Schizophrenia

Posted: December 22nd, 2022

Schizophrenia

Student’s Name

Institutional Affiliation

Schizophrenia

Brief Overview

A Close evaluation of mental disorders globally ranks schizophrenia at the 7^th position in terms of its expensiveness in accessing treatment and constant hospitalization. It costly nature is attributed to the constant hospitalizations, productivity loss and need for psychiatric assistance demanded by a patient.  The annual expenditure directed towards schizophrenia treatment and management is estimated at $60B in the United States. The condition manifests itself in negative and positive symptoms as per the DSM V. In addition, cognitive dysfunction is also detected on further evaluations. In definition, it is a severe and consistent mental disorder whose onset commences at early adulthood or late adolescent stage (Kruse & Schulz, 2016). The clinical symptoms are usually comprised of a wide ranging assortment affecting perceptions and thinking process leading to an individual to behave abnormally. It can present itself as remitting, relapsing or chronic forms.

The term schizophrenia was introduced by a Swiss psych­­iatrist named Bleuler describing it as a cocktail of distorted behaviors and perceptions. Upon its introduction in 1911, it was only until 1959 when its diagnostic criteria was established contributing to its modern day categorization into varying subtypes depending on the severity and duration of the presenting symptoms. One notable feature promoting the important of research on this mental health condition is the poor life quality experienced by individuals with schizophrenia. This outcome is mainly attributed to the side effects of this diagnosis including financial difficulties, pharmacological effects of prescribed medication, societal stigma and diminished social support (Kruse & Schulz, 2016). This discourse explore the intricacies of this condition highlighting on its causative factors, symptoms, diagnosis and treatment with the objective of developing informative content effective in creating social awareness pertaining to this mental health issue.

Diagnosis

Various diagnostic methods have been established in diagnosing schizophrenia. John Haslam diagnosis on James Tilly Matthews is considered as the primary description of schizophrenia in the British literature (Jablensky, 2010). According to this physician, the symptoms take on the form of insanity. Some of the symptoms highlighted in the diagnosis included hallucinations, acute dementia as well as hebephrenia. Phillippe Pinel, recognized as the father of modern psychiatry contributed to mental disorders classification (Jablensky, 2010). His literature, Insanity, provided evidential proof of the existence of schizophrenia which was later conceptualized by Kraeppelin. According to this theory of understanding this condition, he cited its onset was stimulated by transitions between emotional states leading to mental alienation or mania. He attributed these changes terming them as psychosocial factors (Jablensky, 2010).  Emile Kraepelin contributed to the classification of mental orders assigning the term dementia praecox to the condition afflicting individuals who in the modern day suffer from schizophrenia. He provided distinction to this mental disorder in 1887 as people considered to experience madness were associated with other medical illness (Jablensky, 2010). By establishing a clear distinction between manic depression and dementia praecox was elemental in showing schizophrenia affected brain functionality. Symptoms included melancholia or mania and behavioral and cognitive decline.

Eugen Bleuler research on psychoses provided a modification to original concept by Kraepelin by adding the scope of the mental condition (Jablensky, 2010. Additionally, he coined it the term schizophrenia replacing dementia praecox. This term was applied to mean splitting of the mind in conveying the fragmented thinking often experienced by schizophrenics (Jablensky, 2010). Firstly, he described it as appearing as a cluster of diseases. Secondly, he established a distinction between basic and accessory symptoms. The latter included hallucinations and delusion commonly known as positive systems. The basic symptoms include speech and though derailment, affective incongruence, volitional indeterminacy and withdrawal from real life. According to Bleuler, the basic symptoms made up the distinct schizophrenia profile. In the modern day, schizophrenia is diagnosed utilizing DSM-5 which assess the symptoms (Jablensky, 2010). The first stage is performing a physical examination and evaluating the medical history. It is important to note that laboratory tests are not conducted on the patient. However, diagnostic tests include CT and MRI scans as well as blood tests necessary to rule out other maladies. The medical practitioner then refers the patient to a psychiatrist to conduct an evaluation using the DSM-5. A diagnosis is provided if the patient presents two or more primary symptoms which as disorganized speech, hallucinations, low emotional expression, gross disorganization, and delusions (Jablensky, 2010). Other criteria include diminished self-care and low work productivity, schizoaffective, bipolar or depressive disorder, and signs of disturbances.

Identifying Symptoms

As a functional psychotic disorder, schizophrenia is presented by different manifestations. One of the major symptoms is mental distortions which affect the individual’s cognitive process. Symptoms categorization is applied in understanding this mental illness.

1. Positive Symptoms

 The positive symptoms refers are responsible for distorting reality (American Psychiatric Association, 2013). Delusions occur as false beliefs lacking any association to the individual’s culture. It shows when a person demonstrates strong feelings towards the factuality of these dogmas (Glen O. Gabbard, 2014). A noticeable symptom is the person feels as if others are out to cause them harm. This is known as paranoia. The capgras syndrome occur when they believe a person they know has been replaced top monitor them. Other schizophrenics manifest the Cotard’s syndrome where the individual believes they are dead (Glen O. Gabbard, 2014). Hallucination occurs as perception disturbances when an individual will feel, smell, and taste, see something that does not exist. Auditory hallucinations are the most common where most people here voices taking about them or to them. They can be harmless or humiliating and frightening to the individual.

Disorganized speech and though (Glen O. Gabbard, 2014)t processes termed as anhedonia disintegrates the person’s ability to communication. With jumbled thoughts, they often unrelated ideas, skipping subjects, making up unreasonable words. Disorganized behavioral tendencies are also observed with the individual lacking the ability to perform daily activities (American Psychiatric Association, 2013). This is known aliogia. Some of these behaviors are also unusual and uninhibited (Glen O. Gabbard, 2014). An individual also displays catatonic symptoms include motionlessness, right body posture, excessive repetitive movements and unresponsiveness to the environment.

• Negative Symptoms

When describing negative symptoms, it is important to note that they limit an individual’s ability to perform tasks elemental for their functionality hence experience poor life quality. The first symptom is reduced motivation whereby a schizophrenic experiences difficulty in completing tasks or fulfilling task (American Psychiatric Association, 2013). They are have reduced energy before and after their episodes. The second symptom is social withdrawal where they either become highly sensitive to others or demonstrated limited interest (Glen O. Gabbard, 2014). They tend to feel safer while alone in order to avoid feeling negatives attitudes towards other people. Lowered emotional expression is the third symptom that manifests as a blank facial expression as well as reduced expression in terms of body language. Loss of pleasure and interest in things they once loved or passionate about is another sigh (Glen O. Gabbard, 2014). Once a patient is under therapy, their interest resume at full functionality. Reduced verbal communication is also significantly portrayed. Due to blocked and slowed thoughts, the individual might opt to remain silent or limit their verbal interaction.

Possible Causes

Genes

Research suggest several possible causative agents associated with the onset of schizophrenia. Genetics as a cause, presents as a complex interplay triggered by environmental influences. For researchers, understanding heritability remain an evasive topic as it is difficulty in separating environmental triggers and genetic causes (Glen O. Gabbard, 2014). However, various studies have ascertained this association. A study conducted on twins in exploring heritability confirmed the contribution of genetics factors in schizophrenia manifestation citing neuronal signalization responsible for psychotic disorders as being an outcome of DNA sequences duplication or deletion in genes (Glen O. Gabbard, 2014). Within the general population, 10% of individuals diagnosed with this condition are genetically susceptible due to a history showing family psychosis.  Comparing this figure to the 1% of the global population affected by schizophrenia, it is evidently clear that genetics pose a significant risk to people with first degree relatives with this condition.

Environment  

The second cause is the environment whose influence is a multivariable. Firstly, studies posit that exposure of a fetus to malnutrition and viruses during the first and second trimester has a profound effect in increasing their chances of developing schizophrenia at a later stage (Stilo, Di Forti, & Murray, 2011). Other environmental conditions cited include autoimmune maladies and inflammation. Secondly, extreme social environmental experience at childhood have also been associated with schizophrenic diagnosis (Stilo, Di Forti, & Murray, 2011). These experiences encompass social exclusion through radical discrimination, unemployment, family dysfunctionality or impoverished housing conditions. Evidence suggest individuals whose childhood was characterized with abuse, social adversity or urbanicity are likely to develop this condition due to dopamine alteration during the sensitization process leading to the development of cognitive biases (Stilo, Di Forti, & Murray, 2011). This impact is often significant in affecting children development increasing their risk of developing schizophrenia at a later phase in life.

Brain Chemical Composition

The brain chemical composition is significant in determining the causality of this condition. The levels of elemental neurotransmitter including glutamate and dopamine may in some causes led to schizophrenia (Kruse & Schulz, 2016). These components are responsible in driving the brain’s proper functionality and communication facilitated by the neuron network. Dopamine plays a major role in brain activity particularly at the mesocortial and mesolimobic pathways. Any malfunction occurring these regions causes mental health disorders to manifest (Kruse & Schulz, 2016). Thus, it provides a reasonable explanation on the prevalence of dopamine coding genes observed in schizophrenics (Glen O. Gabbard, 2014). Lowered glutamate levels also elicits a similar impact. Therefore any problem arising in their levels is likely to impart a negative effect.

Drug Use

Lastly, drug use increase the likelihood of schizophrenia depending on their biochemical effect on the brain. Exposure to mind altering drug substances at teenage hood and early adulthood can led to this condition dependent on the frequency of usage and the age of the user (Kruse & Schulz, 2016). Evidential proof from numerous studies cite marijuana as a key drug whose pharmacological effect increased the onset of psychotic experiences further exposing an individual to psychosis. Studies suggest it causal effect is doubles the risk at an individual level attributing it to 8% of the schizophrenic cases recorded in the affected population. Other drugs associated to this condition as pharmacological trigger include hallucinogens and amphetamines (Kruse & Schulz, 2016). The later has a worsening effect in manifesting symptoms as it stimulates the dopamine release. The association between drugs and schizophrenia is based on a triggering influence particularly for predisposed individuals.

Recommended Treatment Options

Three goals are highlighted in treating schizophrenia. They include ensuring the patients’ experience increased adaptive functioning, are prevented from having a relapse and symptoms targeting is successful achieved facilitating their integration into the community (Kruse & Schulz, 2016). In attaining long term outcomes, pharmacological and non-pharmacological treatments are applied. The first option is pharmacotherapy. It is commonly applied for schizophrenia management because antipsychotic agents are critical in facilitating the adherence of a patient to enter into a rehabilitation program (Sadock, & Kaplan, 2005, p. xx). Drug treatment is initiated within a five year period following the occurrence of a psychotic episode. The drugs used as effective in reducing patient hostility as well as restoring their normal functionality (Kruse & Schulz, 2016). The first line treatment drugs used include second generation antipsychotics excluding clozapine due to its effect in causing agranulocytosis. The preferential use this medication as opposed to first generations is because the latter elicits more extrapyramidal symptoms. Side effects associated with second generation drugs include diabetes mellitus, weight gain and hyperlipidemia (Kruse & Schulz, 2016). In this therapy, it is also to note that combined therapy involving first line/second generation medication, electroconvulsive therapy are tried as treatment method when a parent in unresponsive to these therapies on their own.

 LAI (long acting injectable antipsychotic agents) are also used as a form of pharmacological treatment in patients demonstrating non-adherence to oral medications. Prior to its use, its oral counterpart should be prescribed to the patients to evaluate the patient’s tolerance (Sadock, & Kaplan, 2005). Clozapine combined with benztropine and chlorpromazine is only used in schizophrenic individuals who show treatment resistance to the highlighted medications. Combination therapy and augmentation is used if clozapine treatment fails (Sadock, & Kaplan, 2005). It includes mood stability or electroconvulsive therapy alongside psychotics. The overall positive outcomes includes improved mood and diminished psychotic symptoms.

However, in instance whereby residual symptoms remain persistent, the second option is applying non pharmacological treatments. Psychotherapy is an approach that can be executed in three categories inclusive of group, invidual or cognitive behavioral. All these forms are used with medication (Sadock, & Kaplan, 2005, p. xx). One of the main advantage of psychotherapy treatment is ensuring the patients remain compliant to taking their prescribed medication. Emergent applications which are current in use include mindfulness, narrative and meta-cognitive therapies (Kruse & Schulz, 2016). The programs are elemental in strengthening families to offer support to their patients which in turn has been seen to have positive outcomes in heightened social functioning and reduced hospitalization (Sadock, & Kaplan, 2005). They are also taught on methods of monitoring the patient as well as reporting incase an issue occurs such as an adverse medical effect.  It is important to note that psychotherapies are often preferred due to their engagement and involvement of the patient’s family.

References

American Psychiatric Association. (1997). Practice guideline for the treatment of patients with schizophrenia. Amer Psychiatric Pub.

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Arlington, VA: American Psychiatric Pub.

Glen O. Gabbard, M. (2014). Gabbard’s Treatments of Psychiatric Disorders, Fifth Edition. Arlington, VA: American Psychiatric Pub.

Jablensky, A. (2010). The diagnostic concept of schizophrenia: its history, evolution, and future prospects. Dialogues Clin Neurosci, 12(3), 271-287. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181977/

Kruse, M., & Schulz, S. C. (2016). Overview of Schizophrenia and Treatment Approaches. Schizophrenia and Psychotic Spectrum Disorders, 4(3), 3-22. doi:10.1093/med/9780199378067.003.0001

Sadock, B. J., Sadock, V. A., & Kaplan, H. I. (2005). Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. Philadelphia, PA: Lippincott Williams & Wilkins.

Stilo, S. A., Di Forti, M., & Murray, R. M. (2011). Environmental risk factors for schizophrenia: implications for prevention. Neuropsychiatry, 1(5), 457-466.