted to also take the opportunity to introduce you all to our very special guest today, Alex, who is a social worker. Today, we'll be discussing everything related to the social impacts of schizophrenia. So welcome, Alex. Hello. Hello. I'm Alex. I'm a licensed social worker. I've been one for eight years now, and I've studied social work at the bachelor's and the master's level. I also have a bachelor's in psychology. I have a certificate in healthcare management, and I'm currently a first year medical student as well. And my work experience is mainly with adults who are living with schizophrenia in a specialized psychiatric hospital. Thank you so much for the introduction. Given your expertise in schizophrenia and given that the audience might be coming from a diverse range of backgrounds, would you like to start by perhaps giving a rundown about what is schizophrenia? What are some kind of symptoms that people can present with just general information about the mental health disorder? Schizophrenia is a psychiatric disorder that's characterized by a number of symptoms and the presentation of schizophrenia changes and is unique to every person. So you might have symptoms from different categories from positive to negative symptoms. You might have cognitive impairments as well, disorganization in your thought processes. It depends on each individual person how they're going to present. But for example, hallucinations are something that we hear very often that is associated with schizophrenia. One of the things people don't know is that you can have hallucinations in many different ways. So we experience our world through our senses, through sight, through hearing, taste, touch, smell. And our brain translates the signals that we get from our environment and it makes us see reality in a general sense. So everyone will see that a table might be green or might be brown. But the reality is when you have a hallucination, your brain is picking up a signal that doesn't exist. So it's tricked in some way to thinking that there might be something else. So some people have visual hallucinations where they might see certain things, they might see people, they might see lights, they might hear sounds or voices in some very advanced cases. You might see a person who is actually feeling that there's something crawling under their skin. This is a very rare presentation, but it happens. And then you can have also delusions in that same positive symptom family, because some individuals might think that they have superpowers, that they can fly, or that they might think that they're God or some kind of delusion of grandeur. You might have other elements, like you might feel that you're being watched, observed, so more paranoid delusions. You might think that maybe the government is looking for you and trying to kill you. And these are very significant, especially in terms of paranoia, because that makes you distrustful of government agencies, of healthcare workers, and that might really impede with a person seeking help. You might have negative symptoms, you might have an inability to feel pleasure, or an inability to be motivated to act or to go outside. You might feel like you're not having any emotions, like you're apathetic to the world. You might also have, and this happens very commonly, where you have some cognitive impairment. So you might feel like your processing speed is slower. So if you try to do, let's say, a mathematical equation in your head, instead of taking a few seconds, it could take a minute. If you're trying to concentrate, you might not be able to do it. So these are very common symptoms of schizophrenia. And the presentation, the intensity, it varies by person. It's a very unique presentation, because every person reacts differently. Every person experiences schizophrenia differently. Oh, that was a really good description. I liked how you mentioned really what's in the DSM, so the positive negative symptoms. One thing that I also just wanted to add, because when I was learning psychiatry, a lot of people were confused by the terms positive and negative symptoms, but that's not the case. I think it's just really important to bring it out here for people who might not be aware. Positive being that it's something additional that you would not typically have in your normal experiences. So like you said, hearing voices, hallucinations, delusions, things like that. And then negative being that something less than what you typically would have. So it's like social withdrawal or disorganized thinking, because the baseline I would say would be like you're able to think and you're able to kind of like assess the world in a functional way. I don't know if that makes sense for people who are watching, let me know. But yeah, that's one thing I also just wanted to share in terms of what I found was a common misconception. And I also had a follow-up question for you. So you mentioned a lot of these symptoms and they clearly could be very distressing for someone. So what is the presentation like in terms of the development of schizophrenia? Will people kind of expect going from nothing to like full blown in a short amount of time? Or is it kind of something that there's a long pro-dromal phase? What's the kind of thing that you see in your practice? So it really depends on the person and what initiates the schizophrenia. So generally we see schizophrenia onset by a first episode psychosis rather. So it's basically you have your first psychosis and then you get diagnosed with varying diagnosis. It could be schizophrenia, but it could be other like a psychotic depression could be a differential for a first episode psychosis. The idea is when you talk about how it starts, there are many different pathways. In general, it's assumed that individuals who develop schizophrenia have a predisposition for it. And then you might have a trigger, a stressful traumatic event might be a trigger. The use of recreational drugs might also or alcohol could in certain cases trigger the onset of psychosis. You'll see different presentations. We know, for example, there's a genetic factor in schizophrenia. So individuals, let's say they're both parents have schizophrenia, they're much more likely to develop it as well. So then you could expect that earlier on in their lives they might have a psychotic episode. So it very much depends on what's going on around the situation. It's not always the same trigger for everyone. And also it might be very fast, whereas you might have, let's say, a degradation of your well-being. So you might start with very mild symptoms. And as you progress and have multiple psychotic episodes, you might become resistant to medication. You might have an increase in the intensity of the symptoms. So some people start off very strong and a lot of people start off milder and then it develops over time. So there is no, to my knowledge, there is not a specific single pathway to the onset and then the evolution. But what we know is that it's a lifetime disorder. There is no cure for schizophrenia and the response to treatment varies. So some people will be extremely responsive and they'll have a management of their symptoms that is incredible. And some people might be resistant to medication. Some people might not actually have the best outcome from just a medical treatment or a pharmaceutical treatment. So from what I hear, there's just so much variability. There's no kind of one-size-fits-all. And because it's such a distressing disorder, I think it really warrants the help from a professional or that someone could really benefit if they go reach out to someone like yourself, like a social worker or a psychologist or a psychiatrist. I acknowledge that there are so many barriers to reaching out for help because a lot of people are scared. They don't know what to expect. So perhaps I wonder if you would be able to speak about what someone could expect when they reach out to you like a social worker with potentially a diagnosis of schizophrenia. So the challenge in the question is actually it depends on where you are. So obviously if you're in a state or a province or a country that has services that are adapted, you might get more out of seeing a healthcare professional or a social worker. In other situations, it might be very difficult because it's a private system. You have to pay out of pocket, but I'll try to be as general as possible. So to answer this, I think it's important to understand what is the impact of schizophrenia on functioning. So we say that there is a very, very strong potential for having psychosocial dysfunction. So being unable to function in your social spheres or in society in general. So for example, some individuals will have trouble finding a job or holding a job. For many reasons, either they can't concentrate or sometimes you hear voices and then you talk back. Some people will talk back and it's not everyone that I think is in an adapted workplace where people don't judge or people don't look at them and say, oh, maybe that person's weird. Why is she talking to herself? These are parts of discrimination, parts of stigma that affect individuals with schizophrenia and still today like you see it everywhere. So you might go see a social worker and they will help you look for adapted workplaces. So there are in different states, in different places, workplaces that accommodate individuals with mental health disorders. So it could be shorter days to help with the concentration. It could be an adapted environment or people who are trained who know about this specific disorder and then they can help out or they can just not be judgmental, not be discriminatory. So these programs are becoming much more popular because in general and historically individuals with schizophrenia were less likely to have full-time employment, were less likely to be able to finish university or to finish training programs. So adding this adapted format really helped bring a lot of patients into a more inclusive society, got them out of welfare, got them into training programs, got them into more fulfilling careers. Now, obviously it's not everyone and it's only a start, I think, but social workers can put you in contact with these various companies that do offer adapted workplaces. You could have really, we see a lot of suffering. Schizophrenia is a disorder that causes a lot of suffering for individuals, their families, their friends, their social circles. And unfortunately, sometimes it leads to suicidal ideations, suicidal attempts. And one of the things that social workers do a lot is crisis intervention. So very often you'll see in psychiatric emergencies a lot of social workers, you'll see them in the community as well that are going or some that do outreach just to help individuals who have these ideations not to go through with it, to find hope, to find reasons to continue on, to find motivation to get treatment, to work on this aspect that is on the suffering. So part of it is getting help in a crisis, but also social workers, at least where I live, are also participating in programs partnering up with police. I know that in a very decompensated state, in a state of psychosis, some people might present as very dangerous. And there have been unfortunate events where the police have had to fire upon these individuals. In that situation, if you add a social worker, if you add a psychosocial intervention, there is less likelihood of having a violent outcome. And there is less likelihood that someone who is most likely less trained with psychosocial interventions that they'll make a mistake. So this is kind of a protective element for our patients is having someone who understands their reality and who can help them in those very difficult crises. So it's very important to have a social worker present. I mean, there are other mental health care workers that can help as well. It's not reserved only to social work. And maybe one of the key points is social workers can do counseling, can help you adapt to your reality. Very often, we forget that schizophrenia is a relatively early onset. So mid teens to late twenties is the hot zone of where you're most likely to have a psychotic episode to develop schizophrenia. And I think it's very important to know that at any point that you that you have a break in your development in in your process of discovering who you are, discovering what you like. What what would you like to do as a job in the future? What would you like to go to university? Like what would you like to do in general? Or making friends, having romantic relationships, you know, all of these elements that you grow through your adolescence or puberty through your young adulthood. You kind of develop who you are, you develop your personality, you develop all these these relationships. And when you have to be hospitalized because you've had a psychotic disorder you've had, you were diagnosed with schizophrenia, you're losing out on a portion of that development process. It's delayed because you're in the hospital, you're not building friendships, you're not going out with with friends or with your partner. You're not going to class, you're not finishing your high school degree, you're not finishing your university degree, you're not working. And you see all your friends, all the people around you advance in life, and you're stuck at the same position. So it's a really big challenge. It's, it's very distrustful. It's very depressing to to see that maybe you have to repeat a year in high school because you missed too many classes, or that you might not be able to finish your university degree, because it's not adapted enough for your needs. And you can't concentrate anymore and you have problems with focusing. So overall, a social worker can help you go through that difficult period, but they can also help you adapt through that difficult period. So are there tools that you can learn? Are there strategies that you can learn to minimize the impact of your disorder? Are there ways that you can go around it? Are there ways of achieving your goals that are maybe a bit more alternative, but get you to your objective? And this is what we try to do. We try to help people adapt to their reality and reach whatever objective, whatever goal they have to get as close as possible to that. And it's a significant partnership. We, we need people to work very hard and we try to work just as hard to get them to that point. I mean, in terms of what an individual might have as services, in terms of counseling, some social workers can do psychotherapy, can do cognitive behavioral therapy, can do very adapted therapies as well. It depends on your training and on your license. Then you can have also more generalized support. And another thing that's very important that gets, gets admitted very often is social workers are very good at getting new services and getting new benefits if those benefits exist. So in my, in my career, I've been filling out welfare forms, I think hundreds, it's not thousands of times, because the first thing is if you're not working, if you're not in school, if you have an apartment, you need to live. You need to be able to afford that. You need to be able to have food to do your groceries. If your, if your government provides benefits such as welfare, disability, we're going to figure out how to get the maximum for you. That's part of the recovery process is making sure that your basic needs are met. So that includes having enough money to support yourself. You're not fortunes, you're not, you're not going to be rich out of government, the disability benefits. It's, it's, it's much less than anyone should ever survive upon, but compared to sleeping in, you know, being homeless and having to sleep on the street, or not having enough food to fill your stomach. There are elements that social workers can do that are extremely important. And they're very bureaucratic, they're very paperwork focused, but they get you services and they get you benefits. So that's super important to talk about as well. So yeah, it's really interesting to hear about the diverse kind of services that a social worker could could provide. So just kind of summarizing what you said to those who just joined, going from trying to find adaptive workplaces to working during crisis interventions to working with the police and also for those who have licensed to do so to also provide therapy. So in that way, it's really kind of a multi level approach to helping and supporting a person towards recovery, whether they're improving the relationship that they have with themselves through therapy, improving the relationship they have with other people, maybe through working with the police, perhaps also their relationship with society. If they're working by finding them resources to engage in workplaces that support them as a human being. So it's really nice to see how social workers help in all those different kind of areas. I wonder, do you, do you have any specific resources, let's say, Canada wide, that someone who might be struggling but who hasn't yet reached out might like to look after the stream. It really depends. I think there's no one specific resource that is that is as adapted, I could say, hey, go here and they'll figure you out. I think the first step, let's say Canada wide is, and the most important step is going to your local community health clinic, going to, if you can have access to a primary care physician, if you have access to any kind of mental health support. Because the first step actually, to be fair, if you have schizophrenia, you probably have already been in contact with some form of healthcare practitioner, most likely a psychiatrist that gives the diagnosis. I think it's important, not necessarily where you go, but that you go somewhere. So I'll give it in a more of a general sense. So shelters, if you don't have anywhere to sleep, go to a shelter, go to a shelter, because no one should sleep in the street. If you don't have enough food, go to a food bank if they exist in your area. It doesn't matter which, as long as you get something from there. If you need support, worst case, go to an emergency department, ask to be referred to a psychiatrist, ask to be referred to a social worker or anyone that works in the public sector that you can have access to. Because the first step when you need help is just reaching out to someone. You can look, there are a lot of, like the Canadian Mental Health Association has a lot of information, you have community organizations that are great and they vary upon location, but it all depends on what your specific need is. If you're not doing well, and this is the most important thing, if you're not feeling well, if you feel like you want to end it, if you're in such a position of distress that you're thinking about suicide, call 911, go to the emergency. Don't let anyone make you feel like what you're experiencing is not big enough or a crisis. Stay there, call 911 if you need multiple times, but say, state what is going on, someone will help you. The idea is, there is always somewhere to go, and I think it's more important to reach out, and even to reach out to family you can trust, people you can confide in, to friends that you can confide in. If you're not ready to go to a social worker or a psychologist or a psychiatrist or any kind of healthcare professional, try as much as you can to confide in someone that you trust and ask them if they can help you in making the first step. Because resources in general, they vary by, you know, by area, by country, by funding, but the important thing is just reaching out somewhere. I think that's the first step, more than giving out names, it's go anywhere where there is a trained professional, and they might be able to refer you to the person that finally helps you out, gets you out of where you are. So I think that's probably the most important aspect is just reaching out. Thank you for sharing that. I think it's really important. I'd like to echo that as well because I think a lot of times a lot of people just don't really know where to begin. They have some sort of distress. Sometimes they can't even put a finger on what is going on. And if possible, it's good to reach out to someone like you said a GP and they'll be able to direct you to other services, at least in Canada and in the UK, you would have to go to see your GP and then they would do a referral to other services like psychiatry or any other relevant clinicians. So yeah, that's definitely a good start. So with that, unless there are any other questions, I just wanted to thank everyone for joining this stream where we've really chatted about schizophrenia in general and then really took a social take on schizophrenia so that people are just more aware about what it is and what they could do to reach out for help. I'm always fully fully behind supporting people who are looking for ways to seek help from themselves. So if you would like to share your experiences, this goes out to everyone who's watching or if you are a clinician who would like to share your experiences, you can reach out to me. Email is Monica at Psych2Go.net and until then, I just wanted to thank you for your time to those watching and thank you so much Alex for being part of this. Thank you so much for having me. Thank you. So bye everyone. Thanks for coming.