Schizophrenia is one of the many psychological disorders that is often very misunderstood, leading to increased stigma against those individuals that suffer with the disease. Schizophrenia is a spectrum disorder, meaning there are a variety of ways that this disorder is manifested (Halter). Individuals with this disorder are unable to determine what is real and what is not real in their everyday life. The disorder affects many aspects of the individual, including his thinking, language, emotions, social behavior, and the ability to perceive what is reality. Individuals diagnosed with the disorder will have at least one psychotic symptom. Possible symptoms include hallucinations, delusions, and disorganized speech. The hallucinations and delusions are not limited to what they may be and differ from patient to patient (Halter). Individuals may also exhibit movement disorders such as agitated body movements (National Institute of Mental Health). These symptoms are terms positive symptoms because they are an added characteristic to the individuals’ persona. There are also symptoms, termed negative symptoms that result in a loss of function, including flat affect, reduced feelings of pleasures, difficulty sustaining activities of daily living, and reduced speaking (National Institute of Mental Health). These symptoms make it extremely difficult for individuals to participate in daily activities and to maintain a variety of relationships with others (Halter).
Schizophrenia can affect individuals of all ages (Halter). In children, before the diagnosis is made, they often exhibit unusual characteristics, including doing less well than their siblings in school, not being as socially engaged as other children of their age-group, having a less positive demeanor, and possessing unusual motor development. In order for children to be diagnosed with childhood schizophrenia, this diagnosis must be made before the age of 12. This is extremely rare and the diagnosis is much more severe than that of the adult-onset version. Adolescents diagnosed with schizophrenia experience prodromal symptoms, those symptoms that indicate there is an issue during development, with a few months to years. Behaviors of concern include social withdrawal, irritability, depression, and an antagonistic attitude. Other concerning characteristics include problems in academics and school conduct, alerting educators there may be a problem (Halter).
As previously stated, the incidence of childhood schizophrenia is rare, and is approximated to affect 1 in 10,000 children (Halter). The number of individuals diagnosed with schizophrenia in adulthood dramatically increased to about 1% of individuals worldwide. In just the United States alone, an average of 3.5 million individuals are affected by the disorder. Just as schizophrenia has the ability to affect individuals of all ages, it also affects a variety of individuals from different races, social statuses, and cultures. The one limitation to its prevalence is the fact that male are more frequently diagnosed with schizophrenia than females in a 1.4 to 1 ratio. Furthermore, individuals raised in urban areas are also more likely to develop the disorder. The disorder often manifests during the late teens and early twenties. Early-onset schizophrenia, defined as the disorder diagnosed between 18 and 25 years of age, occurs more often in males and often manifests as poor functioning, structural brain abnormalities, and increased levels of apathy. Individuals diagnosed in their mid-twenties and early thirties are more likely to be female. These individuals tend to have a better prognosis (Halter).
It should be known that there is a high incidence of comorbidity between schizophrenia and substance abuse disorders (Halter). This comorbidity relationship exists in approximately 50% of individuals diagnosed with schizophrenia. Furthermore, conditions of comorbidity also increase the chance of treatment noncompliance, relapse, imprisonment, homelessness, violence, and suicide. It is thought that the incidence of substance abuse disorders exemplify the inability of individuals to cope with the illness and its intrusion into their life. Individuals with the diagnosis are also at increased risk for anxiety, depression, suicide, and physical health illnesses. The inability to cope and manage the disease leads to anxiety and depression as they withdraw from everyday life. As the anxiety, depression, and withdrawal become increasingly worse, individuals turn to thoughts of suicide and releasing themselves from the disease. Furthermore, these individuals are unable to adequately care for themselves, leading to other health conditions and poor hygiene (Halter).
The exact cause of schizophrenia is unknown, however there are risk factors that have been identified that put persons at risk for developing the disorder (National Institute of Mental Health). It has been found that schizophrenia has the ability to affect more than one individual within a family. However, there is no proof of inheritance of the disorder as those diagnosed with schizophrenia may be the only member of their family to be diagnosed. Scientists have hypothesized that genes do play a role in the development, but no single gene has been pinpointed to increase this risk. Other risk factors include environmental factors, including exposure to viruses, prenatal malnutrition, problems during birth, and other psychosocial factors (National Institute of Mental Health). The disruption of the normal development of the brain before birth and during childhood and adolescence increases the risk of developing schizophrenia. While the brain is developing, it is sensitive to changes and vulnerable to negative forces, affecting its growth and development. These changes may cause the structural and chemical abnormalities seen in those persons diagnosed with schizophrenia (National Institute of Mental Health).
Psychosocial factors that increase the risk for the development of schizophrenia include psychological stressors that the individuals has been exposed to within their lifetime. These stressors include, but are not limited to, childhood sexual abuse, exposure to social adversity, migration and growing up in a different culture, and exposure to psychological trauma (Halter). These individuals have lived through extremely devastating events within their lifetime. At this point, the brain may produce the characteristics of schizophrenia because it does not know how to process the traumatic events. The brain shuts down in an effort to preserve and protect itself.
Experts also hypothesize that there in a difference in the brain structure and chemistry of those diagnosed with schizophrenia (National Institute of Mental Health). Such differences include a disruption of the normal chemical reactions and neurotransmitters in the brain (National Institute of Mental Health). The neurotransmitters that are theorized to add to the development of the disease include dopamine and serotonin (Halter). Structural abnormalities of the brain found in those diagnosed with schizophrenia include enlargement of the lateral cerebral ventricles; ventricular asymmetry; reduced volumes of matter within the cortical, frontal lobe, hippocampal, and cerebellar regions of the brain; an increase in the size of the sulci on the surface of the brain; reduced cortical thickness; and reduced connectivity between different areas of the brain. Furthermore, assessment of the brain during a PET scan may also show a decrease in the amount of blood flow and glucose metabolism in the frontal lobes. The frontal lobes function in planning, abstract thinking, socialization, and decision making. All of these functions are disrupted in a brain affected by schizophrenia (Halter).
The disorder can be categorized into three phases: Acute, Stabilization, and Maintenance, depending on the symptoms the individual is experiencing (Halter). Phase I, termed the Acute phase, is the first initial psychotic break in which the disruptive symptoms of the disorder are manifested. These symptoms can include positive symptoms, negative symptoms, and the inability to care for oneself or participate in their relationships with others. If the symptoms are severe enough, hospitalization may be required. The second phase, termed the Stabilization phase, is when the patient is initialing receiving care and treatment and is working to return to their baseline functioning before the exacerbation of the disease. The symptoms of the disease should be receiving treatment and thus diminish in their frequency and severity. The final phase, the Maintenance phase, is when the patient is continuing treatment, nearing the baseline of their previous functioning, and thus preventing an exacerbation of the symptoms. In this phase, the patient is often able to return to the community and live as they previously did before the onset of their symptoms (Halter).
There is no known cure for schizophrenia (National Alliance on Mental Illness). This means the only treatments available are those that control the symptoms of the disorder, as previously stated. Such treatments include antipsychotic medications, psychotherapy, and self-management (National Alliance on Mental Illness). There are three groups of antipsychotic medications that might be used in the management of symptoms (Halter). For positive symptoms, first-generation antipsychotics may be used. These antipsychotics are extremely well known for causing negative side effects that often mimic the symptoms of Parkinson’s disease. If the patient requires a higher dosage in which they exhibit these side effects, medications that treat Parkinson’s disease may be used. It is extremely important to find a balance between the symptoms of schizophrenia and the side effects of the medication so that the patient does not become aggravated with his course and treatment and stop taking the necessary medications. If the patient is experiencing positive and negative symptoms, the health care provider will prescribe second- and third-generation antipsychotics. The second and third generation antipsychotics are much less likely to produce the side effects associated with first-generation antipsychotics, but still run the risk of causing other adverse side effects and should be monitored accordingly. Adverse side effects of second-generation antipsychotics include agranulocytosis and metabolic syndrome. Again, finding the right dosage for the patient and lowering the incidence of adverse side effects prevents the patient from engaging in medication non-compliance. Antipsychotics work by adjusting the level of chemicals within the brain. The medications typically take two to six weeks to take effect and thus it is extremely important to ensure the patient is compliant with the medication’s program (Halter).
Other therapies to improve the symptoms and control the course of the disease include psychotherapy. Psychotherapy can include cognitive behavioral therapy and often family therapy (Halter). Cognitive behavioral therapy helps the individuals to recognize the symptoms and learn to think rationally about what they are experiencing. This therapy teaches individuals how to cope with their symptoms as they return to participating in the community. Family therapy is also very important to the treatment of schizophrenia. Individuals living with the disorder often feel isolated as they realize that something is wrong and they are unable to perform tasks of daily life and engage in meaningful relationships with those around them. Therefore, it is so important to involve the individual’s family in their therapy to show the individual they have a support system in place. Communication and problem-solving skills are taught to the individual and his family members (Halter). The stigma surrounding mental illness should also be addressed in therapy (Yanos, Roe, Markus, & Lysaker). If patients believe in the stigma that surrounds their diagnosis, they are less likely to get help and work to reintegrate into their community. Individuals may feel they have no place in society because of the thoughts of others, and thus return to isolation, which can become harmful, leading to thoughts of suicide. It was found that internalized thoughts of stigma amongst those diagnosed with schizophrenia was related to negative outcomes and decreased recovery. Patients should be reminded they have not become their diagnosis and that they are still the same person they always were. They should be reminded there is more to a person than his medical diagnosis and that there are ways to control the disease (Yanos, Roe, Markus, & Lysaker). Another study, completed by Pitschel-Walz, Leucht, Bauml, Kissling, and Engel attest to the fact that “psychoeducational interventions are essential to schizophrenia treatment.” Their study found that the combination of pharmacological treatment and therapy were much more effective than using pharmacological treatment along (Pitschel-Walz, Leucht, Bauml, Kissling, & Engel).
Lastly, it is important to educate the patient on the extent of his disease, how to identify triggers and symptoms before they become uncontrolled, and how to prevent future exacerbations from happening (Halter). These skills help to return the individual to society. Compliance to a medication regiment, involvement in therapy, and proper understanding of the disease can help increase the chance of a better prognosis. Individuals must be taught how important it is to be aware of their thoughts and actions. This will help to recognize the problem and seek help before it gets out of hand. With the proper psychotherapy, these individuals will not hesitate to seek the necessary help.
References
Halter, Margaret J. Varcarolis' Foundations of Psychiatric Mental Health Nursing: A Clinical
Approach, 7th Edition. W.B. Saunders Company, 2014. VitalBook file.
Pitschel-Walz, G., Leucht, S., Bäuml, J., Kissling, W., & Engel, R. R. (2015). The effect of
family interventions on relapse and rehospitalization in schizophrenia: a meta-analysis. Focus.
Schizophrenia. (n.d.). National Alliance on Mental Illness. Retrieved February 26, 2016, from
https://www.nami.org/Learn-More/Mental-Health-Conditions/Schizophrenia
Schizophrenia. (2016, February). National Institute of Mental Health. Retrieved February 26,
2016, from http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
Yanos, P. T., Roe, D., Markus, K., & Lysaker, P. H. (2015). Pathways between internalized
stigma and outcomes related to recovery in schizophrenia spectrum disorders. Psychiatric Services.
