SCHIZOPHRENIA

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Schizophrenia is a severe and chronic mental disorder. It affects the emotional well-being of the person. The patients usually seem to have distortions of reality and hallucinating. The family and friends are on the receiving end of the distorted behaviors. If the symptoms are left untreated they have deleterious effects on the society (Janoutova et al., 2016). The hallmark of the symptoms of schizophrenia is psychosis, such as auditory hallucinations and delusions. The patients may also present with impaired cognition though this symptom is often underestimated. Persons with the condition have lower rates of employment, marriage, and are dependent on others. The treatment requires a firm integration of medical, psychological, and psychosocial inputs. The patients are frequently handled in the outpatient setting. Psychosocial interventions are critical in the care of this group of patients.

The lifetime prevalence of schizophrenia in the world is about 1% (Janoutova et al., 2016). Schizophrenia is less prevalent in less developed countries majorly because of little diagnosis. Immigrants to developed states display higher rates of schizophrenia. The disease affects approximately 20 million people globally (Janblensky, 2018). The diagnosis tends to occur in late adolescence and early thirties. The onset is much earlier in males than in females. The clinical manifestations are less severe in women than men, which may be due to the antidopaminergic effect of estrogen hormone. However, the prevalence is similar in both women and men. Schizophrenia is reported rarely in children. The symptoms are worse during the first 5-10 years. Later on, the patient is relatively stable. The schizophrenia symptoms lie in three general categories namely, psychotic, negative, and cognitive symptoms. Psychotic symptoms involve altered perceptions. Therefore, a patient may present with changes in smell, vision, touch, taste, and hearing. The patients may either be deluded or hallucinating. They may have distorted thoughts and may also present with disorganized speech. Negative symptoms are characterized by loss of motivation, disinterest, social withdrawal, and depression of normal functions. Some of these symptoms cause the “flat effect” with reduced speaking (Galderesi, 2018). Cognitive symptoms involve those that alter higher brain functions such as memory, attention, and concentration. In most cases, the cognitive symptoms may be subtle, while in some patients, they are the most prominent features of the disease. They interfere with the person’s normal daily activities leading to social alienation.

There is no definite cause of schizophrenia. It is thought that the interaction of genetic factors and environmental factors lead to schizophrenia. Psychosocial factors may also play a significant role in the condition. Neuroimaging studies of schizophrenic patients reveal appreciable differences from healthy individuals. For example, the ventricles are somewhat larger, with lower brain volumes in the medial temporal areas. Dopamine plays a crucial role in the brain. In schizophrenic patients, the dopaminergic system is somewhat abnormal (Van Den Heuvel, Martijn & Alex, 2014). The immune system also plays a part in the progression of schizophrenia. Overactivation of the immune system results in amplified expression of inflammatory cytokines and subsequent changes to the brain structure and function. The risk is elevated in biological relatives of patients with the disease. First degree relatives have a 10% risk. The risk is at 40% if both parents have schizophrenia. Perinatal factors such as malnourishment of pregnant women may increase the risk of developing schizophrenia (Searles, 2018).

The causes of the disease are complex and, therefore, the treatment focuses on managing the symptoms of the disease. The aims of treatment include to improve the quality of life of the patient and to reduce the symptoms of the disease. The medications may be administered either once or twice monthly. The treatment schedule is convenient for most patients. Clozapine is added to patients whose symptoms do not improve with standard antipsychotic medication therapy. Patients on clozapine must be closely monitored due to potential serious blood side effects. Antipsychotic medications cause the following side effects: xerostomia, restlessness, and drowsiness (Searles, 2018). The above symptoms are prevalent at the start of therapy. Hence, some of them subside with time while others persist. The patient should be advised that abrupt withdrawal of the medications can exacerbate schizophrenic symptoms.

Psychosocial interventions are integral in the management of schizophrenia. The measures may include CBT, behavioral skills training, supported employment, and cognitive remediation. The above approaches may help to address both negative and cognitive symptoms. In practice, psychosocial interventions are combined with antipsychotic therapy. Psychosocial methods aid an individual to blend with the environment. The patient is taught how to interact with colleagues, friends, and family. They can also be helped to pursue life goals. The patient can now participate in community activities and get employment. Patients on psychosocial treatment have fewer relapses and fewer hospitalization incidences (Searles, 2018).

Therapy is incomplete when it does not involve the community. Hence, management integrates education programs for family members and friends. The programs incorporate lessons on the symptoms of the disease, treatment options, adverse effects of drugs, and prognosis. The education programs aim to decrease their distress, promote their cooperation and empowerment, and boost their ability to assist.

The prognosis of the condition is guarded. Full recovery is rare. Some of the following risk factors are associated with poor outcomes: early-onset, conspicuous cognitive manifestations, family history, and structural brain abnormalities. The clinical manifestations follow a wax and wane course. Positive symptoms respond better to medical therapy while the other symptoms tend to prevail. Schizophrenic patients have a 5% lifetime probability of committing suicide (Searles, 2018).

Schizophrenia affects people worldwide with subsequent disability in the population. The patients are less likely to get employment, hence, may lead to social withdrawal. The community should be educated on these notable features to lessen the stigmatization. Let society be sensitized to avoid cases of discrimination and violation of human rights towards schizophrenic patients. Schizophrenia is treatable.

References

Galderisi, S., Mucci, A., Buchanan, R. W., & Arango, C. (2018). Negative symptoms of schizophrenia: new developments and unanswered research questions. The Lancet Psychiatry, 5(8), 664-677.

Jablensky, A. (2018). An overview of the World Health Organization’s multi-centre studies of schizophrenia. The Scope of Epidemiological Psychiatry, 455-471.

Janoutová, J., Janáčková, P., Šerý, O., Zeman, T., Ambroz, P., Kovalová, M., … & Janout, V. (2016). Epidemiology and risk factors of schizophrenia. Neuroendocrinology Letters, 37(1), 1-8.

Searles, H. F. (2018). Collected papers on schizophrenia and related subjects. Routledge.

Van Den Heuvel, Martijn P., and Alex Fornito. “Brain networks in schizophrenia.” Neuropsychology Review 24.1 (2014): 32-48.