Category: Schizophrenia

Identification of the disease

Schizophrenia is a chronic mental condition or disorder with a severe effect on the human mind, especially by affecting the patients thinking system (Barry, Gaughan & Hunter, 2012). In particular, the condition affects a persons ability to distinguish between reality and unreality. Schizophrenic patients are unable to think properly and clearly, manage emotions, or function normally (Barry, Gaughan & Hunter, 2012). Moreover, the condition affects personal relations with others, often causing conflicts.

Symptoms of schizophrenia

The primary and obvious type of impairment caused by the condition involves the disruption of the human processes of thinking. Schizophrenic people lose a lot of their ability to evaluate their surroundings and relate with others in a rational manner (Picchioni & Murray, 2011). They tend to believe in things that are unreal or untrue and reject reality. Hallucinations and delusions are common symptoms in schizophrenic patients (Van Os & Kapur, 2012). Both symptoms are disturbing to the patient and their families because they seem bizarre to the normal people, including those who are consistent with the abnormal perceptions and beliefs associated with the condition (Picchioni & Murray, 2011). Noteworthy, hallucinations and delusions are reflections of the distortions of the human mind, which in turn causes distortions of the persons perceptions and interpretations of reality (Barry, Gaughan & Hunter, 2012).

Individuals tend to develop a fear of anything, including the fear of unknown people, objects, or events. For example, a schizophrenic individual may purchase and use multiple locks due to the fear of theft or harmful individuals, yet the reality is that such fear is unfounded. However, to the patient, the actions are justified because hallucinations occur in the form of heard voices and bizarre and persecutory delusions (Barry, Gaughan & Hunter, 2012). As the condition persists, the individual develops disorganized thinking and speech, which includes loosely connected words that fail to make meaning. Eventually, the disease causes social withdrawal, loss of motivation, poor judgment, and untidiness (Picchioni & Murray, 2011). Some individuals also develop paranoia, inability to work, loss of long-term memory and attention, poor functioning, and slow speed of mental processing.

Conditions such as major depressions, anxiety disorders, and substance use disorders are normally associated with schizophrenia. More than 50% of the patients have are likely to have some of these conditions (Barry, Gaughan & Hunter, 2012).

Prevalence

Currently, about 24 million people in the world are schizophrenic, but only about 1% of the patients have disabilities due to the disease (Barry, Gaughan & Hunter, 2012). The disease causes more than 20,000 deaths per annum (Ayuso-Mateos, 2013). The occurrence is relatively uniform around the world, with Africa, Asia and Japan has about 340, 540, and 378 male patients per 1000,000 people respectively and 370 and 520 female sufferers per 100,000 people in Africa and Europe respectively (Barry, Gaughan & Hunter, 2012).

The peak period for the onset of the condition occurs around late adolescence and early adulthood, which explains why the brain functioning is damaged during its critical period of development. About 40% male and 25% female patients develop the disease before reaching the age of 19 (Kumra, Shaw, Merka, Nakayama & Augustin, 2001).

Moreover, between 0.3% and 0.9% of the total world population are affected by the condition during their lifetime (Barry, Gaughan & Hunter, 2012). Individuals affected by the condition have short life expectancies, often reducing by about 50% (Picchioni & Murray, 2011). The life expectancy of an individual who suffers the condition during childhood, adolescent or early adulthood is likely to be reduced by 10 to 25 years due to the associated physical health problems (Herson, 2011). In addition, it is worth noting that more than 50% of the patients are likely to attempt suicide (Herson, 2011).

Causes

Studies have revealed that schizophrenia occurs due to a combination of factors that affect individuals in any society. In particular, environmental and genetic factors play a significant role in the development of the condition because studies have shown that the condition may run through families (Picchioni & Murray, 2011).

The genetic conditions or factors that influence the condition have been a subject of biomedical studies in the recent past. However, the difficulty of separating the impacts of the environmental conditions and the genetic factors has made it difficult to elucidate the actual estimates of heritability of schizophrenia (Picchioni & Murray, 2011). Despite these difficulties, studies have shown that genetic factors are likely to be associated with the development of the disease because people with schizophrenic first-degree relatives and monozygotic twins have about 6% and 40% risks of developing the condition respectively (ODonovan, Williams & Owen, 2012). In addition, individuals with one schizophrenic parent and both schizophrenic parents have about 14% and 50% risks of developing the condition respectively (ODonovan, Williams & Owen, 2012).

With this knowledge, it has been able to carry out molecular studies to examine the actual genes that may be associated with the condition. In this case, a number of candidate genes have been identified or proposed. For example, the histone protein loci and the associated copy number variations and NOTCH4 gene have been proposed (ODonovan, Williams & Owen, 2012). The Zinc finger protein 804A is an example of genome-wide associations that have been identified and linked with the development of schizophrenia (ODonovan, Williams & Owen, 2012).

On the other hand, several environmental conditions have been identified and linked with the development of the disease. For instance, substance use is highly linked with schizophrenia. Excessive use of alcohol and hard drugs are the major environmental risks associated with the disease. For example, drugs like cocaine, amphetamine and binge drinking are likely to cause psychosis (Herson, 2011). Noteworthy, psychosis and schizophrenia have similar symptoms are may occur in individuals with the genes identified above.

Cannabis and nicotine have also been associated with the development of the condition. Individuals with the condition may resolve to use cannabis in order to cope with the symptoms (McLaren, Silins, Hutchinson, Mattick & Hall, 2010). In addition, some studies have shown that cannabis use cannot cause the disease but contributes to the development when other factors are present (McLaren, et al., 2010).

Apart from drugs and substance use, developmental and living conditions are associated with the disease. For instance, hypoxia, infections, malnutrition during fetal development and stress are associated with increased risks of developing schizophrenia in later life (McLaren, et al., 2010).

Diagnosis

The American Psychological Association has developed a comprehensive criteria for diagnosis of schizophrenia based on the APA 5^th edition of Diagnosis and Statistical Manual of Mental Disorders (DSM 5). In addition, the world health organization recommends the use of the ICD-10 criteria (Picchioni & Murray, 2011). Both methods use the self-reported experiences of the affected individuals as well as reported cases of behavior change and behavior anomalies. A mental health profession is then involved in a clinical assessment to establish the presence of the condition. Before making a positive diagnosis, the observed symptoms must occur continuously within the population and reach a critical level of severity (Picchioni & Murray, 2011).

Management

Antipsychotic medications are the primary treatment methods for the condition. They are combined with social and psychological support methods to ensure effective interventions. It is expected that the psychotic medications will reduce the symptoms within one or two weeks. The most commonly use antipsychotic drugs include olanzapine, clozapine, risperidone and amisulpride. Nevertheless, they have some side effect such as agranulocytosis, extrapyramidal effects and risks of diabetes and metabolic syndrome (Picchioni & Murray, 2011).

References

Ayuso-Mateos, J. L. ( 2013). Global burden of schizophrenia. New York, NY: World Health Organization.

Barry, S. E., Gaughan, T. M., & Hunter, R. (2012). Schizophrenia. BMJ Clinical Evidence, 359(1278), 567-73.

Herson, M. (2011). Etiological considerations. Adult psychopathology and diagnosis. New York: John Wiley & Sons.

Kumra, S., Shaw, M., Merka, P., Nakayama, E., & Augustin, R. (2001). Childhood-onset schizophrenia: research update. Canadian Journal of Psychiatry 46(10), 92330.

McLaren, J. A., Silins, E., Hutchinson, D., Mattick, R. P., & Hall, W, (2010). Assessing evidence for a causal link between cannabis and psychosis: a review of cohort studies. Int. J. Drug Policy 21(1), 109.

ODonovan, M. C., Williams, N. M., & Owen, M. J. (2012). Recent advances in the genetics of schizophrenia. Hum. Mol. Genet. 12(2), R12533.

Picchioni, M. M., & Murray, R. M. (2011). Schizophrenia. BMJ 335(7610), 915.

Van Os, J., & Kapur, S. (2012). Schizophrenia. Lancet 374(9690), 63545.

Abstract

The paper analyses the recent researches on the problem of schizophrenia. The works that study the historical, statistical and medical aspects are reviewed. Particular attention is given to the positive, negative, and psychomotor symptoms of schizophrenia like delusions, hallucinations, poor speech, confused thinking, etc. The importance of their early identification is underlined, as timely diagnosing increases the chance for the positive outcome of the illness. The approaches to diagnosing this disorder are presented. It is underlined that not only the symptoms but their duration are essential for diagnosing schizophrenia. The epidemiology and the possible preconditions for this disorder both in men and women are outlined. The gender differences in schizophrenia development are considered. The research reveals that schizophrenia most frequently develops in early adulthood. That is why special attention should be given to the study of this disorder in young men and women. Besides, the treatment methods which take into account the gender peculiarities are stated. The causes of the differences in schizophrenia development in young men and women are analyzed.

Introduction

Many people in the modern world experience depression, panic attacks, and other mental disorders. These symptoms are the subject of abnormal psychology which studies the pathologies of the mind. Schizophrenia is among the common mental disorders. It occurs in people regardless of culture or status. Butcher, Hooley, and Mineka (p.444, 2013) state that this disorder is characterized by an array of diverse symptoms, including extreme oddities in perception, thinking, action, sense of self, and manner of relating to others. Still, the major sign of schizophrenia is a critical loss of connection with reality. Miller (2015) mentions that the diagnosis of schizophrenia is usually applied to the people who behave so differently from the way they used to, that they look like different people. This state is also called psychosis, which is a psychological condition of breaking or delusion of the persons mind. The majority of researchers agree that the symptoms of this condition are hallucinations, incoherent speech, delusions, bizarre behaviors, disregard for personal safety, erratic dangerousness to self or others, becoming immobilized or completely withdrawn, or being uninterested in self-care and personal hygiene (Miller, 2015). The psychotic symptoms (like hallucinations and delusion) usually appear in men in early adulthood, or just after the age of 20. In women, they are revealed between the age of 25 and 30. The occurrence of schizophrenic symptoms after 45 is rare as well as before adolescence. That is why schizophrenia should be considered first of all as the illness of young men and women. The early disclosure of characteristic symptoms, further diagnosing together with adequate treatment increase the chance of the positive outcome. Thus, the research of the problem among the young people is the primary task.

Literature Review

According to Long et al. (as cited in Comer, 2015, p. 467), about 1 of every 100 people in the world has schizophrenia at some time in his or her life. The statistics of 2010 estimated the number of people with schizophrenia in the world as 24 million, among them 2.5 million people in the United States (Comer, 2015, p. 467). Apart from moral and financial resources, this illness increases the risk of other diseases which are often fatal. Laursen (as cited in Comer, 2015, p.467) states that people with schizophrenia live on average 20 years less than other people.

McNally (2016) investigates schizophrenia in the historical context. He studies the symptoms suggested by researchers throughout the history. He also analyses the problem of defining the notion of schizophrenia by different scholars and psychiatrists. He mentions the historic lack of agreement and inability to find an essential characterization of schizophrenia (2016, p.199). Still, McNally mentions the numerous approaches to schizophrenia treatment already as of 1936 (2016, p.208).

Abel and Nickl-Jockschat (2016) consider schizophrenia a severe neuropsychiatric disorder that not only causes a high burden of disease but also challenges our understanding of how the mind and brain work (p.3). If a healthy person controls actions or thoughts, the one suffering from schizophrenia cannot do it. Thornicroft, Brohan, and Kassam (as cited in Barlow & Durand, 2014, p.477) define schizophrenia as a complex syndrome that inevitably has a devastating effect on the lives of the person affected and on family members. This illness disorganizes the individuals perception, thought, language, and activity. Thus, it affects almost all components of everyday life. In spite of numerous researches and substantial progress in the treatment of schizophrenia, the number of absolute recovery examples is limited. This destructive disorder demands a lot of emotions from the sufferer and the surrounding people. Apart from emotions, it is a very expensive illness. According to Barlow and Durand (2014), schizophrenia costs about $60 billion to the United States every year. This amount includes the cost of treatment, care in the family, and the loss of earnings, for the people with this disorder do not work.

Symptoms

It is certain that schizophrenia is a clinical diagnosis. It has definite symptoms and signs, but there is still no test to discover and prove this disorder. International Classification of Diseases of World Health Organization (as cited in Castle & Buckley, 2015, p.4) states the following symptoms of schizophrenia. If a person observes at least one of those: thought echo, insertion, withdrawal, broadcast; passivity phenomena or delusional perception; third-person conversing or running commentary hallucinations or at least two of the following: persistent hallucinations in any modality, with delusions; disorganized speech; catatonia or any negative symptoms (which are primary), a visit to a doctor should be planned. Comer (2015) speaks of three types of schizophrenia symptoms. They are positive, negative, and psychomotor.

Positive Symptoms

Positive symptoms usually are the extremities and strangeness in an individuals behavior. Among these symptoms are delusions, confused thinking and speech, heightened perceptions, and hallucinations. Delusions are observed by most people with schizophrenia. Those ideas seem true but confuse the people. Some patients experience one dominating delusion during the illness. The others may have various delusions. Among the most frequent delusions is that of persecution. People believe they are chased or spied on. Other common delusions are those of reference, grandeur or control. Confused thinking and speech mean that people lose the ability to think logically, and speak unusually. It complicates the communication with the ill person.

As for heightened perceptions and hallucinations, the researchers agree that some people with schizophrenia observe the intensified perceptions and attention (Comer, 2015). Consequently, any important event becomes a torture for them. The problems with attention and perception may appear long before schizophrenia develops. Thus, they can be a signal of the coming disorder. Another frequent symptom of schizophrenia is hallucinations. Auditory hallucinations are the most common. People may hear voices or other sounds in their heads. The voices often give directions, thus stimulating the people for certain actions. Hallucinations can also be tactile, somatic, visual or gustatory (Comer, 2015). Apart from the mentioned above, people with schizophrenia demonstrate emotions inappropriate to the situation. For example, they may smile when telling bad news, or be sad in a situation happy for a healthy person.

Negative Symptoms

Negative symptoms can be explained by the absence of certain characteristics in people, or pathological deficits (Comer, 2015, p.474). Among the typical characteristics of schizophrenia are poor speech, weakened affect, lack of volition, and retraction from society. These deficits certainly influence the life of a person. The poor speech, or alogia, is usually characterized by little speech content. The people experiencing this disorder do not speak and think much. Some people may speak more, but their utterances lack sense. A lot of individuals with schizophrenia observe a blunted or weakened effect. It means that they are less sad, angry or happy compared to other people in their reactions to the reality. Some of them are unemotional. They are characterized with little eye contact and monotonous voices. As for the loss of volition, it is also observed among the people with schizophrenia. It is often called avolition, or apathy. The people with this symptom feel exhausted, uninterested, and having no aim. As a rule, it is typical of the people who have had schizophrenia for a long time. As a result, they are drained and purposeless. The feelings of people with schizophrenia are contradictory and uncertain. Another negative symptom is social withdrawal. The individuals with schizophrenia often prefer to retract from the society. They are obsessed with their fantasies and ideas; thus they do not need anyone. This withdrawal takes them even further from reality, as their ideas are disorganized and absurd. Such retraction may result in the loss of major social skills, which in its turn can make the treatment more complicated.

Psychomotor Symptoms

Apart from positive and negative, people with schizophrenia may observe psychomotor symptoms. The examples of those symptoms may be slow or strange movements, repeated grimaces, and unusual gestures. They pretend to have a certain magical or ritual purpose. The ultimate form of the psychomotor symptoms of schizophrenia is known as catatonia. The individuals in a catatonic stupor do not react to the surrounding. They may not move and be silent for long periods of time. People who experience catatonic rigidity can stay in a fixed, upright position for hours. Moreover, they turn down the attempts to move them. Besides, other people with schizophrenia may take clumsy and strange poses and hold that way for long periods of time. Another type of catatonia, the catatonic excitement, is characterized by excited and uncontrolled movements of arms and legs (Comer, 2015).

Diagnosing Schizophrenia

Both physical and mental illnesses have a set of characteristic symptoms. The discovery of symptoms, their correct interpretation, and the resulting timely diagnosing is half the way to the successful treatment. Some mental disorders are harsh. As a result, the people who experience them do not realize that their beliefs are not real. Consequently, they are not aware of the problem at all. Oltmanns and Emery (2015, p.4) define schizophrenia as a form of psychosis, a general term that refers to several types of severe mental disorders in which the person is considered to be out of contact with reality. A set of symptoms that are observed simultaneously during a certain period characteristic of a definite disorder is called a syndrome (Oltmanns & Emery, 2015). Every separate symptom is an untrustworthy indicator of a disease. Every feature here is important. The complex of persons behaviors is unique for every disorder. Apart from the complexity of symptoms, their duration is also significant. Constant inadequate behavior may be a sign of a mental disorder. Some accidental awkward behaviors disappear if ignored. Still, if they are repeated, they may be the symptoms of problems.

A problem with diagnosing mental disorders is that the symptoms are varied. Very often two people diagnosed with schizophrenia experience essentially different symptoms. The American Psychiatric Association (as cited in Awad & Voruganti, 2016, p.3) states that the degree of suffering and the degree of subsequent disability varies among individuals similarly diagnosed. Schizophrenia is a symptom-based diagnosis at the moment. The symptoms are confirmed by certain questionnaires. The most significant criterion for diagnosing is the functional decline (Awad & Voruganti, 2016). It means that people see the individuals with schizophrenia as disabled.

The American Psychiatric Association (as cited in Comer, 2015, p.476) considers a diagnosis of schizophrenia true only when the symptoms of the disorder last for at least six months. An individual should be in an active phase in minimum one of these months. This period is characterized by serious delusions, hallucinations, or disorganized speech. Moreover, the degradation of the persons performance in work and social life is observed. Some scholars believe that there is a possibility to predict the way of schizophrenia development. The so-called Type, I and Type II schizophrenia, should be distinguished (Comer, 2015). The individuals having Type I schizophrenia usually reveal mostly positive symptoms. Among these symptoms are delusions, hallucinations, and some thought disorders. The individuals with Type II schizophrenia observe mainly negative symptoms, for example, those of restricted affect, poverty of speech, and loss of volition. Marchesi et al., Corves et al. (as cited in Comer, 2015, p.478) mention that patients with Type I on the whole show more improvement, particularly with the application of medical treatment.

Epidemiology

Schizophrenia is a widespread disorder and is diagnosed all over the world (Awad & Voruganti, 2016). The illness has influenced approximately 50 million people in different countries. Men show a little higher incidence than women. Also, they may first experience this disorder in the earlier age. They also observe more negative symptoms, greater neurologic deficits, a worse course of illness (Awad & Voruganti, 2016). Thus, sex-specific factors are implied. During ones lifetime, the risk of having schizophrenia is less than 1 percent, about 0.7 percent in fact (Butcher et al., 2013, 445). Certainly, the statistics do not mean equal risk for everyone and just evaluates the average risk. There are certain categories of people who are under the high danger of developing schizophrenia. Among them are, for example, the individuals whose fathers were aged 45 to 50 years or more when they were born. Most of the schizophrenia cases start in late adolescence or early adulthood, within the age range of 18 to 30 years. There are the cases of schizophrenia onset in the middle age, but they are rare. Speaking of men, schizophrenia is discovered between ages 20 and 24. As for women, the age range is almost the same. Still, the peak is less obvious. As a rule, after the age of 35, the number of schizophrenia cases among men decreases. At the same time, the number of equal women remains the same.

The discovery of sex differences in neuropsychological measures is not new (Li & Spaulding, 2016). It has already been described. Still, the appearance of strong differences on tests could be connected to certain brain systems. The discrepancies discovered look like sex differences in height and weight rather than sexually dimorphic differences& Men on average are taller and heavier, yet we can readily think of women who are taller and heavier than most men or men who are shorter and lighter than most women (Li & Spaulding, 2016, p.210).

Schizophrenia in Men and Women: The Difference

Generally speaking, the diagnostic criteria for schizophrenia in men and women are the same. Nevertheless, certain differences can be observed between the two genders. As it was mentioned above, there is a slight difference in the age when schizophrenia first develops. For men, it occurs at the age of 15-20. Women may face the illness later, between 20-25 years. Another fact apart from the earlier occurrence for men is that schizophrenia in men often runs harder than in women. Probably, a female hormone estrogen has a protective function and prevents schizophrenia (McNally, 2016). The symptoms of schizophrenia also have some gender differences. When it comes to men, they observe the lack of will and low energy; they are not able to make decisions and plan their actions. As a rule, men with schizophrenia are less affected by medical treatment. As for women, the symptoms they experience are not so serious. The women are likely to give up the job and not make a problem of it, while men suffer the loss of the job severely. On the whole, men are expected to develop more severe forms of schizophrenia than women. While estrogen is efficient, the women have less risk of severe disorder than men (Butcher et al., 2013). Still, with the beginning of the menopause when the quantity of estrogen decreases, the percent of women observing schizophrenia symptoms increases.

Speaking of the preconditions of this mental disorder, the gender differences are also noticed. Women who were born to mothers with a viral infection have more chances to develop schizophrenia. At the same time for men, a birth trauma is a more probable reason to have schizophrenia in adulthood. It may be interesting to deal with male and female peculiarities of schizophrenia in more detail.

Schizophrenia in Men

Schizophrenia in men is a widespread mental illness. In fact, it is a group of progressing illnesses which can develop both slowly and rapidly, resulting in changes in personality, thought disorders, alterations in emotion and volition. Schizophrenia in men is a chronic illness which demands longitudinal observation of a specialist. The symptoms of schizophrenia in men scare their family and may cause the denial of the sufferer. Still, the disorder may be cured only with the support of the close people.

The reasons for schizophrenia in men may be various. One of them is an inherited predisposition. It results in the functional disorder of brain cells performance. The statistics prove that often the relatives of the man observing schizophrenia also suffer from some mental disorders. Then signs of negative inheritance may be obsessions, character oddness, alcoholism, the seasonal change of mood, suicides in the family. In addition to inheritance theory of schizophrenia development, the autoimmune and virus theories should be reviewed (Castle & Buckley, 2015).

The symptoms of schizophrenia in men can be both positive and negative. The positive ones are evident symptoms like hallucinations. The men start behaving strangely. This odd behavior usually includes delirium, pseudo-hallucinations, automatic actions, catatonia, unmotivated foolish behavior, obsessions, mood disorders, and depersonalization. The negative symptoms result in restraint, indifference, unsociable demeanor, the loss of emotional and volition qualities. They have more diagnostic value that the positive ones. However, these are not the only mental disorders characteristic of men with schizophrenia. Schizophrenia in men is often characterized with alcohol addiction. It can also be influenced by the previous traumatic brain injuries, which interfere the effective treatment (Castle & Buckley, 2015). If the illness develops in adulthood, the functions of memory and intellect are not affected. The non-standard perception and thinking may have striking results. There are famous scientists, writers, musicians or poets among the men with schizophrenia.

Schizophrenia can be diagnosed and treated by a qualified and experienced psychiatrist. The disorder may have various cases, both mild and severe. The modern techniques allow treatment out of clinics. The initial treatment stage includes intensive therapy necessary for the general condition stabilization. It is crucial to reduce the major symptoms as they have negative impact on the quality of life. Nevertheless, the treatment within a specialized clinic may have its benefits. In this case, there is no need to transport the patient who is often inadequate. After the basic stabilization, a further complex therapy is applied. It is aimed at the restoration of mental processes and is designed considering individual symptoms. The necessary corrections should be made in the course of treatment depending on patients reactions. In case of early diagnosing and appropriate treatment, the patients can restore their self-care skills and the social status.

Schizophrenia in Women

Schizophrenia in women is a complicated mental disorder with multiform clinical picture. Often it is a smoldering illness characterized by periodic attacks and remission periods. One of the theories of schizophrenia development in women is that of defective gene inheritance. The gene is considered to provoke the personality disorder. The obvious symptoms are observed in adolescence. It may include the low maternal instinct and hormonal disorders. Together they lead to the misbalance of perception, both of the surrounding world and the personality. The initial complex provoking personality pathologic changes is connected with the dissatisfaction of ones appearance. The denial of the social role is the next step. The first symptoms of schizophrenia in women reveal at the age of 25-30. The development of the disorder after the age of 50 is very rare. Apart from genetics, the roots of schizophrenia in women may be found in the change of family atmosphere, lasting stress, post-natal depression, various phobias and complexes (Castle & Buckley, 2015). Up to 2% of the diagnosed cases have virus or bacterial nature. In this case schizophrenia in women may develop as a result of bacterial or virus meningitis.

Among the symptoms of schizophrenia in women are hallucinations (both audial and visual), the persuasion in the influence from outside, the poorness of thoughts and emotions, apathy, the inability to make decisions, etc. The first symptoms are usually revealed in adolescence. Sometimes they may be conditioned by the lack of attention, both in family and from the opposite sex. In some cases, mental disorders lead to the physical ones. For example, bulimia is diagnosed together with schizophrenia among teenage girls. After some time, the symptoms of schizophrenia are followed by some personality changes. The patient may experience bad depression and aggressive behavior. The other symptoms of schizophrenia in women include the characteristic appearance, repetitive movements, delirium, monotonous voice, poor emotions. The patient is not able to feel joy or grief. The hygiene habits also suffer.

The treatment of schizophrenia in women should be organized in a clinic. However, a long stay in a medical institution may have negative results (Awad & Voruganti, 2016). The treatment usually includes biologic and social therapy. Particular attention should be given to prevention of recrudescence, as they make the illness more complicated.

Conclusions

The examination of schizophrenia symptoms, types, and possible variations of this disorder development gives an opportunity to evaluate the risks of the illness. Generally speaking, the disorder development is characteristic of the young age. The illness is widely spread and is not influenced by the race or place of living. It has certain genetic and gender-related roots. The core idea is that the knowledge of the symptoms and their correct interpretation may help to diagnose the disorder timely. As a result, the probability of the successful treatment increases. The treatment should consider the patients peculiarities, which include age, sex, personal characteristics, and the individual symptoms observed by a sufferer. Special approach and the professionalism of a doctor are the factors that influence the illness outcome. Despite the complexity of the disorder, the suitable treatment at the right time may result in the patients recovery and the return to the usual life.

References

Abel, T., & Nickl-Jockschat, T. (Eds.). (2016). The neurobiology of schizophrenia. London, UK: Elsevier.

Awad, A.G., & Voruganti L.N.P. (Eds.). (2016). Beyond assessment of quality of life in schizophrenia. Basel, Switzerland: Basel, Switzerland: Springer International Publishing.

Barlow, D.H., & Durand, V.M. (2014). Abnormal Psychology: An integrative approach. Stamford, CT: Cengage Learning.

Butcher, J.N., Hooley, J.M. & Mineka, S. (2013). Abnormal Psychology (16th ed.). Upper Saddle River, NJ: Pearson.

Castle, D.J., & Buckley, P.F. (2015). Schizophrenia (2nd ed.). Oxford, UK: Oxford University Press.

Comer, R.J. (2015). Abnormal Psychology (9th ed.). New York, NY: Worth Publishers.

Li, N., & Spaulding, W.D. (2016). The neuropsychopathology of schizophrenia: Molecules, brain systems, motivation, and cognition. Basel, Switzerland: Basel, Switzerland: Springer International Publishing.

McNally, K. (2016). A critical history of schizophrenia. Hanpshire, UK: Palgrave Macmillan.

Miller, R.B. (2015). Not so abnormal Psychology: A pragmatic view of mental Illness. Washington, DC: American Psychological Association.

Oltmanns, T.F., & Emery, R.E. (2015). Abnormal Psychology. (8th ed.). Upper Saddle River, NJ: Pearson College Division.

The neurological damage or changes to the brain as a result of the illness

Schizophrenia is a brain disease, which disables its victim in a severe and chronic way. It is estimated that about 1% of the worlds population develops this disease in their lifetime. It occurs in both men and women without notable disparity although it appears earlier in men than in women. Affected people tend to experience sever and chronic damage to brain. They tend to hear internal voices speaking to them; however, those near them cannot hear these voices. It also affects their speech, which appears incomprehensible as well as frightening to listeners. A number of treatments have been recommended but this has done little to eradicate the disease. In fact, it is only estimated that just one out of five patients suffering from schizophrenia recovers fully (Brunet-Gouet & Decety, 2006, p. 75-92).

Studies conducted on schizophrenia patients have revealed possible defects in the structure of brain. For instance, it has been notated that the ventricles, also known as fluid cavities are usually enlarged. These cavities reside in the interior of an individuals brain. In essence, notable imbalance of the complex systems is usually seen in the structure of brain. Moreover, it is usually common to find decreased size of some parts of the brain (Chou, Twamley & Swerdlow, 2012, p. 81-111). For instance, neuroimaging on patients suffering from schizophrenia have shown reduced metabolic activity in some parts of the brain. It is also important to note that microscopic studies on the tissues of brain have shown slight variations in the number of cells of the brain and their distribution patterns. Some scholars have also suggested the need to investigate brain development as a cause of schizophrenia. Biochemical changes in the brain have also been seen to precede symptoms of schizophrenia through studies conducted by neurobiologists (Keefe & Harvey, 2012, p. 11-37).

The behavioral or functional changes that can occur as a result of the illness

A number of behavioral changes are usually observed in people suffering from schizophrenia. These include distorted perception of reality, hallucinations and illusions, delusions, disordered thinking, emotional expression, and other abnormal behaviors. Distorted perceptions are usually observed in schizophrenia patients. They tend to perceive things that are different from those seen by normal people. They therefore feel frightened and confused as well as anxious (Hirsch & Weinberger, 2003, p. 481). This may include behaviors such as siting rigidly or seeming detached or distant. Hallucinations as well as illusions are other behavioral changes observed in schizophrenia patients. For instance, they tend to hear voices that only speak to them and not others around them. Moreover, some of them may experience it in sensory form where their ability to touch, taste or smell is also affected. Illusion is also possible in people affected by schizophrenia, they tend to interpret sensory stimulus incorrectly (Rector & Beck, 2012, P. 832-839).

Delusion is also another behavioral change possible in people affected by schizophrenia. In this regard, affected individuals tend to have weird personal beliefs that are only relevant to them. For instance, those who are paranoid tend to have delusions related to persecutions. It can also make other patients delusional about their neighbors or close family members. People suffering from schizophrenia also tend to have disordered thinking. This affects their capability to think straight since they get distracted easily. This makes it difficult for them to differentiate relevant things from irrelevant ones in a given situation. Moreover, it affects their ability to think logically and sequentially leading to disorganized thoughts. People who suffer from schizophrenia also tend to show lack of emotional expression. Schizophrenia affects their ability to express themselves emotionally. This may make them to appear apathetic. Behavioral changes are therefore numerous in people suffering from schizophrenia. However, the changes depend on the type of schizophrenia in an individual (Van Os & Kapur, 2009, P. 91-95).

References

Brunet-Gouet, E., & Decety, J. (2006). Social brain dysfunctions in schizophrenia: a review of neuroimaging studies. Psychiatry Res, 148 (2-3), 75-92.

Chou, H., Twamley, E., & Swerdlow, N. (2012). Towards medication-enhancement of Cognitive interventions in Schizophrenia. Handbook of Experimental Pharmacology, 213, 81-111.

Hirsch, S., & Weinberger D. (2003). Schizophrenia. New York: John Wiley & Sons.

Keefe, R. & Harvey, P. (2012). Cognitive Impairment in Schizophrenia. Handbook of Experimental Pharmacology, 213, 11-37.

Rector, N., & Beck, A. (2012). Cognitive Behavioral Therapy for Schizophrenia: an Empirical Review. The Journal of Nervous and Mental Disease, 200 (10), 832-839.

Van Os, J., & Kapur, S. (2009). Schizophrenia. The Lancet, 335 (7610), 91-95.

Summary of the Article

The author of the article begins by identifying the current gap in a biological study on schizophrenia (Marley, 1998, p. 437). Many scholars have ignored the significance of the environment in treating and understanding this disease. The author examines how physical and mood symptom changes arise from different interpersonal interactions. The article explains how the surrounding environment affects the psychological and emotional experiences of every schizophrenic patient. The author encourages every mental health professional to understand the critical role played by interpersonal interactions towards minimizing the symptoms associated with this mental disease. The study explores the best ideas towards reducing most of the suicidal behaviors and symptoms associated with schizophrenia.

Diagnostic Topic

The article explains how caregivers can deal with the symptoms associated with schizophrenia. The diagnostic topic identified in the article is the management of schizophrenia. The environment can support the needs of these patients. Mental health workers should allow every patient to interact with other people in society. This approach will present better outcomes. The study indicates how the targeted respondents supported the use of different interpersonal interactions towards reducing the symptoms associated with schizophrenia (Marley, 1998, p. 443). The above plan can supplement every treatment method in order to achieve the targeted health results.

Message to the Reader

This author supports the use of interpersonal interactions in every patient with schizophrenia. The author informs the reader why it is appropriate to promote the best environmental conditions and interpersonal interactions in order to support the needs of these patients. Every environmental force will deal with the symptoms associated with schizophrenia. The reader also understands why mental health workers should understand the importance of interpersonal interaction because it can help every schizophrenic patient. The reader understands why interpersonal interactions are critical towards reducing the symptoms associated with this mental condition (Marley, 1998, p. 442). This practice will play a critical role in assisting every patient with schizophrenia.

Significance to Social Work Practice

Social work practice is important in supporting the needs of every patient. The current research equips every social worker with valid ideas and skills to help every patient with different mental conditions. The article examines the importance of interpersonal communications and interactions. The above information supports the environmental practices that can reduce every symptom of this mental illness. Social workers can use these ideas to reduce the costs incurred whenever there is re-hospitalization. Every social worker will encourage different family members and relatives to support the changing needs of their schizophrenic patients (Marley, 1998). Interpersonal interactions are critical towards changing the symptoms in individuals with schizophrenia.

Why I Chose this Article

I chose this article because it presents new ideas for dealing with different mental conditions. Many biological types of research on the disease have not examined the benefits of the surrounding environment in the management of schizophrenia. The article goes further to explain how interpersonal interactions can support these patients. The practice results in the reduction of the symptoms of this mental condition. This article is meaningful because it helps mental professionals and social workers achieve their goals. I will use different social skills and interventions during my personal practice in order to support every schizophrenic patient. According to Marley (1998), every social worker and health professional should be ready to examine the persons surrounding environment. I will combine my competencies from this article to help every patient.

Reference

Marley, J. (1998). People Matter: Client-Reported Interpersonal Interaction and Its Impact on Symptoms of Schizophrenia. Social Work, 43(5), 437-444.

Methodology

Extraneous Variables

The major extraneous factors about the given research area are socio-demographic. These variables include age, gender, and race. Moreover, such factors as comorbid conditions, current living situation, substance abuse, educational and marital status, etc., may pose additional biases and should thus be considered.

Since the given research is intended as a randomized control trial, the primary methods of control over these variables may be randomization and regression analysis. In random sampling, extraneous factors affect the results of the evaluation of independent variables in different sample groups. Researchers consider this method of control as foreground in ensuring the balance between experimental groups (Martin & Bridgmon, 2012). However, it may be ineffective in case the sample size is insufficiently large. Statistical control implies the assessment of potential impacts of extraneous variables on dependent variables and their consequent elimination through the correction of their average values in each variant of the independent variable (Martin & Bridgmon, 2012). The given method may ensure a high level of internal validity and, therefore, can ensure credible research findings.

Instruments

In this study, quantitative instruments will be mainly used. Quantitative methodology implies the interpretation of numerical information and the use of statistical analysis. Therefore, for the evaluation of initial data, we will use the SPSS as it provides a large number of test options. For starters, the numbers about participants socio-demographic indicators will be assessed (e.g., the average age) using the chi-square test and then the characteristics of different sample groups will be compared. After this, the regression model will be developed applying the variables associated with predictors of readmission and the dichotomous variable as the outcome (yes = 1, no = 0). The model will allow managing differences between the primary and control samples. To examine the suggested model, the likelihood ratio will be evaluated. Researchers suggest using the Hosmer-Lemeshow test as it is one of the most accurate tests for measuring the goodness of regression models (Hosmer, Lemeshow, & Sturdivant, 2013).

Reliable research always shows internal consistency, stability, and equivalence. Thus, the instrument will be evaluated based on these criteria. The first attribute can be measured using item-to-total correlation or split-half reliability, which implies that study results are divided into parts or halves, and correlations are then calculated. Strong correlations will indicate the high reliability of the instrument, and weak correlations will be associated with low reliability (Heale & Twycross, 2015). Stability can be measured using test-retest, i.e., assessment of the same sample several times. And equivalence will be determined by analyzing the level of agreement in more than two researchers opinions on the inter-rater reliability of the instrument.

Description of Intervention

The intervention will be based on findings by Taylor et al. (2016) who suggest that hope, willingness, and responsible action is core to recovery. The researchers state that the implementation of brief recovery-focused interviews before the discharge of a patient at high risk of readmission may be effective in reducing the readmission rates. Considering this, the intervention must aim to engage patients in meta-cognition, development of personal responsibility, and willingness to discuss issues with professionals. To achieve this, health providers in a selected setting will conduct 30-minute interviews with study participants included in one of the sample groups before their discharge. During these sessions, practitioners and patients will discuss barriers to an individual commitment to self-care, causes of current admission and possible ways to overcome them in the future, development of the crisis plan, available sources of community support, aftercare methods, and so on. While the sample group that will be exposed to the suggested intervention will also undergo the formal treatment, the control group will only receive the usual care and will not participate in discussions.

The given intervention targets personal motivations, behavior, and attitudes to continual treatment and self-care. It facilitates access to necessary information about aftercare. In this way, it is expected that it will contribute to the reduction of readmission rates.

Data Collection Procedures

The study will employ both qualitative and quantitative data collection methods. The survey (subjective data), questionnaire (objective, socio-demographic data), and interviews will complement each other and will help evaluate the accumulated data from multiple perspectives. Interviews will provide information on the relationship patterns between the studied variables, e.g., practitioners attitudes, patients self-concepts, and barriers to intervention success (Grenfell & Lebaron, 2014). Qualitative data is interpretable and subjective, whereas, quantitative data is associated with a greater level of precision, accuracy, and objectivity. Quantitative methods (survey and questionnaire) will provide the necessary numerical and statistical information.

The data collection tools will be designed considering the primary ethical principles of research conduct. First of all, it is important to provide complete information about the purpose of the experiment to the participants to get their consent to meet the principle of voluntary participation (Koepsell, 2017). The administration of experiments without participants consent may be regarded as a violation of the ethical code.

References

Grenfell, M., & Lebaron, F. (2014). Bourdieu and data analysis: Methodological principles and practice. Bern, Switzerland: Peter Lang AG.

Heale, R., & Twycross, A. (2015). Validity and reliability in quantitative studies. Evidence-Based Nursing, 18(3), 66-7. Web.

Hosmer, D. W., Lemeshow, S., & Sturdivant, R. X. (2013). Applied logistic regression. Hoboken, NJ: John Wiley & Sons.

Koepsell, D. (2017). Scientific integrity and research ethics: An approach from the ethos of science. Cham, Switzerland: Springer.

Martin, W., & Bridgmon, K. (2012). Quantitative and statistical research methods : From hypothesis to results. Hoboken, NJ: John Wiley & Sons.

Taylor, C., Holsinger, B., Flanagan, J., Ayers, A., Hutchison, S., Terhorst, L., && Hutchison, S. L. (2016). Effectiveness of a Brief Care Management Intervention for Reducing Psychiatric Hospitalization Readmissions. Journal of Behavioral Health Services & Research, 43(2), 262-271. Web.

Background

Schizophrenia is a brain disorder that leaves the affected person unable to differentiate between right and wrong. It involves irregularities that occur within the brain chemicals which usually enable the brain cells to communicate. On the other hand, neurotransmitters are brain messengers that transfer information from one cell to another. These transmitters set themselves together forming circuit-like systems in the brain that process data. If any part of these circuits is destroyed, then the entire system may also fail to work. From the definition of neurotransmitters, it is clear that schizophrenia is caused by the irregular functioning of neurotransmitters. An individual will exhibit symptoms like those related to schizophrenia when neurotransmitters are blocked.

There are no definite known causes of schizophrenia, and just like conditions such as heart diseases which are known to arise from genetic factors, schizophrenia also falls in that category. Research studies have shown that schizophrenia runs in certain families. People who have relatives with this disorder are likely to suffer from the condition. The other causes of schizophrenia include all those factors or conditions that cause changes or affect one or more neurotransmitters in the brain.

There are millions of these transmitters in the brain, and if one is affected or altered, it affects the others since they are all connected. Two main transmitters have been much involved with the cause of schizophrenia. These are dopamine and glutamate which mainly deal with movement and thoughts. This paper explores three articles on schizophrenia and neurotransmitters as well as their contribution to the field of neuroscience.

Andreasen, N.C. (2012) Pharmacists Overview of Alcohol Dependence: Canadian Journal of Psychiatry 163 (11): 27-33.

First, we consider the article on pharmacists overview of alcohol dependence. It focuses on how alcohol dependence can lead to schizophrenia. According to Barnett and Levitt (2011), alcohol dependencies co-exist with schizophrenia. This has been supported by Ju et al. (2012). Alcohol dependency is a disorder that can be genetically passed and can be psychologically or sociologically triggered. Alcohol dependency has been found to have effects on the different neurotransmitters.

It affects the neurotransmitters that are related to an individuals mood, drive and cognition. Alcohol dependency alters the neurotransmitters called GABA, which interact with others causing abnormality in their working. This is assumed to be the cause of behaviors like indistinct speech, impaired balance and loss of muscle harmonization and others exhibited by individuals with alcohol dependency disorder.

The treatment of the alcohol dependency disorder would involve both the clinical treatment of schizophrenia and also the counseling on how to abstain or reduce the alcohol consumption rate because both of these are remarkably much related (Scott & Jeffrey, 2010). Physical abnormalities in the brain have been suspected to be causes of schizophrenia. In addition, people with this disorder have physical damage in their brains. The brains of people with this condition are different from those who are normal. Though research has shown that people with schizophrenia have these damages, not all people with the damages are at risk of being affected by the disorder.

This makes this factor not to be a sure measure of the presence of schizophrenia (Scott & Jeffrey, 2010). In this article, the genetic factor causing schizophrenia has been clarified because researchers have found that if an individuals first-degree relatives have the disorder, then the chance of an individual to be affected is 10%. An individual with second-degree relatives suffering from the condition has increased chances of being affected by the findings in this article.

According to Andreasen (2012), researchers know that certain genes cause schizophrenia, but it has been difficult to use genetics as bases for their research on the cause of schizophrenia. This idea has also been supported by Fava (2012). Kelvin states that if one is exposed to drugs like cannabis Sativa at a tender age, they are prone to this disorder especially if the drug is genetically predisposed in the individual.

Hirvonen, J. & Hietala, J. (2011). Dysfunctional Brain Networks and Genetic Risk for Schizophrenia: Specific Neurotransmitter Systems. CNS Neuroscience & Therapeutics 17(2): 8996.

According to the authors of the article, schizophrenia is the main disturbing factor in multiple neurotransmitter circuits. In addition, there is adequate empirical evidence that dopamine schizophrenia is also a major contributing factor in this type of disturbance. On the other hand, the authors are quite categorical that schizophrenia is a hereditary condition. Despite the risky nature of the condition, it is worth noting that neuroimaging has largely addressed the etiology and possible remedy of schizophrenia due to advances in medical technology that have already taken place. In particular, the article attempts to review the in vivo studies on imaging.

The latter area of study targets the characterization of neurochemical phenotypes of the condition. Hence, genetics and dopaminergic alterations are usually common features worth considering when discussing neurotransmitters and schizophrenia (Hirvonen & Hietala, 2011). From this article, it is clear that not only genes are involved in the development of schizophrenia, but also the environment influences a massive part of the development of it. These factors include lack of enough nutrients before birth, difficulties during birth, and many other factors. The authors have also discussed the role of chemical impedance in the brain contributing to schizophrenia.

It is stated that effects on the neurotransmitters lead to a chemical imbalance in the systems of the brain which involves the main affected transmitters leading to this disorder (Morrison, 2006). Researchers have also discovered that schizophrenia is a developmental disorder that results when neurons form erroneous links during fetal growth. It remains inactive till the puberty stage, which is a critical developmental stage, though research shows that the changes come first before the onset of the symptoms. With these findings, scientists are still exploring how genetics impacts the development of schizophrenia.

It is clear just like in the other articles that the sure causes of this disorder have not been found, but researchers are still working to reveal the mystery of this condition. On the causes of schizophrenia, several factors have been discovered, but there are still individuals with all these factors but do not suffer from the condition (Fuller, 2008).

Byron, K.Y. & Bitanihirwe, T.W. (2011). Oxidative stress in schizophrenia: An integrated approach, Neuroscience Biobehavioral Reviews, 35 (3): 878-893.

Byron and Bitanihirwe (2011) are quite categorical that the pathophysiology of schizophrenia is largely caused by oxidative stress. Specifically, when DNA, proteins, and lipids are damaged, the condition may easily develop bearing in mind that the cells become impaired and reduced in terms of functionality. If such damages persist, they may worsen the illness. There are current empirical studies that note that enzymatic and non-enzymatic antioxidant systems may also be altered in the process of cell damage.

In addition, mitochondrial dysfunction, oligodendrocyte abnormalities, and inflammation may also be observed during oxidative stress that leads to schizophrenia. Although the article provides ample literature review on the etiology and progression of schizophrenia, there is a lack of adequate empirical evidence and cross-study on the condition that can be used to draw tangible similarities and conclusions.

Though it has been found that a person from a family with this disorder is more likely to have the same disorder, research is still being done to understand the genetic factors related to schizophrenia. According to Fuller, (2008), Individuals inherit their genes from both their parents, and it is believed that several genes are responsible for increasing chances of developing schizophrenia. Factors like prenatal difficulties, viral infections and various other stressful conditions affect the development of schizophrenia.

The factor of being in family lineages with a history of this disorder also has been found to influence the development of schizophrenia, but it has not yet been understood how these genetic factors influence the development of this disorder. It is not yet certain that a person Fromm a family with a history of the disorder will have it as it is certain that alcohol dependency contributes to this disorder (Hafner, 2012).

Critique and contribution of the articles in neuroscience

In the article on a pharmacists overview of alcohol dependence, much focus has been put on alcohol dependency as a major cause of schizophrenia. Although alcohol dependency may be a cause of schizophrenia, it is yet to be proven whether the symptoms a patient exhibits are due to the alcohol dependency effects (Jingchun et al., 2011). In this article, the main cause of schizophrenia has not been discovered and it is only stated that scientists are still researching.

In the other articles, several causes of schizophrenia have been discussed, but still, it has been stated that it is not clear the main cause of this condition, just like in the first article. In all articles, all the researchers have not been able to identify the main cause of the condition. Many findings have not been clarified in the articles, for instance, the fact that the fact some individuals exhibit all the factors claimed to trigger the development of the condition, but they dont suffer from it in their lifetime (Scott & Jeffrey, 2010). What is clearly shown from the articles is the lack of enough information on the causes of schizophrenia. This is exhibited by the fact that in all the articles the writers state that more research is still being done (Scott & Jeffrey, 2010).

There are some conflicting findings in the finding in the different articles. In one of the articles, it is stated that scientists know that there are genes that are responsible for schizophrenia. In another article, it is stated that most scientists believe that genes dont cause schizophrenia directly.

The articles have contributed to a vast deal on the study of the brain. In understanding the causes of schizophrenia, the study of the functioning of the brain is highly essential because the brain is responsible for any behavior of an individual who depends on it. From the definition of schizophrenia, the causes of abnormal behavior can only be explained through the study of the functioning of the brain. The studies need to come up with the findings in these articles which are essential in the treatment of other mental disorders like alcohol dependency, epilepsy, and also insanity.

It is also imperative to note that the alcohol dependency condition is not only a clinical matter but also a mental disorder. As a matter of fact, this is a major contribution towards neuroscience bearing in mind that the guidance and counseling approach has been suggested as the best method of managing alcohol dependency. There are myriad other brain-related conditions that can also be managed through guidance and counseling. In addition, information obtained from the articles is also quite conclusive on some of the ways through which the mental health of an individual can be maintained. For instance, identifying factors that can detrimentally contribute towards mental health has been highlighted in the pieces of literature discussed above.

Furthermore, it is also worth noting that some of the health-related factors that lead to schizophrenia are directly or indirectly involved with the brain transmitters. From this discovery, there is an immense of knowledge that has been contributed in the field of neuroscience in regards to how neurotransmitters are instrumental towards the development of schizophrenia.

Conclusion

It is clear that schizophrenia is a mental disorder, which its cause has not been identified though there are leads to the final findings. Many factors have been identified but not fully proven to be the main cause. In the articles are the factors identified are linked to the neurotransmitters and it can be concluded that the main cause of the disorder is the lack of proper coordination in the brain. Remedies to the disorder have not been stated due to the incomplete findings on the causes.

The articles have contributed a vast deal to the already existing information in neuroscience which is an achievement. Other disorders related to schizophrenia have been related to it and how they can be causes of schizophrenia. Remedies to these disorders have been highlighted as well. Though there are many achievements from the research, the main cause of schizophrenia has not been concluded. Hence, the main objective has not been achieved in all the articles.

References

Andreasen, N.C. (2011). Pharmacists Overview of Alcohol Dependence. Canadian Journal of Psychiatry 163 (11): 27-33.

Barnett, H. & Levitt, P. (2010). Schizophrenia: Psychological Disorders. New York: InfoBase publishing.

Byron, K.Y. & Bitanihirwe, T.W. (2011). Oxidative stress in schizophrenia: An integrated approach, Neuroscience Biobehavioral Reviews, 35 (3): 878-893.

Fava, G. (2012). Schizophrenia; Basic Neurochemistry. Mental Health business week Journal 78(16): 18-24.

Fuller, E. (2008). Surviving schizophrenia: A Manual for Families, Consumers and Providers. New York: Harper Perennial.

Hafner, H. (2012). The Influence of Age and Sex on the Onset and Early Course of Schizophrenia. British Journal of Psychiatry 69(20): 80  86.

Hirvonen, J. & Hietala, J. (2011). Dysfunctional Brain Networks and Genetic Risk for Schizophrenia: Specific Neurotransmitter Systems. CNS Neuroscience & Therapeutics 17(2): 8996.

Jingchun S. et al. (2011). Application of systems biology approach identifies and validates GRB2 as a risk gene for schizophrenia in the Irish Case Control Study of Schizophrenia (ICCSS) sample, Schizophrenia Research 125( 23): 201-208.

Morrison, J. (2006) DSM-IV Made Easy: the Clinicians Guide to Diagnosis. New York: The Guilford Press.

Scott, T. & Jeffrey, A. (2010). Antipsychotic Trials in Schizophrenia: The CATIE Project. New York: Cambridge University Press.

Introduction

Searching for and developing alternative and effective methods for treating such a complicated disease as schizophrenia is the primary task of many medical scholars and organizations. In this regard, randomized controlled trials (RCT) are an integral scientific instrument that can assess the effectiveness of a new treatment by examining cause-effect relationships between an implemented intervention and outcome with reduced biases. This paper aims to analyze the article Cannabidiol (CBD) as an adjunctive therapy in schizophrenia: A multicenter randomized controlled trial by McGuire et al. (2018), primarily focusing on the statistical aspect.

Criticism

The objective of the study is to evaluate the effectiveness and safety application of cannabidiol (CBD) as an adjunctive treatment for patients with schizophrenia. The researchers have explored CBDs impact on cognitive performance, positive and negative psychotic signs, level of functioning, and the overall clinical impression of treating a psychiatrist. In a randomized, double-blind, placebo-controlled, parallel-group trial, participants who had partly responded to antipsychotic medication obtained either CBD or placebo as an auxiliary intervention for six weeks.

The number of participants, age structure, gender, race, the dose of received cannabidiol, the patients weight, height, waist circumference, and body mass index can be classified as independent variables. Herewith, the number of participants is a quantitative or discrete type of variable, gender is a binary variable, age structure belongs to the continuous type, and other variables are categorical. Symptom severity, cognitive performance, functioning level, and adverse events belong to dependent variables of categorical, ordinal type. The authors utilized descriptive and inferential statistics to describe input information and data retrieved from the findings. For example, the sample size includes 88 patients who met the inclusion criteria, of which 51 were male. Besides, 82 were white or Caucasian, three were black, and three  were from other races. The mean age accounted for 40.8 with a standard deviation (SD)  of 11.69, while BMI was 28.4 with an SD  of 5.35 (McGuire et al., 2018, p. 227).

Using the Positive and Negative Syndrome Scale (PANSS), the researchers also analyzed the alterations in symptom severity from baseline to the treatment end. Specifically, in the cannabidiol group (N=42), the mean of change from baseline score comprised 11.2 with SD  7.87, whereas, in the placebo group (N=44), the mean amounted to 8.8 with SD  8.87. Hence, the treatment difference between the groups consisted of 2.8 with a p-value of  0.133 (McGuire et al., 2018, p. 228). Similar measures for general functioning, symptoms, extrapyramidal signs, cognitive performance were conducted, and the most frequent adverse events were identified.

In conclusion, the article revealed the beneficial effect of CBD on patients with schizophrenia. In addition, the researchers specify that due to the independence of CBD from dopamine receptor antagonism, the substance can become a new class of treatment for the condition.

Reference

McGuire, P., Robson, P., Cubala, W. J., Vasile, D., Morrison, P. D., Barron, R., Taylor, A. & Wright, S. (2018). Cannabidiol (CBD) as an adjunctive therapy in schizophrenia: A multicenter randomized controlled trial. American Journal of Psychiatry, 175(3), 225-231.

The selected illness is schizophrenia, and three sites can be used for patient education such as Schizophrenia & Psychosis Support, a support group, WebMD, and Mayo Clinic. The critical components that I used to evaluate the sites are the owners, mission, references, and information review (NIH, 2022). Websites and social media platforms should make it straightforward for users to know who controls the site and its material. The Schizophrenia & Psychosis Action Alliance, for instance, developed the support group in partnership with Inspire, an online community that provides help for a range of health issues (Inspire, n.d.). WebMD is the most trusted and up-to-date source of health and medical news and information. According to WebMD (n.d.), the WebMD Medical Team collaborates with over one hundred countrywide doctors and health experts across a wide range of specializations to guarantee WebMDs information is updated, reliable, and valuable to health. Mayo Clinic Staff verifies the information published on the Mayo Clinic website, and the names of the medical specialists are mentioned (Mayo Clinic, n.d.). Additionally, the website explicitly states that it does not provide diagnosis or treatment; it is only for educational purposes.

The benefits of WebMD are that it mentions the authors name and the person who medically reviewed the information. For example, the schizophrenia article was authored by Shaw (2021) and medically evaluated by Neha Pathak. Moreover, there are possibilities to subscribe and sign in to receive the latest information on selected issues. I did not identify any improvements needed because WebMD is beneficial. After all, it ensures that the user gets the required information. Schizophrenia & Psychosis Support groups advantages are that the user can browse community topics easily, start a post, and connect with other group members. Nonetheless, the limitation is that anyone who signed up can create posts, and the information reliability may be questioned. The improvement needed is to medically review each post before it is published and filter for sensitive information that may harm users. Mayo Clinic provides vital data for patients; the limitation is that some articles like the one selected about schizophrenia do not mention the authors names. Hence, the advancement required is to add medical professionals information after the articles header. Essentially, the selected websites, including the support group, serve diverse and difficult-to-reach populations because they are free, easily found by Google search, and explain severe mental issues like schizophrenia in an accessible way.

References

Inspire. (n.d.). Schizophrenia & psychosis support.

Mayo Clinic. (n.d.). Meet out medical editors.

NIH. (2022). How to evaluate health information on the internet: Questions and answers.

Shaw, G. (2021).Schizophrenia: How to ask for help.

WebMD. (n.d.). Who we are?

Article Summary

The article Clinical relevance of paliperidone palmitate 3-monthly in treating schizophrenia discusses how the mentioned injectable antipsychotic (PP3M) improves non-adherence and prevents relapses in schizophrenia treatment using four injections per year. Paliperidone, the active metabolite of risperidone, is an antagonist of the D2 and 5HT receptors (Mathews et al., 2019). PP3M is based on a previous formulation, PP1M, used as a deltoid or gluteal injection. The article provides numbers related to NNT for relapse prevention and NNH indicators, including akathisia, tremor, dyskinesia, and parkinsonism. In addition, the authors argue that treatment stability is indicated by remission and reduction in negative and positive symptoms. However, schizophrenia is a psychiatric disorder that can also involve deterioration or incapacitation, meaning that other factors must be considered to achieve an adequate clinical response.

The articles authors take those factors into account while evaluating PP3M. Aside from everything mentioned, Mathews et al. (2019) discuss the dosing frequency of the antipsychotic, compare it to oral antipsychotics, and analyze how the information provided can improve treatment options and patient selection. The authors use tables to present the research data on placebo, PANSS, psychopathology, hazard ratio, relapse time, extrapyramidal symptoms, anticholinergic use, and other significant factors. Overall, the articles authors evidence supporting benefits of PP3M and encourage further studies on this topic.

List of Medical Terms

1. Paliperidone  brain-working medication.
2. Palmitate  salts and esters of palmitic acid.
3. Antipsychotic  a drug used to treat psychotic disorders.
4. Injectable antipsychotic  an antipsychotic administered as an injection.
5. Oral antipsychotic  an antipsychotic applied orally, usually in the tablet form.
6. PP1M  paliperidone palmitate formulation based on monthly injections.
7. PP3M  paliperidone palmitate formulation based on four injections per year.
8. Adherence  a patients compliance with medical advice.
9. Non-adherence  a patients incompliance with medical advice.
10. Relapse  deterioration after an improvement period.
11. Schizophrenia  a mental disorder related to abnormal interpretation of reality.
12. Treatment  the process of tending to a disease medically.
13. Injection  a method of administering a liquid using a syringe.
14. Metabolite  an endogenous compound formed in the processes of anabolism or catabolism.
15. Risperidone  an antipsychotic used to treat schizophrenia and bipolar disorder.
16. Antagonist  a substance that can stop another substances effect
17. Receptor  a protein-composed chemical structure receiving and transducing signals that may further integrate into biological systems.
18. Deltoid  a thick triangular muscle located in the shoulder.
19. Gluteal  a gluteus muscle located in the buttocks.
20. Prevention  process of preventing a disease or illness from occurring; prophylaxis.
21. NNT  the number needed to treat; a measurement of the medicine impact based on the number of patients needed to be treated to impact one person.
22. NNH  the number needed to harm; an epidemiological measurement indicating the number of people that need to be exposed to a particular risk factor to negatively impact one person.
23. Akathisia  a movement disorder that makes people struggle with standing still.
24. Tremor  involuntary rhythmic muscle contractions make one or several body parts shake.
25. Dyskinesia  involuntary erratic movements of face, trunk, legs, or arms.
26. Parkinsonism  any condition causing a movement abnormality (or a combination of them) related to Parkinsons disease.
27. Remission  partial reduction or complete disappearance of the symptoms of a specific illness.
28. Symptomatic remission  the condition of having less than five symptoms of a specific illness.
29. Functional remission  a combination of several clinical components, including symptomatic remission and the overall illness severity.
30. Symptom reduction  a significant decrease in the symptomatic presence.
31. Symptom  an element of physical or mental condition of the patient that is apparent to them an indicates the presence of a particular disease.
32. Psychotic symptoms  symptoms of a psychotic disorder, such as delusions, hallucinations, disorganized speech, confused thinking, and others.
33. Negative symptoms  symptoms that are abnormal when they are absent.
34. Positive symptoms  symptoms that are abnormal when they are present.
35. Psychiatry  an area of medical science related to mental illnesses.
36. Mental disorder  a mental pattern characterized by abnormal condition of patients thoughts, emotional distress, impaired perception, or a combination of those components.
37. Deterioration  the process of progressive worsening of a particular medical condition.
38. Incapacitation  physical or mental inability to communicate effectively and make rational and informed judgments.
39. Clinical response  communication among the members of a scientific medical community to address requests for various medical information.
40. Dose  an amount of a medical preparation administered at once.
41. Dosing frequency  a time period within which a medical preparation is administered repeatedly.
42. Patient selection  the process of deciding whether to treat a potential patient and accept the corresponding responsibility.
43. Treatment options  available ways of treating a specific patient.
44. Placebo  a medication with no therapeutic effect.
45. PANSS  positive and negative syndrome scale measuring severity of symptoms.
46. Psychopathology  the study of abnormal social behavior and cognition.
47. Hazard ratio  clinical trial statistic allowing physicians to identify the effectiveness of a specific drug.
48. Relapse time  the amount of time required for the patient to go into the relapse phase.
49. Extrapyramidal symptoms  side effects produced by antipsychotics.
50. Anticholinergics  substances blocking the effects of acetylcholine.

Reference

Mathews, M., Gopal, S., Nuamah, I., Hargarter, L., Savitz, A. J., Kim, E., Tan, W., Soares, B., & Correll, C. U. (2019). Clinical relevance of paliperidone palmitate 3-monthly in treating schizophrenia. Neuropsychiatric Disease and Treatment, 15, 1365-1379.

Introduction

Among all mental disorders, schizophrenia is one of the most severe mental illnesses in the human population. This is a chronic progressive disease, proceeding with polymorphic symptoms, leading to persistent impairment of social adaptation and the ability to work with patients at a young age (McCutcheon et al., 2020). At the heart of this disorder is a violation of the processes of synaptic transmission, leading to damage to neurons and their pronounced dysfunction (Searles & Knight, 2018).

According to modern concepts, schizophrenia is a multifactorial disease, the etiology, and pathogenesis of which are still represented by various hypotheses, which have not yet been summarized into one complex. It is unambiguous that the pathogenesis of this disease is based on a violation of neurotransmitter processes in the central nervous system (Alanen et al., 2018). In addition, a significant role in schizophrenia is played by a violation of the mutual regulation of the nervous and immune systems (Alanen et al., 2018). This paper analyzes several major current approaches to studying schizophrenia. It specifically focuses on several streams of research. First, it outlines hormonal and genetic mechanisms by reviewing the most recent studies on this matter. Second, it analyzes the role of neurotransmitters and the research on brain processes involved in the development of schizophrenia.

Hormonal and Genetic Mechanisms

Generally accepted modern biological theories of schizophrenia, based on experimental data and supported by clinical studies, include dopamine and glutamate theories. Along with other actively studied hypotheses, studies of the role of sex hormones in the pathogenesis of schizophrenia are of interest. The most famous in the current literature is the estrogen hypothesis of schizophrenia. First, the hypothesis of hypoestrogenism describes chronic estrogen deficiency in women with schizophrenia (Kulkarni et al., 2019). Second, the estrogen-protective hypothesis postulates the protective role of estrogens in women of childbearing age against the development of schizophrenia (Newton-Mann et al., 2017). Scientific research has shown that estradiol has a variety of functions in the brain. Thus, it was found that estradiol regulates gene expression, neuronal viability, the process of differentiation of neurons and glia, and synaptic transmission, and also has anti-inflammatory and reparative properties (Searles et al., 2018). Estrogens can modulate the number and sensitivity of dopamine receptors and monoaminergic transmission and significantly affect dopamine, serotonin, and GABA (Krolick et al., 2018). Thus, estrogen is seen to be the most important factor in schizophrenia development.

Sex hormones play an essential role in the formation and activation of neural connections in the brain. There is an assumption that a violation of the structural connections of the brain, a change in the density of the nervous tissue of the brain regions associated with the provision of attention, working memory, and executive and emotional-volitional functions in schizophrenia may be partially associated with an imbalance of sex hormones (Soria et al., 2018). In a few studies that control both the level of estrogens and the structural features of the brain, in patients with psychotic disorders, an association between reduced levels of estrogen and a decrease in the thickness of the cerebral cortex is found, which is consistent with the estrogen hypothesis of schizophrenia (Jerotic et al., 2021). Although the influence of sex hormones on the development of schizophrenia was known more than a century ago, the mechanisms of this influence are still poorly understood.

The estrogen hypotheses available today are being actively studied and are being confirmed in experimental and clinical studies. The available data indicate that the estrogen hypotheses do not contradict other modern ideas but rather supplement them. This is especially important for the development of a differentiated approach to the treatment of patients, taking into account their age and gender characteristics, and hormonal levels.

It is necessary to distinguish the chronic course of schizophrenia from therapeutically resistant (TR). Despite the chronic course of schizophrenia, a fairly large number of patients respond well to antipsychotic therapy by reducing symptoms and/or improving functioning (Elkis & Buckley, 2016). However, about one-third of patients do not respond to treatment  they are considered therapeutically resistant (Elkis & Buckley, 2016). For practical health care, this form of schizophrenia is associated with significant impairment of the functioning of these patients, longer hospitalization periods, and, accordingly, rather large financial costs (Elkis & Buckley, 2016). Despite the long-term study of the problem of TR-schizophrenia, the etiology of this condition is unknown.

The genes for receptors and SLC6A4, the main serotonin transporter, are the most fully studied in the aspect of TP-schizophrenia. In addition to the receptors proper (DRD1-5), the dopamine system also includes carrier proteins (DAT  dopamine transporter), metabolic enzymes (COMT  catechol-methyltransferase, MAO  monoamine oxidase) (Baou et al., 2016). A special gene, disrupted in schizophrenia, is also highlighted  DISC1 (Disrupted-in-Schizophrenia-1). The most intriguing information about this gene is that its exact function in the body is unknown, but its role has been shown as a genetic marker of schizophrenic spectrum disorders (Shao et al., 2017). Naturally, its role in the development of TR-schizophrenia is also being studied.

Neurotransmitters and Brain Processes

Previously, the development of schizophrenia was mainly associated with dopaminergic system dysfunction. However, the accumulated data suggested that the pathogenesis of schizophrenia may include dysfunction in the dopaminergic, glutamatergic, serotonergic, and GABAergic systems, which can lead to aberrant functioning of interneurons and manifest itself in the form of cognitive, behavioral, and social dysfunction (Yang & Tsai, 2017). According to graph theory, interactions between neurotransmitters can be depicted as nodes and edges (Yang & Tsai, 2017). The oxidative balance, immune and glutamatergic systems can be multiple nodes that block the central hub (Yang & Tsai, 2017). Thus, an imbalance in any nodes part can impact the whole system.

It was suggested that positive symptomatology in schizophrenia develops due to hyperactivity of dopaminergic neurotransmission. The classical dopaminergic hypothesis is based on the identification of high concentrations of dopamine in the terminals and D2 receptors of the subcortical region of the brain and the nucleus accumbens (Foley, 2019). With the accumulation of knowledge in this area, a hypothesis was formulated that a deficiency of dopamine neurotransmission in dopamine receptors DRD1 in the prefrontal cortex can result in cognitive impairment and other schizophrenia symptoms (Rice et al., 2016). Thus, dopamine is also seen as an essential factor in schizophrenia development.

Glutamate is the primary excitatory neurotransmitter of the central nervous system, and it is used by all neurons of the cerebral cortex, projecting axons beyond its limits (Uno & Coyle, 2019). It is known that glutamate plays a vital role in synaptic plasticity, one of the manifestations of which is long-term potentiation and the formation of new synapses (Uno & Coyle, 2019). An increasing number of publications indicate the involvement of glutamate signaling in the neurobiology of schizophrenia and other psychiatric disorders such as major depression and bipolar disorder (Uno & Coyle, 2019). Posthumous studies show an altered density of dendritic spines in the brains of patients with schizophrenia, indicating that remodeled neural networks may be involved in the disease development (Berdenis van Berlekom et al., 2020). Drugs that interact with the glutamate system tend to attract attention because they show efficacy in animal models and potential therapeutic effects in a clinical setting.

Serotonin is an important neurotransmitter involved in regulating cognitive functions, memory, learning ability, appetite, vascular tone, coagulation, functioning of the immune system, dopamine release, and sexual desire (Stahl, 2018). Serotonin signaling in the brain through cAMP and CREB activates the expression of many genes that encode proteins required for neuronal growth and brain cell viability (Wang et al., 2018). In addition, the signaling pathways of serotonin interact with the signaling pathways of dopamine, glutamate, acetylcholine, and gamma-aminobutyric acid. Dysfunction of serotonergic neurotransmission is a critical link in the pathogenesis of schizophrenia (Yang & Tsai, 2017). Serotonin receptors are involved in various neurobiological manifestations such as aggressiveness, anxiety, increased appetite, decreased learning ability, and memory impairment; they are also targets for antipsychotics. According to the serotonin theory, the development of schizophrenia is due to a deficiency in serotonergic neurotransmission (Stahl, 2018). Thus, serotonin is also included in the explanation of schizophrenia development.

According to the kynurenic hypothesis, schizophrenia is considered the result of an imbalance in the metabolism pathways of tryptophan (Plitman et al., 2017). Kynurenic acid (KA) is a neuroactive metabolite of tryptophan, formed in the brain and peripherally, which is known to block ionotropic glutamate and ±7-nicotinic acetylcholine receptors (±7nAChR), acting as a ligand for the GPR35 receptor for the G-linked protein and the receptor human (AHR) (Plitman et al., 2017). KA appears to modulate several mechanisms that lead to schizophrenia development, including dopaminergic transmission in the mesolimbic and mesocortical regions or glutamatergic neurotransmission (Plitman et al., 2017). The kynurenic hypothesis discusses the appearance of various symptoms of schizophrenia and cognitive impairments characteristic of the disease.

There is also evidence of the relationship between cognitive impairment in schizophrenia and changes in brain structures. Structural changes in the brain, such as a decrease in the volume of gray matter and a violation of the integrity of the white matter, are considered a substrate for the development of cognitive impairments in schizophrenia (Mouchliantis et al., 2016). The data of functional brain imaging methods revealed abnormal neural activity in solving cognitive tasks associated with the function of working and long-term memory, decision-making, and emotional response to relevant situations (Keshavan et al., 2017). At the level of structural and functional connectomes, one can see the differences in the interaction of neural networks in schizophrenic patients and healthy ones (Sun et al., 2019). These differences are especially noticeable when constructing dynamic connectomes at rest.

The influence of a decrease in the volume of the prefrontal cortex and anterior cingulate gyrus on the development of disorders of emotional intelligence and social functioning is also shown, which is reflected in the concept of the theory of mind or the concept of cognitive dysmetria (Mothersill et al., 2016). It is assumed that rest networks can be used as a biomarker for preserving the cognitive-affective sphere in the study of neurodegenerative processes (Mouchliantis et al., 2016). Further research in this direction is required; in particular, conducting a comprehensive neurophysiological, immunological and clinical examination of patients in dynamics is crucial. It will make it possible to establish stable relationships between the studied parameters, as well as the clinical significance of changes detected in patients with fMRI and assessment of immunological parameters, to determine the possibility of research results implementation into clinical practice.

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