Schizophrenia
Introduction
According to MedicineNet, (2010), schizophrenia is a very severe mental disorder that affects those who suffer from it throughout their life. The term schizophrenia is of Greek origin meaning split mind. This notion has made some people in the western cultures believe that the disease denotes a split personality disorder. However, these are two separate disorders as people with schizophrenia do not have a split personality. This disease portrays a wide range of symptoms which may occur throughout life or in episodes. As indicated by the World Health Organization and the Diagnostic and Statistical Manual of Mental Disorders Text Revision (DSM-IV-TR), Delusions, hallucinations, disorganized thinking and speech, motor behavior disorders, and negative social behaviors are some of the symptoms the disease portrays. These symptoms are so severe that they leave a patient fearful and withdrawn. The behavior of the sufferers of schizophrenia is incomprehensible and frightening to others. About 1 of the population develops schizophrenia during their lifetime. Though the disease affects both men and women with the same frequency, its symptoms appear earlier in men than in women. There are treatments that alleviate the symptoms of the disease, but most sufferers experience these symptoms throughout their lifetime. Very few people have been shown to recover completely from the disease. Current research have gone a step ahead and unraveled some mysteries behind the disease that had not been known for long as well as discovered new medications that are a source of hope for sufferers. Molecular genetics is one of the newest scientific research methods that are being applied to find out the causes of the disease. Brain imaging techniques also hold a promise of new insights into the disorder.
Schizophrenia
Depression-Guide, (2005), states that the main cause of schizophrenia has not yet been established. Research however, points to the interaction of environmental factors and genetics during development of the brain. It is believed that Schizophrenia occurs as a result of a combination of various factors. Some of these factors include genetics, environmental, hormonal changes, chemical imbalance and psychological assaults. Environmental factors attributed to Schizophrenia include exposure to viruses and lack of proper nutrition during fetal stage of life and complications during birth. As illustrated by National Institute of Mental Health, (2009), when a pregnant mother gets a viral infection, the virus ends up crossing the placenta thereby causing damage to the developing neural system of the fetus. Psychological factors such as extreme stress occurring mainly due to depression, anger, frustration, and anxiety are other factors that may lead to development of Schizophrenia. Stress in particular is the major cause of psychotic disorders like, disorganized thoughts, delusions, hallucinations, distorted perception of reality, and abnormal expression of emotions. A lot of people suffer from extreme stress starting from their childhood through adulthood.
Chemical imbalance in the brain especially deficiency of neurotransmitters dopamine and glutamate is the factor believed to lead to development of Schizophrenia. Genetic factors as stated by Bhattacharyya (2008) are also associated with the disease. Genes carry the risk of Schizophrenia among members of the family. Individuals, especially those with close relatives having the disease, have a higher risk of developing it than those whose close relatives do no t have the disease. The risk of developing the disease is passed on from parents to children. It is higher in monozygotic twins than in dizygotic twins. Generally people who have family members suffering from the disease are at a higher risk of developing the disease than the general population. Other factors that may be considered causative factors of the disease are biological maladjustment towards certain environmental factors, personality type whereby it is believed that only people of certain personalities are prone to the disease, and conflict between masculine and feminine perspectives. Disorganization of sex glands causing over-secretion of certain hormones which stimulate the production of certain chemicals in the digestive system is also believed to be a cause of the disease though not well documented.
Athealth, (n.d.), asserts that schizophrenia has got both positive and negative symptoms. The positive symptoms of schizophrenia include delusions which are firm beliefs held by a person contrary to reality. Patients often belief they are being followed or watched by strange people. They also tend to belief that programs on TV and radios have special messages directed to them. Hallucinations, the other positive symptom of schizophrenia, are distortions perceived by the senses mainly the auditory senses. Sufferers often hear strange voices and see strange visions of things that are not present in real life. Disorganized thinking is the other positive symptom of schizophrenia whereby the thinking process of a person becomes so impaired that heshe cannot communicate effectively. In grossly disorganized behavior patients have no goal in life and usually display purposelessness in all they do. They exhibit behaviors that are strange to onlookers. Catatonic behavior is the other positive symptom of schizophrenia. Sufferers of schizophrenia react slowly to adverse environmental changes. They may portray unawareness to certain environmental factors or fail to move at all displaying rigid and strange postures. These people can also display increased and aimless motor activity.
Sufferers of schizophrenia also portray negative symptoms which include lessened range and intensity of emotional expression referred to as affective flattening. Minimized speech productivity as well as fluency referred to as Alogia, blank replies to simple questions which reflect slowing and blocking of thoughts and loss of interest. People with schizophrenia cannot start and maintain a goal directed behavior (Athealth, n.d.).
There are different types of schizophrenia. One of them is catatonic schizophrenia whereby individuals portray extreme behaviors including catatonia. The posture of these patients becomes disarranged. They imitate sounds made by objects as well as other people. At times, they may explode to an excited state marked by repetitive and purposeless motion. Disorganized schizophrenia is the other type and is characterized by disorganized speech as well as behavior. Paranoid schizophrenia is the other subtype of schizophrenia and is characterized by persistent delusions and auditory hallucinations. However, in this subtype the cognitive and affective functioning of an individual remains intact. In residual schizophrenia, the other form of schizophrenia, a patient who was previously diagnosed with the disease no longer have psychotic symptoms, but some symptoms of the disease may be present such as unreasonable behavior, social withdrawal, and emotional blunting (Chandler, 2005).
Violence is not considered a symptom of schizophrenia. These people are more likely to cause harm to their body than to the other people. They are usually withdrawn and do not like participating in social functions. The risk of violence from a sufferer is increased by abuse of alcohol and other drugs. Diversion in the criminal justice is provided for an individual who commits a minor offense and is suffering from schizophrenia.
The fourth leading cause of disability in the developed world as indicated by The National Institute of Mental Health, (2009) is Schizophrenia. The disease affects people of all culture, class, color, and religion. It is mainly observed in people between the ages of 15-50 years. The disease affects both men and women with the same frequency. Adverse symptoms such as flat emotions, lack of motivation, and social withdrawal, are mostly observed in men whereas paranoid delusions, depressive episodes, and hallucinations are predominant in women. The disease is rarely diagnosed in children. It is estimated that more than 2 million Americans suffer from the disease at any given time. Approximately 1 of the population as stated by Wolff, and ODriscoll, (1999) develops schizophrenia during their lifetime. Half of the population of patients in psychiatric hospitals in the United States is believed to be suffering from the disease. The course of the disease usually starts at the late teenage and early 30s. The disease can also begin late in life though rarely. The onset of the disease is observed earlier in men than in women and is characterized by a pre-psychotic phase of increasing adverse effects such as social withdrawal, unusual habits and decline in grooming as well as hygiene. Psychotic phase of the disease occurs as the disease progresses. The symptoms of the disease persist for a lifetime either continuously or episodically.
The role played by cultural factors before and after the development of the disease, is an important aspect that cannot be left out in any discussion about schizophrenia. The disease, as a very severe psychiatric disorder, not only affects the sufferers, but also the caretakers and the society at large. Many of those who suffer from it are adversely affected by its symptoms to such an extent that they cannot perform ordinary tasks for themselves. They may also lose the ability of holding onto a certain job. They cannot take part effectively in a conversation as their concentration is greatly distorted (Farmer, and Pandurangi, 1997). Loss of ability to perform simple tasks means that, the patients will either depend on family members or any other caretaker for all their chores. This disease affects people of all socioeconomic backgrounds. However, people from poor backgrounds are affected more by the disease than those from rich families which tend to provide better support and care for a sick family member than poor families. Symptoms of schizophrenia have negative effects on the social life of a person. These include disrupted education and social interaction, social withdrawal, loss of legal involvement, family stress and abuse of illegal substances. Adverse social effects of the disease to an individual increase the risk of suicide of a person (The International Society for the Psychological, n.d.).
Jenkins, and Barrett, (2004), note that Cultural variations occur in consideration of the symptoms of the disease as a psychological disorder. For example, what is considered as delusional in a one community may be accepted in another. Members of some societies consider hearing voices and seeing visions as a religious experience. They consider visitation by a deceased family member as a usual thing. However, delusions, hearing of voices and seeing abnormal visions are all considered psychological disorders by psychiatrists who hail from a cultural background different from that of the patient. Variations in view of these symptoms as psychological disorders may also occur between members of the same community.
It is very important for psychiatrists to become culturally competent in the geographical regions they are operating in, so as to minimize chances of misinterpreting emotional expressions, social behavior, and cognitive styles different from their culture as psychological disorders. A psychiatrist for example may interpret avoidance of direct eye contact as a sign of social withdrawal or paranoia displayed by an individual whereas it is a sign of showing respect to those in authority. Versola-Russo, (2006), states that people from different ethnic backgrounds may suffer from and display symptoms of the disease differently. Culture plays a very major role in shaping the content of both positive and negative symptoms. A very good example is displayed by people suffering from schizophrenia in the western communities who display catatonic behavior commonly than it is in the United States.
As asserted by Sperry (2003), the DSM-IV-TR was developed based on significant advances in research since the 1994 publication of DSM-IV. One of these disorders was schizophrenia. Cultural materials on schizophrenia were incorporated in to DSM-IV-TR in order to provide clinical guidelines for a comprehension on the ways through which culture ought to be taken into consideration during diagnostic evaluations. The DSM-IV-TR includes among other things the knowledge of the characteristic symptoms of the disease as well as the diagnostic procedure. Presence of either one or more of the symptoms of schizophrenia for a significant period of time in a one month period qualifies for one to be diagnosed with the disease. The symptoms of the disease illustrated in the DSM-IV-TR are hallucinations, delusions, disorganized speech, catatonic or disorganized behavior, and negative symptoms.
Social as well as workplace dysfunction are also included in the DSM-IV-TR. Interpersonal relations, self care, academic and occupational achievement are far below the normal level in patient with the disease as indicated in the DSM-IV-TR. The duration for which the symptoms are supposed to persist for one to be diagnosed with the disease is also included in the DSM-IV-TR diagnostic criteria. Persistent signs of disturbance are supposed to take 6 months within which one month of symptoms is included to successfully meet the criterion. The DSM-IV-TR rule out schizoaffective as well as mood disorder since there is no major depressive, manic, or mixed episodes which have occurred alongside active-phase symptoms. Substance and general medical condition have also been ruled out by the DSM-IV-TR diagnostic criteria since the disturbance is not directly a result of physiological effects of a drug or a substance (Sperry, 2003).
The mortality rate of patients with schizophrenia is generally higher than that of the general population. Increased cases of suicide among people with schizophrenia are one of the factors that lead to high mortality rate. Recent studies have shown that people with schizophrenia are mostly affected by other disorders such as dental disease, diabetes, hypertension, and sexually transmitted diseases (National Institute of Mental Health, 2009).
Diagnosis of schizophrenia is a very long and complex process. This is due to the fact that, it is purely a clinical process as there is no blood or physical test to confirm the disease. The process of diagnosis involves ruling out of other diseases. This is because people can suffer from other diseases and portray symptoms similar to those of schizophrenia. The ruling out of other possible causes of symptoms that indicate schizophrenia is made easy by laboratory tests. Blood and urine samples are tested to rule out presence of substances and drugs in the body that give an individual, symptoms similar to those of schizophrenia. The other problem in the diagnostic process of schizophrenia is that, it is very hard to differentiate one mental illness from another. For example, Major depression, Schizophrenia, bipolar disorder, and manic-depressive disorder portray symptoms that are very similar (National Institute of Mental Health, 2009). Other factors that need to be ruled out for proper diagnosis of schizophrenia include presence of a brain tumor, liver disorders, Huntingtons disease, and autoimmune disorders, as all these portray symptoms that are synonymous to those of schizophrenia. It is very important that a medical history be taken as well as physical and laboratory tests be carried out to rule out the presence of other medical causes of the symptoms before making a conclusion that an individual has schizophrenia. It is only clinicians who can diagnose a person with schizophrenia, and a large number of factors are put into consideration for such a diagnosis, particularly the clinicians judgment, expertise, and knowledge. Many variables need to be considered when making a diagnosis for schizophrenia.
Though there is no complete cure for schizophrenia, there are various treatments aimed at alleviating the adverse symptoms of the disease as well as reduce the chances of relapse of symptoms. The duration of psychosis for example, is shortened by antipsychotics like haloperidol and chlorpromazine. Antipsychotics also prevent recurrence of the psychosis in people with the disease. It may take months for individuals to suffer a psychotic relapse after the last does of antipsychotics.
Antipsychotic medication in combination with antidepressants and anxiolytic medications play a vital role in prevention of suicide, reducing cases of re-hospitalization, and improving the social functioning of a person. There are also medications used to minimize the effect neurotransmitters imbalance in the brain. A combination of these drugs helps in reducing the effect of psychotic symptoms such as delusions, hallucinations, and nervousness to an individual. All medications however, should be taken under strict guidance of a physician (Beck, and Rector, 2000).
Supplemental therapies are the other treatment used for patient with schizophrenia. These therapies are composed of, psychosocial therapy, cognitive behavioral therapy, rehabilitation day programs, peer support groups and nutritional supplements among many others. These alternative treatment methods helps an individual manage depression, academics, social interactions and other aspects of life. In psychosocial therapy for example, self esteem, insight and social behavior of a patient who suffer from schizophrenia are improved. Psychosocial therapy should be incorporated in routine care for schizophrenia as it helps a patient deal with the daily challenges of the disease. Psychosocial treatment is also beneficial as it make sure that a patient is taking hisher medication as recommended by the doctor. Patients are helped to understand and cope with the challenge of living with the disease during psychosocial treatment programs (Wiens, and Daniluk, 2009).
Conclusion
Schizophrenia is a very severe mental disorder that affects those who suffer from it throughout their life. The main cause of schizophrenia is not yet known. However, interaction of genetics and environmental factors are attributed to the cause of the disease. Schizophrenia has got various symptoms that negatively affect patients. These include delusions hallucinations, Disorganized thinking, grossly disorganized behavior, Catatonic behavior, social withdrawal, and affective flattening. The disease affects both men and women at the same frequency. About 1 of the population develops the disease at some time in their lifetime. Though the disease is not curable, medications in combination with psychotherapy are employed in minimizing the relapse as well as effects of the symptoms to an individual.
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