Schizophrenia

Schizophrenia

Abstract

Schizophrenia is a mental condition associated with delusions, hallucinations, as well as other cognitive problems and usually appears in early adulthood or late adolescence. The disorder can make a person fail to differentiate between reality and imagination while encountering confusing sounds, images, and thoughts. The initial process in diagnosing schizophrenia is ordering specific tests to exclude the likelihood of other conditions and illnesses that may trigger similar symptoms to this disorder. A blood test is done in instances where the use of drugs may be a factor. Schizophrenia occurs all over the globe. The rates of prevalence of schizophrenia are reliant on different factors such as the response to and availability of treatment. Several genetic alterations or mutations can elevate the probabilities of having a mental illness such as schizophrenia. There is an augmented possibility of getting schizophrenia if an individual in the family has the condition. The aims of treating this disorder include growing adaptive functioning, avoiding relapse, and managing symptoms to facilitate the integration of the patients in the community. Therefore, patients with schizophrenia should be treated to minimize the consequences of the condition.

Introduction

Schizophrenia is a mental condition associated with delusions, hallucinations, as well as other cognitive problems and usually appears in early adulthood or late adolescence (Nordqvist, 2017). The brain ailment alters how a person articulates emotions, sees the truth, acts, thinks, and connects to other individuals. People with Schizophrenia may have problems executing their routine mandate in society, relationships, at school, as well as at work. Proper treatment can control the disorder despite having no cure. Schizophrenia can make a person fail to differentiate between reality and imagination while encountering confusing sounds, images, and thoughts (WebMD, 2018). The disorder varies in severity for different individuals. One psychotic episode characterizes some people, as opposed to others who have several episodes during a lifetime. Another category of persons with schizophrenia may witness their effectiveness decline over time with insignificant progress between full-blown psychotic episodes. This condition occurs in roughly one percent of the population whereby about 2.2 million American inhabitants aged 18 and above are predicted to develop schizophrenia (WebMD, 2018). Therefore, there is a necessity of addressing this disorder and its remedies to ensure that the consequences associated with it are minimized. This paper discusses the diagnosis, epidemiology, etiology, course, and treatment for Schizophrenia.

Diagnosis

Summary of How Diagnosis is completed

            The diagnosis of schizophrenia is attained by observing the patient’s actions. In cases where the doctor suspects the presence of this disorder, they may be necessitated to determine the psychiatric and medical history of the patient (Nordqvist, 2017). The initial process in diagnosing schizophrenia is ordering specific tests to exclude the likelihood of other conditions and illnesses that may trigger similar symptoms to this disorder. A blood test is done in instances where the use of drugs may be a factor. This test is also done to eliminate physical causes of sickness.

On the other hand, imaging studies are completed to rule out problems in the brain’s structure and tumors. On its part, psychological evaluation helps in assessing the mental state of a patient by inquiring about hallucinations, moods, thoughts, violent tendencies, suicidal traits, and observing their appearance as well as demeanor (Nordqvist, 2017). For the diagnosis principles, patients must meet the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders criteria (Mayo Clinic, 2018).

Subtypes of Schizophrenia

            Schizophrenia is a chronic pain ailment that is described by a distorted perception of reality, disorganized behavior, delusional thinking, poor cognitive skills, and hallucinations. The causes of schizophrenia include changes in chemistry, environmental factors, and family history and genetics. The different subtypes are discussed below.

            Paranoid schizophrenia. In the United States, this subtype is the most prevalent of schizophrenia (Pasadena Villa, 2017). It reveals itself during the young adulthood or teenage years of a person. This subtype is similar to psychosis and is associated with delusional thoughts such as being abandoned by a loved one or harmed.

            Schizoaffective disorder. Patients with this condition struggle with co-occurring bipolar condition and depression. Hence, an individual with schizoaffective disorder exhibits various symptoms such as those of mania, depression, and schizophrenia. These may include persistent feelings of worthless, hopelessness, sadness, rapid thoughts, as well as increased heart rate.

            Catatonic schizophrenia. This subtype is an uncommon form of schizophrenia with more identifiable symptoms in an individual’s physical activities as opposed to their views. People with this condition may be mistaken to be under drugs or alcohol’s influence. The symptoms of catatonic schizophrenia comprise a display of unwarranted fits of anger, being unresponsive to those around, imitating the words of other people, and excessive movement without purpose (Pasadena Villa, 2017).

            Disorganized schizophrenia. This subtype is characterized by displaying disorganized speech, behavior, and thinking. It is common in early adulthood and teens between the ages of 15 and 25. Persons exhibiting disorganized schizophrenia often experience problems with their cognitive abilities, including intelligence, memory, as well as attention span.

            Residual schizophrenia. This subtype is the mildest form of schizophrenia. Individuals with residual schizophrenia could be in the process of transition from an acute phase of schizophrenia to remission or vice versa (Pasadena Villa, 2017). Residual schizophrenia can reappear or disappear at any time since it is not cyclical.

Differential Diagnosis

            Several disorders are considered in the differential diagnosis of schizophrenia. They include endocrine conditions, metabolic illness, anatomic lesions, other psychiatric illnesses, vitamin deficiency, miscellaneous conditions, and infectious diseases (Frankenburg, 2018). The differential diagnoses comprise:

·       Bipolar disorder

·       Psychosis related to alcohol

·       Delusional condition

·       Brief psychotic disorder

·       Depression

·       Psychiatric disorders related to cocaine

·       Schizoaffective disorder

·       Mental conditions following general medical illnesses.

Epidemiology

Prevalence

            Schizophrenia occurs all over the globe. The rates of prevalence of schizophrenia are reliant on different factors such as the response to and availability of treatment. Internationally, the prevalence of schizophrenia approaches one percent (Fischer & Buchanan, 2019). The incidence of this condition is roughly 1.5 per ten thousand persons. To some extent, more males are identified with schizophrenia than females. Additionally, there is a tendency of women being diagnosed later in their life compared to men. The onset modal age for females is between 25 and 35 years and 18-25 for males. According to Fischer & Buchanan (2019), there is an sign that the prognosis is severe in men.

Prevalence of Schizophrenia Across Different Cultures

            The outcome of schizophrenia is better in developing countries, an aspect which implies that the point prevalence in these nations should be minor. However, despite this difference in the course of schizophrenia in varying cultures, studies for cross-culture in psychiatry concentrates on resemblances as opposed to dissimilarities. The proportion of acute onset schizophrenia cases in developing nations is twice higher than in developed states. These differences signify a variation in the schizophrenia’s cross-cultural manifestations.

            Regarding persecutory delusions’ prevalence, in Latin America and Western Africa, hallucinations and paranoid delusions are, in most cases, initiated by an extreme terror of witchcraft and magical oppression (Lundbeck Institute, 2016). In Malaysia and Indonesia, the fear of losing fertility is the stressor. Patients with schizophrenia exhibit an increased level of thought insertions and removals, primary delusions, and depressive symptoms in the West compared to those in developing nations. However, patients in underdeveloped states encounter more acoustic and visual illusions than their counterparts in the West.

Comorbidity of Schizophrenia with Other Disorders

Schizophrenia and anxiety. The prevalence of anxiety conditions among schizophrenia patients is higher compared to the general populations. Anxiety disorders comprise panic, PTSD, generalized anxiety, obsessive-compulsive ailment, and social anxiety condition. Heterogeneity among definitions of symptoms and rating instruments utilized for diagnosis influence the prevalence estimates.

Schizophrenia and depression. The dilemma of psychiatric categorization has been fueled by the association between affective and psychotic symptoms. The distribution of bipolar disorder and schizophrenia can be done across a dimensional spectrum. However, unipolar depression and psychosis are the disorders commonly identified to comorbid with schizophrenia condition.

Substance abuse and schizophrenia. There is a link between patients with schizophrenia and substance abuse. A significant percentage of these patients may be diagnosed with lifetime substance abuse disorder. This concept implies that the abuse of substance is connected to several negative outcomes for the course of schizophrenia. The consequences include medication non-adherence.

Etiology of Schizophrenia

Genetics

Several genetic alterations or mutations can elevate the probabilities of having a mental illness such as schizophrenia. There is an augmented possibility of getting schizophrenia if an individual in the family has the condition. For instance, WebMD (2018) notes that if a sister, brother, or parent has schizophrenia, the chances of one getting the illness go up by 10 percent. However, if both parents have the disorder, there is a 40 percent likelihood of one getting the disease. Also, having an identical twin with schizophrenia makes an individual 50 percent vulnerable to get the condition. A change to any of the genes in the body may make an individual exposed to getting schizophrenia (Mental Health Information, 2016). Despite the doctors not being sure of how genetic modifications lead to schizophrenia, it is understood that various minor alterations add up and result in a higher risk.

Environmental Factors

Specific environmental aspects such as highly stressful situations, extensive exposure to toxins, and viral infection may activate schizophrenia, especially in persons who have inherited a tendency of developing the condition. Also, failure to acquire proper nutrition when an individual’s mother is pregnant with them, particularly during the initial six months of pregnancy, increases the chances of getting schizophrenia. This disorder surfaces when the body is experiencing physical and hormonal changes, such as those encountered during the young adult and teen years.

Brain Chemistry and Structure

There are several variances in the brain structure and function between persons with schizophrenia and those free from it. People with schizophrenia have widened ventricles, which denotes spaces within the brain. Also, they have reduced medial temporal lobes, which represent sections of the brain dealing with memory. Finally, individuals with schizophrenia have reduced links between brain cells. Regarding brain chemicals, persons with schizophrenia tend to have differences in neurotransmitters due to their abnormal regulation. These brain chemicals are vital in controlling communication within the brain. After the death of individuals with this condition, their brain structure is observed to be different compared to how it was at birth.

Course of Schizophrenia

Typical Course

            Odd experiences and behaviors begin to be encountered before the full onset of schizophrenia occurs. Such attributes include restlessness, anxiety, and hallucinations. However, these characters and experiences are not at their ultimate force. Also, there may be a continuing loss of reality with a significant number of persons with schizophrenia describing the start of strange thoughts, feelings, and understandings a few months before the proof is visible to other persons (Nemade & Dombeck, n.d). Though, it might be problematic to acknowledge schizophrenia when still in the initial stages. An individual may have been experiencing delusional thoughts and hearing criticizing voices for some time before recognizing the presence of schizophrenia. These symptoms may not be frightening in the early stages of the disease to make a person start acting weirdly. Individuals encountering these symptoms for the first time may manage to conceal them for some time before they can start to be visible. As soon as they start losing touch with reality, it becomes difficult to hide the experiences since their actions start reflecting their inner troubles.

            The recognition of schizophrenia is until when irrational traits are expressed during the psychotic break. At this point, an individual’s internal experience during delusions or hallucinations may be terrifying. However, family members and other people can only notice the outward symptoms of the psychotic break. The actual break with reality may happen even before those surrounding the person notice that there is something wrong. The occurrence of schizophrenia makes it a persistent condition that lasts forever in an individual’s life. Diverse levels of intensity characterize the disorder during its course from the onset. According to Nemade & Dombeck (n.d), the “first break” may be the last if the disorder is minor, and treatment happens immediately and persists as per the psychiatrist’s direction. The first break may result in a pattern of active and residual phases. An individual is symptom-free in the residual phase, with the new periods happening where symptoms resurface. This fluctuating trend of the rise and fall of symptoms, in most cases, perseveres throughout a person’s life.

Predictors of Course

            The major predictors of course of schizophrenia include changes in:

·       Eating or sleeping patterns

·       Self-care

·       Strange sensations

·       Changes in work or school performance

·       Lack of energy

·       Weakness

·       Confused and strange thinking.

Treatment of Schizophrenia

            According to Fatani et al. (2017), the aims of treating schizophrenia include growing adaptive functioning, avoiding relapse, and managing symptoms to facilitate the integration of the patients to the community. Considering that patients rarely restore their standard level of adaptive functioning, both pharmacological and non-pharmacological approaches of management must be utilized to promote long-term outcomes. The somatic and psychosocial treatments of schizophrenia are discussed below.

Somatic and Psychosocial Treatments

            Somatic therapy for patients with schizophrenia aims at recognizing and releasing the physical tension that they experience. Depending on the form of somatic psychology used, sessions may include awareness of breathing techniques, dance, bodily sensations, physical exercise, and healing touch. Psychosocial treatments assist with the occupational, social, psychological, and behavioral concerns related to schizophrenia. Therapy can help patients learn how to control symptoms, determine initial cautionary signals of relapse, and establish a stoppage strategy for relapse (WebMD, 2018).

Psychosocial remedies comprise rehabilitation that concentrates on job training and social skills to help individuals with schizophrenia live independently as well as function in the community. Cognitive remediation entails familiarizing with approaches for compensating concerns with information dispensation either through computer-based exercises and coaching or drills. These practices strengthen precise mental abilities encompassing memory, organization, and attention. Individual psychotherapy can enhance a person’s understanding of his/her condition to learn problem-solving and coping skills. Family therapy helps households deal with a loved one with schizophrenia more effectively, hence, boosting the patient’s chances of getting better. Group therapy avails continuing mutual support for individuals with schizophrenia.

Discussion and Conclusions

            Essentially, schizophrenia is a disorder that requires immediate attention to prevent adverse consequences associated with the condition. The initial process in diagnosing this disorder is aimed at excluding the likelihood of other conditions and illnesses that may trigger similar symptoms to schizophrenia. Schizophrenia has various subtypes, including schizoaffective disorder, paranoid, catatonic, residual, and disorganized schizophrenia. Also, differential diagnosis can be done for schizophrenia, with the condition being identified to comorbid with other disorders. Schizophrenia is distributed differently across varying cultures. The causes of this disorder are attributed to genetics, environmental factors, as well as brain chemistry and structure. The treatments for schizophrenia include both somatic and psychosocial approaches. Psychosocial therapy assists patients with schizophrenia to manage concerns related to this disorder. Therefore, through various practices such as psychosocial treatments, patients with schizophrenia can be assimilated back in the community as their condition is enhanced. As a result, the process of restoring their functioning capability is facilitated. Future research should concentrate on specific symptom complexes connected to schizophrenia or a subgroup of patients to enhance the efficacy of adjunctive agents as opposed to examining the overall improvement in the disorder.

            In brief, schizophrenia is a broadly prevalent psychiatric condition. Both medical and non-medical treatments can be used to reduce the consequences of schizophrenia to patients with this disorder. Medical treatments should be the first option, especially in instances where the symptoms are severe. Medications help in relieving the most troubling symptoms, such as thinking problems, hallucinations, and delusions. Several causes of the illness can be identified, in which some are avoidable while others are not modifiable. Therefore, more studies should be steered to help in the implementation of advanced treatments for schizophrenia.

References

Fatani, B. Z., Aldawod, R., Alhawaj, F. A., Alsadah, S., Slais, F. R., Alyaseen, E. N., ... & Banjar, J. (2017). Schizophrenia: Etiology, pathophysiology and management-a review. The Egyptian Journal of Hospital Medicine, 69(6), 2640-2647.

Fischer, B. A., & Buchanan, R. W. (2019). Schizophrenia in adults: Epidemiology and pathogenesis. Retrieved from https://www.uptodate.com/contents/schizophrenia-in-adults-epidemiology-and-pathogenesis#H31673355

Frankenburg, F. R. (2018). Schizophrenia differential diagnoses. Medscape. Retrieved from https://emedicine.medscape.com/article/288259-differential

Lundbeck Institute. (2016). Schizophrenia across cultures. Retrieved from https://institute.progress.im/en/content/schizophrenia-across-cultures

Mayo Clinic. (2018). Schizophrenia. Retrieved from https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443

Mental Health Information. (2016). Schizophrenia. Retrieved from https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

Nemade, R., & Dombeck, M. (n.d.). Schizophrenia: Statistics and course of schizophrenia. Retrieved from https://www.gulfbend.org/poc/view_doc.php?type=doc&id=8805&cn=7

Nordqvist, C. (2017). Understanding the symptoms of schizophrenia. Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/36942.php

Pasadena Villa. (2017). The five different subtypes of schizophrenia. Psychiatric Treatment Network. Retrieved from https://www.pasadenavilla.com/2017/04/28/the-five-different-subtypes-of-schizophrenia/

WebMD. (2018). Schizophrenia: An overview. Retrieved from https://www.webmd.com/schizophrenia/mental-health-schizophrenia#1