Schizophrenia And Work- 7 Surprising Impacts On Workplace Success

Introduction

Schizophrenia affects approximately 24 million people or 1 in 300 people (0.32%) worldwide. This rate is 1 in 222 people (0.45%) among adults (IHME). Schizophrenia is characterized by symptoms which are known as positive and negative. Positive symptoms are characterized by hallucinations and delusions, and negative symptoms are characterized by the absence of emotions, reduced interest, reduced speech and thought processing, apathy, and reduced social interaction. 

Patients diagnosed with schizophrenia often express a desire to work but face a lot of stigma and resistance to joining the workforce.

Schizophrenia and Work

 When an individual is diagnosed with schizophrenia, the patient and the family members worry about his ability to work. One must remember that schizophrenia will not impair the skill set that the patient has already learned and practiced. Many times, people equate schizophrenia to intellectual disability, which is not so; when the disorder is identified early and the treatment is started, the neuronal damage can be prevented. The patient can continue to work with some lifestyle modifications. A proper work-life balance with adequate time to unwind and relax will be helpful for the individual. Work does come with challenges, but with prior preparation and a proper mindset, it can be dealt with without facing any hindrances.

Can a Person with Schizophrenia Work?

Well, it’s difficult to generalize the answer; some people with schizophrenia have

cognitive difficulty like-

1. Reduced attention span
2. Difficulty in new learning
3. Working memory deficits
4. Reasoning difficulty
5. Delay in task shifting
6. Reduced processing speed
7. Difficulty in judgment and problem-solving.

Assessment of the patient prior to employment and allocating work based on their strengths can help patients with schizophrenia enter the workforce and earn their livelihood. Financial independence can help the patient to be more compliant with his treatment and hence prevent relapses of psychotic symptoms. Regular follow-ups and keeping the disorder in check can help the individual maintain his productivity at work.

How Does a Schizophrenic Brain Work?

Schizophrenia is a disorder that affects the basic sense of perception, emotion, and cognition. It’s been increasingly viewed as a disorder that arises due to changes in neurodevelopment and plasticity. The psychotic symptoms of schizophrenia are striking, but the subtle cognitive problems are increasingly recognized as concerning the disease. While positive and negative symptoms of schizophrenia can fluctuate, cognitive deficits remain relatively stable. Positive symptoms are the symptoms characterized by delusions and hallucinations. The dopamine hypothesis suggests that there is an increased number of DA receptors in the mesolimbic pathway, which leads to increased activity and presentation of psychotic symptoms.

Hyperactive DA D2 receptors

This hypothesis suggests that hyperactivity of DA D2 receptors in subcortical and limbic brain regions can contribute to positive symptoms of schizophrenia. 

Hypofunctional DA D1 receptors

This hypothesis suggests that reduced functioning of DA D1 receptors can contribute to negative and cognitive symptoms of schizophrenia.

Negative symptoms are characterized by lethargy, motivation, apathy, and reduced interest. 

Schizophrenia and Work – Impact on Workplace Success

1.   Assisted employment support: Individuals with significant cognitive impairment might need help finding desk jobs. They might also need help sitting and focusing on one single task for a long duration of time.
2. Limited soft skills favor physical tasks: Impaired soft skills will make the interaction difficult for them. Physical tasks would be ideal for people with these difficulties.
3. Physically limited schizophrenia: Certain individuals with schizophrenia do not have significant cognitive function difficulties but have physical limitations; they find hard labor difficult owing to medications or due to other comorbid conditions associated with schizophrenia. Such individuals prefer desk jobs to physical work.
4. Stigmatization in tailored employment for schizophrenia: Job search and employment are tailor-made or made for each patient, depending upon his or her capabilities. Many times, patients with schizophrenia are perceived as being violent and are often looked down upon and stigmatized.
5. Debunked: This myth needs to be addressed; it has been found that only a few patients exhibit violence, and this can be identified with proper screening. 

Supportive Work Environment for Employees with Schizophrenia

1. Flexibility – There can be flexibility in timing of work , location of workplace, as well as transportation taken to and from workplace.
2. Part time option – There can be scheduling variations available at work- for example- offering part time work.
3. Opportunities for mental health sick days – Additional sick time and reminders should be available, in order to maintain their mental health related appointments.
4. Breaks – opportunities should be made available to take adequate breaks during work.
5. Support system – it is very important to make mental health support systems available to everyone.
6. Work support – They should be allowed additional training, or a change in department should be permitted if needed.

Even though these are just suggestions, it should be emphasized that these  suggestions can be implemented, without them affecting the workplace productivity. If the affected individual still finds it difficult to work, despite the accommodations, then it may suit them to look for opportunities in another area of interest.

Conclusion

To conclude, people with schizophrenia must be aware of their skill set and choose a job profile depending upon it. Similarly, the workplace must also strive to provide a non-judgemental environment, which will help in reducing the stigma attached to schizophrenia.

References

1. Institute of Health Metrics and Evaluation (IHME). Global Health Data Exchange (GHDx).  http://ghdx.healthdata.org/gbd-results-tool?params=gbd-api-2019-permalink/27a7644e8ad28e739382d31e77589dd7 (Accessed 25 September 2021)
2. Mervis JE, Fiszdon JM, Lysaker PH, Nienow TM, Mathews L, Wardwell P, Petrik T, Thime W, Choi J. Effects of the Indianapolis Vocational Intervention Program (IVIP) on defeatist beliefs, work motivation, and work outcomes in serious mental illness. Schizophr Res. 2017 Apr;182:129-134. doi: 10.1016/j.schres.2016.10.036. Epub 2016 Oct 29. PMID: 27802910; PMCID: PMC5828005.
3. Hernandez, M., Barrio, C., Lim, C. et al. The Relationship between Social Competence, Symptom Severity and Employment in Schizophrenia. J. Psychosoc. Rehabil. Ment. Health 4, 231–235 (2017). https://doi.org/10.1007/s40737-017-0088-7