Abstract
Schizophrenia, which is a mental illness associated with psychological effects in human beings, has been cited as one of the most prevalent diseases contributing to chronic disability around the world. The disease is exhibited by a wide range of symptoms but the most notable one is the negative effect it has on a person’s cognitive abilities. Perhaps this is the main reason why it largely leads to the incidences of chronic disability. Though it occurs very rarely in children, Schizophrenia has been reported amongst pre-pubertal children aging from fifteen years and above though with a declining phenomenon in persons above forty years of age. This paper seeks to understand the occurrence of Schizophrenia as a mental bi-polar disorder from a point of its definition, its prevalence, its diagnosis, predisposing factors, available regimens of treatment and the role of nursing in management of the diseases. Sources of information contributing to this study are primarily secondary information from journals articles and reference books.
Introduction
Schizophrenia is a chronic mental illness in which the ability of the affected person to manage his or her emotions, think, interact with others and make rational decisions is greatly compromised . These impacts are linked to a change in normal physiological functioning of the brain which may thus result to a long-term chronic condition . Being a long-term chronic illness, schizophrenia may not only affect the sick person but may also change the lifestyle landscape of the family members of such a person. By the fact that schizophrenia is linked to destabilization of cognitive abilities and social relations of an individual, the possibilities of both mental and physical disabilities are never ruled out. Similarly, such a person may become a danger to the selves and those around them. Incidences of attempted suicide or violence against family and community members have been reported especially in acute cases . Due to such incidences, whether reported or directly experienced, a greater percentage of individuals suffering from schizophrenia have found it impossible to secure jobs or be retained in active employment
Prevalence
Schizophrenia is said to occur within 1% of the world population. This can also be expressed with the perception that one in every one hundred people in the world could be potentially schizophrenic . Occurrence of schizophrenia in children below fifteen years of age is very rare . Occurrence in those of below twelve years of age is unheard of . The most predominant age set in which incidences of schizophrenia are largely reported is within the ages of 15 and 30 . Empirical research shows that prevalence of Schizophrenia in persons above the age of 40 is also uncommon . The most cases, actually up to 70 percent of schizophrenia associated hallucination is associated with hearing
Diagnosis
So much has been invested in terms of time and resources in understanding and managing the diagnosis, the etiological occurrence and the pathophysiology surrounding schizophrenia . Neverthelsee, with all these requisite efforts, it is quite notable that precise diagnostic models for schizophrenia have not been established . The diagnosis, the etiology and the pathophysiology of schizophrenia have remained clearly and precisely incomprehensible .
Several modalities of illustrating probable symptoms have been used to diagnose schizophrenia. These include establishing the occurrence of symptoms such as hallucination and delusion . More importantly, these modalities categorize symptoms as either, positive negative cognitive, prodrome or acute . Positive symptoms may include observations of impacts such as belief on unreal things as a result of delusion, hearing and sight of unreal things as a result of hallucinations and finally impaired speech . Negative symptoms are noted in phenomenon such as loss of or impaired emotional and cognitive well-being . A prodrome state occurs before the onset of positive symptoms where the only thing that can be noticed is the impairment of normal functioning while the acute phase occurs when psychotic symptoms such as hallucination and delusion can be identified . Although the precise diagnosis of schizophrenia has remained elusive, the application of Diagnostic and Statistical Manual of Mental Disorders (DSM) has proved to be a reliable and valid diagnosis . DSM bases its propagation around the identification and elimination of both positive and negative symptoms.
Predisposing Factors
Research has shown that schizophrenia falls within the hereditary categories of diseases . By the fact that schizophrenia is associated with parental genes, it therefore means that it can be passed to the offspring through congenital means. Schizophrenia is found to be common in families with history of the disease . Therefore family history of schizophrenia is a major predisposing factor.
Koenig (2014) clearly indicates the delicate nature of the brain that is developing towards attaining maturity in itself as a predisposing factor to its damage. This often happens in the age groups of persons between 15 years to 30 years. But moreso it is found that the overall impacts that hard situations can have on this organ as possible causes of schizophrenia in in this age group . For example occurrence of prenatal and post natal stress and depression in young women may be associated with early onset of schizophrenia in women aged between 15 and 30 . In-utero immunity stress that a fetus may go through while still in the womb is also thought to contribute to reported cases of schizophrenia later on at puberty stage of such individuals .
Traditional Treatment Approaches
Before a reliable methods of disease management models were discovered and especially advised by the works of Émil Kraepelin, a German psychiatrist who lived between the years 1856–1927, crude and desperate methods of treatment were devised. Several of these treatment regimens were applied. Nonetheless, most of them proved to be of little or no success at all. One example of the old methods of schizophrenia disease management included the inducing of sleep through a prolonged use of barbiturate . This method was used to help reduce the occurrence of sudden incidences of shock and convulsion by making the victim become unconscious through sleep.
Another method involved the administration of large doses of insulin to the sick person with the aim of making them lose consciousness through the acquisition of a hypoglycemic state and that experience physical seizure . Unfortunately the hypoglycemic state proved fatal to the heart and predisposed an individual to other cardiovascular diseases such as stoke thus prompting the discontinuation of the method.
One interesting method involved the undertaking of neurosurgeries that were aimed at severing the nerve paths on the frontal lobes to reduce impulsive expressions . Unfortunately this ended up making the person’s mental state even worse since it contributed further to the impairment.
Recommended Modes of Treatment
Henry Laborit, a French neurosurgeon revolutionized the pharmacological treatment approaches of schizophrenia with his discovery of the drug promethazine on the nerve system. It inspired further research that led to the modification of promethazine to chlorpromazine that produced sedative effects on schizophrenic patients thus lowering their impulsive behaviors . Chlorpromazine has been found to reduce the psychotic symptoms of schizophrenia such as hallucination, delusion and agitation . Non top of use of chlorpromazine as a form of psychopharmacological option, supportive psychotherapy methods such as psychoanalysis are also recommended to improve health outcomes of treatment since psychopharmacological may not be 100% effective. It is also advisable to note that schizophrenia des not have cure and the disease can only be managed as a chronic condition.
Nursing Role in Treatment of Schizophrenia
Practice of nursing and especially that of advanced practice nursing can help with management of schizophrenia as a chronic illness. Nurses can offer therapeutic support such as physiotherapy, occupational therapy, counseling amongst other procedures that are aimed at improving health outcomes for people with chronic mental illnesses.
In summary, as much as the condition of schizophrenia has not found a conclusive cure, it does not mean it cannot be managed. This also means that the patients can be supported to lead normal lives. Advanced practice nurses can provide home-based healthcare services and support to such patients, thus cutting care associated costs in a more efficient way. Schizophrenic patients can still have their lives going on and nurses and the community around them can help make this happen.
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