Schizophrenia
Schizophrenia
Introduction
Schizophrenia is a dysfunctional behavior which is regularly connected with huge ramifications for individuals’ quality of life. The degree to which people with diagnoses of schizophrenia hold fast to their antipsychotic pharmaceuticals is viewed as a critical impact on their results. While solution adherence amongst individuals with schizophrenia has been concentrated broadly, the larger part of research has been quantitative and in this way, the voices of consumers have to a great extent been ignored. One reason that has been proposed for this nonappearance is the presumption that individuals with schizophrenia would not have the capacity to give important commitments to information.
Diagnostic Criteria for Schizophrenia
Based on the survey by the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV the criteria for the diagnosis of schizophrenia is based on several approaches. To begin with is the checking of the marked symptoms of the disease. Some of the standard symptoms that form the basis of the diagnostic criteria include hallucinations, delusions, intelligible speech (it is disorganized and at times incoherence), extremely agitated behavior and overall negative mindset which may involve lack of motivation in the life of the patient. This research paper reviews schizophrenia as a condition and consumers’ voices in regard to the prescriptions available by analyzing their viewpoints through subjective meetings. Investigation of meeting information underpins the huge estimation of the consideration of patients’ voices in examination to improve comprehension of prescription adherence. Likewise, the paper looks into the symptoms required for a diagnosis of schizophrenia. In this approach, especially when the hallucinations are characterized by two voices conflicting with each other or when the delusions are incredibly strange, a base is formed. (Bateson et al., 2006).
The second criterion entails the detection of a social dysfunction among the patients where for the considerable period since the first indication of a disturbance, one or more aspects of the patient’s social structure have been affected. These elements may include, social relations from person to person, work, or the sense of caring for oneself have significantly been affected which means that they are way below the normal levels. In a case of the children, this may be indicated by the failure to attain the average levels of social interaction, occupational or academic performance (Carpenter et al., 2009).
The third approach is hinged on the duration of the earlier mentioned symptoms. This happens when they persist for six months or more; where this period should include at least one month worth of symptoms that are in line with the first criterion and may also involve periods of prodromal signs of the schizophrenia condition. During the prodromal periods, the disturbances may be indicated by one or two symptoms mentioned in the first criterion (the active-phase symptoms) (Andreasen, 2005).
The fourth approach is based on the fact that the condition engenders mood disorders. In this case, the mood disorders and the schizophrenia disorders have been ruled out for the simple reasons that: when the mood disorder occur, they take too short time about the residual and active periods (Tsuang, 2007).
The fifth criterion is the substance exclusions where the patient experiences disturbances not caused by a medical issue or drug abuse. The last criterion is the presence of a Pervasive Development Disorder where such disorders as autism may show significant hallucinations or delusions which have been experienced for at least a month (Tsuang, 2007).
Many conditions share similar symptoms with schizophrenia. Some of these conditions include the Schizotypal personality disorder and the Delusional disorder. Similar to schizophrenia, the Delusional disorder is a mental condition in which the patient is unable to distinguish between what is real and imagined. The main feature of the disease, however, is the regular occurrence of delusions, fanatical belief in something which may be fictional or unfounded (Munro & Mok, 2013). However unlike, schizophrenia, the diseases have non-strange delusions which apes situations that could occur in actual life such as among others, being poisoned, followed, deceived and conspired against. Also, unlike the schizophrenia patients who behave strangely, the delusional patients continue to function and socialize regularly aside from the occasional delusions they might go through. Moreover, different form schizophrenia, the delusion diseases are rare and affects women more than their male counterparts (Winokur, 2007).
The Schizotypal Personality Disorder (SPD) is one among a group of disorders referred to, in the informal circles, as ‘eccentric personal condition.’ The patients suffering from the disease always appear odd and bizarre. They may have strange superstitions or beliefs. They are unable to create close-knit relationships, and they may have a tendency of distorting what is real. In other words, the condition could be thought of as a mild type of schizophrenia and could in rare cases lead to this closely similar disease (schizophrenia). The schizotypal patients tend to have unique personalities, thought patterns, speech, and perceptions. However, unlike schizophrenia, the frequency of hallucinations and delusions are not as intense as those in schizophrenia. Secondly, while the schizophrenic patients may not be called off their delusion as it were, people with the Schizotypal Personality Disorder can tell the difference between their delusions and what is real. Also, the schizotypal patients have both auditory and visual delusions and hallucinations while the schizophrenic patients only experience auditory hallucinations. Lastly, the Schizophrenic patients are so disconnected to the social sense that they may not realize it when they are behaving in generally odd ways. Differently, the schizotypal patients have been guilty of their unique personalities for which reason they lead an isolated life or keep small circles of friends (Peskin and Rein, 2011).
Prevalence Rates of Schizophrenia
Schizophrenia could be a terribly chronic disease, and according to studies it affects approximately 1% of the world’s population a closer look, the disease currently affects about 1.3 % of the American population which is roughly about 3 million of American citizens. According to the projections of a study, the disease is expected to affect at least 1.6 million people around the world. This would mean that about 100,000 people in America will be diagnosed with the disease this year. This could be translated to mean 72 per 1000 people or 31000 within the confines of a city having a population of 4 million will be affected by the disease. Other sources reveal that about 21 % of the people in North America will have the disease at some point in their lifetime. The sources further say that 2 in a group of 200 Canadians will suffer from the disease. This is to say that about 4000,000 people will be affected by the disease somewhere in the path of their life (Penn and Mueser, 2006).
Chatterjee et al, 2003 directed a substantive literature review to illustrate components that impact schizophrenia patients. They found no steady relationship between demographic components and adherence to medication on the condition. In connection to ailment attributes, the studies explored yielded no relationship between adherence and age at onset and span of sickness, age at first hospitalization and premorbid working. Of the studies evaluated which surveyed the relationship between ailment manifestation seriousness or worldwide working and inpatient medicine refusal or future outpatient non-adherence, one reported a relationship between more extreme psychopathology including disorder, threatening vibe and suspiciousness and inpatient drug refusal. A few studies connected side effect seriousness at or after release to poor outpatient adherence or poor states of mind towards solution. One focus additionally connected the self-importance score on the Brief Psychiatric Rating Scale to poor adherence of medication. While the authors did not discover support for a relationship between memory or discernment on adherence, they recognized that a noteworthy rate of patients credited non-adherence to overlooking or showed that suggestions to take their pharmaceutical would be of help. Poor understanding, as measured by an assortment of self-report instruments surveying ailment mindfulness, was reliably connected with non-adherence. different studies demonstrated a relationship between poor knowledge at affirmation or amid hospitalization and non-adherence in inpatient settings. Others connected absence of understanding at confirmation, release or post-release appraisal to poor outpatient adherence. On the other hand, Munro & Mok, (2013) recognized that in spite of the fact that the factual relationship amongst knowledge and adherence has been repeated in an assortment of settings, a few specialists saw sizable subgroups of patients who did not trust they were sick or required drug but rather were, regardless, routinely follower.
More recently, McWilliams et al., (2007) investigated applicable writing and built up a prescient model of danger variables for non-adherence to antipsychotic solutions and line up arrangements amongst individuals with schizophrenia. The model is included eight freely noteworthy indicators from symptomatic, clinical, psychosocial and treatment history areas: Substance use diagnosis; medicine reactions; moderate to serious insanity manifestations; identity issue analysis; monetary issues; earlier hospitalization; current Global Assessment of Functioning scale score and span of treatment from current specialist (McWilliams et al., 2007)
While psychotic disorders are prevalent in many parts of the world, disparities mainly occur due to the racial differences. Research show that the African Americans hold a rate of approximately four to five times higher chances of being diagnosed with the disease than Euro-Americans. Also, the Latino American race was found to be three times more likely to be diagnosed in comparison to the Euro-Americans. On the basis of the research by the Department of Mental Health, there are also ethnic differences in the prevalence of the disease where considerable diagnostic differences were found. To this effect, the African-American, the Hispanics and the Asians were considerably more likely to be diagnosed with the disease than any other ethnic group in the world. The whites were the least ethnic group to have ever had any schizophrenic diagnosis (Mallett et al, 2005).
The existence of gender differences in schizophrenia has been debatable for the longest time now. Even then, there are notable differences in the age of the onset of the disease between men and women. While the illness sets in between 18-26 years among the men, it occurs at the age of between 25-36 years among their female counterparts. Furthermore, the negative symptoms were found to be more in men than in women (McWilliams, et al., 2007).
Ways in Which Schizophrenia Could Impact an Individual’s Social Functioning
While being proficient in social functioning is important for fulfilled social life in a societal setting, the schizophrenic patients are far from being considered to have even the least of skills in social functioning. This is because most of them have difficulties communicating to other people where they may be unclear or have no interest in conversations at all. Also, these patients do not have any assertion skills when challenged in discussions. Moreover, they tend to deny having made any mistakes even when it is clear they made them not to mention the fact that they do not have any capacities whatsoever to solve any problems in life. Additionally, they have impaired social recognition capabilities where they may quickly forget the face of a person they recently met. Added to this, they also have problems understanding the emotions of others and may look snobbish to their friends. Finally, these patients are not aware in any way of the regulations that run the various social situations which facilitate smooth interpersonal communications. All these deficiencies make it word for these patients to do well at work, school, home as well as in relationships. This happens because these patients do not have the necessary social skills required in such settings. This social disconnection could also be explained using the three phases of the disease. The onset phase causes the impairment of the social skills and the inability to complete daily duties (this will affect work and school, relationships), the acute phase engenders hallucinations and exaggerated thinking which makes them uncomfortable companies in the family and friendly relationships and the remission phase marked by the return of a semblance of sanity which soon clears to welcome total bizarre behaviors in such patients especially when they become passive with their mind and cannot concentrate on what they do (López, 2008).
Psychosocial and Psychopharmacological Interventions in Schizophrenia Treatment
There is a myriad of schizophrenic theories, but in this paper, only two such theories will be discussed at length. The first theory in this case is the Psychoanalytic theory which has it that schizophrenia is a retrogressive development of the oral phase during the time when the ego has not come from that part of the human personality component of the brain with unconscious psychotic energy and operates to meet the basic needs and desires (the id). Since there is no discreet ego, the retrogressive phenomena to the primitive narcissistic phase make the people with schizophrenia lose any contact they might have ever had to the world. The impulses in the id are heightened especially the sexual ones during adolescence. According to Roussos et al. (2013), the deficiency of interpersonal connection and the heightened sexual attachment are attributed to their increased sensitivity to behavior and criticism. In attempting to respond to the demanding of the id needs and to have connections with the stimulus of some kind, the symptoms of hallucination, thinking disorders and hallucinations occur.
The second theory is the Social Learning theory of schizophrenia according to which people with schizophrenia do not appropriately respond to the social settings, unlike their normal friends. This deficiency in concentration to the social settings engenders the lack of proper relations and the mental disturbances which affect the thinking processes. Also, the lack of the appropriate concentration to the stimulus from any social setting causes the patient always to seem withdrawn. For the records, schizophrenia is mainly a reaction to the many reinforcements received in the mental hospital where the doctors attend to these patients when they are most incoherent. To put it differently suggests that the condition is as a result of faulty social learning. When children don not receive early reinforcement, they abound to put much of their attention to the irrelevant components of a social environment (Saxena et al., 2007).
The social learning theory brought a change in the treatment of the schizophrenic condition. This became apparent when many mental hospitals passed that the psychosocial approaches created by the theory were the best in the diagnosis and treatment of the condition especially in relieving the patients of their psychotic signs as well as improving their social functioning. Additionally, the psychoanalytic theory bore the Effective Psychoanalytic Therapy of Schizophrenia which concentrates on enhancing safe and healthy relationship in which they can diagnose the symptoms of the patient. Based on Sigmund Freud, the therapy makes adventures into the manner the unconscious mind affects the behaviors as well as thoughts with the aim of creating a solution to the patients. This is a long-term treatment and may go for weeks, months and even years (Bateson et al., 2006).
Psychosocial is a non-medicinal treatment approach for schizophrenia. There are many forms of the treatment, but this paper discusses the two most important ways: The Social skills training and the family psychoeducation. The social skills training modality is an approach given to the patients either in groups or individually. It involves the systematic teaching of patients on particular behaviors that are important for anyone to succeed in societal interactions. Having been developed twenty-five years ago, it is the most efficient time-tested treatment modality for schizophrenia (Buchanan et al., 2010).
The second approach, the family psychoeducation is perhaps the most significant advancement in the treatment of schizophrenia among the two for the last two decades. Its emphasis has been on the positive impact of the family involvement in the processes of treating a patient. To this effect, there have been different treatment models of family involvement which have been created and duly tested. These models share a common component called the psychoeducation which is a united and respectful connection with the family, teaching about schizophrenia as well the communication of the different strategies in problem-solving which makes it efficient.
Psychopharmacological treatment is the use of medication in treating schizophrenia and comes in two drug types antipsychotic and the atypical antipsychotics. Also, known as the neuroleptic antipsychotic, the drugs effectively work by influencing the neurotransmitters that enhance the communication between the nerve cells. An example of such a transmitter is dopamine which is believed to be responsible for the schizophrenic symptoms. However, these medications have such side effects as the stiffness of the muscles and abnormal body movements. As such, there is the second method where the atypical antipsychotics comes in handy since it has no or may have reduced side effects (one side effect is that it causes agranulocytosis). Other side effects of the psychopharmacological treatment include sleep, dizziness, headache, agitation, sedation, dry mouth, nausea among others (Buchanan et al., 2010).
Community-based Resources Useful for Schizophrenia Patients
In conclusion, the importance of community-based centers that deal with and treat schizophrenia cannot be overemphasized. One such example of a community-based resource in Atlanta Georgia is the Skyland Trail which offers treatment for mental illnesses. However, it specializes in schizophrenia, Bipolar Disorder, Dual Diagnosis and Depression. The center enhances the quick recuperation of the many mental illnesses that has been treated. It also promotes the reincorporation of the recovered patients into the community and empowers them to live normally and independently (Chatterjee, 2007). The second example is the Young Adult Treatment Center on the Rollins Campus which is mainly meant for young adults. This center gives care to the young patients aged between 18 and 25. The center also promotes the interaction between the schizophrenic young adults and their families and friends. Moreover, the center acts as a normalizing environment where the patients feel more at home than in a hospital. It is while here that the patients are made to feel that they are not alone since they meet their age mates who are suffering from the same condition as them. For one to access the two centers, they only have to be American citizens by whichever means (Chatterjee, 2007).
References
Andreasen, N. (2005). Symptoms, signs, and diagnosis of schizophrenia. The Lancet, 346(8973), 477-481.
Bateson, G., Jackson, D. D., Haley, J., & Weakland, J. (2006). Toward a theory of schizophrenia. Behavioral science, 1(4), 251-264.
Buchanan, R. W., Kreyenbuhl, J., Kelly, D. L., Noel, J. M., Boggs, D. L., Fischer, B. A., … & Keller, W. (2010). The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophrenia bulletin, 36(1), 71-93.
Carpenter, W. T., Strauss, J. S., & Bartko, J. J. (1973). Flexible system for the diagnosis of schizophrenia: Report from the WHO International Pilot Study of Schizophrenia. Science, 182(4118), 1275-1278.
Chatterjee, S., Patel, V., Chatterjee, A., & Weiss, H. A. (2003). Evaluation of a community-based rehabilitation model for chronic schizophrenia in rural India. The British Journal of Psychiatry, 182(1), 57-62.
Chemerinski, E., Triebwasser, J., Roussos, P., & Siever, L. J. (2013). Schizotypal personality disorder. Journal of personality disorders, 27(5), 652-679.
López, S. R., Nelson Hipke, K., Polo, A. J., Jenkins, J. H., Karno, M., Vaughn, C., & Snyder, K. S. (2004). Ethnicity, expressed emotion, attributions, and course of schizophrenia: family warmth matters. Journal of abnormal psychology, 113(3), 428.
Mallett, R., Leff, J., Bhugra, D., Pang, D., & Zhao, J. H. (2002). Social environment, ethnicity and schizophrenia. Social psychiatry and psychiatric epidemiology, 37(7), 329-335.
McWilliams, S., Hill, S., Mannion, N., Kinsella, A., & O’Callaghan, E. (2007). Caregiver psychoeducation for schizophrenia: is gender important? European Psychiatry, 22(5), 323-327.
Munro, A., & Mok, H. (2013). An overview of treatment in paranoia/delusional disorder. The Canadian Journal of Psychiatry/La Revue Canadienne de psychiatrie.
Penn, D. L., & Mueser, K. T. (2016). Research update on the psychosocial treatment of schizophrenia. The American Journal of Psychiatry, 153(5), 607.
Peskin, M., & Raine, A. Schizotypal Personality Disorder. Corsini Encyclopedia of Psychology.
Saxena, S., Thornicroft, G., Knapp, M., & Whiteford, H. (2007). Resources for mental health: scarcity, inequity, and inefficiency. The lancet, 370(9590), 878-889.
Tsuang, M. T., Stone, W. S., & Faraone, S. V. (2000). Toward reformulating the diagnosis of schiz Gottesman, I. I. Schizophrenia genesis: The origins of madness. WH Freeman/Times Books/Henry Holt & Co. aphrenia. American Journal of Psychiatry, 157(7), 1041-1050.
Winokur, G. (1977). Delusional disorder (paranoia). Comprehensive Psychiatry, 18(6), 511-521