Schizophrenia is one of the most common mental disorders. The WorldHealth Organization (WHO) identifies the disorder as the 7thgreatest cause of disability in terms of disability-adjustedlife-years worldwide affecting about 24 million people worldwide(Frangou, 2008) Many individuals around the world are affected bythis disorder directly and indirectly. This paper looks atSchizophrenia assessing its epidemiology, history, diagnosis,symptoms, causes, and treatment drawing support from relevantsources.
The term Schizophrenia is derived from two Greek words, skhizeinmeaning `to split` and phren meaning `mind` hence the commonmisconception that the disorder equates to split personality. Thedisorder can also be traced to Egypt in second millennium beforeChrist. However, these ancient understanding of this disorder arenothing close to the modern understanding of schizophrenia (Delisi,2008). In fact, during that time, there were no unique factors thatwould differentiate schizophrenia from other psychotic disorders.Such psychotic and mental disorders were all grouped as one and werethought to be caused by possession by evil spirits. The modernunderstanding of the disorder came about at the beginning of the 20thcentury (NIMH, 2014).
Dr. Emile Kraeplin was the first to classify the symptoms that arecurrently associated with schizophrenia as a unique disorder in 1887.However, he used the term dementia praecox rather than schizophrenia.He identified two forms of psychotic disorders whereby one was nameddementia praecox and the other manic depression. Dr. Kraeplinbelieved that the latter disorder primarily affected the brain andwas a just one form of dementia. In fact, he believed thatschizophrenia was the early stages of dementia while Alzheimer’sdisease was the later stage of dementia (Delisi 2008).
Further development came in 1911 through introduction of the termschizophrenia by a Swiss psychiatrist, Eugen Bleuler. Bleulerbelieved that schizophrenia was different from dementia as thedisorder did not always lead to deterioration of the brain or affectthe elderly people only as was expected of dementia. However, bothKraeplin and Bleuler agreed on the categorization of the disorder byidentifying five categories outlined in DSM III as paranoid,residual, disorganized, catatonic and undifferentiated (NIMH, 2014).
Although thecauses of schizophrenia are not well understood medically, there arenumber of factors that have been linked to schizophrenia which areclassified as biological and environmental.
Prenatal and perinatal complications. Several conditions affect fetallife in a manner that increases the risk of developing schizophrenialater in life. They include maternal infection, hypoxia, maternalmalnutrition, prolonged labor etc. Majority of these prenatal factorshave been shown to influence exposure to other major illnesses anddisorders.
Genetic makeup. Research has shown that there is an element ofheredity as high as 85% in schizophrenia. A number of genes have beenidentified to contribute to this with the involvement of theparticular genes varying. The main ones include Neuregulin 1, thecatechol-O-methyl transferase (COMT) and G72/G30. All these genes arelargely involved in neural synaptogenesis and connectivity hence theycontrol brain functioning. The risk of exposure to schizophreniaincreases in family lines that have schizophrenia. For instance, riskof exposure increases by 10% for children who parents hasschizophrenia. For identical twins, the risk increases by 40-65% ifone of them is confirmed case of schizophrenia (CDC, 2014).
The brain structures of schizophrenic patients have shown a differentstructure than the general population. This can also be coupled withsignificant differences in the distribution of their brain cells.Nonetheless, these abnormalities are not only unique to schizophrenicpatients and are not direct indicators of schizophrenia. Another keyissue in understanding schizophrenia is the chemical reaction in thebrain. Any imbalance in the neurotransmitters such as dopamine andglutamate whose functioning is also affected by drugs such as cocaine(Frangou, 2008).
Drugs and excessive consumption increase the risks of exposure. Amajority of illicit drugs target dopaminergic neurotransmission inthe body thereby increasing exposure to schizophrenia. For instanceamphetamine and ecstasy reduce the number of re-uptake transporterswhile cocaine blocks dopamine reuptake (Frangou 2008). Prolongedexcessive alcohol consumption through the kindling mechanism cancause a range substance-induced psychotic disorders includingschizophrenia (NIMH, 2014).
Cannabis is a drug that is commonly used in the treatment ofschizophrenia. However, in collaboration with other factors, earlyexposure to the same drug, especially during adolescent years, hasbeen shown to increase exposure to the disorder. Three studies in theUK showed that teenagers aged 15 years and below who regularly usecannabis were four times more lively to developed schizophrenia byage 26 (NHS, 2014). However, a section of researchers remainpessimistic over the link between cannabis and schizophrenia. Anotherdrug that is linked to schizophrenia in a reverse manner is nicotine.Persons affected by schizophrenia have higher dependency rate sonnicotine at three times the normal rate for the general population(Frangou, 2008). For schizophrenic patients, quitting smoking isalmost impossible hence increasing their exposure risk to othercomplications.
Systematic reviews have indicated that schizophrenia is most commonin people brought up urban areas. In the US, schizophrenia is morecommon in some ethnic immigrant communities compared to nativeAmerican residents. WHO (2014) also reports that 90% of schizophreniccases are reported in developing countries but no link has been madebetween socioeconomic status and the disorder.
Family interaction influences relapse rates in schizophrenicpatients. Hostility and over-involvement in families are predictiveof schizophrenia relapse. This is common where families and personsclose to schizophrenic patients are not well trained and educated onhandling schizophrenic patients. In fact family education is a keycomponent of schizophrenia management (NIMH, 2014).
Symptoms ofschizophrenia are simply classified as positive or negative. Thismeans that there are no specific behaviors that can be identified asschizophrenic but rather it is by comparisons to normal psychoticbehavior.
Hallucinationsare largely associated with drug users. It is for this reasonmajority of schizophrenic patients are confused for drug users.Hallucinations are characterized by imaginary voices, smells andimages. Some of these imaginary voices tend to provide information tothe schizophrenic patient on how to do things or even warn them aboutimpending danger. As a result, some of the actions they engage inmaybe irrational. In some other cases, the images can include of deadpeople or nonexistent individuals.
Delusions arefalse or irrational beliefs that schizophrenic patients that do notmake sense or look bizarre to other people. In some cases, a patientcan believe that they have been bewitched by a neighbor or relativeor even someone is trying to poison them (Insel, 2010).
Dysfunctionalthought processes are positive indicators of schizophrenia. One ofthe main methods of dysfunctional thought processes is disorganizedthinking where individual cannot make logical connections betweenthoughts. Another method is thought blocking where someone gets lostmidsentence and cannot recall whatever he or she was saying. Anothermethod is making up meaningless words what is commonly known asneologism.
Movement maybeinterrupted due to interference with neurotransmitters. In somecases, movement maybe erratic or repetitive while in some casespatients may exhibit limited movement than normal.
A wide range ofcognitive functions can be used to assess schizophrenia. They includeexecutive functioning such as using information to make necessarydecisions. Ability to pay attention can be a symptom especially whereability to pay attention varies greatly from the normal. This is alsoclosely linked to utilize working memory where individuals can recalland use information immediately after learning it.
There are a widerange of antipsychotic drugs which have been in use since the 1950’s.They include Perphenazine (Etrafon, Trilafon), Haloperidol (Haldol),Chlorpromazine (Thorazine), Risperidone (Risperdal), Quetiapine(Seroquel), Olanzapine (Zyprexa), Aripiprazole (Abilify), Ziprasidone(Geodon), Paliperidone (Invega) and Fluphenazine (Prolixin). Thesedrugs are largely used in the treatment of the symptoms and enablingthe patients to cope. However, some of these drugs through their sideeffects have been shown to have adverse effects on patients and inthe process making their lives even harder.
Psychosocialtreatments that include some psychotherapeutic procedures areused in treating schizophrenia. These forms of treatment are gearedtowards overcoming daily challenges that are brought about by themain symptoms of schizophrenia such as disordered through processes,poor memory and others. Furthermore, the treatment enables thepatients to learn coping mechanisms. Another issue that is addressesby these forms of treatment include education on the disorder, theneed for sticking to medication and dealing with side effects ofmedication (Os & Kapur, 2009).
Cognitive behavioral therapy
Thisis a form of psychotherapy that addresses thought processes andbehavior. This form of treatment is complementary to regularmedication in that it enables patients deal with some of the problemsthat cannot be addressed by medication (Os & Kapur, 2009).
Familiesof schizophrenic patients play an integral in the treatment andmanagement of schizophrenia. This is because much of the medicationfor schizophrenic patients is taken away from hospitals at home.Families come in by reminding patients to take their medication,assist them in coping with some of the symptoms and generally makingtheir life easy by being extra sensitive and carefully when dealingwith them. Family members are trained on the best proven ways ofrelating with patients and on methods of identifying any cases ofrelapse.
Rehabilitationprograms target schizophrenic patients to help them accept themselvesand function better in their respective communities. As such, itlargely involves membership to self-help groups, counseling andtraining from professionals (Insel, 2010).
Like all otherpsychotic disorders, schizophrenia affects normal life activities.Early intervention methods are preferred to address the risk ofexposure to the disorder. However, without clear knowledge on theactual causes of schizophrenia, preventing the disorder is evenharder. However, addressing some of the behaviors and factors thanincrease risk of exposure can help. One of the main methods isthrough cessation of drug and substance abuse. Another way is throughearly detection in order to redirect the brain trajectory throughtherapy without necessarily using medication (Os & Kapur 2009).
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