Schizophrenia: Physical & spiritual well-being

• Keeping Fit
• Sexual Health
• Spirituality

Physical Health

Schizophrenia can have a variety of major consequences on a person's lifestyle including their social and financial position. The psychotic symptoms of schizophrenia and the disruption they can have on an individual's daily life are obvious, but physical health can also be affected as a result.

Lifestyle changes may involve higher levels of smoking, which can lead to serious physical health complications including cardiovascular difficulties, respiratory disease and a general increase in infections. These problems may be compounded by high levels of alcohol consumption, illegal drug use, poor diet and lack of exercise, alongside a possible reduction in self care, general hygiene and the impact of poor accommodation.

The changes to lifestyle and the side effects of medication can lead to weight gain and the problems of obesity. Obesity can have a major impact on physical health, such as an increased risk of heart disease or diabetes.

It is therefore recommended that people with schizophrenia should have an annual physical check up. This check should include blood pressure monitoring, urine analysis, an influenza vaccination and information on reducing smoking as appropriate. Individuals with schizophrenia may also need support from a dietician, drug and alcohol services, chiropody, dentistry and other general health promotion information.

It is possible with good health and social care support that the physical risks associated with schizophrenia, including the side effects of treatments and lifestyle changes, can be reduced.

Keeping Fit

When experiencing mental health difficulties, it can be very difficult to focus on looking after oneself. A lack of energy and a loss of motivation can result in an individual neglecting their physical well-being, and research has shown that poor diet, cigarette and alcohol use, and a lack of exercise all contribute to ill health. As with the general population, people with schizophrenia are encouraged to adopt a healthy lifestyle and this includes taking regular exercise.

Exercise is beneficial for the heart and lungs, helps build muscle and strengthens bones. Being overweight is a health risk, and exercise is a good way to lose weight and/or minimise weight gain, which is a possible side-effect of some anti-psychotic medication.

A growing body of evidence is showing that exercise is an effective tool in the treatment of mental illness, and while it is not a replacement for medication for schizophrenia it may aid improvement. In addition to the physical benefits, studies have shown that exercise can lead to an increase in mood and concentration; it can reduce anxiety and stress; and it can lead to an increase in self esteem and motivation. Undertaking exercise in a group setting, for example an aerobics class or a game of football, encourages an individual to meet new people, reducing isolation and improving social skills.

Exercise should be manageable and fun, and individuals should start slowly and gently. It is important for individuals to consult their doctor before starting any new exercise programme and also worth noting that GPs can sometimes prescribe exercise sessions and activities.

Sexual Health

Healthy sexual relationships are an important part of life, and it can be seen as a measure of an individual's quality of life. However, sexual relationships can become more difficult following the onset of schizophrenia.

The side effects of some antipsychotics can result in sexual dysfunction and a reduction in sexual desire. It is important that if this occurs, individuals do not just stop taking their medication. While embarrassment may be an issue, it is important to contact their GP or psychiatrist. There are possible options that can be considered, including a reduction in the dose or possibly a change of medication.

Women wanting to become a parent need to be aware that some medications are not suitable for use during pregnancy and some can cause changes in lactation (the production of milk). GPs or psychiatrist can advise which medications are suitable during these times.

While experiencing acute symptoms, it is possible that some people may become sexually disinhibited, or experience sexual urges that are out of character. As a result they may be more likely to take part in high-risk sexual behaviour, and the incidence of sexually transmitted diseases (STDs) is on the increase. It is important generally that young people should be encouraged to gain information and advice on contraceptives and STDs. If starting a new relationship everyone should think about protecting themselves and their partner. Schizophrenia can also leave individuals feeling less able to cope with unwanted advances, increasing their vulnerability. Any reports of sexual harassment should be taken seriously and reported accordingly.

Sexual health is an important area that needs more exploration, but greater openness can help individuals move towards healthy and happy sexual fulfilment.

Spirituality

An individual's mental health and well-being is affected by the world around them, and in particular a sense of belonging and being part of a community can be very important to an individual and their family.

For many people, spiritual and religious beliefs can add to their sense of comfort, identity, cultural awareness and community involvement. Faith communities can offer a network of support particularly at times of crisis; such communities can also offer 'a friendly face'; and provide an important role for somebody recovering from schizophrenia. Churches and other houses of worship can provide a supportive environment to talk about a situation, reducing any feelings of isolation, fear and discrimination.

However, there may be times when an individual's psychotic symptoms lead them to believe in a more significant, and sometimes distressing, spiritual relationship. Symptoms such as hearing voices and visual hallucinations may be identified as spiritual experiences by the person and can lead someone to being vulnerable to some religious groups. Other faith groups may see these experiences as being the result of a person's actions in life, possibly increasing an individual's distress and isolation by rejecting them or discouraging the use of mental health services.

Nevertheless, whilst negative perceptions of spirituality may occur during a period of illness, the importance of faith and religious beliefs for many individuals cannot be overlooked. Health and social care services cannot offer all of the support needed by some individuals and the role of other community organisations and voluntary groups is invaluable.

The benefits of a holistic support network, including organised religion, spirituality and other faith groups, are important to many people and can help support an individual and their family/carer on the path to improvement.