Yogyakarta Records Highest Schizophrenia Cases in Indonesia

Yogyakarta has come to national attention after being recorded as the province with the highest prevalence of schizophrenia in Indonesia. According to the 2023 Indonesian Health Survey (IHS), 9.3 per cent of households in the Special Region of Yogyakarta (DIY) have members who show symptoms of schizophrenia or psychosis. 

The data was released by the Ministry of Health in June 2024. It shows that DIY has the highest prevalence, followed by Central Java (6.5 percent) and West Sulawesi (5.9 percent). Medically, 7.8 per cent of households in DIY have a family member who has been diagnosed with schizophrenia, with Central Java (5.1 percent) and DKI Jakarta (4.9 percent) following close behind.

Schizophrenia, a Complex Mental Disorder

Schizophrenia is a chronic and severe mental disorder that affects various aspects of an individual’s life, including how they think, feel and behave. The disorder often results in individuals losing touch with reality, experiencing hallucinations, delusions, and profound thinking disorders.

According to Dr Lahargo Kembaren, SpKJ, an expert in psychiatry, an imbalance of neurotransmitters, especially dopamine, is a key factor in the pathophysiology of schizophrenia. Dopamine is a neurotransmitter that plays an important role in brain function, including emotion regulation and sensory perception. In people with schizophrenia, there is an excess of dopamine activity in certain areas of the brain, such as the mesolimbic system. This is believed to cause symptoms of psychosis such as hallucinations (e.g. hearing sounds that do not exist) and delusions (beliefs that do not correspond to reality).

Symptoms of Schizophrenia

Symptoms of schizophrenia vary, but can generally be divided into three main categories:

1. Hallucinations: Patients experience symptoms such as hallucinations, delusions, and thinking disorders. Examples of hallucinations include hearing voices that are not real or seeing things that are not actually there. Delusions are strong, illogical beliefs, such as feeling watched or having supernatural powers.
2. Affect Daily Activities: Symptoms may also reduce or eliminate normal abilities, such as loss of interest in daily activities, social withdrawal, and lack of emotional expression. These are often more difficult to treat than hallucinations and can greatly affect the quality of life of the sufferer.
3. Cognitive Symptoms: These include impairments in memory, attention, and executive functions such as decision-making and planning. These cognitive impairments can make it difficult for people with schizophrenia to function normally in daily life.

Schizophrenia Stigma and Myths in Indonesia

In Indonesia, schizophrenia is often associated with myths and false beliefs, such as the notion that the disorder is caused by curses, black magic, or supernatural disorders. This stigma not only exacerbates the suffering of individuals with schizophrenia but also prevents them from getting the necessary medical treatment. As a result, many schizophrenics feel isolated and are reluctant to seek professional help.

In addition to social stigma, poverty and poor socio-economic conditions can also worsen the prognosis of schizophrenia. Individuals with lower-middle economic status are more vulnerable to stress factors that can trigger or exacerbate mental disorders, including schizophrenia.

Causes of Schizophrenia

Schizophrenia is a complex disorder, with the aetiology involving an interaction between genetic and environmental factors.

1. Genetic Factors: The risk of developing schizophrenia increases significantly if there is a family history of the disorder. Studies on twins reveal that the risk of schizophrenia can reach up to 50% in identical twins if one twin is affected, compared to approximately 12% in fraternal twins when one has the disorder. Additionally, if both parents have schizophrenia, the likelihood of their children developing the condition rises to 40%.However, schizophrenia is not a completely inherited disorder. Genetic factors may interact with environmental factors to increase the risk of this disorder.
2. Environmental Factors: Factors such as severe stress, psychosocial trauma, use of psychoactive substances (such as cannabis or amphetamines), and viral infections during pregnancy may increase the risk of schizophrenia. For example, a study using maternal serum influenza assays found that individuals exposed to influenza in utero during the first trimester were 7 times more likely to develop schizophrenia later in life compared to those uninfected during the same period.
3. Neurobiology: Imbalances in neurotransmitters, especially dopamine and glutamate, also play a role in the pathophysiology of schizophrenia. In addition to dopamine, research suggests that dysfunction of the glutamatergic system, which is involved in cognitive function and learning, may also contribute to cognitive and negative symptoms in schizophrenia.

Prevention and Management of Schizophrenia

Prevention of schizophrenia requires a multidimensional approach involving awareness raising, stress management, and social support. Some of the steps that can be taken include:

1. Education and Awareness: Increasing public knowledge about schizophrenia and its early symptoms is crucial for early detection and intervention. Education can help reduce stigma and encourage people to seek medical help early.
2. Stress Management: Stress management techniques include relaxation techniques, meditation, and cognitive behavioural therapy (CBT). These can help individuals manage stress which is a major risk factor for mental disorders, including schizophrenia.
3. Family Support: Families play an important role in supporting individuals who are at risk or who have been diagnosed with schizophrenia. Emotional and social support from family can help reduce the risk of relapse and improve prognosis.
4. Prevention of Substance Use: Avoiding the use of psychoactive substances, especially during adolescence, can reduce the risk of developing schizophrenia.

Comprehensive Management of Schizophrenia

Schizophrenia treatment involves a comprehensive and integrated approach, which includes medical treatment, psychosocial therapy, and social support.

1. Medical Treatment: Antipsychotic medications are the main pillar in the treatment of schizophrenia. They work by balancing neurotransmitters in the brain, particularly dopamine, to reduce symptoms of psychosis. Monitoring for side effects, such as motor or metabolic disturbances, or dose adjustments, is an important part of treatment.
2. Psychosocial Therapy: Cognitive-behavioural therapy (CBT) can help people with schizophrenia manage their symptoms, improve social skills, and improve their quality of life. Rehabilitation programmes can also help people return to productive lives.
3. Family and social support: Family and community involvement is crucial in helping people with schizophrenia adapt to daily life and reduce social isolation. This support also helps to reduce the risk of relapse and improve long-term outcomes.
4. Rehabilitation and Education: Vocational rehabilitation and education programmes can help people with schizophrenia develop the skills necessary to return to work and participate in social activities.
5. Periodic Monitoring: Regular evaluation by medical personnel is necessary to assess the progress of therapy and adjust treatment accordingly. It is also important to detect early signs of relapse and provide appropriate interventions.

With the right approach and adequate support, people with schizophrenia can manage their symptoms and lead better lives. Good mental health requires the involvement of all parties, including family, community, and medical personnel, to create an environment that supports the recovery and well-being of people with schizophrenia. Education, early detection and effective intervention are key to reducing the impact in society.