Category: Schizophrenia

Unraveling the Complexities of Schizophrenia: Quality of Life

Introduction

Schizophrenia: the “cancer” of mental illness. Schizophrenia is the most severe and debilitating psychiatric disorder that exists. This disorder affects about 1% of the population worldwide (Owen & Mortensen, 2016). Although the percentage may not seem significant, the actual number of people affected is huge. While there are several different causes of schizophrenia, most of them aren’t preventable. There are many signs and symptoms of the illness, but there is no way to foresee the onset of it. As of right now, a cure has not been discovered, but treatment has come a long way from where it used to be. Most people believe schizophrenia is just hallucinations and people acting out of the ordinary, but the truth is that it is an extremely complex, unpreventable mental illness. So, what causes schizophrenia?

Understanding Schizophrenia as a Debilitating Disorder

There isn’t an exact reason people develop schizophrenia, but there are many factors believed to contribute to the disorder, and most of them are things that aren’t preventable. Some of the believed causes happen early in life and even before birth. If a mother has complications or stress during pregnancy or a child develops a serious infection, it could lead to the onset of schizophrenia. Abuse in early childhood could lead to schizophrenia as well. Genetics are believed to be another major cause of people developing schizophrenia. There is a higher risk of a child developing this disorder if one or both of their parents have it. According to Laurens and Cullen (2015), “anywhere between 10% and 15% of children will develop schizophrenia if they have an immediate family member diagnosed with it.”

The final major reason for people developing schizophrenia is the differences in the biological makeup of the brain. Their brains generally have less grey matter than a typical brain, and if left untreated, the grey matter will continue to decrease. The ventricles in their brains tend to be enlarged, which means there is more fluid in the spaces around them. Also, the amygdala is enlarged, and they have decreased function in the prefrontal cortex. There are excessively higher amounts of the hormone dopamine in the frontal lobes than in the average brain (Solanki et al., 2008).

Symptoms of Schizophrenia

Schizophrenics generally have two types of symptoms: positive and negative. Positive symptoms are things such as disorganized speech, hallucinations, catatonic behavior, delusions, and disorganized behavior. With positive signs and symptoms, the person may be unresponsive to their surrounding, see or hear things that aren’t really there, or not be able to care for themself. Types of negative symptoms seen are the flat effect, avolition, and algogia. A person with negative signs or symptoms may show little to no emotion, have a limited vocabulary, or be unable to do everyday tasks such as cooking or tying their shoes.

All of these symptoms, positive and negative, are important to the diagnosis of schizophrenia. “The positive symptoms tend to relapse and remit, though some patients experience residual long-term psychotic symptoms. The negative and cognitive symptoms tend to be chronic and are associated with long-term effects on social function” (Owen & Mortensen, 2016). Both positive and negative symptoms of schizophrenia are devastating and can range in severity. Positive symptoms were named because they are thought of as being added to a person’s psyche. The brain is more stimulated than before the onset of the illness. Negative symptoms occur when the brain has less stimulation, and the person loses the ability to do things they used to be able to, such as routine hygiene or normal emotion.

How the Illness Can Be Treated

Even though there is no cure for schizophrenia, there are many medications and therapies used to help people function and have a life as close to normal as possible. Antipsychotic medicines are the number one type of medication used to reduce symptoms of schizophrenia. The most commonly used medications are as follows:

Zyprexa is used to treat schizophrenia in people 13 and older. It has been shown to block or lessen the effects of several chemicals in the brain. Risperdal is used to treat schizophrenia by changing the activity of certain natural substances in the brain. Seroquel helps to lessen the effects of the neurotransmitter dopamine in the brain. Geodon is an antipsychotic that blocks certain neurotransmitters in the brain that heighten the symptoms of the disorder. Haldol helps with the treatment of schizophrenia by decreasing abnormal excitement in the brain. Thorazine changes the activity of chemicals in the body.

Clozaril is the last resort medication. It is used in patients who couldn’t be helped with any other medication. It helps the patients who have attempted suicide or are likely to attempt it again. Like the majority of the other medications, it is used to lessen the effects of the chemicals and neurotransmitters in the brain. While medications can greatly reduce problems associated with schizophrenia, they all come with a risk of their own side effects. As Millier et al. (2014) have noted, “The most harmful side effects reported are weight gain, diabetes, metabolic syndrome, sexual dysfunction, osteoporosis, and physical impairments such as tardive dyskinesia.”

Using therapy techniques along with medication is the best way to help a patient (Ben-Zeev et al., 2011). Psychotherapy is a major form of therapy used with schizophrenics. With psychotherapy, the patient meets with the therapist or counselor regularly. The therapist helps them to be able to differentiate between what is real and what is imaginary. Also, the therapist helps them to be able to better understand their illness and how to handle themselves properly. Another form of therapy is family therapy. This type of therapy is important because, a lot of times, the families have to help care for the person with the disorder, and they need to understand and know how to cope with the symptoms they have to deal with. With family therapy, the families will learn all about the disorder and know how to manage it. Cognitive behavior therapy can be very effective for a schizophrenic. It would help them to recognize unhealthy behaviors and develop more beneficial ways of doing things.

Quality of Life for a Schizophrenic Patient

The quality of life for someone with a diagnosis of schizophrenia is reduced significantly compared to a healthy person. Historically, about 60% of people living with schizophrenia attempt suicide, and close to 15% are successful (“Negative Symptoms,” 2017). Many times, schizophrenics go into depression because they are so handicapped by the illness. It can lead to social withdrawal and unemployability. Depending on the severity of the diagnosis and how well treatment works, it’s not uncommon for the person to require 24-hour care. Almost half of people with schizophrenia live with their parents or another family member their entire lives (Takamatsu et al., 2009).

Conclusion

Schizophrenia can be a scary mental illness if you don’t know much about it. With so many affected by it in our world, being aware of what it is and what can be done to help people diagnosed with it will make it less frightening. Even though there is no way to see the onset coming, having so many treatment options available makes it much more manageable. Schizophrenia is not just hearing voices, hallucinations, or acting out. It is a complex illness that cannot be prevented in people who are diagnosed with it. The more aware we are about it, the further research can go and hopefully lead to a cure someday.

References

1. “Schizophrenia: Cognitive Theory, Research, and Therapy” by Aaron T. Beck and Neil A. Rector
2. “Divided Minds: Twin Sisters and Their Journey Through Schizophrenia” by Pamela Spiro Wagner and Carolyn S. Spiro
3. “Madness: A Bipolar Life” by Marya Hornbacher

Understanding Schizophrenia: Unveiling the Complexity of a Mental Disorder

Introduction

How would you react if you woke up one day and just felt off? You’d probably go about your day and carry on as usual. Days and weeks would go by, and you probably wouldn’t notice that feeling worsening or even notice anything different at all. Over time, you might start distancing yourself more from the things you once loved, whether it be from social occasions, hobbies, your close friends, or even possibly your loved ones. You might start to experience abnormal behavior and a lack of emotions.

Eventually, you end up having an episode where you might start to experience hallucinations or delusional thoughts. All of this could add up to being diagnosed with Schizophrenia. Schizophrenia is a mental disorder that is typically associated with disruptive thoughts, perceptions, and behaviors. One might experience delusional thinking, loss of emotions, and possibly different hallucinations (Schizophrenia, 2018). This paper will discuss the following information regarding this disorder: history and prevalence, diagnosis and symptoms, contributors and mechanisms, biological components, social effects, and treatments.

Prevalence and History

One of the first forms of possible evidence of mental illness dates back to the Stone Age. Some of the archaeological discoveries that were found were skulls that had burr holes drilled into them, possibly put there to release evil spirits from their remains (Burton, 2017). While researchers believe that mental illness has been around for as long as we have, it wasn’t until 1887 that German psychiatrist Emil Kraepelin first distinguished this illness from other forms of psychosis. He called it ‘dementia praecox’. The name ‘dementia praecox,’ meaning ‘dementia of early life,’ was chosen because, at the time, he had believed it only occurred in adolescence. Later, the title was changed to ‘Schizophrenia’ by Swiss psychiatrist Paul Eugen Bleuler in 1910 (Burton, 2017).

The term is derived from the Greek word schizo, meaning split, and phren, meaning mind. Due to this, It was often mistaken as an unrelated disorder known as Multiple Personality disorder (Burton, 2017). Schizophrenia is now a commonly known disorder in the United States but only occurs in about 1% of the population (Spielman et al.,2016). Having a first-degree relative gives a 6-10% greater risk of developing the disorder. If only one parent is affected, they have about a 13% chance, while having both parents affected puts one nearly at 50% (Pedersen, 2018). For most sufferers, symptoms usually start to appear during late adolescence or early adulthood. While the disorder could begin to show signs in childhood and late adulthood, it is extremely rare (Pedersen, 2018). Research has shown that males often show symptoms at a younger age than women tend to. Before the age of 19, women experienced signs of the disorder at 23%, while men were recorded at a higher rate of 40% (Pedersen, 2018).

Diagnosis and Symptoms

Most cases of Schizophrenia usually develop slowly and over an extended period of time. Other cases have shown signs of starting almost instantly (Nordqvist, 2017). Diagnosing the patient can be a long process, and different tests must be done to acquire a final diagnosis. Blood tests might be in order to rule out any other causes of Schizophrenia symptoms, such as the use of drugs like marijuana or psychedelics. They might also perform imaging studies to look for tumors or other problems in the structure of the brain that might be causing these symptoms. If no issues arise, they will give a psychological evaluation of the patient.

A specialist will observe and ask the patient about his or her mental state. Questions concerning their thoughts, moods, and violent tendencies will be asked. Along with whether they are experiencing any hallucinations or suicidal thoughts (Nordqvist, 2017). The patient must meet the requirements stated in the DSM (Diagnostic and Statistical Manual of Mental Disorders). This manual is used to help diagnose mental illnesses by healthcare professionals. They must be experiencing at least two of the symptoms from the criteria, and the symptoms must persist for at least six months or more (Nordqvist, 2017).

Conclusion

Patients diagnosed with Schizophrenia may experience many unpleasant symptoms daily. Some symptoms that persist are disorganized thinking, hallucinations, delusions, and negative symptoms as well. Auditory hallucinations are most common and occur in about two-thirds of patients diagnosed with Schizophrenia. They hear voices in their head that can make it hard to concentrate on everyday tasks (Spielman et al., 2016). They can also experience different delusions, such as paranoid delusions, grandiose delusions, and somatic delusions. All deal with firm beliefs that are contradictory to their reality.

References

1. “The Center Cannot Hold: My Journey Through Madness” by Elyn R. Saks
2. “Surviving Schizophrenia: A Family Manual” by E. Fuller Torrey

Gender Differences in Schizophrenia: Examining Long-Term Treatment Outcomes

Introduction

Schizophrenia is a mental disorder in which a person’s ability to think, feel, and behave appropriately is affected. A person who is schizophrenic may experience delusions, hallucinations, suicidal ideation, and other cognitive difficulties. Schizophrenia usually appears between late adolescence and early adulthood and can often be a lifelong struggle. In Cechnicki, Bielańska, Mętel, Susz, Błądziński, Plencler-Bańczyk, and Kalisz’s research article Comparison of the long-term treatment outcomes of women and men diagnosed with schizophrenia over a period of 20 years, gender is mentioned as a demographic prognostic factor of schizophrenia. This article explains its research and results about the difference in schizophrenia between women and men diagnosed with schizophrenia over a period of 20 years and how they are responding to long-term treatment.

Summary of Article

There were three objectives identified for this study: to assess and compare the demographic, social, and clinical indicators between women and men during their index psychiatric hospitalization and to assess and compare the clinical and social outcomes of treatment in women and men after 7, 12, and 20 years from index hospitalization and to assess and compare subjective quality of life in women and men after 7, 12, and 20 years from index hospitalization.

The study initially began with 80 individuals hospitalized at the Psychiatric Clinic of the University Hospital in Cracow who were diagnosed with schizophrenia. The 80 individuals had to meet certain criteria that included being over the age of 18, living in Cracow with family, lack of organic brain disorder and dependence on substances, and the exclusion of mental retardation. Over the course of 20 years, the follow-ups were conducted after 7, 12, and 20 years. However, out of the 80 individuals, 57 patients took part in all the follow-ups.

The total of women equaled 57, and the men equal 23. The study consisted of assessing the number of relapses, the number and duration of rehospitalizations, and the evaluation of social relationships, family, and employment. The researchers invented the Anamnestic and Catamnestic Questionnaire. Additional instruments included the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning Scale (GAF), The Cognitive Flexibility Inventory scale (CIF), the Lehman Quality of Life Interview, and the DSM III Axis V social scale.

The article stated that during short and mid-term treatments, women cope better with schizophrenia compared to men.“ Clinical experience indicates that psychotic symptoms in women differ in quality from those displayed by men in terms of their hallucinatory content…….Moreover, calmer behavior of women tends to arouse less unease in their immediate circle, and they have more favorable responses both to pharmacological treatment and in compliance “ (Cechnicki et al. p. 63)

Strengths and Weaknesses of Article

One weakness this article had was that it failed to mention the kind of treatment the patients were receiving. It did not say if they were on any medication or doing any therapies, such as behavior therapy or cognitive therapy. Knowing the kind of treatment each patient was getting may have given a more accurate result for the experiment and can help understand why women cope better than men who are schizophrenic. Another weakness included the women-to-men ratio. There were more women than men. Sixty percent of the individuals were women.

Recommendations

I would not recommend the study to other colleagues. It lacks certain information and still leaves the reader or researcher with an unanswered question. The course of the experiment and study was 20 years, which is a long experiment.

Conclusion

As time progressed, the study concluded that the symptom severity in favor of women faded out after about 20 years of the illness. There was no significant difference in symptoms between men and women after 20 years. Compared to men, women, in terms of terms of social functioning, employment, and subjective quality of life, have a more favorable outcome. The study also showed that men get married more frequently, which improves their social status. (Cechnicki, Bielańska, Mętel, Susz, Błądziński, Plencler-Bańczyk, & Kalisz p. 66)

References

1. Cechnicki, A., Bielańska, A., Mętel, D., Susz, K., Błądziński, P., Plencler-Bańczyk, E., & Kalisz, A. (Year). Comparison of the long-term treatment outcomes of women and men diagnosed with schizophrenia over a period of 20 years. Journal Name

Schizophrenia: Unveiling Pathology, Symptoms and Treatment

Introduction

At around age fifteen, I was browsing around YouTube and found myself looking at various random video clips. Soon enough, I found a specific video that caught my attention. The video was a schizophrenia simulation, and I found it interesting because the video showed different aspects of a psychotic episode from a patient with schizophrenia. This sort of point of view blew my mind because it was like I was put in the shoes of an individual who has this illness. At that point in my life, I did not know what schizophrenia was, so this mental illness was fairly new to me. Eventually, I read numerous academic articles, essays, and videos that revolved around schizophrenia because the illness was very bewildering in my view of it.

Pathology

Schizophrenia is a persisting or constantly reoccurring severe mental disorder. This mental illness affects many things in an individual, which can include the way someone thinks, conveys emotions, acts, associates with others, and perceives reality. The dysregulation of multiple pathways is what causes schizophrenia. Dopaminergic, GABAergic, and glutamatergic are all neurotransmitter systems that are subsequently affected in individuals with schizophrenia. The connections between these receptors contribute to the pathophysiology of schizophrenia. The epidemiology of schizophrenia is around one percent internationally, which is approximately 2 per one hundred thousand people. The age of onset of schizophrenia is around adolescence, and it affects both men and women equally.

Signs and Symptoms

Schizophrenia symptoms can be put into three different categories: positive, negative, and cognitive symptoms. Positive symptoms are symptoms that make people feel sensations that are not real. Positive symptoms include hallucinations, delusions, unrealistic beliefs, or struggling to organize ideas and speech. Negative symptoms refer to the lack of normal behaviors. Negative symptoms include anhedonia, affective flattening, no usual facial expressions, and not being able to follow through. People with schizophrenia may also struggle to sustain activities in time or even start them at all.

Cognitive symptoms involve problems with memory and awareness. Cognitive symptoms include attention troubles, difficulty understanding problems, and inability to follow complex instructions. There are seven common signs of schizophrenia. The signs include being hostile, having poor personal hygiene, overreacting to criticism, being expressionless, saying irrational things, having insomnia or oversleeping, and being forgetful or unable to concentrate. Social withdrawal is also a sign of a person with schizophrenia. For example, a person with schizophrenia may not attend social events and may stay alone most of the time. Individuals with this illness may also suffer depression, which has several similar symptoms. Schizophrenia can affect the body and the mind, and some complications can be depression, self-harm, or suicide. The poor personal hygiene sign affects the body because people with this illness may get sick more often or have poor oral hygiene.

Medical Specialists

Medical specialists that people with schizophrenia should be referred to are psychiatrists and psychologists. Psychiatrists are doctors and can diagnose those with schizophrenia as well as specialize in treatment for this mental illness. Psychiatrists can prescribe medications as well as do psychotherapy. Psychologists, unlike psychiatrists, cannot prescribe medicine. Psychiatrists are able to give tests to see how well people with schizophrenia are able to function in their normal daily lives. Schizophrenia patients should be referred to psychiatrists because they are able to prescribe medication to them and professionally do “talk therapy” with patients, which is effective in maintaining their symptoms. Patients should also be referred to psychologists because they are able to do cognitive rehabilitation, remediation, or enhancement. These sorts of therapies teach patients how to be communicative as well as create an understanding of the necessities of others.

Diagnostic Tests and Treatment

There are really no laboratory tests used to precisely diagnose those with schizophrenia. Therefore, medical specialists might use diagnostic tests in order to rule out that the symptoms are not caused by things like medications, substance misuse, or a medical condition. Some major diagnostic tests used to rule out other things that might cause similar symptoms include magnetic resonance imaging (MRI) or computerized tomography (CT) and a psychiatric evaluation. An MRI or CT scan may help medical specialists rule out a possible brain tumor that might be causing similar symptoms of schizophrenia.

A psychiatric evaluation helps by checking if the patient has any hallucinations, substance misuse, delusions, or is probable for viciousness or suicide. The reasons for schizophrenia are still unidentified. Therefore, the treatments for this illness are mainly to eliminate symptoms caused by this disease. A recent treatment for schizophrenia is dopamine D2-receptor blockers, as well as psychotherapy. Dopamine D2-receptor blockers are effective because they reduce the outcome of dysregulated striatal dopamine release. Psychotherapy is useful by managing the symptoms of a patient, and therefore, the patient would be able to enhance their coping skills and pursue life goals.

Prognosis and Psychosocial Issues

After ten years of treatment, about half of the people with schizophrenia would recover enough so they can live independently. A quarter recovered partially, still needing support, fifteen percent remained unchanged, and ten percent would end up killing themselves. After thirty years, more people become independent. However, the suicide rate goes up fifteen percent. People with schizophrenia are not always able to take care of themselves; they tend to have poor hygiene, poor diet, smoke, sedentary lifestyle, or become obese, resulting in their life expectancy being reduced by 20 years. The majority of people with schizophrenia are unemployed, and thus, most of them live with community support. A person with schizophrenia has various medications. Therefore, it usually becomes a financial issue since most individuals with schizophrenia are unemployed. Patients also need to attend psychotherapies, so the schedules of the caregivers are subject to change in order to keep up with appointments.

Assistive Technology (AT)

Two forms of assistive technology (AT) are smartphones and recording devices. Smartphones can help patients diagnosed with schizophrenia by setting alarms or reminders for medication management as well as having music in order to block out voices. A smartphone also has many other useful applications, like apps specifically made for those with schizophrenia. A recording device is also an AT for those with this illness because patients with schizophrenia are often very forgetful and have trouble with their memory. Therefore, recording devices are beneficial by being able to record certain things that the patient might find extremely important, as well as being easily navigational. The cons of both smartphones and recording devices as AT is that people living with schizophrenia are often unemployed and therefore in need of financial assistance than those who do not have the condition. AT can be expensive to purchase, and this causes problems for those who are financially unstable.

Although the findings from this research prove positive for AT, certain key considerations must be addressed before AT progresses. People living with schizophrenia are more likely to be unemployed and in receipt of social welfare when compared to individuals who are not living with this condition (Brown, 2011). AT can be expensive to buy and maintain. This could be problematic for individuals who are not financially secure. Services would have to explore how they can ensure that they can equitably provide modern mental health care thatis in alignment with our current technological environment. There will be a need for appropriate pathways and procedures to ensure AT is available to people who could benefit from it.

Although the findings from this research prove positive for AT, certain key considerations must be addressed before AT progresses. People living with schizophrenia are more likely to be unemployed and in receipt of social welfare when compared to individuals who are not living with this condition (Brown, 2011). AT can be expensive to buy and maintain. This could be problematic for individuals who are not financially secure. Services would have to explore how they can ensure that they can equitably provide modern mental health care that is in alignment with our current technological environment. There will be a need for appropriate pathways and procedures to ensure AT is available to people who could benefit from it.

Although the findings from this research prove positive for AT, certain key considerations ust be addressed before AT progresses. People living with schizophrenia are more likely to be unemployed and in receipt of social welfare when compared to individuals who are not living with this condition (Brown, 2011). AT can be expensive to buy and maintain. This could be problematic for individuals who are not financially secure. Services would have to explore how they can ensure that they can equitably provide modern mental health care that is in alignment with our current technological environment. There will be a need for appropriate pathways and procedures to ensure AT is available to people who could benefit from it.

Although the findings from this research prove positive for AT, certain key considerations must be addressed before AT progresses. People living with schizophrenia are more likely to be unemployed and in receipt of social welfare when compared to individuals who are not living with this condition (Brown, 2011). AT can be expensive to buy and maintain. This could be problematic for individuals who are not financially secure. Services would have to explore how they can ensure that they can equitably provide modern mental health care that is in alignment with our current technological environment. There will be a need for appropriate pathways and procedures to ensure AT is available to people who could benefit from it.

Although the findings from this research prove positive for AT, certain key considerations must be addressed before AT progresses. People living with schizophrenia are more likely to be unemployed and in receipt of social welfare when compared to individuals who are not living with this condition (Brown, 2011). AT can be expensive to buy and maintain. This could be problematic for individuals who are not financially secure. Services would have to explore how they can ensure that they can equitably provide modern mental health care that is in alignment with our current technological environment. There will be a need for appropriate pathways and procedures to ensure AT is available to people who could benefit from it.

Although the findings from this research prove positive for AT, certain key considerations must be addressed before AT progresses. People living with schizophrenia are more likely to be unemployed and in receipt of social welfare when compared to individuals who are not living with this condition (Brown, 2011). AT can be expensive to buy and maintain. This could be problematic for individuals who are not financially secure. Services would have to explore how they can ensure that they can equitably provide modern mental health care that is in alignment with our current technological environment. There will be a need for appropriate pathways and procedures to ensure AT is available to people who could benefit from it.

Although the findings from this research prove positive for AT, certain key considerations must be addressed before AT progresses. People living with schizophrenia are more likely to be unemployed and in receipt of social welfare when compared to individuals who are not living with this condition (Brown, 2011). AT can be expensive to buy and maintain. Thiscould be problematic for individuals who are not financially secure. Services would have to explore how they can ensure that they can equitably provide modern mental health care that is in alignment with our current technological environment. There will be a need for appropriate pathways and procedures to ensure AT is available to people who could benefit from it.

Research Sources

The first reference source by Goldberg was extremely helpful because it efficiently gave detailed information on the symptoms of schizophrenia. Goldberg was thorough throughout the entire source, and it included an overview of early signs, symptoms, tests, and medication, all pertaining to schizophrenia. Its content was well organized by putting the overview of the illness first and gradually going down to the medication that people with schizophrenia take. I relied on this reference because it gave me various amounts of information relating to schizophrenia as a whole. What I did not find useful about this website was that it was quite broad, and I would have liked it to be more specific on what exactly happens in a schizophrenic mind. My second source by McCutcheon, Marques, and Howes, I found to be very credible because it was published by JAMA Psychiatry, which focuses on mental illnesses.

This source was very detailed, from the medication to the actual genetic factors of schizophrenia, and was fairly easy to comprehend. The source ensured an in-depth look at what exactly schizophrenia is, as well as observations, treatment, and the neuroscience portion of schizophrenia. What I did not like about this source was that it was not really organized because I found that some information should have come before others and vice versa.

My last source, the National Institute of Mental Health, was also credible because this organization is concentrated on mental health. I found this source to be helpful because they have small sections of topics they were going to discuss; for example, they had risk factors, treatments, and therapies, as well as information on how to join a study. What I found neat was that the National Institute of Mental Health provided a Join a Study subtopic, which addressed ways to get into clinical trials, and they gave informative details. This source was straightforward, but I believe they did not dig deep enough for me to completely understand the complex illness of schizophrenia.

Conclusion

Therefore, I would end my case study by referring to the source by Mccutcheon, Marques, and Howes as my primary source of information on schizophrenia because they very accurately described what exactly is schizophrenia as well as provided details exclusive to schizophrenia. This information helped me distinguish this mental illness from others. This source was up to date, as well as offering material that would help treat those with schizophrenia.

References

1. “The Center Cannot Hold: My Journey Through Madness” by Elyn R. Saks
2. “The Soloist: A Lost Dream, an Unlikely Friendship, and the Redemptive Power of Music” by Steve Lopez

Complex Etiology of Schizophrenia: Factors, Diagnosis, Treatment, and Prognosis

Introduction

According to Gray and Zide (2013), Schizophrenia is characterized by a broad range of behaviors marked by a loss of a person’s sense of self, significant impairment in reality testing, and disturbances in feelings, thinking, and behavior. There are five subtypes of Schizophrenia: paranoid, catatonic, disorganized, undifferentiated, and residual type. The causes of the disorder are still unknown. In the story of Mary and Gina Thomas, it is believed to have occurred because of a mental breakdown and high-stress levels.

For example, Gina did not exhibit high signs of Schizophrenia until she divorced her husband and was stuck raising two daughters with a low-paying job and a high cost of living. She had never been placed in this situation before. Therefore, her stress levels were high, which is believed to have triggered severe episodes of hallucinations and paranoia. Betensky (2009) found “that there is an interplay between domestic environmental stressors, a need to act constructively, and resulting depressive symptoms in patients recently diagnosed with schizophrenia.”

Subtypes and Complex Symptoms

According to the American Psychiatric Association (2013), Schizophrenia is diagnosed when two or more of the following, each present for a significant portion of time during a 1-month period: delusions, hallucinations, disorganized speech, grossly recognized or catatonic behavior, and or negative symptoms (diminished emotional expression or avolition). Gina met the criteria and was diagnosed with Schizophrenia. She had auditory hallucinations for many years prior to being diagnosed, and she would scream, “Get the cameras off me.” She would exhibit catatonic behavior, such as banging the broom against the ceiling at two o’clock in the morning. At one point, she became so paranoid that she bought a gun and carried it everywhere, including in the bathroom while she took baths. Gina was an educated woman with two degrees. It took a highly trained expert to recognize her disorganized speech.

Many people who are diagnosed with Schizophrenia are in denial. APA (2013) found:

Some individuals with psychosis may lack insight or awareness of their disorder. This lack of “insight” includes unawareness of the symptoms of Schizophrenia and It may be present throughout the entire course of the illness.

Gina being in denial about her mental health disorder made it hard to receive treatment. Although the cause of Schizophrenia is unknown, recognizing the signs is key to receiving treatment and living a normal life.

Assessment tools related to Schizophrenia

Schizophrenia is a lifelong mental health disorder. It is a strain on not only the person with the disorder but families, co-workers, and friends. When diagnosed, the disorder must be monitored to determine which treatments are effective. There are many assessment tools used to measure the negative and positive symptoms of Schizophrenia. The main assessment tool used is the Diagnostic and Statistical Manual of Mental Disorders. The DSM-V measurement scale is an extraordinary and dependable guide utilized by mental health professionals.

Sadly, a major issue utilizing the DSM-V measurement scale is that Metal Health professionals provide the test, but many individuals who experience depression would prefer not to go to a mental health provider because they are afraid they may be viewed as a disgrace or maybe ashamed to admit to other people that they are in need of mental health treatment. There are other tools used to assess Schizophrenia and its symptoms. According to Kumari (2017):

There are relatively fewer articles on the utility of newer scales like CAINS (Clinical Assessment Interview for Negative Symptoms) and the BNSS (Brief et al.) that compare them to the older scales PANSS (Positive and Negative Symptoms Scale), SAPS (Scale for the Assessment of Positive Symptoms) SANS (the Scale for the Assessment of Negative Symptoms), NSA-16 (Negative Symptom Assessment-16) and CGI-SCH (Clinical Global Impression Schizophrenia.

The Scale for the Assessment of Negative Symptoms or Positive Symptoms (SANS) (SAPS) are the most frequently used tools to assess Schizophrenia. These tools were developed in 1980 to measure the severity of symptoms, whether positive or negative. Both SANS and SAPS use a point scale. SANs use a 6-point scale to measure negative symptoms. The symptoms are rated on 25 items to include emotional response, alogia, motivation or avolition, anhedonia, and attention. The SAPS uses a 6-point scale measurement as well. Symptoms are rated on 34 items to include delusions, hallucinations, bizarre behaviors, and positive thoughts. Both tools have rating scales that are clearly defined.

The Positive and Negative Symptoms Scale (PANSS) is another scale used to measure the positive and negative symptoms of Schizophrenia. According to Giesbrecht (2016), “The Positive and Negative Syndrome Scale (PANSS) is a clinical instrument principally developed for use in schizophrenia to identify the presence and severity of psychopathology symptoms.” During a study, Giesbrecht determined that PANSS is an appropriate and valid clinical measure for more heterogeneous marginalized persons in which substance misuse is ubiquitous. The PANSS is made up of 30 items and placed into sub-categories in which scores range from 30 to 210 points.

The NSA-16 is a semi-organized interview containing 16 items that thoroughly survey the negative disorder of Schizophrenia, and it incorporates the accompanying components: correspondence, feeling/influence, social association, inspiration, and hindrance. These elements are surveyed through an organized meeting and are broad and well-defined to help institutionalize evaluation. The assessments use a 6-point scale that rates five factors. The higher the score reflects the severity of Schizophrenia.

Clinical Global Impression Schizophrenia is a tool used to assess five different symptoms: depressive, negative, cognitive, and positive. The CGI-SCH is a less difficult scale as it comprises just two classes: seriousness of illness and level of progress. There has been great criticism when using this scale. Many critics believe that the scale lacks reliability.

Differential Diagnosis

Differential Diagnosis is the procedure of determining the difference between two conditions that have similar symptoms and signs. Schizophrenia mimics depressive disorder, bipolar with psychotic features, schizoaffective disorder, delusional disorder, schizotypal personality disorder, obsessive-compulsive disorder, and body dysmorphic disorder. According to APA (2013), “The Diagnosis of Schizophrenia is made when the psychotic episode is persistent and not attributable to the physiological effects of a substance or medical condition.

Prevalence

Prevalence is the number of people with a certain characteristic at any given time. Prevalence is estimated by a sample of people to help identify the characteristic. The data is determined by the number of people with the characteristic divided by the number of people randomly selected. A review of most literature shows that only around 1% of adults have Schizophrenia. There is a higher percentage of males versus females that have Schizophrenia. Studies have shown that Schizophrenia has had an effect throughout one’s lifespan. According to Dombeck and Nemade (2013):

It is fairly rare for children and older adults to develop Schizophrenia, but it does happen. The rate of Diagnosis of new cases increases in the teen years, reaching a peak of vulnerability between the ages of 16 and 25 years. Men and women show different patterns of developing the disorder. Males are more likely to have their first episode in the early to mid-20s. Females have two points where the first episodes are most likely to happen. The first is in the late-20s, and the second is after 40 years of age.
Studies have shown that many of the people diagnosed with Schizophrenia go without treatment.

Evidence-Based Treatment

An Evidence-Based treatment is a treatment that is backed by scientific research that proves effectiveness. Although, the patient must be willing to participate in their treatment in order for any treatment to work. There are few evidence-based treatments. The main evidence-based treatments that are used in society are Family Psychoeducation, Psychotherapy, and Pharmacotherapy.

Family members tend to play an important role in the treatment of someone with Schizophrenia. Many people diagnosed with Schizophrenia may present as ashamed and in denial about the disorder. They may even distance themselves from family due to being embarrassed. Family Psychoeducation is an evidence-based treatment that provides families with education and knowledge about mental illness. During this treatment program, families are taught coping, problem-solving, and communication skills to manage someone with mental illness.

In the story of Gina, the family may have been able to help Mary if they had more knowledge about Schizophrenia. Gina, on the other hand, had a daughter who was young but willing to attend the educational classes. It appeared that Gina was less of a burden on the family once they were able to recognize the signs and symptoms of Schizophrenia. According to Dasousa (2012), “It has been estimated across studies that 30-85% of adults with schizophrenia have a family member as a caregiver.”
Psychotherapy is individual counseling to help an individual address the signs and symptoms of the illness. Most sessions last anywhere between 30 to 60 minutes. According to APA (2016):

Research shows that most people who receive psychotherapy experience symptom relief and are better able to function in their lives. About 75 percent of people who enter psychotherapy show some benefit from it. 1 Psychotherapy has been shown to improve emotions and behaviors and to be linked with positive changes in the brain and body. The benefits also include fewer sick days, less disability, fewer medical problems, and increased work satisfaction. Psychotherapy also can have therapy sessions that include family members.

Pharmacotherapy is an evidence-based treatment that entails the use of prescription drugs. In many instances, antipsychotic medications are prescribed to assist with controlling the symptoms of Schizophrenia. During Genevieve’s acute episode of Schizophrenia, she was prescribed Abilify to manage her auditory hallucinations and paranoia. There are other oral medications for Schizophrenia, such as Olanzapine, Aripiprazole, Asenapine, and Paliperone. If a patient is uncooperative with oral antipsychotics, there are intramural injections. Like any other Evidence-Based treatment, the patient must be aware and understanding of a Schizophrenic diagnosis.

Course of Treatment

In the story of Gina, it has been proven with proper treatment and family support, a person with Schizophrenia may live a normal life outside of psychotic episodes. Gina exhibited signs of Schizophrenia in her early thirties. She went without treatment for many years. When she was diagnosed with Schizophrenia, she was in denial. Her family enabled her disorder to the point that it destroyed relationships. Gina was in the hospital involuntarily several times during psychotic episodes. It was Gina’s lack of cooperation that led her to live in a homeless shelter for nearly a year before deciding to get help. She is currently receiving psychotherapy and medications to manage the symptoms. She lives in her own apartment and has a full-time job.

Schizophrenia is not truly recognized until after severe odd behaviors occur. Many people are able to receive treatment and live normal lives. According to APA (2013), “Approximately 5%-6% of individuals with Schizophrenia die by suicide, 20% attempt suicide on more than one occasion, and many more have suicidal ideations.

Conclusion

According to research, there is not a cure for the schizophrenia disorder. Schizophrenia requires treatment throughout one’s life. Many people with the disorder are able to live a meaningful life. Studies have shown that many people with Schizophrenia struggle with social and occupational skills. They tend to make lower wages than their parents. According to APA (2013), “There is a strong contribution of genetic factors in determining risk for Schizophrenia, although most individuals who have been diagnosed with Schizophrenia have no family history of psychosis.

Reference

1. Gray, S. & Zide, M. (2013). Psychopathology: A Competency-Based Assessment Model for Social Workers (4th Ed.) Brooks/Cole.