Category: Mental Illness

Postpartum depression or postnatal depression is a widespread problem occuring in the mother, but also affecting father and child.

INTRODUCTION

Postpartum depression is one of the most common problems occur in the women after giving birth to their offspring. A study has shown that in developed countries 10-20% of mothers were affected by PPD. It can be last for about a year (Beck, 2006). Postpartum depression not only affect mother, but it also imparts detrimental impacts on corporal and cognitive development of infants (Gaynes et al, 2005). It is proved that the older women having age 30 and more are at high risk of postpartum depressions as compared to women with 20 to 25 years old (Silverman et al, 2017).

There are several factors that trigger the PPD, but the prolonged stress is the biggest cause of PPD, which accelerate the production of cortisol that eventually trigger the negative regulation of hypothalamic pituitary adrenal (HPA) via blocking of receptors. Not only this the impairment in HPA regulation disrupt the body’s capability to decrease the cortisol level (Aasheim et al, 2012).

SIGN & SYMPTOMS

It usually occurs in the first year of postpartum. Symptoms are divided into categories like Emotional, cognition & behavioral (“Postpartum Depression”, n.d.).

Behavioral

• Not able to perform daily activities
• Lack of energy
• Change or lack of appetite
• Sleep disturbance
• Fatigue

Cognition

• Inability to think
• Poor memory
• Inability to concentrate on a particular thing

Emotional

• Sadness
• Mood swings
• Numbness
• Guilt or shame
• Unable to have a good bond with baby

To meet social expectation, a mostly new mother ignores these signs which worsen their depression.

Postpartum depression can interfere with mother – infant relationship which can affect child development from acute to long term. Improper routine of feeding a baby, maintenance of health, not enjoying with baby can worse the bonding of mother – baby (Field, 2010).

CAUSES

There is no particular cause for postpartum depression. Change in hormones like estrogen, thyroid hormone, cortisol etc., (Soares & Zitek, 2008) can cause postpartum depression. Physical or social and emotional sign can elevate this depression.

Some risk factor like depression history ongoing in his/her family, prenatal depression, smoking, violence between mother and father, depletion in oxytocin, etc.,. Financial status of the family can also trigger this depression.

DIAGNOSIS

If symptoms like sadness, lack of energy, weight loss, change in appetite, insomnia, suicidal thoughts, lack of interest in daily activities, etc., occur in a period of 2 weeks then that person undergo for postpartum depression diagnosis.

The aim of doctor to rule out the baby blues A person with suspect PPD to complete depression screening questionnaire. If a person has yes to PPD symptoms. Then the person has mild PPD. The doctor also performs some diagnostic test such as a blood test. This test determines whether there are any hormonal problems such as those caused by an underactive thyroid gland or anemia.

TREATMENT

Medication for post-partum depression:

The primary step in treatment is to resolve the problems such as sleep and appetite changes. Antidepressants are common and effective for this. So, the use and choice of antidepressants must be careful. If a women is breastfeeding, then they do not use the antidepressants because it will concern to the infant toxicity. Some antidepressants ,including the serotonin uptake inhibitors like Paxil, Zoloft and Prozac. These have been associated with cranial or cardiac defects when women take early in the pregnancy. The use of antidepressants depends on the history of symptoms of the postpartum depression. Hormone therapy can also be used to treat PPD as estrogen level and progesterone level get imbalanced after delivery of a baby can trigger PPD (Johnson, 2018; Fitelson & Kim, 2010).

Psychological Therapies:

Cognitive Behavioral Therapy is successful in moderate cases of PPD. It is effective for only some people. This therapy is based on principle which deal with the thoughts that can trigger depression. In this therapy, individual is taught how to manage the relationship between state of mind and her thoughts. The main aim of this therapy to change the thoughts of a person. So, that they become positive. For more severe depression this therapy is less effective. It is only used for moderate PPD. Other therapy like interpersonal psychotherapy is also effective in treating PPD (Johnson, 2018; Fitelson & Kim, 2010).

Other like Electroconvulsive therapy (ECT), bright light therapy, massage, social support from family.

EMERGING RESEARCH IN PPD

There are many research ongoing on PPD. Identifying GABAA receptor for PPD, identification of biomarker are recent ongoing research on PPD. Therapy based research without any drug intervention is the hot topic ongoing today.

To treat PPD, there are many therapies but few of them show significant decrease of depression. One of researcher conducted an experiment on the intervention for management of PPD. For the study, mother population was taken who were in a period of 12 months after baby delivery. A tool used was a patient health questionnaire (PHQ-9) which act as primary care for patients (Reindolf et al, 2018).

PHQ-9 is divided into 4 sections that include characteristics, intervention duration and impact of interventions in reducing the depression. For the management of PPD following was used:

1. Psychosocial support
2. Home visits by professional
3. Interpersonal psychotherapy
4. Cognitive therapy

The result shows that cognitive therapy, interpersonal psychotherapy and home visit have no great impact on PPD whereas psychosocial support have a greater ability to reduce PPD (Reindolf et al, 2018).

References

1. Aasheim, V., Waldenstrom, U., Hjelmstedt, A., Rasmussen, S., Pettersson, H., & Schytt, E. (2012). Associations between advanced maternal age and psychological distress in primiparous women, from early pregnancy to 18 months postpartum. BJOG, 119(9), 1108-1116. doi: 10.1111/j.1471-0528.2012.03411.x
2. Beck, C.T. (2006). Postpartum depression. The American Journal of Nursing, 105(5), 40-50.
3. Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: A review. Infant Behavior and Development, 33(1), 1-6. doi: 10.1016/i.infbeh.2009.10.005
4. Fitelson, E., & Kim, S. (2010, December 30). Treatment of postpartum depression: clinical, psychological and pharmacological options. International journal of women’s health, 3, 1-14.
5. Gaynes, B.N., Gavin, N., & Meltzer- Brody, S. (2005). Perinatal depression: Prevalence, screening accuracy, and screening outcomes. Agency for Healthcare Research and Quality Evidence Report/Technology Assessment no. 119. Rockville, MD.
6. Johnson, T. (2018, April 11). Understanding postpartum depression: Diagnosis and treatment. Retrieved from http://www.webmd.com
7. Postpartum Depression. (n.d.). Retrieved from https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617
8. Silverman, M.E., Reichenberg, A., & Savitz, D.A. (2017). The risk factor for postpartum depression: A population – based study. Depression and anxiety, 34(2), 178-187.
9. Soares, C.N., & Zitek, B. (2008). Reproductive hormone sensitivity and risk for depression across the female life cycle: A continuum of vulnerability?. Journal of Psychiatry and Neuroscience, 33(4), 331-343.
10. Reindolf, A., Enoch, A., Amy, B.A., Edmund, I.O., & Adjei, G.A. (2018). Prevalence of postpartum depression and interventions utilized for its management. Annals of General Psychiatry, 17, 18. doi: 10.1186/s12991-018-0188-0

Schizophrenia is a chronic psychiatric disorder that often causes individuals to lose sense of reality. Symptoms normally start to show around 16-30 years of age. (CDC, 2015)

Symptoms show up in three different ways; positive, negative and cognitive. Positive symptoms are visual or auditory hallucinations or delusions. Negative symptoms are monotone voice, withdrawal of everyday activities and difficulty performing those activities. Cognitive symptoms would be having difficulty understand everyday problems or having difficulty with memory.

Schizophrenia is a risk factor for falls, erratic behavior, and drug abuse (National Institute of Health, 2013). Schizophrenics are often stigmatized in society due to the preconceived notion that they are violent and prone to criminal behavior. Treated schizophrenics are more likely to hurt themselves than others and do not have a higher rate of criminal activity than any other mental disorder (Reposki 2015). When untreated and placed in an ill-equip facility schizophrenics due tend to become violent and more erratic which can lead to abuse or neglect (Whalede, 2017)

Literature Review

The main issue is when individuals with schizophrenia become elderly they are usually placed in a long term care facility. In the United States there is a shortage of psychiatric facilities for the elderly so there is normally no other option. In 2010, there were 43,318 psychiatric beds nation wide as a whole. In 2016, there were only 37,679 beds. There are only 11.9 beds available per 100,000 people (Pew Charitable Trusts, 2017). In the United States there are 3.1 million people with schizophrenia; with the numbers listed above the odds are they won’t receive a bed that deserve and require. Regular long term care facilities are often not equipped to care for patients requiring psychiatric help. Long term care facilities are often lacking in staff members. The staff is only trained on psychiatric disorders five percent of the time (Welkes, 2011).

Schizophrenics typically are seen by a primary care physician and not a psychiatrist. Medications that are contraindicated in the elderly are often prescribed due to lack of knowledge. Long term care facilities are often at a very high census. Where there is an open bed, a patient goes. This can create problems when facilities put someone with a mental illness in with someone who doesn’t. Verbal abuse can occur which can worsen feelings of isolation and irritability (Smith 2011).

Independent Survey

In a survey conducted by Louis Grant, (Schizophrenia, 01/2017), Registered Nurses, Licensed Practical Nurses and Medical Doctors were all asked a series of questions. (1) What is your current job title? (2) Do you feel like patients with mental illness in long term care aren’t treated as well as someone with no mental illness? (3) Do you feel like you were properly trained in mental illness during orientation? (4) Have you noticed in increase of injuries in patients with mental illness? Examples: Falls, bruises/scrapes without reason, etc. (5) How would you react to someone refusing medication? (6) Are you or other healthcare workers resistant to give care or enter a room with someone with a mental illness? Responses were completely anonymous but the analyzer of the information is able to tell how each individual medical professional title answered. There were 20 participants in this survey. 25% of them are Licensed Practical Nurses, 50% of them are Registered Nurses and 25% of them are Medical Doctors. 80% of the participants said “yes” to not being trained properly to treat schizophrenia and 80% also have noticed a lack of care in individuals with schizophrenia. 40% of participants were hesitant walking into someon.

Conclusion

The survey and research articles helped validate suspicions around mistreatment and misunderstanding of the mentally ill. Nursing homes/long term care facilities should not be able to accept patients without undergoing psychiatric training. Lack of training can lead to additional undiagnosed mental disorders, lack of proper care, and lack of support. Without proper medical care while elderly a schizophrenic cannot thrive in a setting like this. Mental illness can worsen case loads on untrained and already ill-staffed facilities.

Government agencies should implement a program to help reinstate psychiatric beds in psychiatric facilities nationwide. The mentally ill should not have to suffer because of a lack of proper training, beds and resources. Long term care nurses should have more than a six week rotation in psychiatric patients. If being hired on somewhere that even has the slightest possibility of a psychiatric patient coming on board than there should be numerous inservices yearly as well as additional orientation time. No one should be abused in general but it’s even worse when they’re being abused because their caregivers are frustrated with them. They cannot help their mental illness.

Abstract

Over the past two years, I have been given the opportunity to be of service to three young men in our community between the ages of 35 and 45 diagnosed with schizophrenia. A significant part of my assistance is filling out their confidential paperwork, scheduling their appointments with their doctor, psychiatrist, social security office, landlords and any other resources accessible to their recovery process. There is a stigma surrounding people who live with schizophrenia. They are deemed to be crazy because they hear voices, seeing things that are not actually apparent, have thoughts of others wanting to hurt them, their conversation jumps from one thing to another, and their feeling lines up with the way they look (sad, distant, confused). I have gained a passion for working with the mental health population while working with these men. Two of the men have died due to their inability to accept their personal responsibility of continually living with schizophrenia (refusing to take medicine, drug abuse, and prison); however, I get great delight in my continuous endeavors working with Mr. Doe. My paper will give you an overview of the disorder, importance of the assessment process, across systems impact, evidence-based practices for interventions, conclusion, and recommendations.

Overview of Schizophrenia

Schizophrenia is one of the most frightening of mental illnesses. It is a mental condition that often causes the individual to find they are incapable of handling the social world in any reasonable manner. They rarely hold down jobs for any length of time and their personal relationships suffer a great deal as well. In addition, they frighten the “normal” people in society because they are different and more often than not misunderstood. The following paper examines the condition known as schizophrenia. The sections presented are symptoms, causes or links to the disease, treatment, and family. The last section, family, examines how schizophrenia affects family members of someone diagnosed with schizophrenia.

Symptoms

“Its symptoms include hallucinations, delusions, apathy, and distorted emotional expression. Symptoms usually first appear in adolescence and young adulthood,” though there are apparently forms which have a tendency to hit people in their 20s-30s and sometimes can be short-lived (Bower 164). Most schizophrenics possess a personality which “is seriously disorganized, but not split as is often thought, and contact with reality is usually impaired” (Drury NA). Drury makes note of the film most people are familiar with, “A Beautiful Mind,” which portrays a schizophrenic man who was able to “handle his constant hallucinations and delusions to win a Nobel Prize in physics” (NA). This story, though true, is not necessarily representative of all that schizophrenia is: “While the severity of the illness varies greatly in individuals, most people diagnosed with schizophrenia will usually suffer from one or more of its symptoms. The symptoms that require hospitalization occur during the acute stage and they are delusions, a false belief that cannot be corrected by reason; hallucinations, usually in the form of nonexistent voices; disorganized speech, with frequent derailments or incoherence; and grossly disorganized or catatonic behavior” (Drury NA).

In general “People living with schizophrenia are often robbed of the pleasures in life, and they have less ability to experience feelings. Long-term impairments for people living with schizophrenia include low levels of interest, motivation, emotional arousal, mental activity, social drive and speech” (Drury NA). The social skills they might have possessed prior to schizophrenia begin to dissolve and they find themselves without social skills, losing their jobs, or being expelled from school. “They can be extremely aggressive, or unreasonably silent. But the most common type is intense paranoia” (Drury NA). As such, because they do not necessarily live in the same world of perceptions as most people, from a social perspective, we note that “Schizophrenic patients are prone to saying things that do not always make sense and their intellectual capacity also shows a tendency to decline. The disorder, however, is very individualistic, as no two cases of schizophrenia are exactly the same” and as such the symptoms are not always the same, though paranoia, ridiculous or completely unfounded and unrealistic paranoia, seem to be the most common symptom (Drury NA). As one individual notes, in presenting a picture of such schizophrenic behavior, “The world is against you and the man sitting next to you on the bus just scratched his head, signaling authorities. It is a conspiracy and even the people you once loved are part of it” (Whyte NA). And, while “This may sound like the plot of a movie…for some people living with schizophrenia this is reality” (Whyte NA).

Causes or Links to the Disease

There has been more and more scientific information of late that points to several possibilities in relation to the cause of schizophrenia. For example, recently there has been a great deal of discussion about stress and high blood pressure during a woman’s last trimester of pregnancy. It is believed that certain conditions can raise the chances of a child having schizophrenia by the time they are middle-aged adults. For example, “Pregnant women who take diuretic medication for high blood pressure during the third trimester substantially raise the chances that their unborn children will develop schizophrenia by age 35, according to a new study” (Bower 164).

It is believed that this study, and others like it, give us more information about fetal brain development and thus provide information regarding possible problems later in life. Bower indicates, “Still, the findings provide an intriguing clue in the search for factors that affect fetal-brain development and contribute to schizophrenia (SN: 7/1/00, p. 6), Sorensen’s group contends. Other researchers have found that diuretic use after the first trimester of pregnancy lowers a woman’s blood volume. If that effect occurs in the fetus as well, it could disrupt brain growth enough to lay the groundwork for schizophrenia, Sorensen, and his coworkers theorize” (164).

In addition, it has been noted for quite some time that schizophrenia runs in the genetics of a family. “Schizophrenia is highly heritable, but the genes have remained elusive. Identifying the genes is essential if the pathogenesis and pathophysiology of schizophrenia are finally to be understood and to give the prospect of more effective treatment” (Harrison; Owen 417) The authors note the following in regards to the discoveries being made relating to genes and schizophrenia: “recent papers describe six additional susceptibility genes. Replications are already being reported for some of them. The genes are biologically plausible and may have convergent effects on glutamatergic and other synapses…Given earlier failures to replicate apparent breakthroughs, the results should be viewed with caution. Unequivocal replications remain the top priority. The respective contributions of each gene, epistatic effects, and functional interactions between the gene products, all need investigation. Confirmation that any of the genes is a true susceptibility gene for schizophrenia could trigger the same rapid therapeutic progress as has occurred recently in Alzheimer’s disease.” (Harrison; Owen 417)

There are other rare conditions which can sometimes lead to schizophrenia. For example, one woman suffering from Cushing’s disease became schizophrenic: “35-80 % of patients with Cushing’s syndrome develop mental symptoms which they tend to conceal. It is unusual for such patients to present with schizophrenia-like symptoms: only five cases have been reported” (Zielasek et al. 1392). And, it is also noted that “Chronic schizophrenia-like symptoms may dominate the clinical presentation of Cushing’s syndrome. Even when longstanding, severe, and unresponsive to neuroleptic treatment, they may improve rapidly after the excess cortisol is reduced,” which indicates that particular forms of medication may increase the likelihood of schizophrenia (Zielasek et al. 1392). In fact, in recent years there have been links to marijuana use and schizophrenia.

Treatment

For the most part, since all cases of schizophrenia are different, there is no one form of treatment. Some people receive psychiatric help and others receive medication. But, in all honesty, most treatments do little to truly help the person who suffers from schizophrenia. And, perhaps most interesting, when speaking of the treatment of the condition, it is a family knowledge that seems to make the biggest difference: “Family psychoeducation interventions have repeatedly demonstrated reductions in illness relapse, negative symptoms, and inpatient service utilization…As a result, a family psychoeducation and support interventions are considered a best practice in the treatment of schizophrenia” (McDonell et al. 91).

Family

As noted in the previous section, a family is an incredibly important element within the life of the individual diagnosed with schizophrenia. But, at the same time being related to an individual with schizophrenia can be an incredibly difficult position. One author notes that “Schizophrenia is the most personally destructive and least understood of the entire major mental illnesses. Its principal hallmark is extremely disordered thinking–the kind that robs many of its victims of the ability to keep a job, maintain a relationship or even holds a coherent conversation” (Gorman; Cole 90). As a result “schizophrenia affects far more than one person at a time. For a look at its extended impact, I visited one family to see how schizophrenia touched its members across four generations and how the family coped with the disease” (Gorman; Cole 90). In many “ways, particularly in their struggle to deal with the stigma and isolation of a mental illness, the Beales of Howard, Ohio, are all too typical” (Gorman; Cole 90).

The man under examination is Ed Beale. He is 65 and “never knew his mother, Emma, a vivacious former schoolteacher with a knack for picking up foreign languages. When she was 30 and Ed was just 7 months old, she was committed to a psychiatric institution with what the family later recognized as schizophrenia” (Gorman; Cole 90). Unfortunately, when Ed was three years old his father informed him that his mother had died shortly after giving birth to Ed. “Although she actually lived until 1973–when Ed was 36–he never met her, heard her voice or kissed her cheek” (Gorman; Cole 90).

Ed’s aunt Virginia said that “His father wanted it to be a secret” (Gorman; Cole 90). His aunt was the one who eventually told him everything about his mother. “For a while, Ed blamed himself for his mother’s condition. He wondered if his birth had made her snap, but mostly he tried to banish her from his mind and go on with his life. He joined the Air Force and married his wife Velma” and “they had three children” (Gorman; Cole 90). However, with the fact that schizophrenia can run in families, Ed and his wife’s third child, Peter eventually became a victim of schizophrenia: “A happy, precocious youngster who learned to read in kindergarten, Peter focused less and less on school as he got older. It wasn’t until after he joined the Air Force in 1985, however, that his life truly began to deteriorate. Peter remembers sitting next to another student in a training class and telling him about what seemed to him to be a wondrous, novel idea. ‘But then he just looked at me funny,’ Peter recalls. ‘He says to me, ‘You aren’t saying anything. You’re just making noises’’” (Gorman; Cole 90).

He then started having delusions which clearly interfered with his military duties. “Finally, the Air Force court-martialed him for dereliction of duty, and he was given a less than honorable discharge. Still, neither he nor his parents were ready to accept the idea that he had a mental illness although by then his grandmother’s history was no longer a secret” (Gorman; Cole 90).

Over the next few years, things became more and more confusing and stressful. Peter was involved in numerous college courses and several part-time jobs “from which Peter was invariably fired for erratic performance. He moved constantly, and his parents paid his overdue rent more than once to spare him from being evicted” (Gorman; Cole 90). It was in 1990 that another sibling, Peter’s brother James, “confronted his parents and strongly suggested that Peter get a psychiatric evaluation. They were, James recalls, initially indignant–no doubt remembering the horrific treatment Emma Beale had suffered” (Gorman; Cole 90). They finally agreed and he was admitted to a hospital where he was diagnosed as “paranoid schizophrenia with depression” and was given antipsychotic drugs (Gorman; Cole 90).

When he was released he moved back in with his parents and their “vision of a blissful retirement quickly evaporated. They focused all their energy on their son, who enrolled in a day treatment center that provided him with a social outlet as well as some coping skills” (Gorman; Cole 90). Ed also worked on improving Peter’s military discharge so that “he would be eligible for veterans’ health benefits and monthly disability payments….After a while, things started looking up. Ed and Velma began to see that Peter’s prospects were not as bleak as they had feared” and “They learned to recognize the cyclical nature of schizophrenia; they noticed that Peter would have good days and bad days, and that his ups and downs were not necessarily related to how much medication he was taking” (Gorman; Cole 90).

They became more and more educated about schizophrenia, involving themselves in organizations and mental-health groups. “Today Ed and Velma lead courses teaching other families how to cope when a loved one is found to have a mental illness” (Gorman; Cole 90). Interestingly enough, however, that is not the end of their story and their commitment to Peter. “Peter went on to earn a two-year degree in computer programming. He made friends, started dating, and in May 2000 his son, Dana, was born” (Gorman; Cole 90). However, it became apparent very quickly that “neither Peter nor Dana’s mother was able to take care of a child, and Velma and Ed once again stepped in and agreed to raise the boy. ‘One never knows when the next blessing will appear, does one?’ Ed wrote in a Christmas letter that year to his friends and family.” (Gorman; Cole 90)

Because they have chosen not to put their son in an institution and because they have chosen to raise their grandson, they have made a difference in the life of their son and grandson. “Dana is thriving, and though he is at greater risk of developing schizophrenia at some point than a child without an afflicted parent, there is a better than 80% chance that he will not. The Beales have also learned to cast aside the feelings of shame and stigma that are still too often attached to schizophrenia,” a very common problem for those who have a family member with schizophrenia (Gorman; Cole 90). Velma says, “My mother had cancer…I’m not ashamed to talk about that. Why should I be afraid to tell people about mental illness?” (Gorman; Cole 90) Peter’s siblings are also very open about the disease. And for his part, Peter says he has come to terms with the fact that schizophrenia will always be a part of his life. He knows that others can easily take advantage of him and has learned to ask family members for a ‘reality check’ every now and then when he’s not sure what an appropriate response might be” (Gorman; Cole 90). He states, “I used to think my goal was to become like I was before the illness…Then I realized that I was older, that I had experienced and learned a lot, even from my illness, and my goal became to discover who I am now and make the best future for myself that I can,” something he could likely not have done without the support of his family (Gorman; Cole 90).

REFERENCE

1. The Association of the British Pharmaceutical Industry. “Target Schizophrenia: Psychiatric Approaches.” Retrieved Nov 27, 2017 from http://www.abpi.org.uk/publications/publication_details/targetSchizophrenia/section3.asp
2. Bower, B.. “Schizophrenia linked to fetal diuretic exposure (Pressurized Pregnancies). Science News, March 2003, v163 i11, pp. 164(2).
3. Drury, Barbara. “Schizophrenia, not a beautiful experience.” The America’s Intelligence Wire, December 2002, pp. NA.
4. Gorman, Christine; Cole, Wendy. “One Family’s Burden: First Ed Beale’s mother, then his son developed schizophrenia. How tragedy gave way to love. (Mind & Body).” Time, January 2003, v161 i3, pp. 90+.
5. Harrison, Paul J.; Owen, Michael J.. “Genes for schizophrenia? Recent findings and their pathophysiological implications. (Rapid review).” The Lancet, February 2003, v361 i9355, pp. 417.
6. McDonell, Michael G.; Short, Robert A.; Berry, Christopher M.; Dyck, Dennis G.. “Burden in schizophrenia caregivers: impact of family psychoeducation and awareness of patient suicidality. (Families and Couple Research).” Family Process, Spring 2003, v42 i1, pp. 91(13).
7. Mental Help Net. “Schizophrenia.” Retrieved November 27, 2017 from http://mentalhelp.net/poc/center_index.php?id=7
8. “What Will Confirm a Diagnosis of Schizophrenia: Symptoms Suggesting a Diagnosis.” Retrieved November 27, 2017 from:
9. http://www.ucdmc.ucdavis.edu/ucdhs/health/a-z/47Schizophrenia/doc47diagnosis.html
10. Whyte, Julia. “Fighting the myths about living with schizophrenia.” Asia Africa Intelligence Wire, May 24, 2003, pp. NA.
11. Zielasek, Jurgen; Bender, Gwendolyn; Schlesinger, Stefan; Friedl, Peter; Kenn, Werner; Allolio, Bruno; Lauer, Martin. “A woman who gained weight and became schizophrenic. (Case Report).” The Lancet, November 2002 v360 i9343, pp. 1392.

Recent research suggests that schizophrenia is associated with the development of an advanced aging phenotype (carbonyl stress) and erythrocytes from schizophrenics also exhibit symptoms of cellular aging (increased levels of glycated proteins and ubiquitinated proteins), possibly due to excessive glycolysis-induced methylglyoxal (MG) generation. The endogenous dipeptide carnosine (beta-alanyl-L-histidine), which can delay cellular aging, suppress glycolysis and inhibit MG-induced protein glycation, also exerts some beneficial effects towards schizophrenia. Carnosine is present in human erythrocytes and the olfactory bulb (olfactory dysfunction is associated with schizophrenia).

It is suggested that enhanced erythrocyte and olfactory carnosine levels may be more therapeutic towards schizophrenia, if carnosine was also administered intra-nasally to avoid serum carnosinase activity. Many studies have indicated a relationship between schizophrenia and dysfunctional energy metabolism [1,2,3 ] whilst others indicate that carbonyl stress and generation of advanced glycation end-products (AGEs) accompany schizophrenia [4,5]. Furthermore a recent study suggests that changes in glycolysis and accelerated cellular aging in glial cells contribute to the condition [6]. The glycolytic intermediates glyceraldehyde-3-phosphate and dihydroxyacetone-phosphate are the most likely sources of AGE formation due to their ability to spontaneously decompose into methylglyoxal (MG).

MG is well recognised as a major glycating agent and is thought to be responsible for much macromolecular modifications associated with type-2 diabetes and age-related neurodegenerative conditions [7,8 ]. However, there is no clear evidence whether suppression of MG generation, via decreased glycolytic activity, has any effect on schizophrenia. The suggestion that schizophrenia seems to be associated with accelerated cellular aging [6] is supported by another recent observation reporting that erythrocytes obtained from schizophrenics contain elevated mounts of ubiquitinated proteins [9]. This might arise from either increased generation of targets for ubiquitination (e.g. aberrant polypeptides or denatured misfolded proteins), or decreased de-ubiquitinating activity, or decreased proteasomal proteolytic activity which would normally complete polypeptide destruction. Interestingly, MG and other agents responsible for carbonyl stress, also induce protein cross-linking which not only renders the target protein less susceptible to proteolytic attack but can also result in inhibition of proteasome activity generally [10]. Thus it is conceivable that excessive glycolysis can provoke an aging phenotype (AGE accumulation and proteostatic dysfunction) via increased MG generation; such a relationship has been demonstrated in mice fed a high glycaemic- index diet [11].

Never-the-less it is necessary to show whether glycation compromises proteostasis in erythrocytes from schizophrenics. A number of recent papers have revealed that erythrocytes obtained from patients with neurological problems, such as Alzheimer’s disease (AD) and Parkinson’s disease (PD), exhibit symptoms typical of aging cells in general. For example, compromised proteolytic activity and MG detoxification were detected in AD erythrocytes [12] and accumulation of aggregated protein occurs in red cells from PD patients [13]. Furthermore, dysfunctional energy metabolism, especially in relation to glycolysis culminating in carbonyl stress, are now regarded as characteristics of both AD and PD [14,15]. Therefore it is not surprising that evidence of carbonyl stress is also accompanied by enhanced protein glycation [16] and accumulation of ubiquitinated proteins [9] in erythrocytes (and possibly other cells) obtained from schizophrenic individuals [17]. Moreover, one of the glycated proteins from “schizophrenic” red cells has been identified as a selenium-binding protein (SBP1) [18]; dysfunctional selenium metabolism has long been regarded as an important contributor to schizophrenia [19,20]. Selenium plays an important role in sulphur metabolism required for synthesis of anti-oxidant enzymes such as glutathione peroxidase [21]. Thus, one is beginning understand the relationship between AGE generation, carbonyl and oxidative stress and the apparently disparate biochemical attributes to schizophrenia. That erythrocytes can contain elevated amounts of MG and glycated proteins suggests the possibility that such red cells could become systemic sources of MG and AGEs to the brain and other tissues, following MG-induced eryptosis [22]. Consequently it is important to consider whether suppression of carbonyl stress, not only in erythrocytes but in astrocytes and glia, could possibly be a therapeutic strategy.

The naturally-occurring dipeptide carnosine (beta-alanyl-L-histidine) has been shown to suppress glycolysis in cultured cells [23,24], delay replicative senescence [25], stimulate proteolysis of long-lived proteins in late passage cells [26] and inhibit AGE formation [27]. Furthermore, there is one study showing that schizophrenics subjected to dietary supplementation with carnosine exhibited some beneficial effects [28], possibly due to the dipeptide’s pluripotent properties [29]. It is also interesting to note that (i) olfactory dysfunction is also associated with schizophrenia [30,31] and (ii) carnosine is enriched in the olfactory bulb [32]. Thus one has to consider whether raising olfactory carnosine levels could also be useful. However all studies employing dietary carnosine supplementation are subject to the problem of the presence of serum carnosinase activity which would destroy the dipeptide [33]. There is an alternative route however, which is to use an intra-nasal approach. This could involve a nasal spray of a carnosine solution; another approach could involve use of carnosine powder. Indeed “snorting” carnosine could be far more useful than most white powders some people use, be it illegal drugs or “medicinal snuff “of old. In fact, intra-nasal delivery of potential therapeutic agents is currently being explored [34] with respect to neurodegenerative conditions, as proposed many years ago [35]. Carnosine has been detected in human erythrocytes [36] but in lower amounts when obtained from elderly individuals [36]. It is presumed that red cell carnosine is synthesized (from beta-alanine and histidine) during erythropoiesis.

Consequently it would be useful to determine whether dietary supplementation with carnosine or beta-alanine raises erythrocyte carnosine levels and whether there are any beneficial effects with respect to the recognised changes in “schizophrenic” erythrocytes. Additionally, it is suggested that any carnosine (dietary or nasally administered) supplementation period should last for at least 120 days to ensure maximal numbers of carnosine-enriched erythrocytes. It has been proposed that excessive and continuous glycolysis in erythrocytes enhances red cell MG levels, and thus also facilitate delivery of erythrocyte MG to the tissues including the brain [22]. Consequently it will be also important to determine whether such supplementation protocols decrease carbonyl stress and MG levels not only in red cells but the tissues generally including glia [6].

Why do most of the time think that someone who suffers from Schizophrenia is simply a “crazy” person? We are easy to judge someone because we think that they are just someone who is on drugs and are just simply crazy. Little do we know that those people who have a mental illness like Schizophrenia have actually gone through a very hard situation in their lives which impacted them to be and act a certain way. But have you thought about how schizophrenia affects the person living it? Although schizophrenia may be known as a simple mental illness, schizophrenia is a traumatizing illness, it has four different types, it can be caused by a traumatizing event or it can be genetic, it is hard to live with, and it is often compared with other mental illnesses like bipolar and depression.

Schizophrenia may seem like it just another mental illness and that its not that much of a big deal. In reality schizophrenia is one of the most traumatizing mental illnesses someone could go through. This illness can clearly impair someone with their daily lives and it can also be considered as a disability according to the Mayo Clinic. A person with schizophrenia is required to take lifelong medication to treat their illness. According to the Mayo Clinic there are five symptoms of schizophrenia. The symptoms include, “ delusions, which are false beliefs that are not based in reality, hallucinations which are hearing and seeing things that do not exist, disorganized thinking or speech, extremely disorganized and abnormal motor behavior, and lastly negative symptoms which is the lack of ability to function normally”(Schizophrenia 2018). In the article by the Mayo Clinic it is said that Schizophrenia varies from the ages, “In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It’s uncommon for children to be diagnosed with schizophrenia and rare for those older than age 45” (Schizophrenia 2018). I think that schizophrenia can affect any person at any age because it is unpredictable when someone could face a traumatizing event in their lives.

Schizophrenia may just seem like one simple mental illness, but you would not think that there are more than one type of this illness. According to the article “What Are the 4 Types of Schizophrenia”, there are four catagorized types of schizophrenia. The first one is paranoid schizophrenia, which consists of one being paranoid about everything, even to the point of thinking that you are being followed or looked for. The second one is catatonic schizophrenia, which means that the patient shows no emotion and seems to be paralized without moving for a long period of time. The third type is undifferentiated schizophrenia, which is not caring for anything like not showering or not even talking. Finally the last type of schizophrenia is schizoaffective disorder, which consists of delusional thinking along with other symptoms of schizophrenia.

There is not yet a clear answer on why people suffer from schizophrenia but it can be due to a traumatizing event they went through, or it can even be passed down through genetics. I personally think that schizophrenia is caused by a traumatizing experience. According to the National Health Service of the UK, there can be many things that can trigger for someone to develop this mental illness which include, “stress like losing your job or home, sexual, physical or emotional abuse, or drug abuse”(NHS). I agree with this because I have an aunt who has this mental illness and my mom has told me that the reason my aunt is like that is because she faced many traumatizing events in her life. My aunt was sexually abused when she was young, she married at a young age and her husband used to abuse her physically and emotionally. My aunt now has to be on treatment for the rest of her life, and everytime she stops treatment she is a totally different person. It is hard to recognize her when she is not on treatment because she does things that are not her and people just call her “crazy lady”, but little do they know that my aunt has had a very hard life. Sometimes people would think that she was imply on drugs and that was why she acts like that, but since now mostly everyone in her town know her and know that she has a mental illness they understand her.

Can you imagine having to live with schizophrenia or being around someone with such an illness. It must be hard to comprehend someone who can’t control their thoughts and someone who doesn’t understand why from one day to another has had their life changed. According to PsycsGuide.com an American addiction centers resource, “If you have been diagnosed with schizophrenia, the best thing you can do is to take an active role in managing your illness, have a plan of action to deal with those symptoms. The sooner you respond, the less time you will spend recovering” (Living With Schizophrenia). I think what this article is trying to say is that although you are going through this situation you need to have a plan before falling. For example, my aunt can have control of not getting sick because the only time she gets sick is when she stops taking her medication. The only time she does not take her medication is when she runs out, so now when she is about to run out, she makes sure to have my cousins send her money so that she can get more. Otherwise we know that she will lose control of herself and her actions.

Schizophrenia may most of the time be compared to bipolar disorder or even depression, but schizophrenia is a whole different story in which someone who is suffering from this illness needs the help and support of a family member or loved one . According to Champagne in Joshua’s story: Living with schizophrenia, “There are a lot of folks who do not have family support for one reason or another. They might have treated their family really bad and burnt bridges … Maybe the family is embarrassed due to the views of society. Whatever the case, it helps to have support. There are many programs and centers out there that offer peer-to-peer support … Peers can help fill the void when family support is not there” (Champagne 2018). It is clear that many people who suffer from schizophrenia need the love and support of someone special. I agree with this because like I have mentioned before my aunt suffers from this mental illness, and when we show and give her love she seems to feel like she belongs and is not embarrassed of who she is. In the article What is Schizophrenia by The American Psychiatric Association, “For many people living with schizophrenia family support is very important to their health and well-being and its important for families to be informed and supported themselves”(America Psychiatric Association). Family support should always be part of someone’s life whether they have a mental illness or not because being loved and cared for is all that matters. As mentioned in the article “What is Schizophrenia”, both the patient and the family member needs the support of a family member because they both need to be informed of what is going on and how to handle the situation.

Before judging a book by its cover, remember that everyone who has a mental illness has gone through a tough situation in their lives. These people are clearly not just “crazy” as we most of the time label them. There is a reason why they are like that, and why their actions are made. We need to be educated before judging mental ill people.

References

1. (n.d.). Retrieved from https://www.nhs.uk/conditions/schizophrenia/causes/.
2. Champagne, N. J. (2018, July 8). Joshua’s Story: Living with Schizophrenia. Retrieved from https://psychcentral.com/blog/joshuas-story-living-with-schizophrenia/.
3. DeLisi, L. E., Szulc, K. U., Bertisch, H. C., Majcher, M., & Brown, K. (2006). Understanding structural brain changes in schizophrenia. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181763/.
4. Living With: Schizophrenia. (n.d.). Retrieved from https://www.psychguides.com/neurological-disorders/schizophrenia/living-with/.
5. Schizophrenia. (2018, April 10). Retrieved from https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443.
6. Team, S. (2019, January 11). What Are the 4 Types of Schizophrenia and How Do They Affect You? Retrieved from https://health.clevelandclinic.org/what-are-the-4-types-of-schizophrenia-and-how-can-they-affect-you/.
7. What is Schizophrenia. (n.d.). Retrieved December 1, 2019, from https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia.
8. Schizophrenia does affect the brain according to the article “Understanding the structural brain changes in schizophrenia” by DeLisi, Szulc, Bertisch, Majcher, & Brown.

What is schizophrenia? The often-misjudged mental illness known as schizophrenia is defined as a long-term mental disorder involving the breakdown in the relation between thought, emotion and behavior leading to faulty perception, inappropriate actions, withdrawal from reality into delusions and hallucinations and a sense of mental fragmentation. The word schizophrenia originates from the Greek word schizo meaning to split, to describe disjointed thinking and behavior. A common misunderstanding from the public is believed to associate this definition with the idea of a split personality disorder, or as medical terminology classifies it, dissociative identity disorder. Since the definition of schizophrenia has continuedly changed over time, scientists and psychologists have now tried to more accurately define the different types of mental illness.

In Greek and Roman mythology, mental illness was thought of as a punishment bestowed from the gods. In the middles ages however, religion and medieval asylums and even some monasteries renovated themselves into treatment centers for the mentally ill. Early in the Renaissance period, burning of people suffering from mental illness occurred based on the belief that a demonic possession was among them. During the mid 1600’s and late 1700’s in Europe is where we see a more humane approach to mental illness. John Locke and Denis Diderot disputed prior beliefs and argued that reason and emotions are caused only by sensations. A breakthrough in psychology by a physician named Phillipe Pinel, began viewing mental illness as the leading effect of social and psychological stressors. Shortly after, the first institution for humane care with those suffering from mental illness was established in England.

In 1911, a Swiss psychiatrist named Eugen Bleuler coined the term schizophrenia, meaning split mind, replacing the years of prior stigma. His schizophrenia involved the understanding of a group of illnesses rather than a state of dementia that was associated with this disease years before. Bleuler created his four A’s, as he believed schizophrenia had four main symptoms: blunted Affect- a flat emotional response and personality, loosening in Associations and disorganized thoughts, Ambivalence, or having trouble making decisions, and Autism, meaning loss of awareness to external events and anxiety within one’s individual thoughts.

Examples of treatments of what in today’s society would be documented as mental illness go back thousands of years. People used to drill holes in the skulls of those mentally ill, along with exorcisms to allow “evil spirits” to exit the body. The Greeks and Romans believed that mental illness was a sign of an imbalance in the blood causing madness. Treatment included a change of lifestyle, purging, and even draining of the blood through incisions.

As many years passed, different approaches were taken to treat the mentally ill. In the early 1900’s, shock therapy was sought to be a big breakthrough. However, shock therapy often put people into comas, risking these people of further impairment. Developed in the 1930’s were popular treatments of schizophrenics known as lobotomies. This procedure involved drilling into the skull and injecting into the frontal lobe. This was thought to almost “rewire” the brain. Again, these procedures often led to further harm of these people, causing comas and impairments of social and cognitive function. Starting in the 1950’s, antipsychotic drugs were used to treat schizophrenia. Antipsychotics often lead people to have functional lives, however, they have their downsides. Common side-effects often include tiredness, significant weight loss or gain, low blood pressure and lowered sex drive. These drugs are not a cure by any means, but many patients live functional lives while on them consistently.

The media teaches us about people whom we do not regularly interact with. This constant stream of information often gives a misperception of the nature of other groups of people. Media depiction of those with mental illness often scare us away because of the stigmatization they bring upon them. T.V., film, and social media have all been criticized for bringing upon negative stereotypes of those with mental health problems. It is true that some people with mental illness commit violent actions and crimes, however, so do people without mental illnesses. It is of high important that as a society, we need to give timely aid to these people. It is also important that the negative stereotypes placed on those with mental illness, especially schizophrenia, needs to be heavily reduced.

There are many illustrations of schizophrenia in film. A depiction that is somewhat accurate in film, is the 2001 movie, “A Beautiful Mind”. I urge anyone who is interested in learning more about schizophrenia to watch this film as it made myself extremely curious to find out more about this form mental illness. The movie is based on the life of an incredible mathematician and college professor named John Nash, who dealt with schizophrenia throughout his life. The movie creates a timeline of his life that begins when he studied mathematics at Princeton University. This is where the early symptoms of schizophrenia develop. It continues into the later parts of his life when he becomes a professor and even wins a Nobel Prize while dealing with his illness. As the movie progresses, so does his disability which worsens by his “so-called” involvement with the military working as an undercover spy.

The first time the audience is introduced to his developing schizophrenia is when he begins graduate school. While doing his work in his one-person dorm room, he looks behind him and meets his roommate, Charles. Although the movie may not be entirely accurate since schizophrenics normally have auditory hallucinations rather than visually, like portrayed in the movie, it does help paint an accurate illustration of schizophrenia. The movie follows valid symptoms of schizophrenia including disorganized speech, a flat affect and delusions. Although the scenes may not always appropriately portray what specifically happens to John Nash, they still depict facts about schizophrenia. The movie even incorporates the correct science that was recognized in the mid 1900’s that further helps the audience to understand what was known about this long-lived disorder.

According the National Institute of Mental Health, schizophrenia affects nearly .5 percent of the world. It is more common in men, specifically Caucasian men. It typically starts around the early 20’s and as late as the early 30’s in women. Symptoms include disorganized speech, hallucinations, delusions, catatonic behavior, and a flat affect.

Examined closely was a small study about the misdiagnosis and overdiagnosis of this disorder. In a small study, researchers found that about half of the referred Johns Hopkins Early Psychosis Intervention Clinic, didn’t actually have the disorder. The specialized clinic was designed to give second opinions to reduce the risk of misdiagnosis and ensure proper treatment. “It’s a problem for those who are not schizophrenia specialists because symptoms can be complex and misleading”, says Krista Baker, manager of adult outpatient schizophrenia services at Johns Hopkins Medicine. “Diagnostic errors can be devastating for people, particularly the wrong diagnosis of a mental disorder,” she adds.

The study came to be after health providers in Baker’s specialty clinic began to see a good number of people who were misdiagnosed. It was said that these people often had anxiety disorders and depression. To see if there was a trend, the researchers looked at 78 cases of patient data. Patients were around the ages of 20 and almost 70 percent were men. Seventy-four percent were white, 12 percent were African American, and 14 percent were another ethnicity. Each consultation was around three to four hours long and involved patient interviews, parent interviews, physical exams, questionnaires, and looks at previous medical history.

Of the people referred to the clinic, 54 people went into it with a pre-diagnosis of schizophrenia. Following the consultation, of that 54, only 26 received confirmation of their schizophrenic disorder. Over fifty percent of the entire patients at the clinic who were given a prior diagnosis of schizophrenia were diagnosed with either an anxiety or mood disorder. One of the more common symptoms that the researchers believed was the notion of hearing voices. At times when someone is “hearing voices”, it may be a general statement of distress rather than the literal case. The point is that “hearing voices” doesn’t necessarily mean you have schizophrenia.

“The big take-home message from our study is that careful consultative services by experts are important and likely underutilized in psychiatry,” says Russell Margolis, clinical director of the Johns Hopkins Schizophrenia Center at the Johns Hopkins School of Medicine. “Just as a primary care clinician would refer a patient with possible cancer to an oncologist or a patient with possible heart disease to a cardiologist, it’s important for general mental health practitioners to get a second opinion from a specialty clinic like ours. This may minimalize the possibility that a symptom will be missed or overinterpreted.” Even though this was only one study, it would agree with Johns Hopkins’ prior belief that this may be a national ongoing issue.

Music is all around the world and is a major part of all cultures. It has been around since the beginning of time and it is something every human being can experience on a deep level, bringing forth emotions or memories. Music therapy developed from this connection between emotion and music as a method to support mental health and it spans from just simply listening to music, playing music, or dancing to it. Led by a trained therapist, music therapy is used in hospitals, rehabilitation centers, schools, correctional facilities, nursing homes, hospices and more (American Music Therapy Association). Music therapy is an established health profession that has been used for centuries and leads to many health benefits in the brain such as emotion, cognition, and movement.

Music Therapy

Music Therapy is an established health profession where music is used after assessing the strengths and needs of each patient (AMTA).A qualified music therapist supports the patient with treatment that includes creating, singing, moving to, and/or listening to music. Through musical involvement in the therapeutic context, patients abilities are strengthened and conducted to other areas of their lives. Music therapy also provides pathways for communication that can be helpful to those who find it Hard or stressful to express themselves in words (AMTA). Studies in music therapy support its effectiveness in many areas such as: overall physical rehabilitation and encouraging movement, increasing people’s motivation to become engaged in their treatment/surroundings, providing emotional support for patients and their families, and providing an outlet for expression of their feelings. (AMTA)

History of Music Therapy

“Music gives soul to the universe, wings to the mind, flight to the imagination and life to everything” – Plato

The thought of music as a healing influence that could affect health and behavior is as old as the writings of Aristotle and Plato (AMTA).

The 20th century practice of music therapy started after World War I and World War II when community musicians of all types, both amateur and professional, would visit veteran hospitals around the country to play music for the thousands of veterans suffering both physical and emotional trauma from the wars. (AMTA) The patients’ visible physical and emotional responses to music led the doctors and nurses to ask for the hiring of musicians by the hospitals. It was evident that the hospital musicians needed more training before entering the facility and so the demand grew for a college course. The first music therapy degree program in the world was founded at Michigan State University in 1944. Later the American Music Therapy Association was founded in 1998 as a union of the National Association for Music Therapy and the American Association for Music Therapy. (AMTA)

Educational requirements to be a music therapist

The entry-level curriculum for (M.T.) includes clinical coursework and extended internship requirements in an approved mental health, special education, or health care facility.(AMTA) When you successfully completing academic and clinical training, and pass the national examination administered by the independent Certification Board for Music Therapists, the graduate earns the credentials and licensing, you can visit the Music Therapist-Board Certified (MT-BC) to learn more about becoming a music therapist.(AMTA).

Effects of playing music on the вrain

In addition to the claims of Music Therapy and Health Care Professionals, many artists claim music has changed their lives for the better. The act of playing music affects the brain physically in different ways depending on what instrument is used.

Practicing/playing a musical instrument can lead to many different structural changes in the brain after only about 15 months of training in early childhood. These changes are connected with multiple improvements in areas that impact motor and auditory skills, such as: hand-eye coordination or recognizing repetition and/or patterns in sound.

One place where these structural and functional changes happen, is in the hippocampus, the area of the brain primarily involved in learning and memory. A process that is crucial for learning and memory in the hippocampus is neurogenesis – the accumulation of new neurons in the brain. Musical practice may therefore enhance neurogenesis that’s linked to better learning and memory activity (Sherman).

Musical actions in the music therapy setting communicate much more than the sound and the music we create together; the use of different musical elements as well as the choice of instruments and patterns of musical interaction all have the ability to tap into an individual’s unconscious by acting as transference/countertransference trigger. This is when music becomes much more than just the sound that you hear. (Bruscia)

For example: dissonance in music may make some listeners feel uneasy or uncomfortable, it helps to create tension and a sense of motion in compositions, dissonance is a tool used by composers to achieve a certain effect or mood in listeners; it can be used to create and escalate excitement or nervousness. However, haromoneys have a much different effect A new model suggests that harmonious musical intervals trigger a rhythmically consistent firing pattern in certain auditory neurons, and that sweet sounds carry more information than harsh ones, Each sends an electrical signal to a third neuron, called an interneuron, which sends a final signal to the brain.(Lisa Grossman)

Why humans have a unique relationship with music

From an evolutionary perspective, it doesn’t make much sense that music makes us feel emotional (Resnick). Why would our ancestors have cared about music? Despite many who’d argue the contrary, it’s not necessary for survival. Studies have shown that when you listen to music, your brain releases dopamine, which in turn makes us happy. In one study published in Nature Neuroscience, led by (M.T) Zatorre, the researchers found that dopamine release is strongest when a piece of music reaches an emotional peak (Resnick).

Typically, our brains release dopamine during behavior that’s essential to survival (sex or eating). But music is a pattern. As you listen, you’re constantly anticipating what melodies, harmonies, and rhythms may come next. So if I hear a chord progression — a one chord, a four chord, and a five chord — probably know that the next chord is going to be another one chord, because that’s prediction.

That’s why we usually don’t like styles of music we’re not familiar with. When we are unfamiliar with a style of music, we don’t have a basis to predict its patterns. ( jazz is one music style that many unacquainted have trouble latching onto). When a person can’t predict musical patterns, they get bored. We learn through our cultures what sounds makeup music. (Resnick) It is important to know this in (M.T.) because therapists need to know what kind of musical patterns the human brain is searching for in different people and how to use these patterns of music in an affective and beneficial way.

Conclusion

In conclusion, this paper has shown the positive effects of music on the emotional, psychological, and physical human body. Music therapy is widely used as a very hands on and captivating activity, benefiting individuals lives in multiple ways. Music Therapy has been used since World War I, and has turned into a professional career that requires a college degree. The entry-level curriculum includes clinical coursework and extended internship requirements in an approved mental health, special education, or health care facility along with passing the national examination administered by the independent Certification Board for Music. Practicing a musical instrument can lead to numerous structural changes in the brain and as we listen, we constantly anticipate what melodies, harmonies, and rhythms may come next, releasing dopamine into our brains. For most of us, music is just an everyday aspect of life and not something you would necessarily think of as a therapeutic tool. However, music benefits everyone from every culture and connects us all as human beings and has been recognized for centuries as a healing influence which affect health and behavior.

Some illnesses can be only be improved by being physically fit. This essay will consider schizophrenia, and if being physically fit links with being mentally healthy. It will look at how people with schizophrenia manage their condition and whether exercise can improve their condition. This is important to consider as it is a long-term mental health condition. This essay will first describe what schizophrenia is and the possible causes, then it will then move onto discuss treatments for this illness besides exercise. Finally, it will consider the link between being physically fit and mentally fit and how this can be a possible solution to treat schizophrenia.

Schizophrenia is a long-term mental health disorder that can be diagnosed at any age. There is no cure for this illness. It affects how a person thinks, feels and behaves. Some symptoms can include delusions, abnormal emotional affect, disordered speech and thinking. The cause for this mental illness is a combination of genetic and environmental factors (Schizophrenia.com, 2018). Research has found no gene is responsible for the cause for this illness. Stress is one environmental factor which can trigger schizophrenia. Cannabis or other recreational drugs which contain amphetamines have been found to increase dopamine levels and this can also cause schizophrenia.

Ozbulut et al. (2013) carried out a study to see how exercise can affect those with schizophrenia and those without. They found people with schizophrenia were unhealthy; they found maximal aerobic capacity, power and pulmonary function tests were lower in the male and female schizophrenic groups compared to the controlled group. Pajonk et al. (2010) also found after three months of aerobic training the hippocampal volume increased in patients suffering from schizophrenia. Their findings suggest having a physical exercise program has social advantages. It allows those suffering from schizophrenia to cope with stress and allows them to have a fresh start as their hippocampal increased in size, taking away their stress. They noticed as the patients began improving in fitness it would only drive them forward, and they would continue to push themselves, as they would have no worries. This was an advantage to the case study as it showed there are benefits from being physically fit. Bonnet et al. (2003) found anxiety and depression are associated with physical inactivity, and physical fitness and activity can play a huge role in treatment for people with schizophrenia.

Physical fitness can be seen as a good treatment for many people with schizophrenia as it allows them to be occupied. It may allow them to feel free and not trapped in their own thoughts and help them cope with their mental health. Patel, Frederick and Kidd (2018) found in their study that by being active for the ten months of the study the participants suffering from the illness were showing improvement, as they began having better relationships with those around them. A consideration regarding their study was that they recruited participants who wanted to participate and were interested in improving their illness, which may have had an impact on their results. They noticed a change as for some people physical health problems prevented them from being able to move the way they wanted to. However, one participant gained significant amounts of personal satisfaction and pleasure from long daily walks through the city. This shows people with schizophrenia can benefit from doing physical exercise, as not only does it improve their thoughts it also allows them to not look down on themselves. Patel, Frederick and Kidd (2018) believe physical fitness needs to be explored in the future.

However, this does not necessarily mean being physically fit means you are mentally fit. There are other ways in which schizophrenia can be treated like therapy for example. Therapy can also be used to improve schizophrenia. For example, Bradshaw (1998) spent three years treating with one patient with talking therapy. Bradshaw (1998) found with therapy the patient’s hospital days decreased significantly from the pre-test (figure 2). Also, with therapy the patient began gaining confidence, and her anxiety and depression was slowly fading away. Bradshaw (1998) also found that the patient showed a change in her personality as the test lasted for a few years, and it made the patient appreciate herself as she no longer felt like she had no meaning in life. A limitation to this study was that it was only studying one patient; while it was effective for this patient it might not be the same for other people.

Kuller and Bjorgvinsson (2010) used the cognitive behavioural method on a patient who was diagnosed with paranoid schizophrenia and had a delusion of being under surveillance by the mafia who were out to murder him. His condition got worse as he assumed his wife was an accomplice to kill him and was admitted to the hospital. The results collected from the patient, as he was being treated. The therapist opened the patient up, in the beginning he was being defensive, but overtime he became more comfortable and talked about his problems his self-reported levels of conviction and functioning decreased measurably, as talking it out helped him get past his paranoia. It was later found he showed signs of improvement in mood and psychosocial functioning. This shows there are other ways in which schizophrenia can be treated besides fitness. A limitation of this study is that only one patient was treated, and this does not mean that there would be the same outcome for other patients suffering from the same illness. However, it does show there is another way in which it can be treated. Kuller and Bjorgvinsson’s (2010) study found how CBTp is effective as it does help the patient recover from their paranoia and allow them back into the community.

In conclusion this essay has discussed whether being physically fit does not necessarily mean a person with schizophrenia is mentally fit. In terms of treatment it does give them a motivation to focus on a goal to improve their body as well as mind. However, there are other ways in which this illness can be treated like the treatment used by Bradshaw (1998) which was therapy and improved the patient’s life. He allowed the patient to have a second chance. Not only that but it also had a similar result to those found by Patel, Frederick and Kidd (2018) in physical fitness. They found that some patients began having a better relationship with those around them. The essay has also shown how schizophrenia can be treated with different therapies. The outcome of all four studies were similar as they ended with the patient beginning to recover. However, a difference with the cognitive behavioural method is that only one patient can be treated at a time and this may not be successful for everyone. This study has a small sample whereas, the exercise method has a larger sample, this can make the results more generalisable. Research has found how physical exercise is used to modulate adult neurogenesis significantly and leads to mood improvements. This therefore leads to a better management of different psychiatric disorders, seen as the patients began improving on their everyday life. Kuller and Bjorgvinsson’s (2010) case study is another example of how schizophrenia can be treated, as it does not always have to link to exercise which can help. The patient was not physically fit, as he went through therapy helped him recover and be mentally fit after 30 weeks. It shows how one to one session can have patients suffering from this illness can be treated, even if they are not physically fit. On the other hand, Ozbulut et al. (2013) is another case study which proved being physical fit links to mental fit, as it was shown in the research one patient showed improvement from long daily walks. It improved the patients condition and exercise is considered an important treatment for people suffering from schizophrenia. Ozbulut et al. (2013) suggested exercise should be looked into with more depth.

Schizophrenia is a mental ailment which is marked by hallucinations, delusions, and related health issues. In most cases, it makes its foray during the early adult phase or late adolescent stage of the life of the patient. It could last for the entire duration of life and afflicts about one percent of the entire population. The male patients usually reflect the signals and symptoms of this ailment at an age younger than females do. At times, this affliction may take years to develop into a full blown stage when it can be properly diagnosed. The patient may not even be aware of this malady for a long time. At other times, however, it may come by in a quick and sudden manner. Schizophrenics have to depend on their friends or family for support since they may not be able to fend for their own selves (Nordqvist, 2017).

The symptoms for this disease are categorized into four sub-groups. The first are the positive ones, also referred to as psychotic symptoms. The second are negative in nature and include a withdrawal from motivating factors and lack of expressions (facial). Cognitive symptoms, the third in this list, have a direct influence on the thinking of the individual and include lack of the power to focus. The last category is emotional symptoms which include blunted emotional renditions et al. Schizophrenic patients may be able to lead near-normal lives if they follow proper treatment plans. A combination of medication, self-help strategies, and psychological counseling is usually used for such patients. The use of anti-psychosis drugs has changed the treatment scenario for this ailment. A good many numbers of patients are now able to live within their communities and not be relegated into hospitals or healthcare units. Drugs like Risperidone, Olanzapine, Quetiapine, Ziprasidone, Clozapine, and Haloperidol are utilized for schizophrenia treatment. However, in almost all cases the drugs have to be taken even if the symptoms of the ailment disappear. This is a must to prevent them from recurring. It is also a necessity that the kith and kin and friends of such patients provide them full support and strength so that they are able to cope up with this illness (Nordqvist, 2017).

Schizophrenia is a serious malady to contend with and it may make people behave in an abnormal fashion. They tend to live life in a cocoon without thinking in realistic or practical terms at times. They may think of committing suicide or harming themselves as well and this is a nuance which their family and well-wishers needs to constantly think about and monitor. Schizophrenics may not respond to situations and events in a normal manner and may think of out-of-the-box eventualities which cause problems to not just them but also to the people around them. It is highly advisable for those in their support system to develop a sense of understanding about this disease and inculcate a feeling of belonging and happiness in their lives. The ethical parameters of this disease call upon all members of society to help out such patients in living a life as normal as is possible for them to. It is our moral duty to talk to a person and refer him or her to a specialist if he or she exhibits symptoms of schizophrenia but is not aware of the condition. It is also best to call up 911 or the local emergency number and ask for help if you come across a schizophrenic who is exhibiting uncontrollable symptoms (“Schizophrenia”).

Every town, district, and state has certain self-help groups which help schizophrenics deal with their situation and come to terms with it. It is in the viable interests of society at large to guide those who may be suffering from this ailment to professionals who will help them cope with this debilitating disorder which can overtake their and the lives of their loved ones. Since this ailment afflicts a person for the entire life, it is highly advisable to approach the correct people who can determine what exactly should be done to keep the symptoms in check and to prevent any avoidable health episodes from taking place.

References

1. Nordqvist, C. (2017). “Understanding the symptoms of schizophrenia”. Retrieved March 27, 2019, from www.medicalnewstoday.com/articles/36942.php.
2. “Schizophrenia”. Retrieved March 27, 2019, from www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-2035443/.

Abstract

Schizophrenia is not a common mental illness so scientists today still do not know how exactly schizophrenia manifests. The main theory of how schizophrenia comes about is through genes. Although there is no specific gene that causes the disorder itself, it is believed theinterplay of genes plus an individuals environment combine to determine if schizophrenia develops. The environmental factors that can have an effect are malnourishment before birth, problems during birth, and the most influential, psychosocial factors. This study analyzes how schizophrenia develops through childhood abuse and the object relation deficits that are created through PTSD. It also looks at how the relative roles of hereditary risks and childhood abuse play into the development of schizophrenia. Lastly, the study will look at how anticipated pleasure deficits in people with schizophrenia are actually a heightened anticipated negative emotion and that inaccurate forecasting of emotions can be linked to a decreased motivation for social interaction. It’s goal is to increase awareness that children in families who experience child abuse are at the most at risk group for the development of schizophrenia and ultimately increase treatment to combat object relation deficits early on to heal children before schizophrenia can develop or at the very least, decrease its severity.

Review of Literature

Schizophrenia is an illness that effects one percent of the nation’s population, as well as one percent of the world’s population. Today it is still not possible to use genetic information to predict who will develop schizophrenia. Family history can be used to determine your genetic predisposition of developing the illness, but that alone is not enough to predict your odds of developing the illness. The following review of literature confirms that a person’s genes and the interplay of one’s environment are far better indicators of who is at risk of developing schizophrenia, how environmental factors shape an individual’s object relations, and proposing and reaffirming the best ways to go about prevention and rehabilitation of the illness.

Distorted Social Anticipation

People who have schizophrenia have a distorted view of reality, which can be attributed to the accumulated effect of previous negative life experiences. Martin, Castro, Li, Urban, and Moore (2019) conducted a study on the emotional responses, predicted and experienced, in schizophrenia using the “36 questions that lead to love.” They wanted to create a live social interaction that minimized higher order cognitive functions to see if the decreased motivation to socialize is due to the actual interaction. Confederates were used as the other person playing the game with both groups, but the groups were deceived into believing the confederate was a person of the same group. The study then followed by collecting data from both schizophrenia and control groups about their current mood before the interaction, the anticipated response of how the interaction will go, as well as their final thoughts on how the interaction went. The group with schizophrenia anticipated more negative emotion and were also less accurate with forecasting negative emotion (2019). This study shows that “anticipatory pleasure deficits” in people with schizophrenia could quite possibly be inaccurate forecasting of negative emotions, which can be linked to decreased social motivation.

Object Relation Deficits

Object relations refer to the ideas one forms of themselves and the ideas that are formed of other people, and the relationship these ideas have synchronically in forming healthy human development. The relationship between schizophrenia and object relation deficits is significant and is associated with the source of the disease as well as the recovery. Within a certain group of persons diagnosed with schizophrenia, those with early-onset schizophrenia have worse object relation deficits than those with a later onset (Chapleau, Bell, & Lysaker, 2013). The study used Positive and Negative scale, Post-Traumatic Stress Disorder Checklist, and Bell Object Relations Inventory and administered them to 60 people. Using four hierarchical regressions and controlling for schizophrenia symptoms, diagnosis type, and relevant demographic features, PTSD correlated with three out of the four types of object relation deficits (2013). Insecure attachment, alienation, and egocentricity could all be attributed by PTSD symptoms in persons with schizophrenia. Having social incompetence, the fourth object relation, could be better explained by the core symptoms of schizophrenia rather than PTSD (2013). If PTSD is related to object relation deficits in persons with schizophrenia, then psychotherapy would be beneficial in treating the interpersonal deficits that are present in the individual.

Hereditary Risk and Child Abuse

Genetics can indicate whether someone has higher chance of the manifestation of schizophrenia in their phenotype, but environmental and psychosocial factors are more important to consider in determining development of schizophrenia. Gallagher and Jones (2016) conducted a study that looked at hospital data from a large state hospital in the northeastern U.S. the from 1984 to 1990, which had detailed information on patients’ diagnosis of schizophrenia (positive vs negative symptoms), as well as first-hand family accounts of childhood abuse separated between physical and emotional. The study also took into account family history of mental illness which were also included in the hospital medical records. After analyzing the medical records, they concluded that risk for positive symptoms of schizophrenia are elevated by history of childhood abuse in combination with no history of serious mental illness in the family (2016). Due to the implications that the etiological role childhood abuse has on positive symptoms of schizophrenia, treatment should look at family background and design therapeutical approaches on dealing with the trauma that comes from childhood abuse.

Knowing that schizophrenia causes alterations to your world view, and that these changes come about from childhood trauma that can produce PTSD, which in turn damages object relations, forming good patient relations and a focus on repairing said interpersonal defects is an effective way of treating and rehabilitating people with schizophrenia. Learning more about how people with schizophrenia view the world, and sympathizing with the fact that these are traumatized people who have developed an unhealthy way of coping with such trauma can lead to more effective ways of approaching and dealing with the people suffering from the illness.

References

1. Chapleau, K. M., Bell, M. D., & Lysaker, P. H. (2014). The relationship between post-traumatic symptom severity and object relations deficits in persons with schizophrenia. British Journal of Clinical Psychology, 53(2), 157–169. https://doi.org/10.1111/bjc.12033
2. Gallagher, B., & Jones, B. (2016). Hereditary Risk and Child Abuse: Their Relative Roles in Type of Schizophrenia. Journal of Child & Adolescent Trauma, 9(3), 255–261. https://doi.org/10.1007/s40653-016-0078-z
3. Martin, E. A., Castro, M. K., Li, L. Y., Urban, E. J., & Moore, M. M. (2019). Emotional response in schizophrenia to the “36 questions that lead to love”: Predicted and experienced emotions regarding a live social interaction. PLoS ONE, 14(2), 1–13.
4. https://doi.org/10.1371/journal.pone.0212069
5. https://doi.org/10.1111/bjc.12033
6. https://doi.org/10.1371/