SchizSchizophrenia: Symptoms, Prevalence and Treatmentsophrenia

Schizophrenia

Abstract

This paper will discuss the history of mental disorders, with a focus on Schizophrenia. The symptoms, diagnoses, prevalence or who is most susceptible to Schizophrenia, and treatment will be discussed. To be diagnosed a person will have to exhibit 2 or more symptoms, exceeding 30 days. The most common symptoms experienced by a schizophrenic will include, but not limited to hallucinations, delusions, irrational thoughts and speaking, and other various topics. There is not a specific diagnosis for this disorder, although research shows factors such as genetics, environment, and, and substance abuse will increase the likelihoods of the disorder. Although not sufficient in the past, treatment of mental disorders has improved, giving individuals living with Schizophrenia a chance to live a productive life.

Keywords: Schizophrenia, mental disorders, hallucinations, substance abuse

Schizophrenia

“One in 5 adults experiences a mental health condition every year” (National alliance on Mental illness, 2018 ). In the past our resources and knowledge on mental health was scarce, and led to many different beliefs on what mental illness really consisted of. During the Middle Ages, not only were mentally ill individuals treated differently, but they were also thought to have some type of negative force or spirit within, referring to some form of possession (2015). This previous belief led to the negative stigma on people suffering with a mental health condition, resulting in the isolation and lack of treatment of the mentally ill. One in 17 lives with a serious mental illness such as schizophrenia or bipolar disorder. (NAMI, 2018) Schizophrenia is a psychological disorder characterized by major disturbances in thought, perception, emotion, and behavior (Spielman, et al., 2017). Most individuals assume that persons suffering from schizophrenia are maladaptive and exert themselves frequently with violence; although with the vast improvement in the medical field and proper treatment, individuals living with schizophrenia can function properly and live productive lives.

The term “Schizophrenia” originated 100 years ago from the Greek roots “schizo” or “split”. This is why Schizophrenia is frequently confused with mental disorders concerning multiple personalities as a symptom, such as Dissociative identity disorder. Schizophrenia was deemed a mental illness by Dr. Emile Kraepelin in 1887. (2010), although history shows that this mental disorder revealed itself during the Old Pharaonic Egypt era, and its signs and symptoms were found in the “Book of Hearts”. (2010) Dr. Kraepelin was also the first Doctor to classify or break down mental disorders into categories. In the previous version of the DSM, Schizophrenia was broken down into categories: Disorganized, Catatonic, Paranoid, Residual, and Undifferentiated Schizophrenia. Doctors later discovered that these classifications were not accurate in certain diagnoses and were not helpful. Bringing us to the present DSM- V, where the mental disorder is no longer sub-divided and presents itself as Schizophrenia as a whole.

“Half of mental health conditions begin by age 14, and 75% of mental health conditions develop by age 24.” (NAMI, 2018) in contrast to other mental disorders, research shows that schizophrenia is more difficult to diagnose in teens. “This is because the first signs can include a change of friends, change in grades, sleep problems, and irritability—common and nonspecific adolescent behavior.” (NAMI, 2018). This phase is also known as the Prodromal phase. According to research, in order for someone to be diagnosed a schizophrenic, the person has to exhibit two or more symptoms that exceed 30 days or 1 month. Although, it is not easy to do so, because it cannot be done by a single lab or diagnostic test. A doctor will rule out other disorders, before classifying a person as schizophrenic.

The symptoms of schizophrenia are classified as positive and negative symptoms. The positive symptoms being hallucinations and delusions, and the negative symptoms involving the loss or decrease of a certain aspect of the person’s ability or daily life. Examples of these symptoms can include: loss or decrease in ability to speak, think, or express emotion, loss of motivation, and social withdrawal. Other various symptoms experienced include, but not limited to: catatonia, breaks from reality, and /or psychotic episodes. Positive symptoms are more likely in the present time Delusions deal with thoughts, and are simply false beliefs; such as someone believing that they are Beyoncé, or thinking that their dog is a dragon. Someone will firmly believe their delusions and their delusions feel and are real to the schizophrenic individual. Hallucinations are another symptom that can be experienced by a schizophrenic, but they deal with human senses. The 5 senses to be exact: smell, taste, hearing, and visual disturbances. A person experiencing hallucinations may hear voices speaking to them, or see something that is not part of reality. Catatonia or catatonic behaviors refer to the abnormal state of posture that a person will exhibit, along with a lack of movement and verbal behavior. (Spielman, et al., 2017) Disorganized speech and thoughts speak for itself, and psychotic episodes which may include one or more of the symptoms listed. “Commonly, people with schizophrenia have Anosognosia or “lack of insight.” This means the person is unaware that he has the illness, which can make treating or working with him much more challenging.” (NAMI, 2018). These various symptoms can have a short- or long-term effect on the individual. If symptoms have a short or “acute” onset, the individual will seem well adjusted with a rapid onset of symptoms, resulting in swift transformation in personality and behavior. A more slow and gradual approach is referred to as “chronic onset”.

In addition to Schizophrenia, the mental disorder itself can take different forms. One form of schizophrenia is known as Brief Psychotic disorder. This disorder is short in duration lasting from a single day to 30 days maximum, following the exposure to a significant stressor. A person must experience one or more of the previously stated symptoms during this time frame. Schizophreniform disorder, which also resembles the disorder previously discussed, but the duration is longer, lasting from 1- 6 months. Next is Delusional Disorder, a person diagnosed with Delusional disorder has persistent delusional beliefs, often involving paranoid themes. Schizophrenia can also display itself through a disorder called Erotomania. An individual with Erotomania believes that someone of famous nature or a higher social status is in love with them. The Last known form of Schizophrenia is Schizoaffective disorder; with this disorder, psychotic behaviors associated with schizophrenia occur at the same time as a major mood disorder.

In the past, the knowledge of mental disorders was scarce, but as time progressed the approach and technique in treating persons with mental disorders has improved tremendously. The primary treatment for Schizophrenia and similar thought disorders is medication. Unfortunately, compliance with a medication regimen is often one of the largest challenges associated with the ongoing treatment of schizophrenia. (Grohol, 2018) The most common medication class to treat schizophrenia is Antipsychotics. Antipsychotics can also classify into two categories, atypical and typical antipsychotics, and come in various forms such as tablets, syrup, or injections. Atypical antipsychotics result in less side effects than in typical antipsychotics, therefore this regimen will be attempted in treating the patient first. An important atypical antipsychotic is Clorazil (Clozapine). This drug is used when other forms of medications have failed or when an individual is experiencing suicidal ideation, due to the serious side effect, Neutropenia or reduce in white blood cells. (Grohol, 2018) Patients taking this medication must frequently monitor their white blood cell count in order to prevent infection and/or death. Other various medications to treat this mental disorder include: aripiprazole, iloperidone, ziprasidone, lurasidone, and the list continues. Typical Antipsychotics were the first generation of antipsychotics that were developed, starting in the 1950s (Grohol, 2018). The main concern with this branch of medications is the side effect of Tardive Dyskinesia or “TD”. People experiencing this side effect may inhibit random movements in the muscles, eyes, tongue, jaw, and/or lips. In more recent years, a new treatment option has become available to help ensure patients are taking their medications. “Long-Acting Treatment” are long- acting injectable medications given on a weekly or monthly basis. (Grohol, 2018).

 In addition to medication, research shows it is important to conjoin the medicinal approach along with the therapeutic approach. “Successful treatment of schizophrenia, therefore depends upon a life- long regimen of both drug and psychosocial or support therapies” (Grohol, 2018). Medication by itself will not manage the symptoms to its best potential, without engaging in all aspects of treatment. Doing so will result in a more productive being. In 2015, research shows that people who experienced their first episode of psychosis, enjoyed the best outcomes when a team-based treatment approach was used. (Grohol, 2018) This includes family and work support, medications, psychotherapy and case management.  There are many different types of Psychotherapy, and each type of therapy can be beneficial in distinct ways. In specific, Cognitive behavioral therapy “CBT” deals with identifying and changing thinking or behavioral patterns that aren’t valuable to the disordered person, and replacing them with more useful ideas. (American psychiatry Association, 2017) Interpersonal therapy or “IPT” is a short term therapy, aiding in the understanding of interpersonal issues, such as grief or personal relations. This form is most often used to treat depression. Another form of therapy to treat schizophrenia and other mental disorders, Dialectical behavior therapy is certain type of CBT that regulates emotion mostly used in PTSD cases. Other forms of therapy include Supportive therapy, Psychoanalysis, psychodynamic therapy and many more. It is very important for the patient and therapist to build a trusting relationship for the best results. If all of these aspects of treatment are met, more than likely the individual can live life productively in support communities or at home with family members. In extreme cases, medication and therapy are not sufficient enough to control some of the extreme possibilities of a person mentally ill with Schizophrenia. 

If these medical aspects are unsuccessful, a psychiatrist will institutionalize the individual, seeking more extensive treatment. “In the 1840s, activist Dorothea Dix lobbied for better living conditions for the mentally ill after witnessing the dangerous and unhealthy conditions in which many patients lived. Over a 40-year period, Dix successfully persuaded the U.S. government to fund the building of 32 state psychiatric hospitals.” (2015). This concept came into place as families struggled to care for their mentally ill family member, and to receive a more extensive regimen of treatment. Although this concept of treatment drastically decreased as reports of inhumane conditions surfaced.  “By the mid-1950s, a push for deinstitutionalization and outpatient treatment began in many countries, facilitated by the development of a variety of antipsychotic drugs.” (2015) This caused for many of the mental institutions to close and patients resorted to a more home- based environment to pursue treatment, known as Deinstitutionalization. This changed the mental health system in whole, in positive such as adaptive behaviors and friendships, but also declining in the medication and treatment compliance. This debate continues to the present day, but efforts to improve community-based programs, institutions, and mental health care continues.

There has not been a specific reason for the diagnoses of schizophrenia, but research shows many different factors that can contribute to the problem: a person’s environment, genetics, brain anatomy, exposure in utero, neurotransmitters and substance abuse. From the genetic aspect, there is no specific genetic link, but research shows chances are increased if closely related to a person suffering from this disorder. To support this theory, many researches have been conducted with twins, paternal and identical, due to their similar genetic make-up. The closer the relation, the higher the chance. This genetic link would also have to exist with one of the other factors listed to be prevalent. Many factors contribute to this study such as where and how each individual grew up in their early years of life. Adoption studies; using adopted children in different environments, also gives support to the genetic link and schizophrenia. “One of the first adoption studies of schizophrenia conducted by Heston in 1966 followed 97 adoptees, including 47 who were born to mothers with schizophrenia, over a 36-year period. Five of the 47 adoptees (11%) whose mothers had schizophrenia were later diagnosed with schizophrenia, compared to none of the 50 control adoptees.”( Textbook) “Other adoption studies have consistently reported that for adoptees who are later diagnosed with schizophrenia, their biological relatives have a higher risk of schizophrenia than do adoptive relatives” (Shih, Belmonte, & Zandi, 2004)- textbook. Research revealed, adoptees with an elevated genetic link were likely to exhibit signs of schizophrenia, only if raised in distressed surroundings.

Research shows that Brain anatomy can also play a role in the disorder. Brain imaging studies reveal that people with schizophrenia have enlarged ventricles, the cavities within the brain that contain cerebral spinal fluid (Spielman, et al., 2017). This finding later made researchers conclude that schizophrenia had a connection with the loss of brain tissue, specifically in the frontal lobe. Studies show individuals are also at risk if while in utero, their mothers are exposed to Influenza or high amounts of stress. “One study reported that the risk of schizophrenia is elevated substantially in offspring whose mothers experienced the death of a relative during the first trimester of pregnancy.” (Spielman, et al., 2017) Marijuana research has also shown a relation to schizophrenia. Exposure to mind- altering drugs during early adulthood has shown a significant increase in obtaining schizophrenia. Longitudinal research also revealed the increased probability of acquiring schizophrenia in more frequent marijuana users. Although the two factors cannot be directly connected.

Many researchers have also considered the neurotransmitter Dopamine in connection with diagnosing this disorder. “Interest in the role of dopamine in schizophrenia was stimulated by two sets of findings: drugs that increase dopamine levels can produce schizophrenia-like symptoms, and medications that block dopamine activity reduce the symptoms.” (Spielman, et al., 2017) Recently Serotonin is also being used in research to treat schizophrenia.

It has been proven early detection of the symptoms and seeking treatment in the earlier years increases the effect of treatment. Compliance with the medication regimen and following through with the therapy sessions will also help an individual suffering from this order maintain their symptoms. Persons initially diagnosed with schizophrenia will require a strong support system, not only from medical professionals, but also from family and friends. Most individuals assume that persons suffering from schizophrenia are maladaptive and exert themselves frequently with violence; although with the vast improvement in the medical field and proper treatment, individuals living with schizophrenia can function properly and live productive lives.

References

• Grohol, M. M. (2018, March 13). Schizophrenia Treatment. Retrieved from         https://psychcentral.com/disorders/schizophrenia/schizophrenia-treatment/
• K. (Ed.). (2010). The History of Schizophrenia. Retrieved from http://schizophrenia.com/history.htm
• NAMI. (2018). My Parents’ Support Shaped My Recovery. Retrieved October 2, 2018, from    https://www.nami.org/Learn-More/Mental-Health-Conditions
• Parehk, D., & American Psychiatric Association. (2016, July). What is Psychotherapy? Retrieved from https://www.psychiatry.org/patients-families/psychotherapy
• Spielman, R. M., Dumper, K., Jenkins, W., Lacombe, A., Lovett, M., & Perlmutter, M. (2017). Psychology. Houston, TX: OpenStax, Rice University.
• Unite For Sight. (2015). Retrieved from http://www.uniteforsight.org/mental-health/module2