Schizophrenia is a severe, insistent, and an incapacitating mental illness. People with the disease have decreased rates of engagement, marriage, and self-regulating life than other individuals do. The positive symptoms of the disease incorporate hallucinations associated with hearing, illusions, and disordered language and behavior (Frankenburg, Dunayevich, and Albucher). It also has negative symptoms comprising of diminished sensitivity, lack of speech, and diminished interest. The disease also presents cognitive symptoms associated with memory (Keefe and Joseph 12). Finally, schizophrenia patients also exhibit symptoms associated with mood swings, such as being unreasonably happy or sad.
Main Body
“Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM – IV – TR)” is applicable in diagnosing schizophrenia (Frankenburg, Dunayevich, and Albucher). The diagnosis takes place through observing patients’ symptoms to determine whether they meet the DSM – IV – TR benchmarks for identifying the disease (Frankenburg, Dunayevich, and Albucher). The symptoms of schizophrenia captured in the DSM – IV – TR includes illusions, hallucinations, and disordered language. The tool also captures disordered behavior and harmful symptoms.
Specialists acknowledge the difficulty in distinguishing schizophrenia from methamphetamine (METH) induced problems (Rawson 19). The difficulty emerges because of the similarity in their hallucination characteristics. It is normally problematic to differentiate the hallucinations of the disease from those of METH. METH induced disorders also incorporate noticeable hallucinations and illusions (Rawson 19). The presence of METH-induced illnesses is determined through a psychosis process involving a comprehensive examination of the history of patients. The determination takes place after undertaking physical examination, urine, drug, and reality tests.
Specialists argue that the hallucinations of schizophrenia comprise hearing problems. On the contrary, the hallucinations of METH-induced illnesses normally comprise of visual or tactile problems. Furthermore, a meth-induced disorder exhibits visual illusions (Lieberman, Stroup, and Perkins 194). The illusions are associated with hyperactivity, overactive sexual needs, misperception, and confusion, and signs of disorganized thinking. Schizophrenia patients also exhibit symptoms of inability to speak. Generally, the inability to speak lacks among patients with METH disorders (Tsuang, Stephen, and Stephen 71).
Although the symptoms of the two diseases are largely similar, the schizophrenia is real. Schizophrenia patients show an inability to speak while people with METH do not. Furthermore, some studies have linked heavy METH use to escalated schizophrenia (Rawson 21). The study focused on people without a history of mental disorders. The study showed that people with conditions linked to METH had a high chance of developing schizophrenia than individuals who do not use the drug (Rawson 19). Therefore, the use of METH escalates the emergence of schizophrenia.
It is notable that most schizophrenia-related cases have been recorded in the U.S. This is not an indication that Americans are at risk of developing schizophrenia. The country has advanced technology and methods for disease identification (Lieberman, Stroup, and Perkins 194). Therefore, the investigation of diverse diseases within the population has expanded extensively as compared to the level of studies to identify diseases in other countries. Furthermore, there is nothing special about the many cases of schizophrenia recorded in the country. The high cases of schizophrenia are associated with widespread disease investigation.
Conclusion
Schizophrenia entails a chronic psychiatric disease categorized by deficiencies in perception, awareness, and social and work-related effectiveness. Schizophrenia patients exhibit positive and negative symptoms. The disease has shown great similarities with METH induced disorders. This has generated doubts about whether schizophrenia is real. However, this paper suggests that Schizophrenia is real because some of its aspects are different from those of illnesses induced by methamphetamine use.
Works Cited
Frankenburg, Frances., Dunayevich, Eduardo., and Albucher, Ronald. Schizophrenia. 2013. Web.
Keefe, Richard S. E, and Joseph P. McEvoy. Negative Symptom and Cognitive Deficit Treatment Response in Schizophrenia. Washington, DC: American Psychiatric Press, 2001. Print.
Lieberman, Jeffrey A., Stroup, Scott., and Perkins, Diana. Textbook of Schizophrenia. Washington, DC [u.a.: American Psychiatric Publ, 2006. Print.
Rawson, Richard A. A Clinician’s Guide to Methamphetamine. Center City, Minn: Hazelden, 2004. Print.
Tsuang, Ming T, Stephen V. Faraone, and Stephen J. Glatt. Schizophrenia. Oxford: Oxford University Press, 2011. Print.
Cognitive psychotherapy, a therapeutic method that is normally used in conjunction with behavioural approaches, has been proven to be an effective method in the treatment of a variety of psychological conditions. These conditions include panic attacks, schizophrenia, or even a problem like depression. Sometimes the two approaches intrinsic in this kind of treatment are combined to form its name, as in cognitive-behavioural psychotherapy.
The basic idea in cognitive therapy is the fact that the cognitive aspect of esteem, the way we perceive problems, the world, and other mundane aspects of life like expectations and beliefs are chief determinants of our success in dealing with problems and working towards the realization of our dreams. Schizophrenia is a psychological problem in which the victim suffers distorted perceptions of self, and the world.
This disorder is caused by disordered thinking, which is also a major characteristic of the disorder after it is diagnosed. With this definition of schizophrenia, it is logical that a cognitive approach is employed in the treatment of the problem 3. This is because medical interventions, which are associated with alleviation of psychotic thought processes, would jeopardize therapy.
History of treatment
The treatment of schizophrenia has used behavioural approaches for many years. This has, however, been implemented through programs for psychosocial rehabilitation as opposed to an approach biased on individual treatment. The programs for psychosocial rehabilitation were very expensive and thus they were either based in hospitals, funded by the government, or they were funded by NGOs.
This led to group behavioural treatment that was offered by providers with mediocre expertise. Although some success in was realized by these programs, the real value that can possibly come with behavioural treatment was hidden by the massive structure of the rehabilitation programs 5. This is because the programs were, to a large extend, dissimilar, and thus it was hard to evaluate their comparative effectiveness.
The cognitive component
Among the major symptoms for schizophrenia is the habitual misinterpretation of happenings. The patient may not change after the misinterpretations are explained clearly to him/her 4. This may occur due to complications in the biological set-up of the client. Cognitive therapy can also work in a case where the psychologist comes up with a tailor-made solution for his/her patient that consists of a way of dealing with life problems in the patient’s state of mind.
That is, the doctor will understand the extent of the imperceptions of his/her patient and make the patient use his/her imperceptions in the recovery process 2. The intention is to make the client to learn from experience, after the therapy, for him/her to make the necessary adjustments.
After treatment, a patient is not expected to recover completely, but the manner in which he/she handles issues in life is expected to change for the better. The patient is also expected to have a sense of autonomy, and make good decisions in times of crisis. Thus the patient will be able to cope with stress positively and avoid unrealistic mentalities.
The behavioural component
The behavioural therapeutic option for schizophrenia operates under the assumption that certain life skills have the ability to make a person solve life problems with more ease, and live a more fulfilling life. It uses the fact that the development of psychosocial skills in human beings is as a result of experience.
Thus the saying that people learn from their past mistakes, and success in solving life problems is applicable in this kind of therapy. From the fact that different people have different experiences in life, it follows that some people will be able to learn skills better than others 3.
Another difference that normally occurs in the learning capability of individuals is the extent to which an individual can learn from his/her past experiences. It is common knowledge that for a person to learn from experience, he/she has to have the capability to critically analyze the experience. The individual must, therefore, be able to point out the effective and ineffective methods that he/she used to solve the problem.
This should be followed by a strategic replacement of the ineffective methods with better methods and retention of the effective methods. Since different people have different abilities to analyze experiences, there are significant differences in the abilities of people to use past experiences as stepping stones to success. The role of a therapist here would be to help his/her client to correctly analyze his/her experiences, and suggest changes that could improve the problem solving ability of the patient.
Unfortunately, we also adopt maladaptive approaches to problems in cases where the approaches are able to minimize our pain or embarrassment caused by a given problem. This is, in fact, the reason why schizophrenia keeps on getting worse in its patients. The maladaptive practices that the patients develop for specific problems act as a haven from the problems, and thus the patient may keep on adopting other negative responses to feel secure in a problem 1.
It can thus be argued that development of maladaptive approaches to problems is the root cause of cognitive distortions which, in turn, render an individual unable to assess cause and effect in relation to problems.
This is actually the main reason why behavioural therapy and cognitive therapy go hand-in-hand. To evidence the necessity of the cognitive-behavioural psychotherapy individuals with schizophrenia, schizophrenic individuals are unable to make correct assessments of their problems, and thus they cannot perform a reliable cause-effect analysis.
They are also characterized by an inability to learn from experience due to the characteristic distortions associated with their thinking. Therefore, the behaviour therapy that is accorded to them by a therapist is meant to help them learn social and decision making skills. It also makes them learn how to apply the aforementioned two skills in solving their personal problems.
Conclusion
As evidenced in the discussion above, the combination of cognitive therapy and its behavioural counterpart is efficient in the treatment of schizophrenia. This is primarily because the disorder itself has cognitive components as well as behavioural components, and an application of either of the two without the other will not be effective. For instance, schizophrenic patients have distorted and disorganized mental frames.
This is a cognitive component of the disorder that cannot be effectively treated by behavioural therapy. On the other hand, schizophrenic patients are normally unable to effectively learn from their past because of their poor analytical skills. This is a behavioural component of the disorder that cannot be effectively treated solely by cognitive therapy. It is thus of essence that schizophrenic patients are exposed to cognitive-behavioural therapy in order for their situation to improve.
The development of the effective treatment plan is one of the main tasks of professionals who work with patients suffering from mental or personality disorders. Oscar, a 25 year-old Hispanic man, reports that he is hearing voices and that his colleagues are planning to bury the young male alive. In order to be able to help Oscar seeking the therapy, it is important to focus on all the provided details, to identify symptoms, and to conclude regarding the possible psychiatric evaluation and further treatment. The purpose of this paper is to examine the symptoms characteristic for Oscar in order to determine whether it is necessary to conduct the psychiatric evaluation for the young man and propose the plan of treatment appropriate for Oscar.
Reasons to Recommend Psychiatric Evaluation
Psychiatric evaluation is important to test the hypotheses regarding the patient’s state that are made by professionals. Focusing on Oscar’s reported symptoms, it is necessary to recommend the psychiatric evaluation because the young male is concerned about his state, and his symptoms can be regarded as hallucinations and delusions typical for psychotic or mental disorders. It is possible that Oscar suffers from such hallucinations as hearing voices as well as from visual hallucinations when he states that he can see spiders in the workplace and in the bedroom. Furthermore, Oscar’s ideas about delusions about co-workers who are plotting to bury the man alive can also be symptoms of psychotic disorders.
Although the evaluation procedure may not lead to formulating the diagnosis, it is necessary to conduct the assessment of Oscar with the focus on interview, psychological assessments, and physical examination in order to state whether a psychotic disorder is observed. Oscar is seeking the therapy, and it is important to collaborate with the patient and evaluate his state in order to guarantee the patient’s safety.
Possible Disorders
The careful psychiatric evaluation is necessary in case of Oscar because the reported symptoms can be associated with such diagnoses as schizophrenia and schizoaffective disorder. It is possible to speak about schizophrenia because Oscar reports hearing voices that can be discussed as auditory hallucinations. Furthermore, it is important to focus on Oscar’s experience with finding spiders in the workspace and in the bedroom because these experiences can be discussed as visual hallucinations. In addition, the ideas about plotting against Oscar can be discussed as delusions typical for paranoid schizophrenia as a subtype of schizophrenia.
Oscar also focuses on the problems with concentration. Much attention should be paid to the fact that Oscar often argues with the relatives and the young man discusses the mother and brothers as attacking him. In combination with the high blood pressure, these symptoms and behaviors are typical for the paranoid schizophrenia.
In addition, it is also important to focus on the results of the psychiatric evaluation in order to conclude about the possible presence of the schizoaffective disorder because Oscar’s discussion of quarrels and relatives’ attacks can be associated with changes in the mood. However, the young man does not demonstrate problems with cleanliness and other aspects of physical appearance. The information about possible episodes of mania or depression can be gathered with the help of the interview and psychological tests.
Possible Treatment
Medication
The pharmacological treatment with the help of medications of first and second generations is effective to control a range of psychotic symptoms that are typical for schizophrenia. The psychosis that is not treated with the help of medications often has the negative prognosis, and psychosis episodes are characterized by the longer duration. However, the use of medications can be problematic because of many side effects influencing the patient’s physical state, emotional state, and social activities.
It is important to pay much attention to choosing the appropriate medication for Oscar because of his problems with the blood pressure. For instance, Aripiprazole can cause the undesired activation and then abrupt sedation, Risperidone can cause the acute hypotension (Gadelha, Noto, & De Jesus Mari, 2012, p. 491). Such changes in the blood pressure can affect the physical state of Oscar negatively.
Approaches
Professionals determine person-focused, empathic, and collaborative perspectives and approaches along with perspectives associated with psychological, social, and psychosocial interventions. In spite of the positive effects of person-focused, empathic, and collaborative approaches to working with patients suffering from schizophrenia, these approaches are rather ineffective when they are not supported with other types of treatment.
Therapeutic Techniques
Therapies are closely connected with the discussed approaches, and there are such types of therapies used for treating patients with schizophrenia as cognitive therapy including the cognitive behavioral therapy, psycho-education, psychosocial adaptation, family intervention, community treatment, and social skills training. These therapies and associated therapeutic techniques are considered as effective to help persons with schizophrenia to balance their lives, to improve their social relations, to improve their emotional state, and to teach them how to cope with hallucinations and delusions (Addington, Piskulic, & Marshall, 2010, p. 261).
It is important to note that many specialists choose therapeutic techniques even in contrast to the use of medications because pharmacotherapy often has significant limitations, and the main focus of treating schizophrenia is to help patients cope with their symptoms while guaranteeing functional and emotional improvements.
Best Possible Treatment
Referring to the discussion of the proposed approaches to treat schizophrenia, it is possible to state that the best option for Oscar is the combination of pharmacotherapy and psychosocial therapy. According to Gadelha, Noto, and De Jesus Mari, “the main aim of treatment, by combining medications and psychosocial interventions, is to improve functional recovery and social reintegration of patients” (Gadelha et al., 2012, p. 496).
Thus, the reason for choosing the combined method is that the psychosocial therapy includes the elements of the traditional cognitive behavioral therapy and therapies oriented to the social adaptation and improvement of relations with relatives and the other people (Addington et al., 2010, p. 262).
The psychosocial therapy is important for Oscar to improve his social interactions, relations with the mother and brothers, and relations with co-workers. Still, pharmacotherapy is also necessary because Oscar needs to control such psychotic symptoms as hallucinations and delusions. However, in case of Oscar, it is important to pay much attention to the selection of the medication that has minimal side effects and does not influence the young man’s blood pressure. From this point, the choice of the combination of pharmacotherapy and the psychosocial therapy seems to be relevant if the main focus is on the psychosocial therapy.
Conclusion
Symptoms reported by Oscar can be discussed in the context of developing schizophrenia. As a result, it is possible to propose the psychiatric evaluation and the further treatment of the patient with the focus on the psychosocial therapy. The combination of pharmacotherapy and psychosocial therapy is expected, but the use of medications can be limited to address the young male’s problem with the high blood pressure.
References
Addington, J., Piskulic, D., & Marshall, C. (2010). Psychosocial treatments for schizophrenia. Current Directions in Psychological Science, 19(4), 260-263. Web.
Gadelha, A., Noto, C., & De Jesus Mari, J. (2012). Pharmacological treatment of schizophrenia. International Review of Psychiatry, 24(5), 489-498. Web.
This paper supports the argument that schizophrenia is an extreme form of schizotypy. This argument bases its structures on research studies, which demonstrate the genetic link between both disorders and the medical evidence showing schizophrenia as an extreme form of schizotypy. The use of Meehl’s model to expose extreme forms of schizotypy as a manifestation of schizophrenia also informs the findings of this paper. This evidence (coupled with the fact that schizotypy is a continuum of mental disorders) demonstrate that schizophrenia is an extreme form of schizotypy. Comprehensively, the redefinition of schizophrenia as an extreme form of schizotypy signifies a strong impact on the classification of mental disorders.
Introduction
Clinically, it is often difficult to distinguish schizophrenia from schizotypy. However, Hoermann (2009) explains that both concepts are unrelated because schizophrenic patients exhibit severe symptoms of mental disorder while patients suffering from schizotypy experience mild forms of mental disorder. Schizophrenia is a mental disorder, which is often characterised by a strange perception of reality. Perhaps the most feared outcome for patients who have this disease is their high probability of committing suicide.
Recent estimates show that about a third of patients suffering from schizophrenia are suicidal (Hoermann, 2009). These statistics also show that most of these patients commit suicide within the first 20 years of diagnosis (Hoermann, 2009). The ambiguity in distinguishing schizophrenia from schizotypy partly contributes to this high suicide rate because some schizophrenic patients get the wrong diagnosis (a wrong diagnosis contributes to worsened mental states, which later contribute to high suicide rates).
It is, therefore, crucial to distinguish schizophrenia from schizotypy because they share similar symptoms. For example, if a patient suffers from schizotypy and gets the correct treatment plan, they may reduce the probability of developing schizophrenia. This way, the relationship between schizophrenia and schizotypy is established and severe outcomes of mental disorder (such as suicide) reduce. However, understanding the relationship between schizophrenia and schizotypy depends on understanding both mental disorders.
Schizotypy refers to a continuum of psychological states, which range from mild forms of normal dissociative behaviours to extreme forms of imagination and illusion (Mental Health Centre, 2012, p. 1). Patients who suffer from schizotypy show odd and peculiar behaviours, which characterise their personality throughout their illness. They are also more socially isolated than ordinary people are. The Mental Health Centre (2012) adds that it is also unsurprising to see patients who suffer from schizotypy harbouring odd beliefs and superstitions.
From the above definitions (of schizophrenia and schizotypy), many debates that have questioned the relationship between the two terms have arisen. Broadly, both disorders pose similar symptoms but this paper suggests that schizophrenia is simply an extreme form of schizotypy. This classification has a significant influence on the general classification of mental disorders.
Similarities between Schizophrenia and Schizotypy
The similarities between schizophrenia and schizotypy show that the two personality disorders share many characteristics. In fact, Stirling and McCoy (2012) mention that schizotypy is similar to schizophrenia because patients who suffer from both disorders perceive reality in a way that is extremely difficult for other people to understand. For example, the emotionless nature and social isolation of schizophrenic patients occur among schizophrenic and schizotypy patients (Birchwood, 2001). Nonetheless, the similarities between schizophrenia and schizotypy do not show (exclusively) that one disorder is an extreme form of the other. However, since patients with schizophrenia exhibit severe symptoms of schizotypy, this paper reinforces the fact that schizophrenia is an extreme form of schizotypy.
Genetic Relations
Emil Cocarro and Larry Siever have done several family-centred studies to investigate the relationship between schizophrenia and schizotypy. They discovered that patients suffering from schizotypy have a high likelihood of suffering from schizophrenia (or a family member suffering the same disorder) (Woods, 2011).
From this observation, there has been a clear genetic relationship between the two disorders. Albeit both disorders are genetically similar, their closeness does not provide enough evidence to show that schizophrenia is an extreme form of schizotypy; however, because mental disorders are often hereditary (and manifest in different degrees), it is correct to say that schizophrenia is commonly witnessed among patients with schizotypy (because schizophrenia falls under the continuum of schizotypy disorders). Woods (2011) explains that
“There is some indication that there is a strong genetic relationship between the two disorders since some of the symptoms and abnormal patterns in brain chemistry, brain structure, and brain functioning found in people with schizophrenia can also be found in people with Schizotypal Personality Disorder” (p. 3).
Albeit this paper demonstrates the genetic relation between schizophrenia and schizotypy as a manifestation that schizophrenia is an extreme form of schizotypy, Woods (2011) explains that this definition is reversible. In other words, Woods (2011) explains that schizotypy can be a mild form of schizophrenia. Referring to this observation, Woods (2011) explains that
“Some experts argue that schizotypal personality disorder might be a mild form of schizophrenia, whereas other researchers suggest that there is evidence that schizotypal personality disorder shares some characteristics with schizophrenia and that there are similar deficits in certain areas” (p. 5).
From the reliance on scientific evidence (showing that schizotypy is a mild form of schizophrenia), correctly, the opposite is also true because schizophrenia is an extreme form of schizotypy (Lauriello and Pallanti, 2012).
Nature of Schizotypy
The nature of schizotypy demonstrates that the illness is a continuum of personality disorders, which represent varying degrees of mental conditions. This characteristic shows that varying degrees of mental disorders fit the scope of schizotypy. Indeed, this paper has already shown that schizotypy refers to a continuum of personality characteristics, which range from “normal dissociative, imaginative states to more extreme states related to psychosis and in particular, schizophrenia” (Lauriello and Pallanti, 2012, p. 5).
These varying characteristics of mental disorders show that schizophrenia fits in an extreme category of schizotypy (because if schizotypy were not a continuum of personality disorders, it would be difficult to categorise schizophrenia as part of schizotypy). The nature of schizotypy as a dynamic mental disorder, therefore, promotes the view that schizophrenia is an antecedent of schizotypy (Kuo-Ming, 2009).
Meehl’s Model
Meehl’s model demonstrates that schizophrenia is an extreme form of schizotypy. Meehl’s model traces its roots to the early sixties when there was an ongoing inquest into the genetics of schizophrenia (Lenzenweger, 2006). Meeh’ls model traces its name from a well-known psychologist – Meehl. To “emphasise a genetically influenced aberration in the neural transmission that could lead to clinical schizophrenia, nonpsychotic schizotypic states, or apparent normalcy depending on the coexistence of other factors” (Lenzenweger, 2010, p. 163), Meehl’s model was revised. Within Meehls’ model, schizophrenia explains a blown-up version of schizotypy. This assertion reinforces the fact that schizophrenia is an extreme form of schizotypy.
However, according to Meehl’s model, not all forms of Schizotypy develop into schizophrenia (Lenzenweger, 2006). The model also warns that not all forms of schizophrenia are diluted versions of schizophrenia. Nonetheless, the specific types of schizotypy, which develop into schizophrenia, remain unclear because there is insufficient empirical evidence to predict this outcome. So far, there is enough evidence to show that schizotypy can develop into schizophrenia but the factors leading to this outcome are open for debate.
For example, some researchers advance the view that schizophrenia is different from schizotypy. These researchers base their evidence from the presence of psychotic behaviour among schizophrenic patients and not patients suffering from schizotypy. For example, Woods (2011) explains that patients suffering from schizophrenia have frequent and intense psychotic behaviours, which make them lose touch with reality. Woods (2011) further demonstrates the absence of psychotic signs among patients suffering from schizotypy as a difference between schizophrenia and schizotypy mental disorders. Instead, schizotypal patients are in touch with reality and can comprehend what goes on around them.
In fact, patients suffering from schizotypy understand the difference between reality and imaginary thoughts. From the above observations, some researchers believe that schizophrenia and schizotypy are different. The evidence used to prove the differences between the two conditions are reliable because valid medical research informs these findings. However, researchers who do not perceive schizophrenia and schizotypy to be different fail to conceptualise the bigger picture informing the definition of the two mental disorders. They fail to present schizotypy as a continuum of symptoms, which manifest different stages of mental disorders. From this understanding, their presentation of schizophrenia and schizotypy is shallow. To this extent, there is a reinforced view that schizophrenia is an extreme form of schizotypy.
Implications for the Classification of Mental Disorders
Scholars accredit Kraepelin (a well-known psychologist) to the process of classifying mental disorders. Kraepelin claimed that mental disorders shared different groups because they bore unique characteristics that were only exclusive to their group (Guha, 2005). This form of classification is unique for many other types of clinical classifications.
To classify mental disorders, Kraepelin based his analysis on the symptoms, course, and outcomes of mental illnesses. Kraepelin’s classification of mental illnesses fell into two groups: dementia praecox (schizophrenia) and manic-depressive psychosis (Guha, 2005). This classification was widely used to develop the now famously known Diagnostic statistical manual of mental disorders (DSM) (Guha, 2005).
This paper shows that schizophrenia (a major classification of Kraepelin’s mental disorders) manifests as an extreme form of schizotypy because schizophrenia is an extreme form of schizotypy. This analysis has a significant implication on the perception of schizophrenia as a wider classification of mental disorders because schizotypy now emerges as an umbrella continuum of mental disorders (that defines even severe mental disorders such as schizophrenia) (Hillman, 1998).
This redefinition of mental orders has a subsequent impact on the development of the DSM classification. Apart from the reclassification of DSM technique, the International Classification of Diseases (ICD) similarly reclassifies because (under the F2) classification; schizophrenia, delusional disorders and schizotypy are categorised under one group (Hillman, 1998). Since this paper proposes that schizophrenia is an extreme form of schizotypy, it will be untenable to present schizophrenia and schizotypy as equals under the same (F2) classification. Comprehensively, after considering the findings of this paper, a reclassification of schizophrenia and schizotypy is unavoidable. The reclassification would imply that schizophrenia is reclassified under a subgroup of schizotypal disorders (under the F2 classification of ICD). This reclassification would also imply that chapter five of the ICD, which relates to mental disorders, is revised again (Hillman, 1998).
Conclusion
Schizophrenia and Schizotypy share many similarities in their diagnosis. The difficulties in distinguishing the two disorders highlight the similarities (in the definition) that the two concepts share as well. This paper demonstrates that schizophrenia is an extreme form of schizotypy because the latter disorder is a continuum of mental disorders. Schizophrenia, therefore, represents an extreme form of schizotypy. Indeed, previous medical researches show that extreme forms of schizotypy manifest in schizophrenia. Furthermore, Meehl’s model shows that schizotypy can easily develop into schizophrenia. However, the same model shows that schizophrenia does not necessarily amount to schizotypy. Therefore, there should be a careful understanding that both disorders are not synonymous to one another.
Recent research is done on patients who have schizotypy and schizophrenia demonstrated that the two disorders commonly occur in patients who share similar genes. In other words, patients who have schizotypy suffer a high risk of developing schizophrenia. The genetic links between patients who share the two disorders, therefore, show that both disorders have a close relation in occurrence.
This outcome reinforces the fact that schizophrenia is an extreme manifestation of schizotypy. From this understanding, this paper shows that the redefinition of schizophrenia as an extreme form of schizotypy has a significant implication on the classification of mental disorders. Here, the implication of schizophrenia as an extreme form of schizotypy shows that schizotypy occurs as a broader classification of mental disorders. Schizophrenia, therefore, falls under it. Comprehensively, after weighing the findings of this paper, correctly, schizophrenia is simply an extreme form of schizotypy.
References
Birchwood, M. (2001). Schizophrenia. East Sussex: Psychology Press.
Guha, M. (2005). Encyclopedia of Applied Psychology. Reference Reviews, 19(2), 16 – 17.
Hillman, H. (1998). A study of 131 patients with schizophrenia and provision for them, International Journal of Health Care Quality Assurance, 11(3), 102 – 112.
Hoermann, S. (2009). Schizotypal Personality Disorder and Schizophrenia. Web.
Kuo-Ming, C. (2009). A study of members’ helping behaviours in online community. Internet Research, 19(3), 279 – 292.
Lauriello, J., & Pallanti, S. (2012). Clinical Manual for Treatment of Schizophrenia. New York: American Psychiatric Pub.
Lenzenweger, M. (2006). Schizotaxia, schizotypy, and schizophrenia: Paul E.
Meehl’s blueprint for the experimental psychopathology and genetics of schizophrenia, J Abnorm Psychol, 115(2), 195-200.
Lenzenweger, M. (2010). Schizotypy and Schizophrenia: The View from Experimental Psychopathology. London: Guilford Press.
Stirling, J., & McCoy, L. (2012). Psychological effects of ketamine: a research note. Drugs and Alcohol Today, 12(3), 164 – 179.
Woods, A. (2011). Memoir and the diagnosis of schizophrenia: reflections on the Centre Cannot Hold, Me, Myself, and them, and the “crumbling twin pillars” of Kraepelinian psychiatry. Mental Health Review Journal, 16(3), 102 – 106.
Patients with schizophrenia are generally at high risk of readmission. More than a half of patients was readmitted within 10 years. Patients with schizophrenia often refuse to take oral antipsychotics what leads to the reoccurrence of symptoms and rehospitalization. The purpose of this paper is to propose a research analyzing the frequency of admission rates among patients with schizophrenia treated with long-acting injectable antipsychotics or with oral antipsychotics. The hypothesis of the research will be that treatment with long-acting antipsychotics leads to lower readmission rates than treatment with oral antipsychotics.
The readmission rates among patients with schizophrenia are very high. According to Chi et al. (2016), “570 (70.5%) patients were readmitted within 10 years; the median time between admissions was 1.9 years, and 25% of subjects were readmitted within 4 months of the first hospitalization” (184). Remarkably, these rates were not influenced by age, gender, or length of hospitalization of patients. These results allow concluding that the main difference between readmission and non-readmission groups of patients is the type of their treatment.
There are two main types of treatment for patients with schizophrenia: long-acting injectable antipsychotics and oral antipsychotics (Chou, Reome, & Davis, 2016). After being discharged from a hospitalization, patients act on their own and do not receive compulsive medication.
They should take oral antipsychotics that help them to eliminate symptoms and maintain their stable condition. Nevertheless, it is very hard for patients with schizophrenia to follow the medication plan because they often suffer distortions of reality and think in a disorganized way. Therefore, the hypothesis of this research will be that patients treated with long-acting injectable antipsychotics show lower readmission rates.
The comparison of readmission rates between patients treated with long-acting injectable antipsychotics and oral antipsychotics calls for the detailed analysis of statistics. Therefore, the current research will be of the quantitative design. According to the chosen research design researcher will use non-probability purposive sampling to find records about patients of particular groups according to the type of treatment.
The analysis of selected records from hospital databases should be limited by the age of patients, the nature of their hospitalization, and the type of treatment. According to the research by MacEwan et al. (2016), “Medical claims of patients with schizophrenia who were ages 18–64 and had a first hospitalization for a serious mental illness (index hospitalization, October 2007 through September 2012) and at least one prescription for a first- or second-generation antipsychotic were analyzed from the Truven Health MarketScan Multi-State Medicaid Database” (p. 1184). This example shows good stratification of analyzed medical records.
For the purposes of the research, the patients should not be too young and too old, the description of their first hospitalization should present symptoms of schizophrenia, and their treatment should include the use of antipsychotics. For the exhaustive representation of the statistics, the sample size should include records covering cases of schizophrenia within 10 years to trace the development of antipsychotics of both types and their influence on the readmission rates (Busch, Epstein, McGuire, Normand, & Frank, 2015). The findings may be generalized to all people with schizophrenia treated with oral antipsychotics or long-acting injectable antipsychotics. Differences in the patient behavior present limitation to the generalizability of results.
The current paper proposed a research on the difference in readmission rates between patients with schizophrenia treated with oral antipsychotics or long-acting injectable antipsychotics. The proposed research used quantitative design and non-probability purposive sampling. The researcher selected the sample from hospital medical records about patients with schizophrenia. The sample was limited according to the age of patients, their symptoms during the first hospitalization, and the type of treatment.
References
Busch, A. B., Epstein, A. M., McGuire, T. G., Normand, S. L. T., & Frank, R. G. (2015). Thirty day hospital readmission for medicaid enrollees with schizophrenia: The role of local health care systems. The Journal of Mental Health Policy and Economics, 18(3), 115.
Chi, M. H., Hsiao, C. Y., Chen, K. C., Lee, L. T., Tsai, H. C., Lee, I. H.,… & Yang, Y. K. (2016). The readmission rate and medical cost of patients with schizophrenia after first hospitalization—A 10-year follow-up population-based study. Schizophrenia Research, 170(1), 184-190.
Chou, F., Reome, E., & Davis, P. (2016). Impact on length of stay and readmission rates when converting oral to long-acting injectable antipsychotics in schizophrenia or schizoaffective disorder. Mental Health Clinician, 6(5), 254-259.
MacEwan, J. P., Kamat, S. A., Duffy, R. A., Seabury, S., Chou, J. W., Legacy, S. N.,… & Karson, C. (2016). Hospital readmission rates among patients with schizophrenia treated with long-acting injectables or oral antipsychotics. Psychiatric Services, 67(11), 1183-1188.
The research study aims to discover the effectiveness of peer-led self-management programs in reducing readmissions among adults with schizophrenia. In this case, the target population is adults with schizophrenia who tend to attend one of the medical centers that take part in this study. A simple random sampling technique will be used to select participants, and it implies that each respondent will be randomly chosen to take part in the study to avoid bias and ensure the validity of information (Johnson & Christensen, 2013). It is estimated to have 250 participants due to a potential 30-40% dropout rate.
The participants have to be within the 21-65-years-old age range, and both males (70%) and females (30%) will take part in this study. These numbers are estimated and may change after the randomization of participants is accomplished.
To determine the effectiveness of the chosen intervention, the total number of participants (250) will be split into control (125) and experimental (125) groups. The participants will be randomly divided while relying on the concepts of randomization (Balakrishnan, 2014). In this instance, both groups will receive professional medical treatment, but the experimental group will also participate in peer-led self-management programs. The educational sessions will be organized by well-trained adults (5) with schizophrenia, who successfully manage their condition in their lives and are recommended by the medical centers (Chan et al., 2013).
The data will be collected using questionnaires. To analyze the demographic data, descriptive statistics will be used. In the first place, the whole data set will be split into categories, including gender (male or female) and age (21-30; 31-40; 40-65; 65+). Using this method is crucial since it enhances data screening procedures and helps understand a relationship between the variables (Sreejesh, Mohapatra, & Anusree, 2014). For example, it will help us understand whether there is a correlation between gender, age, and proposed intervention. At the same time, mean, median, and mode values will be calculated, as they assist in understanding general tendencies by determining the average, middle, and the most frequent values (Sreejesh et al., 2014).
Data Analysis
It is apparent that in the first place, the information will be collected by using a mixed approach that implies relying on both qualitative and quantitative methods. To find proof of the hypothesis, the data will be collected with the help of surveys (subjective data) and interviews (qualitative data). Thus, to analyze the acquired information, apart from randomization, different statistical tests have to be used. One of them is regression analysis. It could be said that it is one of the most appropriate methods in the context of the selected topic, as it aims to find a relationship between variables while determining the reasons for these outcomes (Uyanik & Guler, 2013).
In this case, it will help portray graphically a relationship between peer-led self-management programs and conditions of the patients that will be evaluated by the medical indicators and interviews with them. Thus, descriptive statistics such as mode, median, and mean will be calculated to determine general tendencies. Interviews will assist in unveiling additional insights concerning the topic while the information will be split into categories to ensure that it supports data in surveys (Alshenqeeti, 2014).
In turn, it will be reasonable to use related statistical software to randomize participants, split data into categories, and conduct regression analysis. In this instance, relying on SPSS can help calculate both descriptive (mean, mode, and mean) and inferential statistics, as it is one of the most actively used programs in different fields of research (Johnson & Christensen, 2013). Utilizing it will speed the overall evaluation process, as different formulas can be used to input data effectively and perform the required calculations (Johnson & Christensen, 2013).
References
Alshenqeeti, H. (2014). Interviewing as a data collection method: A critical review. English Linguistics Research, 3(1), 39-45.
Balakrishnan, N. (2014). Methods and applications of statistics in clinical trials: Concepts, principles, trials, and designs. Hoboken, NJ: John Wiley & Sons.
Chan, S., Li, Z., Klainin-Yobas, P., Ting, S., Chan, M., & Eu, P. (2013). Effectiveness of peer-led self-management program for people with schizophrenia: A protocol for a randomized control trial. Journal of Advanced Nursing, 70(6), 1425-1435.
Johnson, B., & Christensen, L. (2013). Educational research, qualitative, quantitative, and mixed approaches. Thousand Oaks, CA: SAGE Publications, Inc.
Sreejesh, S., Mohapatra, S., & Anusree, M. (2014). Business research methods: An applied orientation. New York, NY: Springer Science+Business Media.
Uyanik, G., & Guler, N. (2013). A study of multiple linear regression analysis. Procedia – Social and Behavioral Sciences, 106(1), 234-240.
There is a range of theories related to particular measures that patients can take in order to improve their physical and mental condition without the help of those specializing in healthcare. The particular theory that needs to be paid in increased attention to was developed by Dorothea Orem who remains one of the most famous nursing theorists. Unlike other ones, the theory by Orem focuses on the lack of self-care in some patients; according to the theorist, it acts as one of the most important reasons why patients’ condition become worse despite successful nursing interventions (Shah, Abdullah, & Khan, 2015).
In her theory, the author touches upon a few guiding propositions for specialists in nursing. To begin with, the latter are supposed to provide their patients with the access to knowledge about proper self-care related to different diseases (Alligood, 2013). What is more, nurses should help their patients to better understand their needs and activities helping to fulfil them. To do that, it can be necessary to provide patients with support and help them to perform essential tasks that can ameliorate their condition. Apart from that, specialists are supposed to help the patients to understand which things and skills they need to possess to conduct an effective self-care intervention.
In reference to the proposed research project, it can be stated that these general rules proposed by Dorothea Oren in her theory can be applied in case with people suffering from schizophrenia as self-care interventions outlined by the author can be appropriate for those with mental illnesses as well (Ciftci, Yildirim, Altun, & Avsar, 2015). Moreover, it is extremely important to define whether self-care is effective in reducing readmissions.
Methodology
The proposed study is a quasi-experimental quantitative research that evaluates the effects of self-management programs on health condition of the patients with schizophrenia and possibility of their readmission. The given type of study has been chosen because it provides strong evidence and helps to avoid the use of unverified information (Yin, 2014).
In order to collect the data for further analysis that will help to answer the defined research question (whether self-management programs help to reduce readmission in patients with schizophrenia), it will be necessary to conduct the study allowing the researchers to track changes in behavior and condition of patients caused by self-care programs. As for the place where the data will be collected, it may be important to form two groups of participants with the history of schizophrenia and conduct two independent experiments. For the first group (the one that will be strictly controlled to avoid false conclusions), it will be necessary to organize special unit in a hospital where the participants will be kept for a month (Barker & Milivojevich, 2016).
The given unit will be equipped with everything that is necessary for successful self-care interventions. Apart from that, it may be necessary to introduce additional methods of control that would not involve violation of patients’ privacy but will allow to ensure that measures prescribed by nursing specialists are taken properly and on schedule (Brown et al., 2016). The second group will be given an advisory opinion of nursing specialists on proper self-care, they will be supposed to follow the recommendations without being controlled, and their mental condition and possible changes will be evaluated in the end of each week.
To become a participant, one will have to be older than 21, have the previous experience of receiving treatment in the hospital, and have no additional life circumstances that could become the reason of deterioration of their mental condition. As for the way that the participants will be divided into two groups, the researchers will use randomized lottery.
References
Alligood, M. R. (2013). Nursing theory: Utilization & application. St. Louis, MO: Elsevier Health Sciences.
Barker, T. B., & Milivojevich, A. (2016). Quality by experimental design. New York, NY: CRC Press.
Brown, S. M., Aboumatar, H. J., Francis, L., Halamka, J., Rozenblum, R., Rubin, E.,… Frosch, D. L. (2016). Balancing digital information-sharing and patient privacy when engaging families in the intensive care unit. Journal of the American Medical Informatics Association, 23(5), 995-1000.
Ciftci, B., Yildirim, N., Altun, Ö. Ş., & Avsar, G. (2015). What level of self-care agency in mental illness? The factors affecting self-care agency and self-care agency in patients with mental illness. Archives of Psychiatric Nursing, 29(6), 372-376.
Shah, M., Abdullah, A., & Khan, H. (2015). Compare and contrast of grand theories: Orem’s self-care deficit theory and Roy’s adaptation model. International Journal of Nursing, 5(1), 39-42.
Yin, R. K. (2014). Case study research: Design and methods. New York, NY: Sage Publications.
Schizophrenia is a complicated illness. Hence, it is difficult to determine whether it is a single condition, or it has other related conditions. The generalization of various factors in schizophrenia may be true in limited cases. Generally, people develop conditions for the disorder between the age of 15 and 25 years. The prominent feature is mainly disorganized thought processes and challenges in processing information.
Functional capacity is the ability to conduct desirable activities in one’s life. Thus, the functional limitation may hinder performance in everyday living. The functional limitation of schizophrenia may be positive or negative. Some cognitive functional limitations include hallucinations and changes in thinking processes. On the other hand, negative limitations include diminishing motivation, social isolation, mood changes, and withdrawal.
Functional limitations lead to declines in engaging in physical and mental activities in daily lives. Physical activities are generally mobility, body strengths, and other body senses like hearing, vision, and communication. Mental activities relate to emotional and cognitive activities. All these conditions can be great sources of trouble for persons with schizophrenia.
A functional limitation associated with vision leads to disruptive life among people with the condition. It also affects those who provide care to people with schizophrenia. Visual impairment among people with schizophrenia normally increases when one approaches the age of 75 years. It will affect other activities like mobility.
Schizophrenia causes mobility challenges to people with it. The limitation advances with the age of the patient. In such cases, people may find it difficult to move on their own. Mobility challenges usually increase with the various stages of life. They find it difficult to conduct mobility actions anywhere. At the age of 65 years, the problem may hinder movement around the house, such as climbing stairs. The situation advances in severity with the age of the patient. Vision impairment also contributes to low-levels in other activities like physical, social contacts, depression, and comorbidity. Overall, schizophrenia patients ought to observe regular medical checkups, exercise activities, and social networks to improve their conditions.
Schizophrenia normally makes people withdraw and isolate them from others. This situation has an impact on social relations with family and friends. Impaired social functions may also result in hostility and suspicion. However, this depends on the type of schizophrenia, e.g., paranoia.
Assessment of social functions among people afflicted with schizophrenia is generally scarce. The major cause of poor assessment is a lack of appropriate tools. Previous studies have noted that many facilities did not conduct an assessment of social functions among people with schizophrenia. Moreover, there was no clear definition of social functions in studies and available literature. As a result, various researchers used different approaches to measure social functions. These included interviews, self-reports, and some rating scales. In most cases, researchers normally measure social conditions in relation to certain disorders among patients.
Schizophrenia also causes cognitive function limitations among patients. Neurocognitive functions result in negative outcomes among people with schizophrenia. Patients may have challenges with attention, information processing speed, recall, and language use. This condition may affect work, social, training, and interpersonal relations and skills among people with the schizophrenia condition.
Studies show that the functional limitations of schizophrenia have severe impacts on patients. However, studies have not developed effective assessment tools for various conditions of schizophrenia (Reichenberg, 2010). Thus, it is necessary to understand the factors that are responsible for functional limitations and appropriate interventions to mitigate limitations.
Summary of treatments and/or resources that can help to address functional limitations of schizophrenia
At first, the impacts of schizophrenia will be restricted with minor alterations in actions only, but not in a disturbing way. However, with time, when overlooked or with no effective interventions, schizophrenia can have harmful consequences on the patient and the lives of other stakeholders.
Improving Patient Functioning
Most people have raised the question about the cure for schizophrenia. Unfortunately, schizophrenia has no known cure (Kane and Correll, 2010). However, about 90 percent of schizophrenia patients may recover to certain degrees, which would allow them to function and have improved quality of life.
The patient must make and keep their regular appointments with their physicians
Patients should meet their physicians at least once in a month. This is necessary for reviewing schizophrenia symptoms and other developing challenges. Patients should also have an arrangement for emergencies with their physicians.
Observe diet and other foods
Patients should avoid substances that can cause a chemical imbalance within the body, serious challenges, and deter any progress of improvement. Patients should use consumer decaf products and use chocolate cautiously.
Managing stress
Self-management is critical for patients. They should also engage in productive activities to avoid negative thoughts and stress.
Engage in healthy activities
Patients should get adequate sleep, rest, regular exercise, take balance diets, and take part in productive activities.
Monitor potential cases of relapse
Patients should know signs of relapse and notify their physicians immediately.
While the current medicine cannot cure schizophrenia, patients should engage in positive activities and behaviors to facilitate their chances of recovery. Family members and friends must also provide their support to the patient.
The disease “partly affects patients’ functions” (Lindenmayer, 2008). Treatment approaches differ from one patient to another (Kane, 2010). However, the acute phase requires managing and improving major domains, which can have significant impacts on the patient’s functional capabilities. These may include managing paranoia, aggressive tendencies, and self-care.
In the stable phase, care providers should concentrate on improving “autonomous social behaviors, encourage the patient to take part in rehabilitative therapy, and improve positive outcomes at the workplace” (Lindenmayer, 2008). The general improvement in these domains can ensure that the patient improves relationships and increases the chances of getting employment.
Assessment of functional limitations among schizophrenia is a difficult undertaking, which many people fail to do, particularly during the stable phase. Several cases of relapse may cause poor chances of regaining previous levels of functional abilities. On the other hand, improved symptom control can facilitate the chances of regaining functional abilities. However, some studies have indicated that impairment in symptoms does not automatically affect the functional capacities of the patient. Indeed, physicians should assess functioning limitations independently. This is necessary for enhancing long-term intervention outcomes for schizophrenia patients.
Physicians have associated certain symptoms of schizophrenia with negative outcomes and specific cognitive limitations, such as social perception, attention, memory, and other functions. Several studies have demonstrated that negative symptoms normally show consistency with social limitations and poor relationships. However, such symptoms may not affect skill acquisition. Patients’ cognitive functioning may have an impact on subsequent functional outcomes. The impact may affect independent living, cognitive abilities, relationships, and sustained employment. It is also important to note that functional limitations of schizophrenia based on outcomes may not be associated with the cognitive conditions of the disease. This implies that improvement in symptoms may not enhance functional abilities.
There are several scales of assessment for patient functional abilities. Jean-Pierre Lindenmayer noted that assessment tools based on the DSM-IV criteria were the most clinically meaningful to clinicians and researchers (Lindenmayer, 2008). Thus, physicians should work with such instruments when assessing the functional abilities of the patient.
Summary of Assessment and Interventions
Assessment
A comprehensive assessment that covers physical, psychiatric, and psychological conditions.
Regular assessment of anxiety, depression, comorbidity, drug and substance abuse, and physical conditions.
General approach
Get informed consent
Provide support to all stakeholders in terms of information required.
Allow the patient to seek the second opinion if necessary.
Manage the patient during transfer to different services.
Early treatment of the first episode.
Refer critical cases to mental.
For the acute episode, use pharmacological intervention, fast tranquilization, psychosocial and psychological interventions.
Monitor post-acute recovery.
Facilitate recovery.
Service-Level Interventions
Provide home treatment care providers.
Offer early intervention services.
Encourage community mental health services.
Create an outreach team.
Provide acute day hospitals.
Use appropriate assessment scale.
Pharmacological Interventions
Use the normal antipsychotic treatment agents.
Use specific antipsychotic treatment agents.
Observe the duration of drug administration.
Monitor the patient.
Psychological Treatments
Apply cognitive-behavioral therapy.
Use family and friends’ intervention to avoid relapse (Pharoah et al., 2010).
Use art therapy.
Provide counseling and supportive services.
Apply cognitive remediation.
Some useful resources for Assessment and Intervention
Kane, J. and Correll, C. (2010). Past and present progress in the pharmacologic treatment of schizophrenia. Journal of Clinical Psychiatry, 71(9), 1115-24.
Kane, J. (2010). Pharmacologic treatment of schizophrenia. Dialogues Clinical Neuroscience, 12(3), 345–357.
Lindenmayer, J-P. (2008). Increasing Awareness of Patient Functional Impairment in Schizophrenia and Its Measurement. Primary Psychiatry, 15(1), 89-93.
Pharoah, F., Mari, J., Rathbone, J., and Wong, W. (2010). Family intervention for schizophrenia. Cochrane Database Syst Review, (12), CD000088.
Reichenberg, A. (2010). The assessment of neuropsychological functioning in schizophrenia. Dialogues Clinical Neuroscience, 12(3), 383–392.
Just like many other diseases, mental illnesses are rather debilitating to the affected individuals. In particular, schizophrenia is one of the mental diseases that are associated with a range of other physical conditions, increased mortality, and comorbidities (Correll et al., 2017). The primary characteristics of schizophrenia include behavioral dysfunction, cognitive impairment, and psychosis; this disease affects approximately 1% of the population of the United States (Correll et al. 2017).
Effective management and treatment strategies are required for the patients with schizophrenia in order to reduce their readmission rates (Kripalani, Theobald, Anctil, & Vasilevskis, 2014). This literature review is focused on the exploration of self-management programs for patients with schizophrenia and their effectiveness in terms of the reduction readmission rates and the overall management of the condition.
The severity of schizophrenia is recognized not only in the United States. For instance, in China, schizophrenia is linked to a wide range of impactful disabilities and, in this regard, is acknowledged to be far more dangerous than other mental conditions (Zhou, Zhang, & Gu, 2014). There exist different self-management and rehabilitation strategies aiming at the minimization of symptoms and burdens associated with the prevalence of schizophrenia, as well as at the improvement of the overall quality of life of the affected individuals.
However, it is important to note that one of the major factors contributing to the success of these strategies is the patients’ adherence to the necessary measures, activities, and medications. According to the data of Zhou et al. (2014), among the entire population segment of people affected by schizophrenia in China, only about 2% adhere to their management and rehabilitation strategies.
Moreover, when it comes to the results worldwide, the review by Barkhof, Meijer, de Sonneville, Linszen, and de Haan (2012) covering the past decade revealed that the general rates of nonadherence could vary in range from 20 to 89% in different studies. In that way, it is possible to make a conclusion that the situation in China is quite demonstrative of the adherence to dynamics of schizophrenia treatment and intervention strategies occurring on the global scale.
In addition, the authors found that, on average, the rate of adherence to treatments in schizophrenic patients could be approximated to 50%; also, the findings of this review showed that if within two years after the first psychotic episode the patients demonstrated 50 or 55% rate of nonadherence, their likeliness of being readmitted within the next year grew significantly (Barkhof et al., 2012). In that way, adherence can be recognized as a very important issue to discuss in regard to readmission and self-management among schizophrenic patients.
All in all, as mentioned earlier, low adherence to antipsychotic medication and self-management strategies is highly prevalent among patients suffering from schizophrenia due to a variety of determinants and factors associated with this phenomenon (Barkhof et al., 2012). In particular, as one of the health behaviors, adherence can be studied from the perspective of Health Belief Model that states that a patient’s desire, intention, and readiness to comply with their doctor’s prescriptions is majorly dictated by the perceived effects of the medication outweigh its costs, and, most importantly, when the patient can observe noticeable health risks and threats (Barkhof et al., 2012).
In turn, as a mental condition characterized by cognitive impairment, paranoid delusions, and other psychotic symptoms, schizophrenia may be accompanied by low illness awareness in the patients; and as a result, such individuals are likely to have reduced rated of adherence to treatments and interventions based on both medication and self-management (Barkhof et al., 2012).
In that way, the set of main factors contributing to nonadherence to treatments causing readmissions involves low illness awareness and the perceived lack of efficiency of the medication; the additional factors are substance abuse that has a strong negative impact on adherence rates, therapeutic alliance, and environmental factors (the creation of nourishing and stress-free conditions for the patients by their doctor, family, and community) (Barkhof et al., 2012).
The latter factor (the participation of families and communities in the management and treatment programs for people with schizophrenia) is a rather important aspect of the contemporary interventions that work based on a patient-centered model and approach mental illness holistically. The study by Armijo et al. (2013) targeting management programs involving communities in Chile was carried out in the form of a qualitative review of the literature covering the period from 1999 to 2012 and showed that the involvement of holistic approach helped address many challenges associated with management of schizophrenia. In particular, in addition to the significant reduction of psychotic and other negative symptoms of this mental condition, the researchers found that the community-based management of the illness helped improve the patients’ rates of adherence to their treatment (Armijo et al., 2013).
In that way, taking into consideration the findings of Barkhof et al., (2012) showing that low or even 55% rate of nonadherence often results in a significant increase in readmission chance, it is possible to note that the improvement of adherence achieved by the management programs involving the patients’ communities and families actually helped address readmission rates. Another positive effect that can be linked to potential readmission rate is the reduction of psychotic symptoms in schizophrenic outpatients. Alongside with these outcomes, the other effects of the discussed interventions were the minimization of terms of hospitalization and the reduction of comorbidities linked to schizophrenia (Armijo et al., 2013).
Also, it is important to point out that the management programs involved patients, as well as their families and other community members and worked through the delivery of psychoeducation and the improvement of the communities’ and individuals literacy in regard to schizophrenia (Armijo et al., 2013). Some of the additional results of this management program were the improved understanding of the disease from the side of both patients and their family members leading to the minimization of self-stigmatization, isolation, and alienation due to involuntary ableism and similar attitudes directed at people with mental health conditions.
Another study researching self-management programs based on psychoeducation for people affected by schizophrenia was conducted in China and focused on educational intervention focused on the application of mindfulness (Chien & Thompson, 2014). The authors noted that psychoeducation is at the core of many self-management programs for patients with schizophrenia; however, even though this intervention is known to increase the patients’ awareness of the illness and insights into their condition and treatment, its practical effect on such factors as psychotic symptoms and readmission rates remains under-researched or is reported to be low.
In fact, as reported by Chien and Thompson (2014), psychoeducational self-management programs based on mindfulness can be characterized as particularly effective compared to the standard treatments for schizophrenia as they produce a noticeable positive impact on the patient’s knowledge of the illness, awareness of the condition, insight, and the readiness to manage schizophrenia; moreover, another visible positive effect of this type of treatment is the reduction of negative psychotic symptoms. In addition, even though readmissions occurred in the research sample, the findings showed a significant decrease in their length (Chien & Thompson, 2014).
Another study researching educational self-management programs was carried out by Zou et al. (2012); the findings of this research showed that self-management education for patients with schizophrenia is strongly associated with the events of re-hospitalization and relapse. Similarly to the results reported in the previously discussed studies, the authors mentioned that self-management education was also linked to the improvement in adherence to medication and the prevalence of psychotic symptoms in comparison with the results of the patients who did not enroll in educational self-management programs (Zou et al., 2012; (Armijo et al., 2013; Chien & Thompson, 2014).
In addition to the confirmed benefits of self-management programs powered by mud fullness and education, there exists a theory that peer-led self-management programs could be highly advantageous (Chan et al., 2014).
All in all, schizophrenia is a mental condition that is rather debilitating to the affected individuals. Due to cognitive impairments and delusions associated with its development, low illness awareness and the consequent adherence to medication are seen as some of the main causes of readmissions. Education and mindfulness-based self-management programs are known to help reduce symptoms of schizophrenia and improve the illness insight and readiness to comply with the medication, thus producing a positive effect on the rate of readmissions, as well as their length.
Zhou, B., Zhang, P., & Gu, Y. Effectiveness of self-management training in community residents with chronic schizophrenia: A single blind randomized-controlled trial in Shanghai, China. Shanghai Archives of Psychiatry, 26(2), 81-87. Web.
The mental illness that is reviewed within the framework of the current paper is schizophrenia. It can be defined as a loss of the ability to care for one’s self that was caused by a series of critical disturbances that affected the individual’s emotions and reasoning (Liberman, 2012). The existing approaches to the treatment of schizophrenia commonly focus on the basic biological models that were narrowed by research so as to comply with the variables that are inherent in such mental illness as schizophrenia. Nonetheless, modern research on the subject showed that this model is mostly irrelevant, and patients with schizophrenia should be treated differently (Zou et al., 2012).
Therefore, the significance of the problem that is reviewed in this paper consists in the fact that the approaches to the treatment of schizophrenia can be optimized. This claim is also supported by the fact that despite its conventionality, the majority of psychopharmacological treatment strategies are becoming to fade away (Siantz & Aranda, 2014).
The key reason for that is their impact on the cognitive functioning of patients with schizophrenia and other negative sources of influence that trigger certain limitations interfering with the treatment process. Therefore, it is safe to say that long-term usage of schizophrenia medications bears a negative connotation due to immunity that develops in patients during the continuing intake of those medications. Moreover, the significance of the study can be explained by the insufficient justification of the positive effects of the medications mentioned above and their ability to reduce the risk of readmission (Zou et al., 2012).
Currently, one of the most prevalent recommendations is to fight the illness illiteracy inherent in the patients and their families so as to increase the efficiency of the existing patient-focused and psychosocial interventions. It is safe to say that self-management programs are expected to improve the health outcomes in patients with schizophrenia and make it easier to provide care for these patients (Liberman, 2012).
One of the requirements is the continual collaboration between all the parties that participate in the treatment process. By doing this, the health care providers will ensure that the patients are treated in an optimism-based environment, and only tools justified by research are used in practice.
Statement of the Problem and Purpose of the Study
The purpose of the study is indicated by the changes that are now gradually transforming the schizophrenia treatment process (Goldberg et al., 2013). Currently, more and more research projects support the claim that self-treatment of schizophrenia is possible by means of special programs. These programs are based on the information regarding psychosocial treatment and other pivotal data concerning schizophrenia and other related mental illnesses (Cook et al., 2011).
Moreover, the problem of the current study consists of the fact that the effectiveness of pharmacological treatment reduced significantly over the last decade. Therefore, the research is intended to prove that self-management programs will provide patients with critical practical skills (Ben-Zeev, Kaiser, Brenner, Begale, & Duffecy, 2013).
These educational self-management programs become more and more popular, so it is imperative to evaluate their efficiency and define the upsides that are inherent in this schizophrenia treatment option. The researcher expects to assess the overall efficiency of self-management programs that are used to treat schizophrenia and define the core variables that may impact the effectiveness of the latter (Ben-Zeev et al., 2013). It is also important to realize that advanced technologies may become one of the main actors in the future treatment of schizophrenia, so it is crucial to support the development of applications that are aimed to facilitate the treatment process of this illness (Ben-Zeev et al., 2013).
The purpose of the study can also be supported by the fact that the viability of self-management programs will only be achieved if they are developed with all the important variables being taken into consideration (for instance, preferences, requirements, or features of the target population) (Ben-Zeev et al., 2013). Schizophrenic people will be able to use these applications, and readmission rates will be mitigated if we test the developed self-management programs in real-life conditions.
Research Questions, Hypothesis, and Variables with Operational Definitions
Research Question
Do schizophrenia self-management programs help to reduce the readmission rates and manage schizophrenia in male and female patients aged from 18 to 65?
Hypothesis: Research and Null
Null hypothesis – If the self-management programs are applied, there will be no statistical difference between the outcomes.
Research hypothesis – If the self-management programs are applied, the readmission rates will be reduced, and the efficacy of schizophrenia treatment will be increased.
Dependent variables – readmission rates, indicators of schizophrenia, the prevalence of schizophrenia, and efficiency of the self-management programs.
Operationalize Variables
Male and female participants aged from 18 to 65 will be exposed to the use of a self-management program intended to help them manage their schizophrenia. The researcher expects to measure the readmission rates, categorize the key indicators of schizophrenia in the chosen sample, and evaluate the efficiency of the selected self-management program on the basis of the prevalence of the indicators of schizophrenia after the experiment.
References
Ben-Zeev, D., Kaiser, S., Brenner, C., Begale, M., & Duffecy, J. (2013). Development and usability testing of FOCUS: A smartphone system for self-management of schizophrenia. Psychiatric Rehabilitation Journal, 36(4), 289-296. Web.
Cook, J. A., Copeland, M. E., Jonikas, J. A., Hamilton, M. M., Razzano, L. A., Grey, D. D.,… Boyd, S. (2011). Results of a randomized controlled trial of mental illness self-management using wellness recovery action planning. Schizophrenia Bulletin, 38(4), 881-891. Web.
Goldberg, R. W., Dickerson, F., Lucksted, A., Brown, C. H., Weber, E., Tenhula, W. N.,… Dixon, L. B. (2013). Living well: An intervention to improve self-management of medical illness for individuals with serious mental illness. Psychiatric Services, 64(1), 51-57. Web.
Liberman, R. P. (2012). Recovery from schizophrenia: Form follows functioning. World Psychiatry, 11(3), 161-162. Web.
Siantz, E., & Aranda, M. P. (2014). Chronic disease self-management interventions for adults with serious mental illness: a systematic review of the literature. General Hospital Psychiatry, 36(3), 233-244. Web.
Zou, H., Li, Z., Nolan, M. T., Arthur, D., Wang, H., & Hu, L. (2012). Self-management education interventions for persons with schizophrenia: A meta-analysis. International Journal of Mental Health Nursing, 22(3), 256-271. Web.